bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Modeling of Phase Crossings in Two-Phase Flow
Authors: Madsen S. , Veje C. , Willatzen M.
Published: May 2012

Two-phase flow and heat transfer, such as boiling and condensing flows, are complicated physical phenomena that generally prohibit an exact solution and even pose severe challenges for numerical approaches. If numerical solution time is also an issue the challenge increases even further. We present here a numerical implementation and novel study of a fully distributed dynamic one-dimensional model of two-phase flow in a tube, including pressure drop, heat transfer, and variations in tube cross-section. The model is based on a homogeneous formulation of the governing equations, discretized by a high resolution finite difference scheme due to Kurganov and Tadmore.

The homogeneous formulation requires a set of thermodynamic relations to cover the entire range from liquid to gas state. This leads a number of numerical challenges since these relations introduce discontinuities in the derivative of the variables and are usually very slow to evaluate. To overcome these challenges, we use an interpolation scheme with local refinement.

The simulations show that the method handles crossing of the saturation lines for both liquid to two-phase and two-phase to gas regions. Furthermore, a novel result obtained in this work, the method is stable towards dynamic transitions of the inlet/outlet boundaries across the saturation lines. Results for these cases are presented along with a numerical demonstration of conservation of mass under dynamically varying boundary conditions. Finally we present results for the stability of the code in a case of a tube with a narrow section.
AUSM-Based High-Order Solution for Euler Equations
Authors: Scandaliato Angelo L. , Liou Meng-Sing
Published: May 2012

In this paper we demonstrate the accuracy and robustness of combining the advection upwind splitting method (AUSM), specifically AUSM+-UP, with high-order upwind-biased interpolation procedures, the weighted essentially non-oscillatory (WENO-JS) scheme and its variations, and the monotonicity preserving (MP) scheme, for solving the Euler equations. MP is found to be more effective than the three WENO variations studied. AUSM+-UP is also shown to be free of the so-called “carbuncle” phenomenon with the high-order interpolation. The characteristic variables are preferred for interpolation after comparing the results using primitive and conservative variables, even though they require additional matrix-vector operations. Results using the Roe flux with an entropy fix and the Lax-Friedrichs approximate Riemann solvers are also included for comparison. In addition, four reflective boundary condition implementations are compared for their effects on residual convergence and solution accuracy. Finally, a measure for quantifying the efficiency of obtaining high order solutions is proposed; the measure reveals that a maximum return is reached after which no improvement in accuracy is possible for a given grid size.
Drivers of flood risk change in residential areas
Authors: Elmer F. , Hoymann J. , Düthmann D. , Vorogushyn S. , Kreibich H.
Published: May 2012

Abstract. The observed increase of direct flood damage over the last decades may be caused by changes in the meteorological drivers of floods, or by changing land-use patterns and socio-economic developments. It is still widely unknown to which extent these factors will contribute to future flood risk changes. We survey the change of flood risk in terms of expected annual damage for residential buildings in the lower part of the Mulde River basin (Vereinigte Mulde) between 1990 and 2020 in 10-yr time steps based on measurements and model projections. For this purpose we consider the complete risk chain from climate impact via hydrological and hydraulic modelling to damage and risk estimation. We analyse what drives the changes in flood risk and quantify the contributions of these drivers: flood hazard change due to climate change, land-use change and changes in building values. We estimate flood risk and building losses based on constant values and based on effective (inflation adjusted) values separately. For constant values, estimated building losses for the most extreme inundation scenario amount to more than 360 million € for all time steps. Based on effective values, damage estimates for the same inundation scenario decrease from 478 million € in 1990 to 361 million € in 2000 and 348 million € in 2020 (maximum land-use scenario). Using constant values, flood risk is 111% (effective values: 146%) of the 2000 estimate in 1990 and 121% (effective values: 115%) of the 2000 estimate for the maximum land-use scenario in 2020. The quantification of driver contributions reveals that land-use change in the form of urban sprawl in endangered areas is the main driver of flood risk in the study area. Climate induced flood hazard change is important but not a dominant factor of risk change in the study area. With the historical exception of the economic effects in Eastern Germany following the German reunification, value developments only have minor influence on the development of flood risk.
Closed-Loop Dynamic Parameter Identification of Robot Manipulators Using Modified Fourier Series
Authors: Wu Wenxiang , Zhu Shiqiang , Wang Xuanyin , Liu Huashan
Published: May 2012

