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Recent research on the TIMIT corpus suggests that longer-length acoustic models are more appropriate for pronunciation variation modelling than the context-dependent phones that conventional automatic speech recognisers use. However, the impressive speech recognition results obtained with longer-length models on TIMIT remain to be reproduced on other corpora. To understand the conditions in which longer-length acoustic models result in considerable improvements in recognition performance, we carry out recognition experiments on both TIMIT and the Spoken Dutch Corpus and analyse the differences between the two sets of results. We establish that the details of the procedure used for initialising the longer-length models have a substantial effect on the speech recognition results. When initialised appropriately, longer-length acoustic models that borrow their topology from a sequence of triphones cannot capture the pronunciation variation phenomena that hinder recognition performance the most.

Epithelioid sarcoma is a rare soft tissue sarcoma with a known high propensity for locoregional recurrence and distant metastases. The clinical behavior and prognostic factors that influence the survival of patients with epithelioid sarcoma were studied.Twenty‐three patients, including 16 men (70%) and 7 women (30%), who were treated for epithelioid sarcoma between 1979–2003 at the University Medical Center Groningen and Radboud University Nijmegen Medical Center, were reviewed retrospectively. The median age at diagnosis was 22 years (range, 1–54 years). At the time of diagnosis, 11 patients (48%) had metastases. Six patients with distant metastasis and 1 patient with an unresectable tumor received palliative treatment (30%). The remaining 16 patients underwent surgical treatment of local disease (11 patients) or locoregional disease (5 patients). Five patients in that group received isolated limb perfusion with tumor necrosis factor and melphalan.The 5‐year and 10‐year disease‐free survival rates for all patients were 34% and 17%, respectively; for the 16 patients who received curative treatment, both rates were 56%. In the latter group, 8 patients developed local recurrence (50%) after a median follow‐up of 4 months (range, 1–14 months). Nine patients were disease free after a median follow‐up of 50 months (range, 6–290 months). Tumor size >5 cm (P < .0026) at diagnosis and local recurrence (P<.0008) were significant predictors of survival.The prognosis for patients with epithelioid sarcoma is poor, because a substantial number of patients present with extensive disease, lymph node metastases, and/or distant metastases. Treatment consists of radical surgical excision of the tumor and, if indicated, therapeutic lymph node dissection. In patients who have large tumors, isolated limb perfusion may be useful. Cancer 2006. © 2006 American Cancer Society.

The continuous development of new biomaterials for tissue engineering and the enhancement of tissue ingrowth into existing scaffolds, using growth factors, create the necessity for developing adequate tools to assess tissue ingrowth rates into porous biomaterials. Current histomorphometric techniques evaluating rates of tissue ingrowth tend either to measure the overall tissue content in an entire sample or to depend on the user to indicate a front of tissue ingrowth. Neither method is particularly suitable for the assessment of tissue ingrowth rates, as these methods either lack the sensitivity required or are problematic when there is a tissue ingrowth gradient rather than an obvious tissue ingrowth front. This study describes a histomorphometric method that requires little observer input, is sensitive, and renders detailed information for the assessment of tissue ingrowth rates into porous biomaterials. This is achieved by examining a number of computer-defined concentric zones, which are based on the distance of a pixel from the scaffold edge. Each zone is automatically analyzed for tissue content, eliminating the need for user definition of a tissue ingrowth front and thus reducing errors and observer dependence. Tissue ingrowth rates in two biodegradable polyurethane scaffolds (Estane and polycaprolactone–polyurethane [PCLPU]) specifically designed for tissue engineering of the knee meniscus were assessed. Samples were subcutaneously implanted in rats with follow-up until 6 months. Especially at the earlier follow-up points, PCLPU scaffolds showed significantly higher tissue ingrowth rates than Estane scaffolds, making the PCLPU scaffold a promising candidate for further studies investigating meniscus tissue engineering.

