bluuebunny/crossref_metadata_2025_split huggingface dataset:
A randomized controlled trial of day hospital and day centre therapy
Authors: Burch Sarah , Longbottom Jenny , McKay Maggie , Prevost Toby 
Published: May 2003

Objective: To compare the outcome of day hospital to day centre rehabilitation. Design: Single blind randomized controlled trial with home assessments at baseline (twice), six weeks and three months. Setting: Mainly rural health district. Day hospital and social services day centres in market towns. Subjects: One hundred and five physically disabled older patients living at home referred for day hospital rehabilitation or maintenance before discharge from hospital (66) or referred as outpatients (39). Interventions: Day hospital treatment or day centre rehabilitation by a physiotherapist and two health support workers. Main outcome measures: Barthel Index, Philadelphia Geriatric Morale Scale and Caregiver Strain Index. Results: More day centre (23/55) than day hospital patients (6/50) ( p <0.001) withdrew from allocated treatment by choice or because of operational difficulties. Both groups improved significantly in functional ability and reduction of care-giver strain by three months but there was no significant difference between groups. The mean improvement in Barthel Index (standard error) for day hospital = +1.5 (0.41) ( n = 34) and day centres = +1.5 (0.48) ( n = 38). The mean difference (95% confidence interval) between day hospital and day centre was 0 (–1.28, +1.28). Likewise the mean Philadelphia Geriatric Morale Scale improvement for day hospital +1.8 (0.66) ( n = 35) and day centres was +0.9 (0.63) ( n = 38). The mean difference was –0.88 (–2.7, +0.95). The mean reduction in Caregiver Strain for day hospital was –1.45 (0.5) ( n = 23) and day centre was –1.59 (0.47) ( n = 27). The difference was –0.14 (1.52,+1.24). (These analyses are all on an intention-to-treat basis.) Conclusion: Whilst the improvement in functional ability and care-giver strain was similar in both groups, day centre rehabilitation was less popular and had practical difficulties. If these difficulties can be overcome the model should be tested elsewhere.
Post-stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke
Authors: van de Weg F B , Kuik D J , Lankhorst G J 
Published: May 2003

Objective: To investigate the influence of depression on functional recovery after stroke. Design: Multicentre cohort study of 85 patients admitted for clinical rehabilitation. A two-stage case-finding procedure was used to identify patients with depression. For the control group, consecutive nondepressed stroke patients were enrolled. Patients were interviewed at 3–6 weeks and six months after stroke onset. Setting: Three rehabilitation centres in the vicinity of Amsterdam. Main outcome measures: Functional outcome was determined by the Functional Independence Measure (FIM) and the Rehabilitation Activities Profile (RAP). Results: The prevalence of depression (35%) was comparable with the findings of earlier studies in other settings. Patients classified as depressed according to DSM III R criteria (American Psychiatric Association Diagnostic and statistical manual of mental disorders) had a significantly lower functional score, both at onset and after follow-up (FIM and RAP). There was, however, no significant difference in functional improvement between the depressed and the nondepressed group. Mean functional improvement in the six patients treated with antidepressants was 30% better than in the untreated (depressed) patients; numbers were too small for the results to attain statistical significance. Subset analysis showed a significantly higher outcome for nondepressed patients for the FIM subitems personal care and transfers. However, functional improvement was not significantly different for any of the subitems in depressed versus nondepressed patients. Conclusion: Stroke patients with depression have significantly lower functional scores both at onset and after six months. Our results suggest under-recognition of post-stroke depression and a possible beneficial effect of antidepressant medication in depressed stroke patients. Further studies are required to determine the effect of antidepressants.
Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function
Authors: Boissy Patrick , Bourbonnais Daniel , Carlotti Marie Madeleine , Gravel Denis , Arsenault Bertrand A 
Published: May 2003

