Current aspects and future prospects of total anorectal reconstruction - a critical and comprehensive review of the literature

PURPOSE: Many rectal cancer patients undergo abdominoperineal excision worldwide every year. Various procedures to restore perineal (pseudo-) continence, referred to as total anorectal reconstruction, have been proposed. The best technique, however, has not yet been defined. In this study, the different reconstruction techniques with regard to morbidity, functional outcome and quality of life were analysed. Technical and timing issues (i.e. whether the definitive procedure should be performed synchronously or be delayed), oncological safety, economical aspects as well as possible future improvements are further discussed. METHODS: A MEDLINE and EMBASE search was conducted to identify the pertinent multilingual literature between 1989 and 2013. All publications meeting the defined inclusion/exclusion criteria were eligible for analysis. RESULTS: Dynamic graciloplasty, artificial bowel sphincter, circular smooth muscle cuff or gluteoplasty result in median resting and squeezing neo-anal pressures that equate to the measurements found in incontinent patients. However, quality of life was generally stated to be good by patients who had undergone the procedures, despite imperfect continence, faecal evacuation problems and a considerable associated morbidity. Many patients developed an alternative perception for the urge to defecate that decisively improved functional outcome. Theoretical calculations suggested cost-effectiveness of total anorectal reconstruction compared well to life with a permanent colostomy. CONCLUSIONS: Many patients would be highly motivated to have their abdominal replaced by a functional perineal colostomy. Given the considerable morbidity and questionable functional outcome of current reconstruction technique improvements are required. Tissue engineering might be an option to design an anatomically and physiologically matured, and customised continence organ.

The Quiet Eye in Motor Performance and Learning – Functional and Theoretical Considerations

High precision in motor skill performance, in both sport and other domains (e.g. surgery and aviation), requires the efficient coupling of perceptual inputs (e.g. vision) and motor actions. A particular gaze strategy, which has received much attention within the literature, has been shown to predict both inter- (expert vs. novice) and intra-individual (successful vs. unsuccessful) motor performance (see Vine et al., 2014). Vickers (1996) labelled this phenomenon the quiet eye (QE) which is defined as the final fixation before the initiation of the crucial phase of movement. While the positive influence of a long QE on accuracy has been revealed in a range of different motor skills, there is a growing number of studies suggesting that the relationship between QE and motor performance is not entirely monotonic. This raises interesting questions regarding the QE’s purview, and the theoretical approaches explaining its functionality. This talk aims to present an overview of the issues described above, and to discuss contemporary research and experimental approaches to examining the QE phenomenon. In the first part of the talk Dr. Vine will provide a brief and critical review of the literature, highlighting recent empirical advancements and potential directions for future research. In the second part, Dr. Klostermann will communicate three different theoretical approaches to explain the relationship between QE and motor performance. Drawing upon aspects of all three of these theoretical approaches, a functional inhibition role for the QE (related to movement parameterisation) will be proposed.

Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study

BACKGROUND AND PURPOSE The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population. METHODS We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed. Hypoattenuation on CTA-SI, relative reduction in CBV or CBF, or relative increase in MTT were rated as abnormal. RESULTS CTA and CTP were available in 27/592 BASICS patients (4.6%). The proportion of patients with any perfusion abnormality was highest for MTT (93%; 95% confidence interval [CI], 76%-99%), compared with 78% (58%-91%) for CTA-SI and CBF, and 46% (27%-67%) for CBV (P < .001). All 3 patients with a CBV pc-ASPECTS < 8 compared to 6/23 patients with a CBV pc-ASPECTS ≥ 8 had died at 1 month (RR 3.8; 95% CI, 1.9-7.6). CONCLUSION CTP was performed in a minority of the BASICS registry population. Perfusion disturbances in the posterior circulation were most pronounced on MTT parameter maps. CBV pc-ASPECTS < 8 may indicate patients with high case fatality.

Functional notation and lazy evaluation in Ciao

Certain aspects of functional programming provide syntactic convenience, such as having a designated implicit output argument, which allows function cali nesting and sometimes results in more compact code. Functional programming also sometimes allows a more direct encoding of lazy evaluation, with its ability to deal with infinite data structures. We present a syntactic functional extensión of Prolog covering function application, predefined evaluable functors, functional definitions, quoting, and lazy evaluation. The extensión is also composable with higher-order features. We also highlight the Ciao features which help implementation and present some data on the overhead of using lazy evaluation with respect to eager evaluation.