This study presents the clinical and radiological results of 62 consecutive acetabular revisions in 58 patients, at a mean of 16.5 years follow-up (15 to 20). The Kaplan-Meier survivorship for the cup with end-point revisions for any reason, was 79% at 15 years (95% confidence interval (CI); 67 to 91). Excluding two revisions for septic loosening at three and six years, and one revision of a well-fixed cup after 12 years in the course of a femoral revision, the survivorship was 84% at 15 years (95% CI; 73 to 95). At review there were no additional cases of loosening, although seven acetabular reconstructions showed radiolucent lines in one or two zones. Acetabular revision using impacted large morsellised bone chips (0.7 cm to 1.0 cm) and a cemented cup, is a reliable technique of reconstruction, when assessed at more than 15 years.

ObjectivePartial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce ingrowth of repair tissue and thus avoid degeneration of articular cartilage.

This study identified suitable predictors of ruminal pH and identified relationships between ruminal pH and animal measures for diets based on fresh pasture. Animal and dietary variables (121 treatment means from six countries) were collated from 23 studies of lactating dairy cows fed pasture. Mean daily ruminal pH ranged from 5.6 to 6.7 across studies. Within studies, a low ruminal pH was associated with higher (P<0.05; r20.40) microbial N flow from the rumen, total and individual volatile fatty acid concentrations, milk and milk component yields, and dry matter intake, and with lower (P<0.05; r20.30) concentrations of milk fat, fat:protein, and acetate:propionate. Large variation between studies meant that these ruminal and production variables could not be used to make reliable predictions of ruminal pH in future pasture-based studies or feeding scenarios. Ruminal pH was positively related (P<0.05; r2<0.15) to forage neutral detergent fiber (NDF) and NDF content within study, and negatively related (P=0.001; r2=0.14) to nonstructural carbohydrate across studies. No single dietary variable, or group of variables, could be used to make a reliable prediction of ruminal pH. Estimates of effective fiber for diets containing only pasture were made using the Cornell Net Carbohydrate and Protein System ruminal pH equation. Mean effectiveness of fiber in pasture was 43% of NDF, and ranged from 17 to 78% across studies. High flows of microbial nitrogen, milk, milk fat yield, and dry matter intake suggested that the performance of cows fed high quality pasture was not limited when mean ruminal pH decreased to 5.8.

A historic cohort study was conducted to investigate surgical correction and sagittal alignment in 33 patients with thoracic Scheuermann’s disease.

We evaluated the results of 27 acetabular reconstructions in 21 patients with secondary osteoarthritis resulting from congenital dysplasia of the hip in which the acetabular bone defects were restored with impacted morcellized bone–grafts in combination with a cemented cup. At an average follow-up of 7 years, 7 months (range, 5-15 years), 2 hips were revised. One cup was revised after 27 months for sciatic nerve problems; the other hip was revised for aseptic loosening of the cup at 12 years' follow-up. The cumulative survival of the acetabular reconstruction was 96.3% at 5- and 10-year intervals. Additionally, 2 hips (7.7%) showed stable radiolucent lines in zone III without migration of the cup. None of the cemented stems were revised. The bone impaction grafting technique is a safe and attractive method to restore bone deficiencies in dysplastic hips.

Many models of digestion assume steady-state conditions and do not account for diurnal variation in the rumen environment. This experiment examined the relationships between diurnal pH, pasture digestion, and microbial protein synthesis. Four dual-flow continuous culture fermenters were used to test the effect of increasing time at suboptimal pH on parameters of digestion. Fermentation of high quality pasture was controlled at pH 5.4 (suboptimal) for four intervals during each 24-h period (0, 4, 8, and 12h) according to a 4 × 4 Latin square design. During the remainder of each day, pH was controlled at 6.3 (optimal). Samples were collected during the last 3 d of each of the four 9-d experimental periods. A negative quadratic relationship was observed between time at suboptimal pH and apparent digestibility of organic matter and dry matter. The largest reduction in digestibility of organic matter, dry matter, and neutral detergent fiber was exhibited after 4h at suboptimal pH. A negative linear relationship was found between time at suboptimal pH and microbial N flow, with the greatest decline in microbial N flow occurring at 12h at suboptimal pH. These results suggest that the period of time that pH is below optimal may be more critical for digestion than the relationship between mean daily pH and optimal pH. Modeling nonsteady-state ruminal conditions to account for diurnal variation in the ruminal environment may improve the prediction of digestion, especially fiber.