Objectives: Previous studies have shown that recovery of recordable grip strength in acute stroke subjects is one of the most sensitive assessments of initial upper limb recovery and a good prognostic factor for latter recovery. The objectives of this study were to test the reliability of maximal voluntary grip force (MVGF) measures and evaluate the relationship between paretic grip strength deficit and paretic upper extremity function in chronic stroke subjects. Design: Over a three-week period, bilateral MVGF was assessed three times with a modified strain gauge dynamometer in 15 chronic stroke subjects and 10 control subjects. The paretic MVGF deficit was expressed in relation to the MVGF of the nonaffected hand. Outcome measures: Upper extremity function in stroke subjects was measured using the Fugl-Meyer, the upper extremity performance test for the elderly (TEMPA), Box and Block and finger-to-nose tests. Results: MVGF measures in both groups of subjects demonstrated good reliability (intraclass correlation, ICC >0.86) and low standard error measurements (SEM). The paretic MVGF of the stroke subjects was greatly impaired in comparison to the control subjects. Results of linear and quadratic regressions analyses show that this impairment was significantly correlated ( p <0.01) with the performance of the stroke subjects on the four upper extremity function tests. The percentages of variances explained by the MVGF deficit on all four upper extremity tests varied from 62% to 78% for the linear regressions and from 72% to 93% for the quadratic regressions. Conclusions: These results suggest that the paretic maximal grip strength, normalized with the maximal grip strength on the nonaffected side, appears to be a valuable outcome measure of upper extremity function in chronic stroke subjects.
The UK FIM+FAM: development and evaluation
Authors: Turner-Stokes Lynne , Nyein Kyaw , Turner-Stokes Tabitha , Gatehouse Claire 
Published: May 2003

Background and aims: The aim of this study was to develop and evaluate the UK version of the Functional Assessment Measure (UK FIM+FAM). Design: Before and after evaluation of inter-rater reliability. Development: Ten ‘troublesome’ items in the original FIM+FAM were identified as being particularly difficult to score reliably. Revised decision trees were developed and tested for these items over a period of two years to produce the UK FIM+FAM. Evaluation: A multicentre study was undertaken to test agreement between raters for the UK FIM+FAM, in comparison with the original version, by assessing accuracy of scoring for standard vignettes. Methods: Baseline testing of the original FIM+FAM was undertaken at the start of the project in 1995. Thirty-seven rehabilitation professionals (11 teams) each rated the same three sets of vignettes – first individually and then as part of a multidisciplinary team. Accuracy was assessed in relation to the agreed ‘correct’ answers, both for individual and for team scores. Following development of the UK version, the same vignettes (with minimal adaptation to place them in context with the revised version) were rated by 28 individuals (nine teams). Results: Taking all 30 items together, the accuracy for scoring by individuals improved from 74.7% to 77.1% with the UK version, and team scores improved from 83.7% to 86.5%. When the 10 troublesome items were taken together, accuracy of individual raters improved from 69.5% to 74.6% with the UK version (p<0.001), and team scores improved from 78.2% to 84.1% (N/S). For both versions, team ratings were significantly more accurate than individual ratings (p<0.01). Kappa values for team scoring of the troublesome items were all above 0.65 in the UK version. Conclusion: The UK FIM+FAM compares favourably with the original version for scoring accuracy and ease of use, and is now sufficiently well-developed for wider dissemination.
Fear of falling in patients with stroke: a reliability study
Authors: Hellström Karin , Lindmark Birgitta 
Published: May 2003

