Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation. Amphetamine, a sympathomimetic, might have haemodynamic effects in stroke patients, although limited data have been published. Subjects were recruited 3-30 days post ischaemic stroke into a phase II randomised (1:1), double blind, placebo-controlled trial. Subjects received dexamphetamine (5mg initially, then 10mg for 10 subsequent doses with 3 or 4 day separations) or placebo in addition to inpatient physiotherapy. Recovery was assessed by motor scales (Fugl-Meyer, FM), and functional scales (Barthel index, BI and modified Rankin score, mRS). Peripheral blood pressure (BP), central haemodynamics and middle cerebral artery blood flow velocity were assessed before, and 90 minutes after, the first 2 doses. 33 subjects were recruited, age 33-88 (mean 71) years, males 52%, 4-30 (median 15) days post stroke to inclusion. 16 patients were randomised to placebo and 17 amphetamine. Amphetamine did not improve motor function at 90 days; mean (standard deviation) FM 37.6 (27.6) vs. control 35.2 (27.8) (p=0.81). Functional outcome (BI, mRS) did not differ between treatment groups. Peripheral and central systolic BP, and heart rate, were 11.2 mmHg (p=0.03), 9.5 mmHg (p=0.04) and 7 beats/minute (p=0.02) higher respectively with amphetamine, compared with control. A non-significant reduction in myocardial perfusion (Buckberg Index) was seen with amphetamine. Other cardiac and cerebral haemodynamics were unaffected. Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and heart rate without altering cerebral haemodynamics.

Higher-Order Functions for Parsing

In combinator parsing, the text of parsers resembles BNF notation. We present the basic method, and a number of extensions. We address the special problems presented by white-space, and parsers with separate lexical and syntactic phases. In particular, a combining form for handling the offside rule is given. Other extensions to the basic method include an $quot;into$quot; combining form with many useful applications, and a simple means by which combinator parsers can produce more informative error messages.

Ordinal Arithmetic: A Case Study for Rippling in a Higher Order Domain

This paper reports a case study in the use of proof planning in the context of higher order syntax. Rippling is a heuristic for guiding rewriting steps in induction that has been used successfully in proof planning inductive proofs using first order representations. Ordinal arithmetic provides a natural set of higher order examples on which transfinite induction may be attempted using rippling. Previously Boyer-Moore style automation could not be applied to such domains. We demonstrate that a higher-order extension of the rippling heuristic is sufficient to plan such proofs automatically. Accordingly, ordinal arithmetic has been implemented in lambda-clam, a higher order proof planning system for induction, and standard undergraduate text book problems have been successfully planned. We show the synthesis of a fixpoint for normal ordinal functions which demonstrates how our automation could be extended to produce more interesting results than the textbook examples tried so far.