We used a visual analog scale (VAS) to assess the satisfaction after total knee arthroplasty (TKA) in a group of 108 patients (126 TKAs) with short-term to medium-term follow-up. We also used the Knee Society scoring system, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), pain VAS, and survival analysis. A comparison between the subjective and objective outcome systems revealed only poor correlations. This comparison suggests that the concerns and priorities of patients and surgeons differ. The outcome assessed with the satisfaction VAS revealed a significantly better subjective outcome in rheumatoid arthritis patients compared with osteoarthritis patients, whereas Knee Society scores were not different. The satisfaction VAS provides additional information about subjective outcome after TKA.

Background:Multiple myeloma is an incurable disease and after several lines of chemotherapy, patients enter a phase in which no standard treatment options are available. The poor outlook of these patients requires mild, palliative therapy with low toxicity. Previously used regimens either require frequent hospital attendance, lack efficacy or have significant toxicity.

The ruminal pH of dairy cows fed high quality pasture is often below values recommended to optimize digestion. Four continuous culture fermenters were used to determine the pH required for the optimal digestion of pasture. High quality pasture was fermented at four controlled levels of pH (5.4, 5.8, 6.2, and 6.6) according to a 4 x 4 Latin square design. Automatic infusion of 5 MNaOH and 5 MHCl controlled pH to±0.1. Digesta samples were collected during the last 3 d of each of the four 9-d experimental periods. Digestion and synthesis of microbial protein were largely insensitive to pH across a broad range of pH (5.8 to 6.6), but a large reduction in both occurred when pH was 5.4. The digestibility of pasture dry matter and synthesis of microbial protein were optimized at pH 6.35 and 6.13, respectively. The proportions of individual volatile fatty acids were not changed as pH increased. Digestion of high quality pasture in continuous culture was comparable to that predicted by the Cornell Net Carbohydrate and Protein System between pH 6.2 and 6.6. However, the model underpredicted organic matter and fiber digestibility between pH 5.4 and 5.8, compared with values obtained in continuous culture. This suggests that when ruminal pH is less than 6.2, the model may overpredict the production response to supplementation of high quality pasture with an effective fiber source.

Modular endoprostheses are often used in bone tumor management. However, the conical coupling that connects the various modules has several shortcomings. As an alternative, four new couplings have been developed. To find out if they have sufficient strength and show no movement during loading, each coupling was analysed using the finite element method. Bolt force and friction coefficient was varied to examine their influence.From the analysis it was concluded that coupling B, a dovetail coupling, meets all requirements and is the best alternative to the conical coupling. Sensitivity to bolt force and friction coefficient is very limited.

A definite relationship is emerging between periodontal infections and systemic conditions. The objective of this review is to address this relationship as it pertains to cardiovascular disease and diabetes mellitus. Furthermore, because recent reports link the presence of periodontal disease to preterm delivery, the possible relationship between the development and progression of periodontal disease and certain hormonal states in women such as puberty, oral contraceptive use, menopause, and pregnancy will also be discussed. Although the current literature suggests a strong association between periodontal disease and a number of the discussed systemic conditions, causality can only be established with prospective studies. Intervention studies are needed to address how treatment effects the incidence and/or severity of periodontal disease-related systemic illness.