This paper concerns the problem of dynamic parameter identification of robot manipulators and proposes a closed-loop identification procedure using modified Fourier series (MFS) as exciting trajectories. First, a static continuous friction model is involved to model joint friction for realizable friction compensation in controller design. Second, MFS satisfying the boundary conditions are firstly designed as periodic exciting trajectories. To minimize the sensitivity to measurement noise, the coefficients of MFS are optimized according to the condition number criterion. Moreover, to obtain accurate parameter estimates, the maximum likelihood estimation (MLE) method considering the influence of measurement noise is adopted. The proposed identification procedure has been implemented on the first three axes of the QIANJIANG-I 6-DOF robot manipulator. Experiment results verify the effectiveness of the proposed approach, and comparison between identification using MFS and that using finite Fourier series (FFS) reveals that the proposed method achieves better identification accuracy.
Got Ammonia?
Authors: Henrie Tarrah , Rezania Lih‐In W. , Nagy Dick , Lytle Darren A.
Published: May 2012

This is the last of three articles to help water system operators understand ammonia and how to control and monitor its effects at the plant and in the distribution system. The first article (Opflow, April 2012) provided an overview of ammonia's chemistry, origins, and water system effects. The second article (Opflow, May 2012) focused on treatment options for removing ammonia from source water prior to distribution and how to monitor and control ammonia. This article provides case studies explaining how utilities have dealt with ammonia.
Relationship Between Domestic Violence and Multiple Sclerosis
Authors: O'Leary Margie , Lammers Sherie , Mageras Anne , Boyd Marilyn , Constantino Rose , Heyman Rock
Published: May 2012

Domestic violence (DV) is the leading cause of injury to women in the United States. The problem also affects men but at a lower rate. An innovative program to address DV and abuse of people living with multiple sclerosis (MS) has been developed by the Allegheny District Chapter of the National Multiple Sclerosis Society (NMSS). The program, known as REACH, was designed to improve the ability to screen for DV and abuse and to provide subsequent crisis intervention, empowerment options, counseling, and safety planning. A critical part of REACH has been the instruction provided to health care and legal professionals, NMSS staff, caseworkers, and people diagnosed with MS. The REACH program has been enormously successful in increasing awareness and detection of DV and abuse within the chapter service area, and this expertise has been widely communicated throughout the organization.
Expanded Disability Status Scale Calculator for Handheld Personal Digital Assistant: Reliability Study
Authors: Markowitz Clyde E. , Hughes Mary D. , Mikol Daniel D. , Shi Lisa , Oleen-Burkey MerriKay , Denney Douglas R. ,   on behalf of the EDSS Calculator Study Group
Published: May 2012

Through a standard neurological examination, the Expanded Disability Status Scale (EDSS) score is traditionally determined by a pen-and-paper method. The objectives of this study were to compare the interrater/method reliability of EDSS scores obtained through the pen-and-paper method with those obtained with the EDSS Calculator, evaluate test-retest reliability of the EDSS Calculator, and examine the validity of EDSS Calculator scores through correlation with the Ambulation Index (AI). During a single office visit, 62 subjects with multiple sclerosis (MS) from six study centers had disability levels evaluated by separate raters using the EDSS calculator and pen-and-paper methods in random order. Seven days later, subjects returned for reevaluation with the EDSS Calculator; AI was also evaluated. Mean EDSS scores for the sample were 3.5 ± 2.2 with the calculator and 3.4 ± 2.0 (range 0–8) with the traditional method. Interrater reliability between scores with the two methods was high (κ = 0.84; confidence interval [CI], 0.74–0.94). Test-retest reliability with the calculator was also high (κ = 0.93; CI, 0.86–0.996). Correlation between disability scores from the EDSS Calculator and AI was 0.73 (P <.001). Relative to the pen-and paper method, the EDSS Calculator was found to be highly reliable and provide valid results when measuring disability in MS patients.
Quality of Life According to Duration of Disease in Women With Low Disability in Multiple Sclerosis
Authors: Fjeldstad Cecilie , Pardo Gabriel , Bemben Michael
Published: May 2012

