Evidence-based perspective on CP rehabilitation : Reviews on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices

This thesis utilises an evidence-based approach to critically evaluate and summarize effectiveness research on physiotherapy, physiotherapy-related motor-based interventions and orthotic devices in children and adolescents with cerebral palsy (CP). It aims to assess the methodological challenges of the systematic reviews and trials, to evaluate the effectiveness of interventions in current use, and to make suggestions for future trials Methods: Systematic reviews were searched from computerized bibliographic databases up to August 2007 for physiotherapy and physiotherapy-related interventions, and up to May 2003 for orthotic devices. Two reviewers independently identified, selected, and assessed the quality of the reviews using the Overview Quality Assessment Questionnaire complemented with decision rules. From a sample of 14 randomized controlled trials (RCT) published between January 1990 and June 2003 we analysed the methods of sampling, recruitment, and comparability of groups; defined the components of a complex intervention; identified outcome measures based on the International Classification of Functioning, Disability and Health (ICF); analysed the clinical interpretation of score changes; and analysed trial reporting using a modified 33-item CONSORT (Consolidated Standards of Reporting Trials) checklist. The effectiveness of physiotherapy and physiotherapy-related interventions in children with diagnosed CP was evaluated in a systematic review of randomised controlled trials that were searched from computerized databases from January 1990 up to February 2007. Two reviewers independently assessed the methodological quality, extracted the data, classified the outcomes using the ICF, and considered the level of evidence according to van Tulder et al. (2003). Results: We identified 21 reviews on physiotherapy and physiotherapy-related interventions and five on orthotic devices. These reviews summarized 23 or 5 randomised controlled trials and 104 or 27 observational studies, respectively. Only six reviews were of high quality. These found some evidence supporting strength training, constraint-induced movement therapy or hippotherapy, and insufficient evidence on comprehensive interventions. Based on the original studies included in the reviews on orthotic devices we found some short-term effects of lower limb casting on passive range of movement, and of ankle-foot orthoses on equinus walk. Long term effects of lower limb orthoses have not been studied. Evidence of upper limb casting or orthoses is conflicting. In the sample of 14 RCTs, most trials used simple randomisation, complemented with matching or stratification, but only three specified the concealed allocation. Numerous studies provided sufficient details on the components of a complex intervention, but the overlap of outcome measures across studies was poor and the clinical interpretation of observed score changes was mostly missing. Almost half (48%) of the applicable CONSORT-based items (range 28 32) were reported adequately. Most reporting inadequacies were in outcome measures, sample size determination, details of the sequence generation, allocation concealment and implementation of the randomization, success of assessor blinding, recruitment and follow-up dates, intention-to-treat analysis, precision of the effect size, co-interventions, and adverse events. The systematic review identified 22 trials on eight intervention categories. Four trials were of high quality. Moderate evidence of effectiveness was established for upper extremity treatments on attained goals, active supination and developmental status, and of constraint-induced therapy on the amount and quality of hand use and new emerging behaviours. Moderate evidence of ineffectiveness was found for strength training's effect on walking speed and stride length. Conflicting evidence was found for strength training's effect on gross motor function. For the other intervention categories the evidence was limited due to the low methodological quality and the statistically insignificant results of the studies. Conclusions: The high-quality reviews provide both supportive and insufficient evidence on some physiotherapy interventions. The poor quality of most reviews calls for caution, although most reviews drew no conclusions on effectiveness due to the poor quality of the primary studies. A considerable number of RCTs of good to fair methodological and reporting quality indicate that informative and well-reported RCTs on complex interventions in children and adolescents with CP are feasible. Nevertheless, methodological improvement is needed in certain areas of the trial design and performance, and the trial authors are encouraged to follow the CONSORT criteria. Based on RCTs we established moderate evidence for some effectiveness of upper extremity training. Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most physiotherapy interventions is available to guide clinical practice. Well-designed trials are needed, especially for focused physiotherapy interventions.

Neutrinos and Thermal Leptogenesis

One of the unanswered questions of modern cosmology is the issue of baryogenesis. Why does the universe contain a huge amount of baryons but no antibaryons? What kind of a mechanism can produce this kind of an asymmetry? One theory to explain this problem is leptogenesis. In the theory right-handed neutrinos with heavy Majorana masses are added to the standard model. This addition introduces explicit lepton number violation to the theory. Instead of producing the baryon asymmetry directly, these heavy neutrinos decay in the early universe. If these decays are CP-violating, then they produce lepton number. This lepton number is then partially converted to baryon number by the electroweak sphaleron process. In this work we start by reviewing the current observational data on the amount of baryons in the universe. We also introduce Sakharov's conditions, which are the necessary criteria for any theory of baryogenesis. We review the current data on neutrino oscillation, and explain why this requires the existence of neutrino mass. We introduce the different kinds of mass terms which can be added for neutrinos, and explain how the see-saw mechanism naturally explains the observed mass scales for neutrinos motivating the addition of the Majorana mass term. After introducing leptogenesis qualitatively, we derive the Boltzmann equations governing leptogenesis, and give analytical approximations for them. Finally we review the numerical solutions for these equations, demonstrating the capability of leptogenesis to explain the observed baryon asymmetry. In the appendix simple Feynman rules are given for theories with interactions between both Dirac- and Majorana-fermions and these are applied at the tree level to calculate the parameters relevant for the theory.