Autologous transplantation of chondrocytes is currently under investigation as a potential therapy to stimulate intrinsic repair in articular cartilage defects. The quality of the repair tissue may benefit from the preservation of the characteristic chondrocytic phenotype of the transplanted cells together with the production of a new extracellular matrix composed of collagen type II and larger proteoglycans. A number of growth factors are believed to play an important role in the process of generating new cartilage repair tissue. In this study. the dose‐dependent response of bovine chondrocytes to recombinant human insulin‐like growth factor‐1, recombinant human transforming growth fac or‐β2, and recombinant human bone morphogenetic protein‐2 was studied in an alginate culture system under different culture conditions. The chondrocytes were cultured in medium with increasing concentrations of fetal calf serum. The cultures were assessed by the total amount of DNA, quantitative and qualitative synthesis of proteoglycan, production of nitric oxide, and histology, Cells cultured in the presence of each growth factor had an equal, nonsignificant stimulation of DNA synthesis compared with those cultured in basal medium alone. Recombinant human insulin‐like growth factor‐1 and recombinant human transforming growth factor‐β2 stimulated proteoglycan synthesis in a dose‐dependent and reversed dose‐dependent fashion, respectively. Recombinant human bone morphogenetic protein‐2 stimulated proteoglycan synthesis significantly only in the absence of fetal calf serum or in the presence of small amounts of the serum. Overall, proteoglycan synthesis dramatically decreased with the addition of each growth factor as the concentration of fetal calf serum in the medium decreased, and the dose‐dependent stimulation pattern, as observed for recombinant human insulin‐like growth factor‐1 and recombinant human transforming growth factor‐β2, disappeared. Apart from a moderate increase in mRNA for aggrecan and decorin, the growth factors did not greatly affect the type of proteoglycans synthesized. Histological examination confirmed the presence of a dense pericellular matrix deposition, especially when the chondrocytes were cultured in the presence of recombinant human insulin‐like growth factor‐1 or recombinant human transforming growth factor‐β2. The results indicate that these growth factors can stimulate qualitatively superior matrix production and that the responsiveness of the chondrocytes to the growth factors changes with the culture conditions. Further knowledge about the interaction between chondrocytes, growth factors, and the external environment is important to stimulate chondrocytes to produce adequate repair tissue in cartilage defects in vivo.Insulin‐like growth factor‐1 especially seems capable of stimulating, in the most consistent and predictable fashion, qualitatively superior proteoglycan synthesis by differentiated chondrocytes. Additional in vivostudies are needed to evaluate the potential of these growth factors as stimulators in cartilage repair.

Periodontitis is a chronic multifactorial inflammatory disease of the supportive tissues of the teeth. Pathophysiological evidence suggests a possible common inflammatory background between periodontitis and cardiovascular diseases (CVD). Pathological and epidemiological associations between these two diseases have been presented, but are still debated. This study aimed to investigate the association between the inflammatory burden of periodontitis and the presence and extent of coronary calcification. Secondary aims were to study other cardiovascular parameters and cardiovascular risk predictors in relation to periodontitis and dental health.

We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture.We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required.We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.

To evaluate the oncological and functional result of the treatment of patients with a synovial sarcoma. This paper gives a retrospective review of 20 patients (15 male and five female) treated for synovial sarcoma at the Nijmegen University Hospital, The Netherlands.

To shed light on the controversy surrounding the methods of evaluating, staging and final treatment of intramedullary chondroid lesions. Controversy particularly exists for enchondroma and low-grade chondrosarcoma located in the extremities, because their accurate distinction is hampered by their radiographical and histological similarity.

Porous materials of a high-molecular-weight 50/50 copolymer ofl-lactide and ɛ-caprolactone with different compression moduli were used for meniscal repair. In contrast to the previously used 4,4′-diphenylmethane and 1,4-trans-cyclohexane diisocyanates containing polyurethanes, degradation products of the copolymer are non-toxic. Two series of porous materials with compression moduli of 40 and 100 kPa respectively were implanted in the knees of dogs using a new, less traumatizing suturing technique. A porous aliphatic polyurethane series with compression modulus of 150 kPa was implanted for comparison. Adhesion of the implant to meniscal tissue was found to be essential for healing of the longitudinal lesion. Copolymer implants showed better adhesion, probably due to the higher degradation rate of the copolymer. Fibrocartilage formation was found to be affected by the compression modulus of the implant. Implants with a modulus of 40 kPa did not show ingrowth of fibrocartilage, whereas implants with compression moduli of 100 and 150 kPa yielded 50–70 and 80–100% fibrocartilage respectively. During degradation the copolymer phase separated into a crystalline phase containing mainlyl-lactide and an amorphous phase containing mainly ɛ-caprolactone. The copolymer degraded through bulk degradation.

The electronic properties of charged line defects in semiconductors are investigated in some detail. The influence of short-range dielectric screening and long- range macroscopic screening are taken into account. It is shown how the short- range part of the potential can be separated from the macroscopic band-bending term. This allows a calculation of the shift in position of the dislocation band as a function of its line charge. Finally, it is shown that one recovers the result of Schroter and Labusch (1969) but now with Weil-defined microscopic parameters.