The primary aim of this study was to investigate the relationship between Expanded Disability Status Scale (EDSS) scores and quality of life (QOL) in women with multiple sclerosis (MS) and low disability and whether duration of disease influenced the established relationship. Sixty-six women diagnosed with MS (44.0 ± 1.2 [standard error] years) had EDSS scores of <5.0 as determined by their neurologist. Duration of disease from time of diagnosis ranged from 2 months to 28 years, and subjects were arbitrarily divided into three groups (group 1: 0.1–10.0 years; group 2: 10.1–20.0 years; group 3: 20.1–33.0 years). After giving informed consent, all subjects completed the MS Quality of Life-54 questionnaire (MSQOL-54). Mean EDSS was 1.4 for group 1, 2.0 for group 2, and 2.1 for group 3. Group 3 had the highest score for both the physical and mental components of MSQOL-54. In general, the relationship between the functional systems (FS) of EDSS and subcomponents of MSQOL-54 were negative and low to moderate in strength (r = −0.25 to −0.61; P < .01 or < .05), with cerebral FS having the most significant relationship with QOL variables. When duration of disease was considered, sensory FS was the only one that showed a significant difference between groups 1 and 2. In women with low disability caused by MS, the longer the duration of disease, the better the QOL, as reported by MSQOL-54.
Challenges, Needs, Rewards, and Psychological Well-Being of Multiple Sclerosis Support-Group Facilitators
Authors: Juraskova Ilona , Chapman Julie , Butow Phyllis N. , Jolan Afsaneh , Zordan Rachel , Kirsten Laura T. , Sedgwick Christine
Published: May 2012

Support groups are an important resource for people living with multiple sclerosis (MS). However, little is known about the effect of leadership on support-group facilitators, despite their importance in producing positive group-member outcomes. The current study assessed the needs, challenges, rewards, and psychological well-being of 61 MS support-group facilitators (56% response rate), with purpose-designed and standardized measures. On the whole, participants did not display significant difficulty with group leadership, had good psychological well-being, and found their work highly rewarding. However, one third of leaders reported a lower level of personal accomplishment, which is suggestive of burnout. Leadership training, resources, and support were identified as the main areas of concern. Significant predictors of a higher number of challenges among MS facilitators included being male, not receiving formal supervision, and spending more time running MS group meetings per week. Further investigation of MS support-group facilitators who display lower levels of personal accomplishment and those who have decided not to continue in their role is required to elucidate the predictors of group dissipation and support/training needs of group facilitators.
Team Focus: Occupational Therapist
Authors: Forwell Susan J. , Zackowski Kathleen M.
Published: May 2012

Occupational therapists (OTs) have a unique and valued role in the health and functional recovery of individuals with multiple sclerosis (MS). To maximize the benefit of occupational therapy by both health care professionals who refer patients and the patients who use the services, an understanding of the scope of services that OTs offer is essential. This article describes the breadth of the OT evaluation and intervention specific to the treatment of individuals who have MS. As an overriding goal, the OT assists clients in processing the implications of physical, cognitive, and emotional changes and creatively developing strategies to cope with and, when appropriate, minimize the effects of these changes. The occupational therapy process is described, beginning with evaluation and providing guidelines and resources for appropriate client-centered goal setting. The OT and client then discuss intervention that ensures optimal functional outcome and includes symptomatic management, according to the specific functional difficulties and implications and the particular symptoms of each patient. Through discussion, the OT helps each client achieve health and well-being with remedial and compensatory techniques that enable participation in meaningful activities and roles in the home, work, and community. OT services are essential to the appropriate and optimal delivery of comprehensive care and support to individuals with MS.
The Effect of Impaired Plantar Sensation on Gait in People with Multiple Sclerosis
Authors: Kelleher Kevin J. , Spence William D. , Solomonidis Stephan E. , Apatsidis Dimitrios P.
Published: May 2012