Operational Aspects of Full Reduction in Lambda Calculi

Esta tesis estudia la reducción plena (‘full reduction’ en inglés) en distintos cálculos lambda. 1 En esencia, la reducción plena consiste en evaluar los cuerpos de las funciones en los lenguajes de programación funcional con ligaduras. Se toma el cálculo lambda clásico (i.e., puro y sin tipos) como el sistema formal que modela el paradigma de programación funcional. La reducción plena es una técnica fundamental cuando se considera a los programas como datos, por ejemplo para la optimización de programas mediante evaluación parcial, o cuando algún atributo del programa se representa a su vez por un programa, como el tipo en los demostradores automáticos de teoremas actuales. Muchas semánticas operacionales que realizan reducción plena tienen naturaleza híbrida. Se introduce formalmente la noción de naturaleza híbrida, que constituye el hilo conductor de todo el trabajo. En el cálculo lambda la naturaleza híbrida se manifiesta como una ‘distinción de fase’ en el tratamiento de las abstracciones, ya sean consideradas desde fuera o desde dentro de si mismas. Esta distinción de fase conlleva una estructura en capas en la que una semántica híbrida depende de una o más semánticas subsidiarias. Desde el punto de vista de los lenguajes de programación, la tesis muestra como derivar, mediante técnicas de transformación de programas, implementaciones de semánticas operacionales que reducen plenamente a partir de sus especificaciones. Las técnicas de transformación de programas consisten en transformaciones sintácticas que preservan la equivalencia semántica de los programas. Se ajustan las técnicas de transformación de programas existentes para trabajar con implementaciones de semánticas híbridas. Además, se muestra el impacto que tiene la reducción plena en las implementaciones que utilizan entornos. Los entornos son un ingrediente fundamental en las implementaciones realistas de una máquina abstracta. Desde el punto de vista de los sistemas formales, la tesis desvela una teoría novedosa para el cálculo lambda con paso por valor (‘call-by-value lambda calculus’ en inglés) que es consistente con la reducción plena. Dicha teoría induce una noción de equivalencia observacional que distingue más puntos que las teorías existentes para dicho cálculo. Esta contribución ayuda a establecer una ‘teoría estándar’ en el cálculo lambda con paso por valor que es análoga a la ‘teoría estándar’ del cálculo lambda clásico propugnada por Barendregt. Se presentan resultados de teoría de la demostración, y se sugiere como abordar el estudio de teoría de modelos. ABSTRACT This thesis studies full reduction in lambda calculi. In a nutshell, full reduction consists in evaluating the body of the functions in a functional programming language with binders. The classical (i.e., pure untyped) lambda calculus is set as the formal system that models the functional paradigm. Full reduction is a prominent technique when programs are treated as data objects, for instance when performing optimisations by partial evaluation, or when some attribute of the program is represented by a program itself, like the type in modern proof assistants. A notable feature of many full-reducing operational semantics is its hybrid nature, which is introduced and which constitutes the guiding theme of the thesis. In the lambda calculus, the hybrid nature amounts to a ‘phase distinction’ in the treatment of abstractions when considered either from outside or from inside themselves. This distinction entails a layered structure in which a hybrid semantics depends on one or more subsidiary semantics. From a programming languages standpoint, the thesis shows how to derive implementations of full-reducing operational semantics from their specifications, by using program transformations techniques. The program transformation techniques are syntactical transformations which preserve the semantic equivalence of programs. The existing program transformation techniques are adjusted to work with implementations of hybrid semantics. The thesis also shows how full reduction impacts the implementations that use the environment technique. The environment technique is a key ingredient of real-world implementations of abstract machines which helps to circumvent the issue with binders. From a formal systems standpoint, the thesis discloses a novel consistent theory for the call-by-value variant of the lambda calculus which accounts for full reduction. This novel theory entails a notion of observational equivalence which distinguishes more points than other existing theories for the call-by-value lambda calculus. This contribution helps to establish a ‘standard theory’ in that calculus which constitutes the analogous of the ‘standard theory’ advocated by Barendregt in the classical lambda calculus. Some prooftheoretical results are presented, and insights on the model-theoretical study are given.