For crystals with dislocations, the tight-binding recursion method is reformulated to maintain the translational symmetry along the dislocation line. The method is applied to the deep electron levels at dislocations in Ge and Si. Because of the translation symmetry up to 110 pairs of significant recursion coefficients (an, bn) could be evaluated, revealing an asymptotic oscillatory behaviour of the coefficients. For unreconstructed and reconstructed 30°, 60° and 90° partial dislocations in Ge and Si, the one-dimensional bands of deep electron levels are presented as deduced from the continued-fraction density of states. Including the changes in the chemical shift brings the calculated deep level structure of the unreconstructed 90° partial into rather close agreement with the experimental findings.

In this paper, the process of controller design for nonlinear systems, using linear synthesis techniques, is examined. Specifically, proportional and integral control of nonlinear systems is investigated. The crucial role of integral action in linearization-based controller design for nonlinear systems is highlighted.

Intralesional instillation of steroids is currently the first choice of treatment for eosinophilic granuloma of bone. However, some lesions fail to respond or are unsuitable for injection therapy due location, pending pathologic fracture, and soft tissue intrusion. The authors treated six patients with these lesion characteristics using curettage, cryosurgery, and bone grafting. After a mean follow-up of 34.3 months, all lesions healed completely, although one femoral fracture occurred 8 months after the operation. In selected cases of eosinophilic granuloma of bone, a primary surgical treatment seems feasible. The use of cryosurgery as adjuvant treatment extends the surgical margin and is of value in averting local recurrence.

Claims for long-term conservatism of an Australian desert adaptation are assessed by re-examining one component of the stone artefact assemblage from Puntutjarpa, a rocksheiter in the Western Desert. It is concluded that significant technological changes occur and especially that adzing tools are absent from the early Holocene levels of the site. This finding confirms recent discoveries of demographic, settlement, and technological change elsewhere in the Australian arid zone; and it necessitates the rejection of perceptions of cultural continuity since the Western Desert was first occupied.

A leg length inequality can be treated by using a Wagner distractor. With this apparatus, it is possible to extend the upper or lower leg slowly. By analysing the measurements of the axial force acting on the femur or tibia the treatment can be optimized and soft tissue damage prevented.To measure the axial force, a load cell has been designed and constructed. This load cell is built into a Wagner distractor and connected with a specially designed measuring amplifier. The load cell and amplifier do not interfere with the lengthening procedure. They are safe for the patient and have an acceptable error of 7 per cent.

A malignant tumour may develop around the knee joint of a child. In the majority of cases it will then be necessary to resect the involved bone with adjacent tissue. A joint team of Groningen University Hospital and University of Twente is currently working on the project of developing a modular endoprosthetic system to bridge the defect resulting from the resection. Since the other, normal, leg continues to grow, the endoprosthetic system will have to include an element the length of which can be adjusted non-invasively. The main conditions to be met by the lengthening element are non-invasive continuous adjustability and a maximum total lengthening of 114 mm. This was achieved by using an external magnetic field. Animal experiments showed that the lengthening element worked well, although moisture infiltrated the telescopic tubes and the lengthening element was covered by proliferating bone at an early stage. Also, the necessary magnetic field proved to be larger than calculated. In a revised design, these problems are resolved. In vitro tests show that the new lengthening element meets all requirements.

We describe a previously healthy 69-year-old man presenting with osteomyelitis of the humerus due to the zygomycete Apophysomyces elegans. The infection was acquired in Aruba, The Netherlands Antilles. The skin provided the most likely portal of entry, although there was no history of a traumatic inoculation. The patient had no history of diabetes, and no underlying immune defects were found. Despite treatment with 7.9 g of amphotericin B, an interthoracoscapular amputation proved necessary to curtail the rapid spread of the fungus in this immunocompetent host.

A malignant bone tumour may develop in the femur of a child. In the majority of cases it will be necessary to resect the bone involved, growth plate and adjacent tissues. A modular endoprosthetic system has been developed which can be extended non-invasively to bridge the defect resulting from such a resection. Elongation is achieved by using an external magnetic field. In vitro tests with a prototype showed that the lengthening element met all requirements. Six animal experiments showed that the lengthening element also functioned in vivo.