bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fuzzy control strategies to provide cost and energy efficient high quality indoor environments in buildings with high occupant densities
Authors: Shepherd A B , Batty W J 
Published: November 2003

Since the oil crises of the 1970s building professionals have become increasingly aware of the effects of their design decisions on the energy consumption rates in buildings. Often this has led to strategies that have compromised aspects of human requirements such as thermal comfort or air quality. When this has been combined with an architectural approach that often takes little heed of local climate or custom the result has been uncomfortable buildings that are disliked by and have often affected the health of their occupants. The comfort of building occupants is dependant on many environmental parameters including those provided by the building envelope, building environmental services and control systems. Inadequate design and control can lead to reductions of occupant comfort, energy efficiency and cost efficiency. To achieve a high quality internal environment with good energy and cost efficiencies, the interactions between the contributory factors must be taken into consideration. An examination of the notion of indoor environmental quality and the potential for control strategies and methodologies for this multivariate problem are considered within the contexts of energy efficiency and running costs. The use of fuzzy logic control is examined as a technical response to this dilemma. A high level fuzzy supervisor was used to make control decisions on the best course of action to achieve high levels of indoor environmental quality while taking into account effects on energy and cost efficiency. Simulation results indicated the potential for improvements in system operation.
Antegrade cerebral perfusion with hypothermic circulatory arrest: a case report
Authors: Fitzgerald David , Resley Justin , Speir Alan , Munoz Ruben , Hill Aaron 
Published: November 2003

Techniques for the surgical correction of aortic aneurysms have steadily improved since the first described successful repair in 1955 by DeBakey et al.1 Despite these improvements, postoperative neurological complications remain a major factor in determining an adverse outcome. By using Deep Hypothermic Circulatory Arrest (DHCA), Retrograde Cerebral Perfusion (RCP) and now Selective Antegrade Cerebral Perfusion (SACP), the surgeon may provide better cerebral protection during extensive arch reconstruction. A 73-year-old female presented with an abnormal chest X-ray. Computerized tomography scan revealed a 4.5 cm mid aortic saccular arch aneurysm. Surgical intervention using cardiopulmonary bypass (CPB) with systemic cooling to 24°C was employed. SACP was administered via cannulation of the innominate artery and the left common carotid artery using pediatric cannulae. Flow rates of 10 mL/kg/min and perfusion pressures of 60-90 mmHg were employed. Transcranial oximetry was used to monitor cerebral oxygen consumption. Circulatory arrest with SACP lasted for 36 min. Total bypass time was 178 min and myocardial ischemic time was 63 min. The patient was discharged on postoperative day five with no evident sequelae. While RCP has many benefits, SACP as used in this procedure may further improve patient outcome.
New technologies for respiratory assist
Authors: Matheis Georg 
Published: November 2003

‘The artificial lung especially has lingered behind progress with artificial hearts and ventricular assist devices, not because the need for lungs has not been recognized, but because we have not had a full understanding of the engineering problems and the unique material requirements until recent years.’1 Brack Hattler, MD PhD The development from the first clinical use of haemo-dialysis over five decades ago to widespread chronic treatment took more than two decades. The histories of other artificial organ technologies, such as artificial hearts, follow similar long development paths. For five decades, due to a lack of technology, artificial lungs have been limited to use with a heart-lung machine for cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO). The advent of pumpless biocompatible artificial lungs will open new treatment options for patients with acute or chronic lung failure.
Do static or dynamic AFOs improve balance?
Authors: Cattaneo D , Marazzini F , Crippa A , Cardini R 
Published: November 2003

Objective: To verify if partial or total limitation of degrees of freedom at ankle joints could help patients with balance disorders in standing and walking. Design: A cross-over design was chosen. Patients with multiple sclerosis (MS) were tested in three experimental conditions: barefooted, wearing ankle foot orthoses (AFOs), and wearing AFOs that allowed plantar flexion. Setting: Neurorehabilitation unit in a rehabilitation centre. Subjects: Fourteen patients suffering from MS with mild strength problems and balance disorders that required them to use walking aids outside. Main outcome measures: Tests inferring static and dynamic skills were carried out in the three experimental conditions described above. Results: Improvements were obtained in static balance tests especially wearing dynamic AFOs; the number of patients who were able to pass tasks on balance in upright position such as flstanding with feet together, head extended' increased from three to nine. Dynamic balance was impaired especially with static AFOs; the time spent walking 10 metres with these orthoses increased by 172% with respect to barefoot; less difference (113%) has been reported wearing dynamic AFOs. Conclusion: Static and dynamic AFOs improved static balance, while dynamic balance was impaired especially by static AFOs; less negative influence on dynamic balance has been found while wearing dynamic AFOs.
Goal attainment scaling in evaluating a multidisciplinary pain management programme
Authors: Fisher K , Hardie R J 
Published: November 2003

