Use Of Subjects Research Articles

34 LATEST ASPECTS OF DENTAL HARD TISSUE ABLATION BY ULTRA-SHORT LASER PULSES

Occlusal disharmony due to processing can cause discomfort to the patient.The purpose of this investigation was to identify whether refinement in occlusion was correlated with patient comfort and the number of postinsertion visits.Maxillary and mandibular complete dentures were fabricated for 30 subjects who were randomly divided into 3 groups of 10 subjects using a lottery: Group LCRO, the control group, received both laboratory and clinical remount procedures along with occlusal corrections; Group LRO subjects received only laboratory remount with occlusal corrections; and Group OOC subjects underwent routine procedures in complete denture construction without remount corrections and only occlusal corrections where required, intraorally. A pilot study was conducted to identify the feasibility of a close-ended questionnaire designed by the investigator and containing 5 questions regarding the comfort, pain, masticatory ability, swallowing, and occlusal contacts of maxillary and mandibular complete dentures. The evaluation was performed following the subject's use of the dentures for 7 days. All 30 subjects were examined for tissue irritation at this time. The evaluation was conducted by a single examiner who was unaware of the groups to which the subjects belonged. An analysis of statistical difference between the treatment groups for the number of postinsertion visits, comfort, pain during mastication, swallowing, and areas of tissue irritation during use of complete dentures was assessed using the chi-square test and Kruskal-Wallis test (α =.05).The results indicated that remount procedures and occlusal corrections significantly reduced the number of postinsertion visits (Kruskal-Wallis test, P<.001). There was less pain during mastication in group LCRO compared to the other groups (Kruskal-Wallis test, P=.0399). Group LCRO subjects also reported less incidence of tissue irritation compared to group LRO and group OOC (χ2=18.26, P<.001)The combination of laboratory and clinical remount procedures with occlusal corrections enhanced patient comfort, compared to the other groups in which either one or both of the procedures were not performed.

Factors affecting agreement between severely mentally ill alcohol abusers' and collaterals' reports of alcohol and other substance abuse.

This study examined subject-collateral reports of alcohol use among a sample of 167 dually diagnosed individuals seeking outpatient treatment at a community mental health clinic. All subjects met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for a schizophrenia-spectrum or bipolar disorder and for alcohol abuse or dependence. Subjects were recruited within 2 weeks of treatment entry and completed measures of cognitive functioning, alcohol dependence severity, psychiatric symptoms, and quantity and frequency of substance use over the previous 60 days using the Timeline Follow-Back interview (L. C. Sobell & M. B. Sobell, 1996). They also provided a urine sample, which was screened for recent drug use. Collateral interviews were conducted by phone and included an assessment of the subject's alcohol and drug use over the same 60-day period. Collaterals also reported their confidence in the accuracy of their reports. Overall, the results indicated generally poor subject-collateral agreement. However, subject-collateral agreement appeared better for those individuals (n = 97) with negative urine drug screens. The most consistent predictor of subject-collateral discrepancy scores was subjects' recent drug use. Recommendations for enhancing the validity of self-reports of substance use in a severely mentally ill population are discussed.

Remote monitoring of primates using automated GPS technology in open habitats

Automated tracking using a satellite global position system (GPS) has major potential as a research tool in studies of primate ecology. However, implementation has been limited, at least partly because of technological difficulties associated with the dense forest habitat of many primates. In contrast, primates inhabiting relatively open environments may provide ideal subjects for use of GPS collars, yet no empirical tests have evaluated this proposition. Here, we used an automated GPS collar to record the locations, approximate body surface temperature, and activity for an adult female baboon during 90 days in the savannah habitat of Amboseli, Kenya. Given the GPS collar's impressive reliability, high spatial accuracy, other associated measurements, and low impact on the study animal, our results indicate the great potential of applying GPS technology to research on wild primates.