Leptin can induce proliferation, differentiation, and functional activation of hemopoietic cells

Many cytokines exert their biological effect through members of the hemopoietin receptor family. Using degenerate oligonucleotides to the common WSXWS motif, we have cloned from human hemopoietic cell cDNA libraries various forms of the receptor that was recently shown to bind the obesity hormone, leptin. mRNAs encoding long and short forms of the human leptin receptor were found to be coexpressed in a range of human and murine hemopoietic organs, and a subset of cells from these tissues bound leptin at the cell surface. Ectopic expression in murine Ba/F3 and M1 cell lines revealed that the long, but not the short, form of the leptin receptor can signal proliferation and differentiation, respectively. In cultures of murine or human marrow cells, human leptin exhibited no capacity to stimulate cell survival or proliferation, but it enhanced cytokine production and phagocytosis of Leishmania parasites by murine peritoneal macrophages. Our data provide evidence that, in addition to its role in fat regulation, leptin may also be able to regulate aspects of hemopoiesis and macrophage function.

Dissociation of response conflict, attentional selection, and expectancy with functional magnetic resonance imaging

Two different attentional networks have been associated with visuospatial attention and conflict resolution. In most situations either one of the two networks is active or both are increased in activity together. By using functional magnetic resonance imaging and a flanker task, we show conditions in which one network (anterior attention system) is increased in activity whereas the other (visuospatial attention system) is reduced, showing that attentional conflict and selection are separate aspects of attention. Further, we distinguish between neural systems involved in different forms of conflict. Specifically, we dissociate patterns of activity in the basal ganglia and insula cortex during simple violations in expectancies (i.e., sudden changes in the frequency of an event) from patterns of activity in the anterior attention system specifically correlated with response conflict as evidenced by longer response latencies and more errors. These data provide a systems-level approach in understanding integrated attentional networks.

Functional activation in motor cortex reflects the direction and the degree of handedness

Handedness is the clearest example of behavioral lateralization in humans. It is not known whether the obvious asymmetry manifested by hand preference is associated with similar asymmetry in brain activation during movement. We examined the functional activation in cortical motor areas during movement of the dominant and nondominant hand in groups of right-handed and left-handed subjects and found that use of the dominant hand was associated with a greater volume of activation in the contralateral motor cortex. Furthermore, there was a separate relation between the degree of handedness and the extent of functional lateralization in the motor cortex. The patterns of functional activation associated with the direction and degree of handedness suggest that these aspects are independent and are coded separately in the brain.

Evolutionary relationships among Rel domains indicate functional diversification by recombination

The recent sequencing of several complete genomes has made it possible to track the evolution of large gene families by their genomic structure. Following the large-scale association of exons encoding domains with well defined functions in invertebrates could be useful in predicting the function of complex multidomain proteins in mammals produced by accretion of domains. With this objective, we have determined the genomic structure of the 14 genes in invertebrates and vertebrates that contain rel domains. The sequence encoding the rel domain is defined by intronic boundaries and has been recombined with at least three structurally and functionally distinct genomic sequences to generate coding sequences for: (i) the rel/Dorsal/NFκB proteins that are retained in the cytoplasm by IkB-like proteins; (ii) the NFATc proteins that sense calcium signals and undergo cytoplasmic-to-nuclear translocation in response to dephosphorylation by calcineurin; and (iii) the TonEBP tonicity-responsive proteins. Remarkably, a single exon in each NFATc family member encodes the entire Ca2+/calcineurin sensing region, including nuclear import/export, calcineurin-binding, and substrate regions. The Rel/Dorsal proteins and the TonEBP proteins are present in Drosophila but not Caenorhabditis elegans. On the other hand, the calcium-responsive NFATc proteins are present only in vertebrates, suggesting that the NFATc family is dedicated to functions specific to vertebrates such as a recombinational immune response, cardiovascular development, and vertebrate-specific aspects of the development and function of the nervous system.

Event-related functional MRI: Past, present, and future

The past two decades have seen an enormous growth in the field of human brain mapping. Investigators have extensively exploited techniques such as positron emission tomography and MRI to map patterns of brain activity based on changes in cerebral hemodynamics. However, until recently, most studies have investigated equilibrium changes in blood flow measured over time periods upward of 1 min. The advent of high-speed MRI methods, capable of imaging the entire brain with a temporal resolution of a few seconds, allows for brain mapping based on more transient aspects of the hemodynamic response. Today it is now possible to map changes in cerebrovascular parameters essentially in real time, conferring the ability to observe changes in brain state that occur over time periods of seconds. Furthermore, because robust hemodynamic alterations are detectable after neuronal stimuli lasting only a few tens of milliseconds, a new class of task paradigms designed to measure regional responses to single sensory or cognitive events can now be studied. Such “event related” functional MRI should provide for fundamentally new ways to interrogate brain function, and allow for the direct comparison and ultimately integration of data acquired by using more traditional behavioral and electrophysiological methods.