People with multiple sclerosis (MS) often experience debilitating motor and sensory dysfunction. The aim of this study was to determine whether impaired plantar sensation affects gait patterns in MS patients, as it does in other patient populations such as those with diabetes mellitus. Sixteen patients with MS were recruited and divided into two groups according to their ambulatory ability. Ten healthy subjects made up a control group. Plantar sensation thresholds were measured and kinematic and kinetic gait data were collected for both MS groups and the control group. The MS patients had less sensation than the control group at all plantar sites tested. Gait speed and hip, knee, and ankle joint sagittal plane excursion were significantly lower in both MS groups than in the control group. Braking and push-off ground reaction forces were significantly lower in both MS groups than in the control group, and patients were found to carry the limb through the swing phase using the hip flexors and knee extensors owing to insufficient push-off from the ankle plantar flexors. The reduced plantar sensation in MS patients is likely to be a significant factor in this “cautious” gait pattern. Improving sensory feedback from the sole of the foot through the prescription of specialized footwear and orthoses may facilitate gait in people with MS.
Perceptions of Health and Relationships to Disability Measures Among People with Multiple Sclerosis
Authors: Becker Heather , Stuifbergen Alexa
Published: May 2012

Researchers use various measures to assess health status, impairment, functional limitations, and disability among people with multiple sclerosis (MS). Conceptual and empirical associations among measures are not always clear, however. The purpose of this study was to examine the relationships among measures of impairment, disability, functional status, and health-related outcomes in a sample of 443 individuals with MS. A secondary purpose was to compare the self-reported health status of this sample with that of a population-based sample of individuals with and without disabilities. Although both the MS sample and a population-based sample of individuals with activity limitations indicated poorer health than did their nondisabled counterparts, the MS sample reported more days in the preceding month when their physical and mental health were not good and more days when poor health kept them from usual activities than the population-based sample of individuals with disabilities. Most measures were moderately intercorrelated, but the pattern suggests that issues such as the time frame specified may affect the relationships. Researchers should carefully consider operational as well as conceptual definitions, length of proposed measures, and appropriate time frame, in addition to the more traditional criteria of reliability and validity, when selecting study measures.
Physical Activity Levels in People with Multiple Sclerosis in Saskatchewan
Authors: Currie Angela S. , Knox Katherine B. , Glazebrook Karen E. , Brawley Lawrence R.
Published: May 2012

A substantial body of literature supports the benefits of physical activity for people with multiple sclerosis (MS). This study examined the types and amounts of physical activity reported by a cross-sectional sample of people with MS in Saskatchewan, Canada. Individuals with MS who were seen in the Saskatoon Multiple Sclerosis Clinic in 2006 were mailed a physical activity survey. Demographic information was collected from a confidentiality-protected clinical database. The response rate was 38.2% (108 of 283). No statistically significant differences in baseline demographics were found between responders and nonresponders. Of the responders, 93.5% engaged in some form of moderate physical activity at least once per week. Of these, 15.7% participated in group classes (mean [SD], 2.35 [1.32] days per week), 63.9% performed a minimum of 15 minutes of self-directed continuous activity (mean [SD], 4.5 [1.8] days per week), and 88.0% accumulated short bouts of moderate physical activity totaling a minimum of 20 minutes daily (mean [SD], 5.4 [1.9] days per week). In addition, 28.7% of responders reported that daily self-care required moderate physical effort. Physical activity decreased with increasing disability. The majority of responders participated in regular physical activity when multiple types of activity are considered. All activity sources should be considered when examining activity levels of individuals with MS.
The Impact of Pain on the Quality of Life of People with Multiple Sclerosis:
Authors: Douglas Clint , Wollin Judy A. , Windsor Carol
Published: May 2012