The effect of remount procedures on patient comfort for complete denture treatment

Occlusal disharmony due to processing can cause discomfort to the patient. The purpose of this investigation was to identify whether refinement in occlusion was correlated with patient comfort and the number of postinsertion visits. Maxillary and mandibular complete dentures were fabricated for 30 subjects who were randomly divided into 3 groups of 10 subjects using a lottery: Group LCRO, the control group, received both laboratory and clinical remount procedures along with occlusal corrections; Group LRO subjects received only laboratory remount with occlusal corrections; and Group OOC subjects underwent routine procedures in complete denture construction without remount corrections and only occlusal corrections where required, intraorally. A pilot study was conducted to identify the feasibility of a close-ended questionnaire designed by the investigator and containing 5 questions regarding the comfort, pain, masticatory ability, swallowing, and occlusal contacts of maxillary and mandibular complete dentures. The evaluation was performed following the subject's use of the dentures for 7 days. All 30 subjects were examined for tissue irritation at this time. The evaluation was conducted by a single examiner who was unaware of the groups to which the subjects belonged. An analysis of statistical difference between the treatment groups for the number of postinsertion visits, comfort, pain during mastication, swallowing, and areas of tissue irritation during use of complete dentures was assessed using the chi-square test and Kruskal-Wallis test (alpha =.05). The results indicated that remount procedures and occlusal corrections significantly reduced the number of postinsertion visits (Kruskal-Wallis test, P<.001). There was less pain during mastication in group LCRO compared to the other groups (Kruskal-Wallis test, P=.0399). Group LCRO subjects also reported less incidence of tissue irritation compared to group LRO and group OOC (chi2=18.26, P<.001) The combination of laboratory and clinical remount procedures with occlusal corrections enhanced patient comfort, compared to the other groups in which either one or both of the procedures were not performed.

Quantifying and Mitigating the Splitting Bias and Other Value Tree-Induced Weighting Biases

This paper develops a model for estimating and correcting attribute-weighting biases (such as the splitting bias) that result from the use of value trees when structuring value function weight elicitation. The model is based on the conjecture that attribute weights are influenced by tree structure and a subject's use of the “anchor-and-adjust” heuristic, meaning that the subject starts with an equal allocation of weight among attributes in each tree partition and then adjusts the weights to reflect his or her innate preferences. Adjustments tend to be insufficient, resulting in attribute weights that are closer in value to each other than if the anchor-and-adjust heuristic was not employed. Weights corresponding to environmental and economic attributes of electric system expansion alternatives are elicited from employees of an electric utility and used to illustrate the existence and correction of value tree-induced attribute-weighting biases. Two weight sets are elicited from each subject, one using a nonhierarchical assessment and the other using a hierarchical one. The model results support the hypothesis that a bias exists that is consistent with the anchor-and-adjust heuristic. An analysis of rankings of alternatives and value losses caused by using elicited versus model-estimated debiased weight sets is provided.

A comparison between screened NIMH and clinically interviewed control samples on neuroticism and extraversion

The National Institute of Mental Health (NIMH) has supported the collection of DNA samples on over 4000 subjects for use primarily as controls in psychiatric genetic studies. These subjects, though screened online, were not directly interviewed or assessed on family history. We compared this sample to one that was directly interviewed using structured diagnostic assessments on comparable measures of neuroticism and extraversion. The screened sample completed an online self-report based on the Composite International Diagnostic Instrument Short-Form (CIDI-SF). The interviewed sample was assessed by clinically trained personnel using the Schedule for Affective Disorders and Schizophrenia (SADS-LA-IV) and Family History Screen; final diagnoses were made blind to trait scores by a clinician using the best-estimate procedure. Neuroticism and extraversion were assessed on the NEO five-factor inventory (NEO-FFI) and the revised Eysenck Personality Questionnaire short form (EPQ-R). We found that subjects in the NIMH-screened sample who did not report any psychiatric symptoms on the self-report were indistinguishable from interviewed diagnosis free and family history negative controls on neuroticism and extraversion. Subjects in the screened sample who screened positive for anxiety disorders, however, deviated significantly on these measures both from the screened subjects with no self-reported symptoms, as well as from subjects in the interviewed sample diagnosed with comparable disorders. These findings suggest that control groups generated from the NIMH sample should ideally be restricted to subjects free of any self-reported symptoms, regardless of the disorder being addressed, in order to maximize their reflection of diagnosis-free populations.

Proprioceptive contribution of postural control as assessed from very slow oscillations of the support in healthy humans

Maintaining erect human posture depends on graviceptive information. This can come from at least of three origins: vestibular, visual and somaesthetic. We hypothesize here that subject's use proprioception rather than visual or vestibular cues for their control of upright body posture and this even when subjects stand on a tilting body support surface. In order to find experimental evidence for this hypothesis, we exclude in our experiments visual cues (eyes close) and by keeping frequency and amplitude of the tilt stimulus so low that it would be below the detection threshold for vestibular semi-circular canal stimuli. The orientations of body segments were analysed during various phases of the perturbation cycle. Segmental stabilisations were defined in terms of both the global anchoring index calculated during the whole perturbation cycle and an appropriate sequential anchoring index calculated during various phases in the perturbation cycle. We show that subjects tend to align their bodies with the space vertical and do so better for their heads than for their upper bodies and lower bodies. A further finding is that stabilisation is related to the tilt stimulus in the form that it is minimal at the turning points of the tilt, where peak tilt velocity is minimal with the sinusoidal stimulus used. These finding suggest first that proprioceptive cues are predominant in the control of body orientation in quasi-static condition and second that the head and trunk stabilisation strategies used as the basis of postural control depend on the properties of the moving support.