Objective: To examine the value of Goal Attainment Scaling (GAS) as a therapeutic tool and an outcome measure in a rehabilitation programme in the management of chronic pain. Design: A prospective observational study. Setting: A 15-day pain management programme, day case or residential, in an NHS Regional rehabilitation centre. Subjects: One hundred and forty-nine consecutive patients enrolled during a 15-month period. Interventions: Multidisciplinary structured educational programme of physiotherapy, occupational therapy and clinical psychology. Main outcome measures: GAS; timed tests of physical mobility measures; McGill Pain Questionnaire (MPQ); Pain Intensity Numerical Rating Scale (NRS); Oswestry low back pain Disability Questionnaire (ODQ); General Health Questionnaire (GHQ); Pain and Impairment Relationship Scale (PAIRS). GAS and physiotherapy measures were compared with baseline data at enrolment and at discharge 15 days later. At six-month follow-up all measures were repeated. Results: significant improvements at discharge were found for GAS, and physiotherapy measures. One hundred and twelve patients returned for review at six months, when improvements were maintained for GAS, sit/stand, Pain, ODQ and GHQ. GAS was shown to be a valid measure of ability, correlating significantly with walking improvement and somewhat less with a therapist-defined measure, suggesting some ability to discriminate. Conclusions: The improvement measured by GAS showed that patients were enabled by the programme to achieve personally valued goals over a six-month period and to improve on these more than on other more conventional outcome measures.
Bone density in chronic low back pain: a pilot study
Authors: Gaber TA-ZK , McGlashan K A , Love S , Jenner J R , Crisp A J 
Published: November 2003

Background and objective: Levels of physical activity in chronic low back pain patients are relatively low due to their fear of provoking pain. This may have a secondary impact on maintenance of bone mass. The objective of this study is to determine if patients with chronic low back pain are at a higher risk of bone demineralization. Design: Bone mineral density (BMD) was measured in 25 chronic low back pain patients at the lumbar spine, hip and distal forearm. Setting: A university hospital. Subjects: Twenty-five chronic low back pain patients (mean age 45 years) enrolled on a residential back pain rehabilitation programme. Results: Thirteen patients (52%) were osteopenic or osteoporotic in one or more sites. BMD at the lumbar spine was generally lower than the mean BMD of age-matched subjects ( p = 0.04). There was no significant relationship between BMD and duration of pain, disability, sex or previous surgical intervention. Conclusions: Chronic low back pain patients have an increased incidence of osteopenia and osteoporosis. This finding reinforces the importance of motivating patients to incorporate exercise into daily life. Given the limited set of subjects used in the present study, further studies are required.
Use of cognitive-behavioural arthritis education programmes in newly diagnosed rheumatoid arthritis
Authors: Freeman K , Hammond A , Lincoln N B 
Published: November 2003

Objective: To identify the effect of attending a cognitive-behavioural arthritis education programme on the health status of participants with newly diagnosed rheumatoid arthritis (RA) compared with a control group. Design: Randomized controlled trial. Setting: Hospital based. Subjects: Newly diagnosed with RA. Intervention: Participation in either a cognitive-behavioural arthritis education programme or a standard arthritis education programme (control group). Sessions for both groups lasted for 2 hours per week for four weeks. Subjects were examined at home by an assessor blinded to group allocation, prior to and three and six months following attendance. Outcome measures: The main outcome measure was the Physical Function subscale of the Arthritis Impact Measurement Scale Two. Other outcome measures included erythrocyte sedimentation rate (ESR), joint count scores, assessments of pain and psychological status. Results: Fifty-four subjects (mean time since diagnosis 4.5 months) took part. Baseline analysis revealed that the control group had significantly better levels of functional ability ( U = 185; p = 0.009) and lower levels of helplessness ( U = 168; p = 0.002) prior to intervention. This difference remained unchanged three months later. Six months following the intervention no significant differences were noted between the groups for any measure of health status. There were no significant changes in health status over time in either group. Conclusion: Attending a cognitive-behavioural arthritis education programme had no significant effect on the health status of individuals newly diagnosed with RA. The move to early use of these programmes should be examined further, with a larger sample size and longer duration of follow-up.
The Standardized Three-metre Walking Test for elderly people (WALK3m): repeatability and real change
Authors: Simpson Janet M , Valentine John , Worsfold Christian 
Published: November 2003