The purpose of this study was to examine the impact of pain on functioning across multiple quality of life (QOL) domains among individuals with multiple sclerosis (MS). A total of 219 people were recruited from a regional MS society membership database to serve as the community-based study sample. All participants completed a questionnaire containing items about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the preceding 2 weeks. Respondents who reported pain then completed an in-person structured pain interview assessing pain characteristics (intensity, quality, location, extent, and duration). Comparisons between participants with and without MS-related pain demonstrated that pain prevalence and intensity were strongly correlated with QOL: physical health, psychological health, level of independence, and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. These findings suggest that for people with MS, pain is an important source of distress and disability beyond that caused by neurologic impairments.
Disease and Demographic Characteristics Associated with Unemployment Among Working-Age Adults with Multiple Sclerosis
Authors: Johnson Kurt L. , Bamer Alyssa M. , Fraser Robert T.
Published: May 2012

Previous studies of employment in people with multiple sclerosis (MS) have been inconsistent in identifying associated factors, and few have examined the role of secondary health conditions. The goal of this study was to examine the association of these health conditions, including pain, fatigue, depression, sleep problems, anxiety, and incontinence, with employment status in individuals with MS. Data were collected using a cross-sectional self-report survey of 1271 people with MS, of whom 1124 were between the ages of 18 and 65 years and provided employment information. Self-report of employment status was used as an outcome variable for multivariate logistic regression. In total, 40.4% (n = 454) of surveyed individuals were employed half-time or more. Variables significantly associated with unemployment in the multivariate model were severity of disease (as measured by Expanded Disability Status Scale score), difficulties in thinking, female sex, increased age, and increased duration of MS. The symptoms of fatigue, pain, depression, and anxiety were not significantly associated with employment status in this sample. The combined impact of cognitive changes and overall severity of mobility impairment significantly influenced employment status in this community sample. Future longitudinal studies are needed to better elucidate the circumstances surrounding changes in employment status and identify points at which vocational rehabilitation interventions might be most effective.
Assessment of Depression in Multiple Sclerosis
Authors: Crawford Peggy , Webster Noah J.
Published: May 2012

Signs and symptoms of multiple sclerosis (MS) may overlap with those of depression, a common comorbidity. This study explored whether inclusion of somatic items on the Beck Depression Inventory-II (BDI-II) falsely elevated scores in a clinical sample of 557 adults with MS evaluated by the health psychology service within an MS center. Our sample's BDI-II responses were subjected to exploratory factor analysis, and the results were compared with those reported in the BDI-II manual. Analyses were then conducted to compare patients who identified fatigue as their worst MS symptom with those who did not and to compare those with high and low levels of fatigue and daytime sleepiness in terms of total BDI-II score, percentage contribution of specific somatic items (ie, tiredness or fatigue) to total BDI-II score, and the sum contribution of the somatic-affective factor to the BDI-II score. Respondents who reported fatigue as their worst MS symptom and those who did not had almost identical BDI-II scores. Among patients reporting fatigue as their worst symptom, only the “loss of energy” item was significantly higher, as was the “tiredness or fatigue” item among patients with severe fatigue. Percentage contribution of the somatic-affective factor to the total BDI-II score did not differ significantly by the presence of fatigue as the worst MS symptom or level of daytime sleepiness. In conclusion, somatic items do not necessarily confound depression scores for individuals with MS and should be retained when using the BDI-II to assess depression in this population.
Challenges in the Treatment of Mobility Loss and Walking Impairment in Multiple Sclerosis
Authors: Halper June , Ross Amy Perrin
Published: May 2012