Objective: To examine the scaling properties and test–retest reliability of an expanded version of the Falls Efficacy Scale (FES) and to compare group differences in the scores. The expanded version focuses on more basic, primary activities of daily living (ADL), which makes the scale more suitable for subjects with moderate to low functional ability, e.g. patients with stroke. Design: A test–retest reliability study with one group convenience sample. Setting: Two day-care units: a rehabilitation unit and a geriatric rehabilitation unit. Subjects: A volunteer sample of 30 patients (mean age 65 years, SD 11 years) who had sustained stroke between 5 and 84 months prior to the investigation. Main outcome measure: A 13-activity questionnaire (the Swedish modification of the Falls Efficacy Scale (FES(S)) comprising the 10 activities of the original FES and three additional activities was used. Falls efficacy was rated on a 10-point visual analogue scale for each activity on two occasions, 5–22 (mean 10, Md 7) days apart. Results: The overall test–retest reliability of the FES(S) was high (intraclass correlation coefficient (ICC) = 0.97). The ICC for the personal ADL (items 1–6) scores was 0.93 and for the instrumental ADL (items 8–13) 0.97. ICC for the individual items ranged from 0.76 to 0.97. Conclusions: On the basis of these preliminary findings, the FES(S) appears to have acceptable test–retest reliability. The test may be a reasonable addition for assessing stroke patients with balance disturbances and risk for falls.
Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke
Authors: Baskett Jonathan J , Broad Joanna B , Reekie Gabrielle , Hocking Clare , Green Geoff 
Published: May 2003

Objective: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. Design: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. Setting: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. Main outcome measures: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. Results: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group ( p = 0.003). Conclusions: A supervised home-based programme is as effective as outpatient or day hospital therapy.
IPCC Sres Revisited: A Response
Authors: Nakicenovic Nebojsa , Grübler Arnulf , Gaffin Stuard , Jung Tae Tong , Kram Tom , Morita Tsuneyuki , Pitcher Hugh , Riahi Keywan , Schlesinger Michael , Shukla P. R. , van Vuuren Detlef , Davis Ged , Michaelis Laurie , Swart Rob , Victor Nadja 
Published: May 2003

Mr. Castles and Mr. Henderson have criticized the Special Report on Emissions Scenarios (SRES) and other aspects of IPCC assessments. It is claimed that the methodology is “technically unsound” because market exchange rates (MER) are used instead of purchasing power parities (PPP) and that the scenarios themselves are flawed because the GDP growth in the developing regions is too high. The response is: The IPCC SRES reviews existing literature, most of which is MER based, including that from the World Bank, IEA and USDoE. Scenarios of GDP growth are typically expressed as MER (the preferred measure for GDP growth, as opposed to PPP which is a preferred measure for assessing differences in economic welfare). IPCC scenarios did include PPP-based scenarios, which Mr. Castles and Mr. Henderson have conveniently ignored. Contrary to what Mr. Castles and Mr. Henderson claim, IPCC scenarios are consistent with historical data, including that from 1990 to 2000, and with the most recent near term (up to 2020) projections of other agencies. Long-term emissions are based on multiple, interdependent driving forces, and not just economic growth. Mr. Castles and Mr. Henderson need to look beyond GDP. The IPCC scenarios provided information for only four world regions, and not for specific countries. Mr. Castles' and Mr. Henderson's critique is not of IPCC scenarios but of ongoing unpublished work in progress that is not part of SRES. We therefore show that Mr. Castles and Mr. Henderson have focused on constructing a “problem” that does not exist. SRES scenarios are sound and the IPCC has responded seriously and conscientiously. We detail our response below in nine sections. After an introduction (Section 1), we outline the SRES methodology for measuring economic output (Section 2). Section 3 compares SRES to long-historical economic development and provides five responses to the critics. Section 4 addresses the issue of country-level economic projections even if not part of SRES. Sections 5, 6 and 7 validate the SRES scenarios by comparing them with recent trends for economic and CO2 emission growth, as well as more recent scenarios available in the literature. Section 8 refutes the argument that lower economic growth in developing countries would lower GHG emissions correspondingly. Section 9 concludes.
An hp‐adaptive finite element method for electromagnetics. Part 3: A three‐dimensional infinite element for Maxwell's equations
Authors: Cecot W. , Rachowicz W. , Demkowicz L. 
Published: May 2003