Physicians' communication with patients about adherence to HIV medication in San Francisco and Copenhagen: a qualitative study using Grounded Theory.

BackgroundPoor adherence is the main barrier to the effectiveness of HIV medication. The objective of this study was to explore and conceptualize patterns and difficulties in physicians' work with patients' adherence to HIV medication. No previous studies on this subject have directly observed physicians' behavior.MethodsThis is a qualitative, cross-sectional study. We used a Grounded Theory approach to let the main issues in physicians' work with patients' adherence emerge without preconceiving the focus of the study. We included physicians from HIV clinics in San Francisco, U.S.A. as well as from Copenhagen, Denmark. Physicians were observed during their clinical work and subsequently interviewed with a semi-structured interview guide. Notes on observations and transcribed interviews were analyzed with NVivo software.ResultsWe enrolled 16 physicians from San Francisco and 18 from Copenhagen. When we discovered that physicians and patients seldom discussed adherence issues in depth, we made adherence communication and its barriers the focus of the study. The main patterns in physicians' communication with patients about adherence were similar in both settings. An important barrier to in-depth adherence communication was that some physicians felt it was awkward to explore the possibility of non-adherence if there were no objective signs of treatment failure, because patients could feel "accused." To overcome this awkwardness, some physicians consciously tried to "de-shame" patients regarding non-adherence. However, a recurring theme was that physicians often suspected non-adherence even when patients did not admit to have missed any doses, and physicians had difficulties handling this low believability of patient statements. We here develop a simple four-step, three-factor model of physicians' adherence communication. The four steps are: deciding whether to ask about adherence or not, pre-questioning preparations, phrasing the question, and responding to the patient's answer. The three factors/determinants are: physicians' perceptions of adherence, awkwardness, and believability.ConclusionCommunication difficulties were a main barrier in physicians' work with patients' adherence to HIV medication. The proposed model of physicians' communication with patients about adherence – and the identification of awkwardness and believability as key issues – may aid thinking on the subject for use in clinical practice and future research.

SU‐FF‐I‐41: A Series of 4D Pediatric Hybrid Phantoms Developed From the UF Series B Tomographic Phantoms

Purpose: To develop a series of the pediatric hybrid computational phantoms based on the non‐uniform rational B‐spline (NURBS) technology by converting the existing series of UF pediatric tomographic phantoms. Method and Material: The series of UF tomographic phantoms, newborn female, 9‐month male, 4‐year female, 8‐year female, 11‐year male, 14‐year male, which were developed by the researchers at University of Florida, were employed for this study. The tomographic phantoms were imported to the 3D‐DOCTOR (Able Software Corp., Lexington, MA) segmentation and 3D rendering software, and polygon mesh models representing internal organs and body contour were generated. The polygon mesh models were imported to the Rhinoceros software (McNeel, Seattle, WA) based on NURBS‐technology, and Smooth NURBS surfaces were developed for organ and tissue contours, and the NURBS‐based organ models were generated organ‐by‐organ. The NURBS organ models were integrated into hybrid human phantoms by the Rhinoceros software. Results: A total of 6 hybrid human phantoms were developed from the existing 6 UF tomographic phantoms. The cube‐shaped organ contours in the tomographic phantoms were innovatively smoothed in the resulting hybrid phantoms based on NURBS surfaces. The organ volumes calculated from tomographic and hybrid phantoms were in agreement within 5%. Conclusion: The resulting phantoms are deformable and can thus be used to represent 25th or 75th percentile subjects through the adjustment of control points surrounding each organ and body contour. The NURBS‐based pediatric phantoms developed in this study can be imported into Monte Carlo calculation code, and broadly utilized for dosimetry calculation. The techniques developed in this study will be also applied to the development of NURBS‐based 3D phantoms representing 50th and other percentile adult male and female subjects for use in radiation protection applications, as well as occupational or medical exam dose reconstruction.