Parity violation in molecular magnetic resonance properties

The Standard Model of particle physics consists of the quantum electrodynamics (QED) and the weak and strong nuclear interactions. The QED is the basis for molecular properties, and thus it defines much of the world we see. The weak nuclear interaction is responsible for decays of nuclei, among other things, and in principle, it should also effects at the molecular scale. The strong nuclear interaction is hidden in interactions inside nuclei. From the high-energy and atomic experiments it is known that the weak interaction does not conserve parity. Consequently, the weak interaction and specifically the exchange of the Z^0 boson between a nucleon and an electron induces small energy shifts of different sign for mirror image molecules. This in turn will make the other enantiomer of a molecule energetically favorable than the other and also shifts the spectral lines of the mirror image pair of molecules into different directions creating a split. Parity violation (PV) in molecules, however, has not been observed. The topic of this thesis is how the weak interaction affects certain molecular magnetic properties, namely certain parameters of nuclear magnetic resonance (NMR) and electron spin resonance (ESR) spectroscopies. The thesis consists of numerical estimates of NMR and ESR spectral parameters and investigations of the effects of different aspects of quantum chemical computations to them. PV contributions to the NMR shielding and spin-spin coupling constants are investigated from the computational point of view. All the aspects of quantum chemical electronic structure computations are found to be very important, which makes accurate computations challenging. Effects of molecular geometry are also investigated using a model system of polysilyene chains. PV contribution to the NMR shielding constant is found to saturate after the chain reaches a certain length, but the effects of local geometry can be large. Rigorous vibrational averaging is also performed for a relatively small and rigid molecule. Vibrational corrections to the PV contribution are found to be only a couple of per cents. PV contributions to the ESR g-tensor are also evaluated using a series of molecules. Unfortunately, all the estimates are below the experimental limits, but PV in some of the heavier molecules comes close to the present day experimental resolution.

Determining the CP Properties of the Higgs Boson

The search and the probe of the fundamental properties of Higgs boson(s) and, in particular, the determination of their charge conjugation and parity (CP) quantum numbers, are the main tasks of future high-energy colliders. We demonstrate that the CP properties of a standard model-like Higgs particle can be unambiguously assessed by measuring just the total cross section and the top polarization in associated Higgs boson production with top quark pairs in e(+)e(-) collisions.

Measurements of branching fraction ratios and CP asymmetries in B±→DCPK± decays in hadron collisions

We reconstruct B+/- -> D K+/- decays in a data sample collected by the CDF II detector at the Tevatron collider corresponding to 1 fb-1 of integrated luminosity. We select decay modes where the D meson decays to either K- pi+ (flavor eigenstate) or K- K+, pi- pi+ (CP-even eigenstates), and measure the direct CP asymmetry A_CP+ = 0.39 +/- 0.17(stat) +/- 0.04(syst), and the double ratio of CP-even to flavor eigenstate branching fractions R_CP+ = 1.30 +/- 0.24(stat) +/- 0.12(syst). These measurements will improve the determination of the CKM angle gamma. They are performed here for the first time using data from hadron collisions.

1, 2-Bis (diphenylphosphino) etane bridged dinuclear copper (I) complexes: Investigations of solid state and solution structures by CP/MAS31P NMR spectroscopy, X-ray crystallography, IR spectroscopy and solution 31P NMR and 63Cu NMR spectroscopy

Three different complexes of copper (I) with bridging 1, 2-bis(diphenylphosphino)ethane (dppe), namely [Cu2 (mu-dppe) (CH3CN)6] (ClO4)2 (1), [Cu2 (mu-dppe)2 (CH3 CN)2] (ClO4)2 (2), and [Cu2 (mu-dppe) (dppe)2 (CH3CN)2] (ClO4)2 (3) have been prepared. The structure of [Cu2 (mu-dppe) (dPPe)2 (CH3CH)2] (ClO4)2 has been determined by X-ray crystallography. It crystallizes in the space group PT with a=12.984(6) angstrom, b=13.180(6) angstrom, c=14.001(3) angstrom, alpha=105.23(3), beta=105.60(2), gamma=112.53 (4), V=1944 (3) angstrom3, and Z=1. The structure was refined by least-squares method with R=0.0365; R(w)=0.0451 for 6321 reflections with F0 greater-than-or-equal-to 3 sigma (F0). The CP/MAS P-31 and IR spectra of the complexes have been analysed in the light of available crystallographic data. IR spectroscopy is particularly helpful in identifying the presence of chelating dppe. P-31 chemical shifts observed in solid state are very different from those observed in solution, and change significantly with slight changes in structure. In solution, complex 1 remains undissociated but complexes 2 and 3 undergo extensive dissociation. With a combination of room temperature H-1, Cu-63, and variable temperature P-31 NMR spectra, it is possible to understand the various processes occurring in solution.