Objectives: (i) To examine the relative and absolute retest within-session reliability of the Standardized Three-metre Walking Test for elderly people (WALK3m), using walking time and number of steps as measures. (ii) To give clinicians details of how they can use the minimal detectable change in order to decide whether a patient's WALK3m performance has really changed. (iii) To give rules to decide whether one trial rather than three is sufficient. Design and analysis: Subjects made three trials of WALK3m in the same session. Variability and level of performance were related so the data were log (ln) transformed. Relative reliability was measured by the intraclass correlation coefficient (ICC) then absolute reliability by the repeatability factor (RF) and minimal detectable change (MDC) (one-tailed and two-tailed) was derived from the within-subjects standard deviation. Setting: Rehabilitation areas in the acute geriatric medical units at three south-west London hospitals. Subjects: The standardizing sample consisted of 81 inpatients approaching discharge to their own homes. Results: The ICC for walking time was 0.97 and for step counts 0.96. The MDC for walking is a 36% decrease between first and second measurements. The corresponding value for step counts is 21%. Conclusion: WALK3m, whether measured by time or by step counts has excellent repeatability. Knowing the minimal detectable change can be of great value to clinicians who can calculate whether their patient is really making progress.
Electrically induced and voluntary activation of physiologic muscle pump: a comparison between spinal cord-injured and able-bodied individuals
Authors: Faghri Pouran D , Yount John 
Published: November 2003

Objective: To evaluate the central haemodynamic responses during position changes from supine to sitting and during 30 min of standing between able-bodied and spinal cord-injured subjects. Also to assess the effects of the physiologic muscle pump in both groups during 30 min of standing. Design: A repeated measure design. Both groups were tested on two different days under two conditions of 30 min of stationary standing and 30 min of dynamic standing (voluntary activation of the lower leg muscles in able-bodied and FES-induced activation of these muscles in spinal cord injured). The order of testing was random. Setting: Rehabilitation hospital. Subjects: Fifteen healthy able-bodied and 14 healthy spinal cord-injured subjects. Main outcome measured: Stroke volume, cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and total peripheral resistance during supine–pre sitting, sitting–pre standing and during 30 min of standing. Results: Significant reductions ( p< 0.05) in systolic blood pressure, diastolic blood pressure and mean arterial pressure were found when spinal cord-injured subjects moved from sitting to standing during stationary standing; these values were maintained during dynamic standing. These values were maintained during both standing sessions in able-bodied subjects. During 30 min of stationary standing, there were significant reductions in stroke volume, cardiac output in both able-bodied and spinal cord-injured while their total peripheral resistance increased ( p< 0.05). During 30 min of dynamic standing, both groups maintained their haemodynamics at pre-standing values with the exception of significant reduction in stroke volume at 30 min of standing. Conclusion: FES-induced activation of the physiologic muscle pump during change in position from sitting to standing prevented orthostatic hypotension in spinal cord-injured subjects. During standing it had equal or even greater effect on improving blood circulation when compared with voluntary activation in able-bodied subjects. The use of FES during standing and tilting in spinal cord-injured individuals may prevent orthostatic hypotension and circulatory hypokinesis and improve tolerance to tilting and standing.
Prediction of outcome of physiotherapy in advanced Parkinson's disease
Authors: Nieuwboer Alice , De Weerdt Willy , Dom René , Bogaerts Kris 
Published: November 2003

Objective: Prediction of the effect of a home physiotherapy intervention on the basis of four clinical characteristics of patients with advanced Parkinson's disease. Design: A repeated measures design comparing six weeks without treatment with six weeks of physiotherapy and a follow-up of 12 weeks. Subjects: Persons with Parkinson's disease without dementia and suffering from considerable functional disability. Intervention: Community physiotherapists treated patients in the home situation three times a week teaching cueing and conscious movement control for walking and carrying out transfers in and out of beds and chairs. Main outcome measures: Mental status, disease severity, age and mood were included as predictor variables. A new functional scale developed as part of a previous study was used as the dependent variable administered in both the hospital and the home to determine whether the outcome generalized from the learning to a different environment. Results: Only disease severity was a negative predictor of treatment outcome at home. In the hospital setting none of the factors predicted the immediate effect of treatment but cognitive ability and age were determinants of whether the treatment effects were maintained in the long term. Conclusions: Using cueing and cognitive strategies benefited younger and older patients with Parkinson's disease alike. However, the findings indicate targeting of treatment at patients with milder disease severity and providing follow-up treatment for older and cognitively less able patients.
Whiplash-associated disorders – predicting disability from a process-oriented perspective of coping
Authors: Söderlund Anne , Lindberg Per 
Published: November 2003