Obviousness and IP: time to reconsider

On 6 February, the day this editorial was written, the United Kingdom Patent Office surprised members of the local intellectual property professions when it launched an unexpected discussion paper, Consultation on the Inventive Step Requirement in United Kingdom Patent Law and Practice and sought informed response by 31 May. On the assumption that the provisions of patent law are intended to reflect a balance between the complementary and sometimes conflicting interests of inventors, the public at large, and the British economy, the paper seeks to probe two lines of enquiry. First, responses are sought as to whether too many ‘trivial’ patents are being granted. Secondly, it wants to know whether respondents regard innovation and competitiveness are best served by ‘easy patenting with low hurdles’. Serving the best interests of the patent-using professions and the grant of trivial patents are not necessarily incompatible. The high cost and considerable effort that must be expended in procuring patent protection itself operates in many instances as a selection mechanism, encouraging most patent applicants to direct their resources to obtain patents that are not trivial but have some genuine substance. Nor does the fact that a patent is invalid for lack of inventive step constitute a proof that it is trivial; no commercially aware industrial company would commit large resources to the protection or enforcement of trivia. A ruling of obviousness means in most countries that a court or patentissuing body has ruled that a hypothetical uninventive person, skilled in what has a painstakingly assembled prior art, has been considered capable of making that invention with no faculty more creative than the ability to draw upon that prior art—which might be quite elderly by the time the issue is argued before a court. The present patent system is perfectly capable of generating trivial patents and does so regularly, as any number of humorous publications and websites can testify. However, triviality is not in itself a ground for invalidity of a patent and most trivial patents rarely pose problems. If a patent has no genuine market role, it is unlikely to be the subject of use by its owner or of infringement by third parties. It is worth reflecting that a requirement of nonobviousness is not found in the law on the protection of the two other major statutory intellectual property rights: trade marks and copyright. Trade mark law is driven by the need for a sign to distinguish goods or services of one business from those of others, a need that sidelines obviousness. Where the choice of a trade mark is ‘‘obvious’’ through the use of a purely descriptive term such as SUPER-STICK for glue, it is the term’s inherent inability to distinguish, and/or the perceived need to keep that term available for descriptive use, that will prevent it being protected. Even then, where through its continued use such a term acquires distinctive character, its obvious nature is no bar to its registration. Copyright too employs no ‘‘obviousness’’ doctrine. Although the notion of inventive step is deeply entrenched in modern patent law, at both international and regional levels, there is strong reason for challenging its continued role. The requirement of novelty demands that patentable inventions be new— a criterion that is objectively assessed and that can generally be ascertained by diligent search. Obviousness, however, is a phenomenon of conjecture: expensive to construct, subjective to assess, unpredictable, and unproductively time-consuming in its mode of assessment. If any proof were needed of this, just take a look at the typical opposition proceedings taking place before the European Patent Office. The current initiative on re-evaluating the inventive step should be applauded. Unfortunately it will almost certainly be buried in the unmarked grave of stillborn initiative. Where normative intellectual property law is highly harmonized and countries strive to achieve a level playing field in their patent protection, it is unlikely that any movement for change will gather momentum if it starts at the periphery, with a single jurisdiction, rather than at the centre through the World Intellectual Property Organization or the European Patent Office.

Does Visual Reference Depend on Sortal Classification? Reply to Clark

Clark's main thesis is, roughly, that the visual system proper is not smart enough to sustain demonstrative reference in the way I describe. Rather, visual information processing has to be helped out by the subject's intelligent use of sortal concepts. I think there are two ways in which his line of thought underestimates the resources available to vision without appeal to the intelligent use of sortal concepts. First, the internal management of information in vision is significantly more sophisticated than Clark allows: in effect he maintains, to make his point, that amodal completion, which does seem demanded by our ordinary use of visual demonstratives, requires the intelligent use of sortal concepts, and we will see that it does not. Secondly, some of the appearance of smartness on the part of the visual system may be owed, not to its internal organization, nor to the subject's intelligent use of sortal concepts, but to the way in which the visual system is embedded in the world of concrete objects. Suppose we think of visual attention to an object as a relation in which the subject stands to a particular concrete thing. The organizing work of the visual systems in the brain may be regulated over time by the particular token object seen, so that visual attention can keep locked on to that particular thing. What does the work is the

Development of Clinical Scale Cytomegalovirus-Specific T Cells for Adoptive Immunotherapy Using pp65.