Several recent studies have shown that mobility loss and walking impairment are significant concerns among people living with multiple sclerosis (MS). Ongoing challenges related to the assessment and management of mobility loss can have a direct impact on outcomes and patient quality of life. These challenges are evident across the spectrum of patient experience and at all stages on the treatment continuum. In June 2009 a panel of MS experts met to review current standards of care in the treatment of mobility loss in MS. The objective of the roundtable meeting was to identify specific actions that patients, care partners, and health-care professionals should consider to improve the assessment, diagnosis, and treatment of mobility loss and walking impairment in people with MS. The meeting was hosted by the International Organization of Multiple Sclerosis Nurses and was supported by a grant from Acorda Therapeutics.
Emerging Therapies for Multiple Sclerosis
Authors: Syc Stephanie , Schiess Nicoline
Published: May 2012

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that can result in severe morbidity and mortality. The past 15 years have seen a dramatic improvement in the available treatment options for MS patients. Before the 1990s, steroids administered during acute attacks were the only effective medications for the disease. Since then, seven drugs have been approved by the US Food and Drug Administration for use in MS, and many trials investigating new treatments are in progress. The experimental agents range from vaccines to monoclonal antibodies to drugs with novel mechanisms of action. In addition, the importance of vitamin D and its interaction with the immune system has become increasingly apparent. This selective review of current clinical trials provides a concise summary of promising new MS therapies on the horizon.
Adherence to Disease-Modifying Agents and Association with Quality of Life Among Patients with Relapsing-Remitting Multiple Sclerosis
Authors: Cerghet Mirela , Dobie Elizabeth , Lafata Jennifer Elston , Schultz Lonni , Elias Stanton , Pladevall Manel , Reuther Jackie
Published: May 2012

This study was conducted to evaluate the association of adherence to disease-modifying agents (DMAs) and outcomes among multiple sclerosis (MS) patients in a practice setting. The study had a cross-sectional design. A survey was administered to 214 patients with relapsing-remitting multiple sclerosis (RRMS) to measure quality of life, health status, disability, and employment. Measures of health-care costs and adherence to DMAs were constructed using claims data. The relationship between DMA adherence and outcomes was evaluated using generalized estimating equation methods, adjusting for patient sociodemographic characteristics, comorbidities, medication on hand at the time of the survey, insurance status, prescription copay, and duration of disease. A total of 163 patients (76%) responded to the survey, of whom 111 had been dispensed a DMA. Mean adherence in the 12-month period preceding the survey was 78.1%. Patients with higher adherence had better mental health and pain interference scores. Increasing adherence was also associated with a greater likelihood of employment and lower Expanded Disability Status Scale score. These findings illustrate the potential for improved outcomes among RRMS patients who adhere to DMA regimens and highlight the importance of considering medication adherence when evaluating DMA use and outcomes in practice.
A Short-Term, Multidisciplinary, Intensive Inpatient Neurorehabilitation Program for Multiple Sclerosis Patients with Moderate Disability: A Pilot Study
Authors: Cabrera-Gómez José A. , Real-González Yanely , Díaz-Márquez Roberto , Valle Alexander Echemendia del , González-Quevedo Alina , Martinez-Aching Gilda , Lopez-Hernandez Mayda , Torres-Izquierdo Jorge Luis , Torriente-Herrera Neivys , Cabrera-Núñez Anelis , Valle-Ramos Yamile , Gonzalez-Figueredo Vilma
Published: May 2012