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

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

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

AbstractBreast cancer is one of the leading causes of cancer death among women all over the world, with about one million new breast cancer cases diagnosed per year. This large number of cases make the diagnosis, treatment, and determination of the factors affecting the survey extremely important. The aim of this study was to evaluate the importance of the preoperative plasma CA 15‐3 and carcinoembryonic antigen (CEA) levels when determining the conventional histopathologic prognostic factors (tumor grade, lymphatic infiltration, stromal invasion, vessel invasion, tumor necrosis, elastosis, and number of positive lymph nodes in levels I and II). We believe that with this protocol doctors can add to their knowledge about the prognosis of patients. After examining the serum tumor marker levels and the histopathology results of 29 patients and submitting them to statistical calculations, we strongly believe that preoperative serum CA 15‐3 levels can be taken into consideration when evaluating the prognosis because the CA 15‐3 level is directly and positively correlated with the gold standard prognostic factor: the number of level I and II positive lymph nodes.
High Incidence of Reflux Esophagitis Observed by Routine Endoscopic Examination after Gastric Pull‐up Esophagectomy
Authors: Shibuya Shunsuke , Fukudo Shin , Shineha Ryuzaburo , Miyazaki Shukichi , Miyata Go , Sugawara Koh , Mori Takahiro , Tanabe Shuichi , Tonotsuka Norio , Satomi Susumu 
Published: May 2003

AbstractA gastric tube has been widely used for reconstruction of the esophagus after esophagectomy for esophageal cancer. Reflux esophagitis after esophagectomy is frequently observed. Therefore we retrospectively investigated the risk factors for reflux esophagitis after gastric pull‐up esophagectomy in 74 outpatients with thoracic esophageal cancer. Reflux esophagitis was diagnosed endoscopically. Esophagitis was classified according to the Los Angeles classification. Reflux symptoms, medications, and the surgical procedure were reviewed. The relation between reflux symptoms and reflux esophagitis and the influence of the anastomotic site were evaluated. Reflux esophagitis was observed in 53 patients. Severe esophagitis (grade C or D) was found in 75.6% of these patients. Although all patients with esophagitis took antacid agents, histamine receptor‐2 blocker was effective in only 35% of them. The correlation between reflux symptoms and reflux esophagitis was not significant. Reflux esophagitis was present in 56.4% of patients with neck anastomosis and in 88.6% of patients with intrathoracic anastomosis (p = 0.0039). We concluded that routine endoscopic examination is necessary after gastric pull‐up esophagectomy because reflux esophagitis is not diagnosed based on reflux symptoms. When a gastric tube is used for reconstruction after esophagectomy, neck anastomosis is recommended to lower the risk of reflux esophagitis.
Review of the “Chirurgia” of Giovanni de Vigo: Estimate of His Position in the History of Surgery
Authors: Gurunluoglu Raffi , Gurunluoglu Aslin , Piza‐Katzer Hildegunde 
Published: May 2003

AbstractGiovanni de Vigo, who was born in at Rapallo, Italy, lived in the early Renaissance period (1450–1525). In 1503, De Vigo became the personal surgeon to Pope Julius II. He wrote a surgical book, “Practica Copiosa in Arte Chirurgia,” which was completed in 1514 and published in Latin. It was translated into English by Richard Traheron and printed by Edward Whytchurch in 1543. Vigo’s “Chirurgia” consists of nine books ranging from a consideration of anatomy necessary for a surgeon, to sections on abscesses, wounds, ulcers, benign and malignant tumors, fractures and dislocations, pharmaceuticals, ointments and plasters, as well as sections on dentistry, exercise, diet, syphilis, among others. De Vigo introduces a novel approach for treating mandible dislocations and describes a trephine he invented, as well as a number of new instruments. Examination of his surgical piece demonstrates that he had a broad spectrum of knowledge in surgery based in part on the ancient Greek and Arabic medical literature but mainly on his personal experience. Giovanni de Vigo contributed significantly to the revival of medicine in the sixteenth century, and he can be considered as a bridge between Greek medicine of antiquity, Arabic medicine, and the Renaissance.