Cytomegalovirus (CMV) represents a major cause of morbidity in patients undergoing allogeneic stem cell transplantation (SCT). Although antiviral prophylaxis has contributed to the reduction of early CMV disease, recovery of CMV-specific cytotoxic lymphocytes is still necessary for the long-term control of CMV reactivation after SCT. It has been demonstrated that CMV-specific CD4+ and CD8+ cytotoxic T lymphocytes from the donor are important in resolving CMV infection and protecting recipients from developing CMV disease post SCT. Recently CMV recombinant protein pp65, an immunodominant target for CD4+ and CD8+ T cell responses, has been developed for the stimulation and isolation of donor CMV-specific T cells. The aim of this study was to investigate the potential of pp65 to generate CMV-specific CD8+ and CD4+ T cells from seropositive subjects for use as adoptive immunotherapy after SCT. Peripheral blood mononuclear cells (5x108 cells) were isolated from single unit CMV-positive buffy-coats and were stimulated with pp65 for 16 hours. CMV-specific T cells that produced IFNγ were captured using the IFNγ-secretion assay and were enriched using the CliniMACS system. The phenotype of the cells, both pre and post enrichment was evaluated by flow cytometry using monoclonal antibodies against CD3, CD4 and IFNγ. Enriched IFNγ producing T cells were cultured with irradiated feeder cells in the presence of IL-2 for 18 days. Alloreactivity experiments were performed by mixing 105 enriched T cells at day 0 and day 18 of culture with 105 third party cells for seven days. Proliferation was assessed by the 3H-thymidine incorporation assay. Experiments to date have shown that pp65 is capable of stimulating both CD4+ and CD8+ T cells to secrete IFNγ. Flow cytometric analyses revealed that prior to enrichment, IFNγ+ cells represented 0.13% of the CD3+/CD4+ cell population and 2.1% of the CD3+/CD4− cell population. Whereas, following magnetic enrichment and an 18-day expansion phase, the proportion of IFNγ+ cells increased significantly (554-fold and 6-fold) to 72% and 13.3% in the CD3+/CD4+ and CD3+/CD4− subfractions, respectively. The alloreactivity of the expanded positive cells had decreased by an average 95.5% (SD=5.7, n=3) compared to prior to enrichment and cell expansion. The proliferation of the expanded cells was still high (Stimulation Index >3), but considerably reduced compared to the cells at day 0. The cytotoxicity of these cells will be assessed to determine their suitability for immunotherapeutic use post-SCT. Large scale CMV-specific T cell capture experiments, performed under GMP conditions, are ongoing.

Effects of Peer Mentoring on HIV-Affected Youths' Substance Use Risk and Association with Substance Using Friends

This study evaluates the effectiveness of peer mentoring (PM) for urban youth with a HIV-positive parent. Families were randomly assigned with a weighting procedure to a PM program centered around 20 older, trained peer mentors with adult supervision (59 families with 96 eligible youths), or control condition (35 families with 61 eligible youths). The youths were 51% male, 91% minority; mean age was 11.4 years. Outcomes measured one year later were: (1) friends' substance use; and (2) substance use risk, a composite measure of subject's substance use plus friends' substance use. Since only about half (53%) of assigned youths attended PMactivities, PM attendance frequency rather than group assignment was used as the variable representing program participation. Ordinary least squares regression was used to control for baseline covariates and multilevel modeling to control for the nested effect of youths within families. PM attendance predicted both outcomes for the two types of analysis. Results show that participating in peer mentoring activities may reduce the size of peer substance-user networks and substance use risk among vulnerable youth.

Exposure to Traffic and the Onset of Myocardial Infarction

An association between exposure to vehicular traffic in urban areas and the exacerbation of cardiovascular disease has been suggested in previous studies. This study was designed to assess whether exposure to traffic can trigger myocardial infarction. We conducted a case-crossover study in which cases of myocardial infarction were identified with the use of data from the Cooperative Health Research in the Region of Augsburg Myocardial Infarction Registry in Augsburg, in southern Germany, for the period from February 1999 to July 2001. There were 691 subjects for whom the date and time of the myocardial infarction were known who had survived for at least 24 hours after the event, completed the registry's standardized interview, and provided information on factors that may have triggered the myocardial infarction. Data on subjects' activities during the four days preceding the onset of symptoms were collected with the use of patient diaries. An association was found between exposure to traffic and the onset of a myocardial infarction within one hour afterward (odds ratio, 2.92; 95 percent confidence interval, 2.22 to 3.83; P<0.001). The time the subjects spent in cars, on public transportation, or on motorcycles or bicycles was consistently linked with an increase in the risk of myocardial infarction. Adjusting for the level of exercise on a bicycle or for getting up in the morning changed the estimated effect of exposure to traffic only slightly (odds ratio for myocardial infarction, 2.73; 95 percent confidence interval, 2.06 to 3.61; P<0.001). The subject's use of a car was the most common source of exposure to traffic; nevertheless, there was also an association between time spent on public transportation and the onset of a myocardial infarction one hour later. Transient exposure to traffic may increase the risk of myocardial infarction in susceptible persons.