R-parity violation in neutralino decays at an e gamma collider

At an e gamma collider, a selectron (e) over tilde(L,R) may be produced in association with a (lightest) neutralino <(chi)over tilde>(0)(1). Decay of the selectron may be expected to yield a final state with an electron and another <(chi)over tilde>(0)(1). If R-parity is violated, these two neutralinos will decay, giving rise to distinctive signatures, which are identified and studied. (C) 1998 Published by Elsevier Science B.V.

Denaturant mediated unfolding of both native and molten globule states of maltose binding protein are accompanied by large [Delta]Cp's

Maltose binding protein (MBP) is a large, monomeric two domain protein containing 370 amino acids. In the absence of denaturant at neutral pH, the protein is in the native state, while at pH 3.0 it forms a molten globule. The molten globule lacks a tertiary circular dichroism signal but has secondary structure similar to that of the native state. The molten globule binds 8-anilino-1-naphthalene sulfonate (ANS). The unfolding thermodynamics of MBP at both pHs were measured by carrying out a series of isothermal urea melts at temperatures ranging from 274–329 K. At 298 K, values of [Delta]G°, [Delta]Cp, and Cm were 3.1 ± 0.2 kcal mol−1, 5.9 ± 0.8 kcal mol−1 K−1 (15.9 cal (mol-residue)−1 K−1), and 0.8 M, respectively, at pH 3.0 and 14.5 ± 0.4 kcal mol−1, 8.3 ± 0.7 kcal mol−1 K−1 (22.4 kcal (mol-residue)−1 K−1), and 3.3 M, respectively, at pH 7.1. Guanidine hydrochloride denaturation at pH 7.1 gave values of [Delta]G° and [Delta]Cp similar to those obtained with urea. The m values for denaturation are strongly temperature dependent, in contrast to what has been previously observed for small globular proteins. The value of [Delta]Cp per mol-residue for the molten globule is comparable to corresponding values of [Delta]Cp for the unfolding of typical globular proteins and suggests that it is a highly ordered structure, unlike molten globules of many small proteins. The value of [Delta]Cp per mol-residue for the unfolding of the native state is among the highest currently known for any protein.

From the Icosahedron to Natural Triangulations of CP(2) and S(2) x S(2)

We present two constructions in this paper: (a) a 10-vertex triangulation CP(10)(2) of the complex projective plane CP(2) as a subcomplex of the join of the standard sphere (S(4)(2)) and the standard real projective plane (RP(6)(2), the decahedron), its automorphism group is A(4); (b) a 12-vertex triangulation (S(2) x S(2))(12) of S(2) x S(2) with automorphism group 2S(5), the Schur double cover of the symmetric group S(5). It is obtained by generalized bistellar moves from a simplicial subdivision of the standard cell structure of S(2) x S(2). Both constructions have surprising and intimate relationships with the icosahedron. It is well known that CP(2) has S(2) x S(2) as a two-fold branched cover; we construct the triangulation CP(10)(2) of CP(2) by presenting a simplicial realization of this covering map S(2) x S(2) -> CP(2). The domain of this simplicial map is a simplicial subdivision of the standard cell structure of S(2) x S(2), different from the triangulation alluded to in (b). This gives a new proof that Kuhnel's CP(9)(2) triangulates CP(2). It is also shown that CP(10)(2) and (S(2) x S(2))(12) induce the standard piecewise linear structure on CP(2) and S(2) x S(2) respectively.

CP Asymmetries in Higgs decays to ZZ at the LHC

We examine the effect of a general HZZ coupling through a study of the Higgs decay to leptons via Z bosons at the LHC. We discuss various methods for placing limits on additional couplings, including measurement of the partial width, threshold scans, and asymmetries constructed from angular observables. We find that only the asymmetries provide a definitive test of additional couplings. We further estimate the significances they provide.

Minimization of Constraint Violation in Fuzzy Multiobjective Programming

Fuzzy multiobjective programming for a deterministic case involves maximizing the minimum goal satisfaction level among conflicting goals of different stakeholders using Max-min approach. Uncertainty due to randomness in a fuzzy multiobjective programming may be addressed by modifying the constraints using probabilistic inequality (e.g., Chebyshev’s inequality) or by addition of new constraints using statistical moments (e.g., skewness). Such modifications may result in the reduction of the optimal value of the system performance. In the present study, a methodology is developed to allow some violation in the newly added and modified constraints, and then minimizing the violation of those constraints with the objective of maximizing the minimum goal satisfaction level. Fuzzy goal programming is used to solve the multiobjective model. The proposed methodology is demonstrated with an application in the field of Waste Load Allocation (WLA) in a river system.