Magnetic resonance imaging (MRI) detection of the murine brain response to light: temporal differentiation and negative functional MRI changes.

Using a 9.4 T MRI instrument, we have obtained images of the mouse brain response to photic stimulation during a period between deep anesthesia and the early stages of arousal. The large image enhancements we observe (often >30%) are consistent with literature results extrapolated to 9.4 T. However, there are also two unusual aspects to our findings. (i) The visual area of the brain responds only to changes in stimulus intensity, suggesting that we directly detect operations of the M visual system pathway. Such a channel has been observed in mice by invasive electrophysiology, and described in detail for primates. (ii) Along with the typical positive response in the area of the occipital portion of the brain containing the visual cortex, another area displays decreased signal intensity upon stimulation.

Impact of social group processes and functional diversity on communication in networked organizations

This study examines the role of social group processes in perceptions of effective communication in Australian Cooperative Research Centres (CRCs). Communication professionals in 25 CRCs discussed the barriers and opportunities for communication in their diverse networked organizations. Thematic analysis of the transcripts highlighted the contribution of social group processes to both barriers and opportunities. Communication challenges implicated the social identity of organizational members, many of which were associated with distinct structural aspects of these organizations. Opportunities for communication frequently involved features that implicated social identity, including taking advantage of existing organizational or industry identities, preventing conflicting identities from becoming salient, and promoting a collective CRC identity.

Functional-structural plant modelling using a combination of architectural analysis, L-systems and a canonical model of function

This paper presents a new method for producing a functional-structural plant model that simulates response to different growth conditions, yet does not require detailed knowledge of underlying physiology. The example used to present this method is the modelling of the mountain birch tree. This new functional-structural modelling approach is based on linking an L-system representation of the dynamic structure of the plant with a canonical mathematical model of plant function. Growth indicated by the canonical model is allocated to the structural model according to probabilistic growth rules, such as rules for the placement and length of new shoots, which were derived from an analysis of architectural data. The main advantage of the approach is that it is relatively simple compared to the prevalent process-based functional-structural plant models and does not require a detailed understanding of underlying physiological processes, yet it is able to capture important aspects of plant function and adaptability, unlike simple empirical models. This approach, combining canonical modelling, architectural analysis and L-systems, thus fills the important role of providing an intermediate level of abstraction between the two extremes of deeply mechanistic process-based modelling and purely empirical modelling. We also investigated the relative importance of various aspects of this integrated modelling approach by analysing the sensitivity of the standard birch model to a number of variations in its parameters, functions and algorithms. The results show that using light as the sole factor determining the structural location of new growth gives satisfactory results. Including the influence of additional regulating factors made little difference to global characteristics of the emergent architecture. Changing the form of the probability functions and using alternative methods for choosing the sites of new growth also had little effect. (c) 2004 Elsevier B.V. All rights reserved.

Safety issues in functional capacity evaluation: Findings from a trial of a new approach for evaluating clients with chronic back pain

Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the persons performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.

Is health care seeking for irritable bowel syndrome and functional dyspepsia a socially learned response to illness?

In a population-based study of 207 subjects with irritable bowel syndrome (IBS) or functional dyspepsia (FD) and controls (n = 100), we aimed to determine whether dimensions of abnormal illness behavior from the Abnormal Illness Behaviour Questionnaire and aspects of social learning of illness behavior from the Social Learning of Illness Behaviour scale were independent predictors of health care seeking for IBS and FD. Results showed that dimensions of abnormal illness behavior and aspects of social learning of illness behavior (encouragement, reinforcement, and modeling) did not significantly differentiate between consulters and nonconsulters with IBS and/or FD. The Disease Conviction scale (OR = 1.55; 95% CI, 1.15-2.09) of the Abnormal Illness Behaviour Questionnaire was an independent predictor of having a diagnosis of IBS and/or FD, independent of age and gender, psychiatric diagnoses, and symptom severity. We conclude that a belief in the presence of serious pathology characterizes community subjects with IBS and FD, but not health care seeking.