Measuring Adherence with the Doser CT in Children with Asthma

Non‐adherence with prescribed asthma treatment causes compromised treatment effectiveness, including greater morbidity, mortality, and health care utilization costs. As a result, there is an increasing interest in measuring patient adherence behaviors. Electronic monitoring devices offer a promising method for assessing patient adherence behavior patterns. The reliability of the Doser Clinical Trials (CT) (Meditrack Products, Hudson, MA), an inexpensive, pressure‐actuated device that monitors metered‐dose inhaler (MDI) usage, was evaluated in a field study of outpatient pediatric asthmatics. Canister weight and various Doser CT measures of patient medication use were compared to determine the reliability and usefulness of the device. Doser CTs were dispensed to 16 research subjects for use on corticosteroid MDIs over a period of several months. One Doser CT per month was dispensed to each subject. Doser CTs were collected at 30–60 day intervals, with a total of 61 months of Doser CT data obtained across the subjects. MDI canister weights were monitored for a subset of 6 subjects. Usable Doser CT data were summarized and average adherence estimates were computed. Adherence estimates differed from one another and the adherence estimate, as measured by canister weight, was significantly higher than each Doser CT estimate. However, overall, the Doser CT showed adequate reliability as evidenced by high correlations among the Doser CT estimates of adherence and the existing gold standard of canister weight. The Doser CT is likely to be useful for monitoring MDI use in clinical care and research, potentially providing greater accuracy than the standard of canister weight.

Exposure assessment for study of olfactory function in workers exposed to styrene in the reinforced-plastics industry.

This study was undertaken in conjunction with an evaluation of the olfactory function of 52 persons exposed to styrene vapors to provide quantitative styrene exposure histories of each subject for use in the interpretation of the results of olfactory function testing. Current and historic exposures were investigated. Historic exposures were reconstructed from employment records and measurements of styrene exposure made in the subject facilities over the last 15 years. Current exposures were estimated for every exposed subject though personal air sampling and through pre- and post-shift measurements of urinary metabolites of styrene. The study population had been employed in the reinforced-plastics industry for an average of 12.2 +/- 7.4 years. Their mean 8-hr time weighted average (TWA) respirator-corrected annual average styrene exposure was 12.6 +/- 10.4 ppm; mean cumulative exposure was 156 +/- 80 ppm-years. The current respirator-corrected 8-hr TWA average exposure was 15.1 +/- 12.0 ppm. The mean post-shift urinary mandelic and phenylglyoxylic acid (PGA) concentrations were 580 +/- 1,300 and 170 +/- 360 mg/g creatinine, respectively and were highly correlated with air concentrations of styrene. This quantitative exposure evaluation has provided a well-characterized population, with documented exposure histories stable over time and in the range suitable for the purposes of the associated study of olfactory function.

Traffic density and the risk of childhood leukemia in a Los Angeles case-control study.

To investigate the relationship between traffic density and the risk of childhood leukemia. The study group consisted of 212 cases and 202 controls from the London et al. (1991) study of childhood leukemia conducted in the Los Angeles area during 1978 to 1984. Using GIS methods, traffic counts on all streets within 1500 feet of each subject's residence of longest duration were determined. From these counts, an integrated distance-weighted traffic density measure was calculated for each subject for use as the analytic variable. Additional information, including magnetic fields and wire-code, was obtained from the original case-control study. Association between traffic density and leukemia, and confounding and effect modification by other variables, were assessed using standard matched case-control analyses. Although the unadjusted traffic density-childhood leukemia rate ratios were slightly elevated, this weak association was explained by confounding by wire code. Wire code remained associated with leukemia after controlling for traffic density. There was little evidence of effect modification between traffic density and magnetic fields, wire code or other variables. There is no evidence of an association of traffic density with childhood leukemia in the Los Angeles case-control study.

Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients.

The purpose of this study was to critically examine current approaches for estimating energy expenditure and requirements of hospitalized patients requiring nutrition support. All indirect calorimetry tests performed by our adult nutrition support service from 1991 to 2000 were reviewed. Stress factors were calculated as the measured energy expenditure divided by the predicted energy expenditure using the Harris-Benedict equation. Various methods for adjusting the body weights of obese subjects for use in the Harris-Benedict equation were evaluated. The average stress factor for these hospitalized patients was 1.25, and there were no differences in the stress factors between men and women. For obese subjects, using an adjusted body weight equal to ideal body weight plus 50% of the difference between ideal and actual body weight in the Harris-Benedict equation gave stress factors comparable with normal weight subjects. For underweight subjects, using the actual rather than ideal body weight gave stress factors that were most similar to normal weight patients. Disease-specific stress factors were calculated and compared with literature values. Mechanical ventilation, recent feeding, fever, and restlessness during the indirect calorimetry measurement increased the measured energy expenditure. Our findings provide nutrition support services with updated information on disease-specific stress factors that can be used for estimating energy expenditure in hospitalized patients. An adjusted body weight equal to ideal body weight plus 50% of the excess body weight should be used for estimating the energy requirements of obese patients requiring nutrition support.

Desnaturat son li Frances: Language and Identity in the Twelfth-Century Occitan Epic