Objective: To describe the coping process over time for patients with whiplash-associated disorders (WAD). Design: The study was conducted by following patients prospectively for 12 months. Settings: The orthopaedic clinic at a university hospital. Subjects: Fifty-three patients out of 59 had complete data-sets. Main outcome measures: Two measures were used: the Pain Disability Index (PDI) and the Coping Strategies Questionnaire (CSQ). Results: The results showed that the proportion of variance in disability shared with coping increased over time. Conclusion: The importance of coping as an explanatory factor for disability increased during the one year follow-up. Thus, coping has a crucial role for disability. The possibility of a positive long-term outcome could therefore be improved by teaching patients to use active and adaptive coping strategies shortly after an accident.
Predictors of a nursing home placement from a non-acute geriatric hospital
Authors: Aditya B S , Sharma J C , Allen S C , Vassallo M 
Published: November 2003

Background: Identifying patients who need Nursing Home (NH) care following a hospital admission is important. Objective: To identify the factors that predispose to an NH discharge. Design: Prospective observational study with blinded end-point evaluation. Setting: A non-acute geriatric hospital. Subjects: Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness. Main outcome measures: Discharge to an NH or home. Results: Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p < 0001). They were more likely to have visual impairment (p = 0.0009), confusion (p < 0.0001), wandering behaviour (p = 0.003), incontinence (p < 0.0001 or unsafe gait (p = 0.0005), to be on tranquillizers (p = 0.003), to be at risk of falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p < 0.001), tranquillizers (p < 0.001), impaired distant vision (p = 0.01) and living alone (p < 0.001) as independently associated with the risk of an NH discharge. This risk proportionately increased with the number of risk factors present: 4.28% for 0–2 factors, 25.8% for 3–4 factors and 81.8% for 5–6 factors (p < 0.0001). Conclusion: These factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.
The effect of physical exercise following acute disease exacerbation in patients with dermato/polymyositis
Authors: Varjú Cecília , Pethö Edit , Kutas Réka , Czirják László 
Published: November 2003

Objective: To study the effect of physical exercise shortly after an acute episode of dermato/polymyositis (DM/PM). Design: Pilot study of a descriptive nature. Setting: Rehabilitation unit of a large general hospital. Subjects: Ten patients 2–3 weeks after an acute phase of DM/PM (early recovery group) and 11 patients in the inactive stage of DM/PM for at least three months (chronic stage group). Interventions: Isotonic muscle training consisted of several series of different repeated movements at 65–70% of individual maximal repetition limit. Special training was applied for the respiratory muscles. Relaxing baths, mud packs and massages were also applied. Outcome measures: Dynamometer and spirometer were used for measuring the changes in muscle strength and respiratory function. Disability tests were done before and after therapy. Results: No disease relapses or decreases in muscle function were seen. In the early recovery group, the average muscle strength improvement was 17 ± 31% ( p > 0.05) in the proximal muscles and 37 ± 23% ( p < 0.05) in the distal muscles, while the vital capacity also increased by 17 ± 21% ( p < 0.05). In the chronic stage group the average improvement in muscle strength was 46 ± 34% ( p < 0.05) in the proximal muscles and 37 ± 29% ( p < 0.05) in the distal muscles. By the end of the therapy both groups showed improvements in disability tests ( p < 0.05). Conclusions: Physical training started 2–3 weeks following an acute exacerbation of the disease seems to be useful and safe. Some improvement in muscle strength and respiratory function can be obtained, muscle atrophy due to inactivity may be partially prevented and the level of disability can be decreased.
A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms
Authors: Wade Derick T , Robson Philip , House Heather , Makela Petra , Aram Julia 
Published: November 2003

Objectives: To determine whether plant-derived cannabis medicinal extracts (CME) can alleviate neurogenic symptoms unresponsive to standard treatment, and to quantify adverse effects. Design: A consecutive series of double-blind, randomized, placebo-controlled single-patient cross-over trials with two-week treatment periods. Setting: Patients attended as outpatients, but took the CME at home. Subjects: Twenty-four patients with multiple sclerosis (18), spinal cord injury (4), brachial plexus damage (1), and limb amputation due to neurofibromatosis (1). Intervention: Whole-plant extracts of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), 1:1 CBD:THC, or matched placebo were self-administered by sublingual spray at doses determined by titration against symptom relief or unwanted effects within the range of 2.5–120 mg/24 hours. Measures used: Patients recorded symptom, well-being and intoxication scores on a daily basis using visual analogue scales. At the end of each two-week period an observer rated severity and frequency of symptoms on numerical rating scales, administered standard measures of disability (Barthel Index), mood and cognition, and recorded adverse events. Results: Pain relief associated with both THC and CBD was significantly superior to placebo. Impaired bladder control, muscle spasms and spasticity were improved by CME in some patients with these symptoms. Three patients had transient hypotension and intoxication with rapid initial dosing of THC-containing CME. Conclusions: Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.