DESNATURAT SON LI FRANCES: LANGUAGE AND IDENTITY IN THE TWELFTH-CENTURY OCCITAN EPIC Todaywordslike"French" and "Occitan" aremarkers ofidentity as well aslinguistic categories.* However, thishas not alwaysbeen selfevidently the case and this article will seek to contribute to the documentationoftheemergent associationbetweenlanguageand identity intwelfth-century Occitania. Theprevalence ofLatin astheinternational language ofhighculture, apoliticalmap ofEuropeinwhichlinguisticand political frontierswere rarely coterminous, and a sense ofthe Saracen or GermanicOtherasinfinitelymoreforeignthan speakersofotherRomance languages are factors that mean that differences between Romance languagesrarelyhadanydiscernibleideologicalvalueinthetwelfthcentury. Butbythe endthetwelfth and beginning ofthethirteenth centuries texts writtenforavariety ofdifferentreasonsindicatethatlanguageinWestern Europe hadbecome a strong markerofcultural and political difference, a marker, in otherwords, ofidentitycategories: consider, forexample, the bilingual tensocomposedbyRaimbaut deVaqueirasincollaborationwith an anonymous Genoesewomanin whichRaimbaut speaks Occitan, but his interlocutor speaks Genoese while criticizinghis"Provençal" ways and speech.' How and why, then, does linguistic difference emerge as a basis ofidentity? One factor is surely that language begins to play a role in the erectionofboundariesthatdefinewhat isforeign. InthisarticleI willfocus upon two twelfth-century Occitan chansons de geste—Girart de RoussilionandDaureletBeton—that mayhavebeenpart ofthisprocess inOccitaniaandFranceinthe secondhalfofthetwelfthcentury.2Whether these texts should be viewed as a partial cause ofemergent linguistic identities, oras a symptom ofthem, is not aproblemI canhopeto solve here: bothtextswere probably originally composed shortly after 1 150; bothtextsconcernconflict betweenNorthern and SouthernFrance; both evincelinguisticpeculiarities,thoughtodifferentdegrees, inthatbothtexts survivein anOccitanthat is lacedwith hybrid forms, that isformsthat are 10 "DESNATURAT SON LI FRANCES" neither French nor Occitan but which have elements ofboth. It is also perhaps relevant to note that despite evidence that other chansonsde geste were disseminated in Occitan in thetwelfth century, these are the onlytwosubstantialpoemstohavesurvived(andDaurelonlyinfragmentary form). In other words, the chanson de geste is therefore primarily a "French" genre.3 A number ofhypotheses have been put forward to explain the linguistic peculiarities ofthese texts: oneis thattheyreflectadialect spoken onthe linguisticfrontierbetweenFrenchand Occitan; anotheristhat one orboth texts were originally composed in French andthat we have "bad" translations; yet another is that theuse ofgallicized forms results fromthegeneric specificity ofthe chansonsdegeste whichareidentified asFrench; finally, it hasbeen suggested that thelanguemixte oiGirartin particularresultsfromadesiretobroadenthepotential publicofthepoem by makingit intelligible to bothFrench and Occitan speakers. I shall returnto the relative plausibility ofthese hypotheses in duecourse. I wish firstto sketchthetheoretical framework I shall useto considerthe significance ofthe linguistic features ofthese two unusual texts: postcolonial translationtheory. Thenotionoftranslationinpostcolonialtheoryhasabroaderresonancethan simplythetransposition ofatext orutterancefrom an original to atargetlanguage: translationbecomes anissuewhenevertwo cultures come into contact with each other; it can define national identities, with the point ofcontact between two cultures being crucial to the definition of borders. Hybrid forms, accordingto this view, are symptoms ofcultural transactions. To quoteJacquesDerrida"'Translation' identifiesherenot a distinct genre ... but ratherazone for engaging with the possibility and impossibilityofan 'absolutelypure, transparent, and unequivocaltranslatability ' wherewhat is at stakeisthequestion ofthehistorical constituenciesthat arerepresented intranslations."4 Thus inarecent, semi-autobiographical intervention, Derridareflects ongrowingup incolonialNorthAfrica, where Frenchwasboth his 11 SIMON GAUNT own language, and yet also that ofa hegemonic culture he only knows fromtheoutside, as a subordinate. Hence hebegins withtheaffirmation: "the onlylanguage I speak is not mine" (Monolingualism ofthe Other 5),awhileheclaimsat anotherpointthatthemonolingualcolonial subject's use ofFrenchis infact"atranslationwithout apole ofreference, without an originarylanguage, and without a source language. For himthere are onlytarget languages," (61) whichleadshimto assert that"All culture is originarilycolonial," (39)andthatalllanguage"isthelanguageoftheother" (25). But ifDerrida paints a picture ofthe subject (all subjects) as the product ofinvasionbythe other's language, henonetheless leaves open the possibilitythatthe subject might resistthe other's hegemony: For contraryto what one is often temptedto believe, the masterisnothing.And he doesnothave exclusive possession ofanything. Because the master does not possess exclusively, and naturally, what hecalls his language, because , whatever hewants or does, he cannot maintain any relations ofproperty or identitythat are natural, national, congenital, orontological,with it, because hecangive substancetoandarticulatethisappropriationonlyinthecourse ofanunnaturalprocess ofpolitico-phantasmaticconstructions . (23) Ifthe languageoftheotherisnot "naturally" his, thenthisleavesit opento others to appropriate for their own purposes, whatever the other may pretend. This, inturn, isreflected inrecent speculations byJudithButler in "RestagingtheUniversal"aboutthepoliticalpossibilitiesoftranslationwithin apostcolonial context. Iftranslationis always potentially acolonial gesture , Butlerstressesithasotherpossibilities: itcan, forexample"bringinto reliefthenon-convergenceofdiscourses so that onemight knowthrough the very ruptures ofnarrativity the founding violencesofan episteme" (3T). Translationsometimestherefore"exposesthelimitsofwhatthedominant discoursecanhandle" (5). Thefocuswouldthenbe asmuchonwhat translationleaves out—the irreducible kernel offoreignnessthatwill not 12 "DESNATURAT SONLI FRANCES" and cannotbe translated into thetarget language—as on what atranslation is ableto transpose from onecultureto another.5 How might these ideas enrich our understanding oìGirart and Daureland their linguistic peculiarities? Beforeturningto...

A Comparison of Time Use on an Acute Rehabilitation Unit: Subjects With and Without a Stroke

This study describes the time use of subjects on a mixed diagnosis inpatient rehabilitation unit. Twelve subjects were observed during two days: one weekday and one weekend day for 8 hours each observational day. Seven subjects had sustained a stroke (CVA) and 5 subjects had other diagnoses (non-CVA). The observers used the behavioral mapping technique to obtain an objective description of the subject's time use and the admission, discharge, and efficiency scores of the Functional Independence Measure (FIM) to obtain a measure of functional activity level.During the weekday observations, the subjects who had a stroke spent more time inactive, 25.0%, as compared to the subjects who had other diagnoses, 15.0%. In addition, the subjects who had a stroke spent more time alone, 53.6%, while the other subjects spent 38.8% time alone. While both amounts of inactivity and time alone increased during the weekend observation, the pattern remained the same. All FIM measures were lower for the subjects who had a stroke as compared to subjects who had other diagnoses.It appears that those who are recovering from a stroke show a discrepancy in self-directed activity level from those who did not have a stroke, while hospitalized on the same unit.