Intensive inpatient neurorehabilitation may be an effective form of intervention for people with multiple sclerosis (MS) to supplement treatment with disease-modifying agents. The primary objective of this study was to evaluate the tolerability and safety of a personalized, one-on-one, short-term, intensive inpatient neurorehabilitation program for MS patients with moderate disability. Thirty MS patients (diagnosed using Polman criteria) with moderate disability as indicated by Expanded Disability Status Scale (EDSS) score of 5.0 to 6.5 were enrolled in a 4-week intensive inpatient neurorehabilitation program. The primary outcome measures were tolerability and safety. Secondary outcome measures were impairment, disability/activity, handicap/participation, fatigue, and quality of life. The results showed good tolerability, with only three patients (10%) developing transitory neuromuscular fatigue; and safety, with adverse events observed in only six patients (20%). Significant improvement was found in impairment and disability/activity as measured by the Scripps Neurological Rating Scale (P = .000) and the EDSS (P = .001), respectively. The Multiple Sclerosis Quality of Life–54 showed improvement in physical (P = .008) and mental health (P = .026), and the Fatigue Impact Scale showed improvement in fatigue (17 patients) (P = .005). This pilot study demonstrated good tolerability and safety of the short-term inpatient intensive neurorehabilitation program. Impairment, disability/activity, quality of life, and fatigue were improved at the completion of the program. Sustained improvement remains to be determined in future clinical trials.
Impact of Visual Impairment on Health-Related Quality of Life in Multiple Sclerosis
Authors: Pawar Vivek S. , Pawar Gauri , Miller Lesley-Ann , Kalsekar Iftekhar , Kavookjian Jan , Scott Virginia , Madhavan S. Suresh
Published: May 2012

The aim of this study was to evaluate the impact of visual impairment on health-related quality of life (HRQOL) in patients with multiple sclerosis (MS). Patients at an outpatient MS clinic were asked to complete a battery of patient-reported outcome questionnaires. Health-related quality of life was measured using the Hamburg Quality of Life Questionnaire for Multiple Sclerosis (HAQUAMS), while visual impairment was measured using the Visual Function Questionnaire (VFQ). Hierarchical regression was used to determine the relative contribution of visual impairment to HRQOL. Usable responses were obtained for 116 MS patients. Those with higher levels of visual impairment (lower scores on the VFQ) reported significantly lower HRQOL (β = –0.01, P = .0007). Visual impairment also explained an additional 4% variance in the HRQOL scores, independent of disability and depression (ΔR2 = 0.04, F7,108 = 36.58). Overall, disability was the strongest predictor of HRQOL, explaining over 60% of the variation in HRQOL scores. The model explained 70% of the total variance in HRQOL. Given the prevalence of visual impairment and its influence on overall HRQOL, MS patients should be routinely screened using standard ophthalmic examination procedures or self-administered questionnaires such as the VFQ.
Program Evaluation Results of a Structured Group Exercise Program in Individuals with Multiple Sclerosis
Authors: Charlton Mary E. , Gabriel Kelley Pettee , Munsinger Terry , Schmaderer Lorene , Healey Kathleen M.
Published: May 2012

Although research-based and anecdotal evidence support the beneficial role of physical activity in symptom management among individuals with multiple sclerosis (MS), the integration of physical activity into the lifestyles of people with disabilities remains a challenge. The purposes of this study were to evaluate the feasibility and perceived effectiveness of a group Jazzercise program that was modified to fit the needs of individuals with MS. The study population included patients diagnosed with definite MS who were receiving care at the University of Nebraska Medical Center. Eleven of 14 initial participants remained in the program after 16 weeks and were mailed a short anonymous questionnaire designed to assess self-reported improvement in balance, confidence, coordination, energy, flexibility, mood, and strength, and to determine satisfaction and motivation to continue the course. Nine of the 11 participants (82%) at week 16 returned the survey. Of the nine respondents, all (100%) reported improvements in mood and energy, seven (77.8%) reported improvements in confidence, six (66.7%) reported improvements in flexibility and strength, and five (55.6%) reported improvements in balance and coordination. All nine respondents indicated that they enjoyed the class and were motivated to continue the program. The results provide justification for continued evaluation of this unique structured group exercise program in individuals with MS. A larger sample size and a more rigorous study design are needed to further examine the impact of the program on physiologic and psychosocial factors in individuals with MS.
A Profiling Study of People with Multiple Sclerosis Who Access Physiotherapy Services in Ireland
Authors: Coote Susan , McKeown Grainne , Shannon Michelle ,   for the Physiotherapists Interested in Multiple Sclerosis (PIMS) Group
Published: May 2012

In a survey of its members conducted by the MS Society of Ireland, access to physiotherapy was reported as the greatest unmet need. This national multicenter profiling study surveyed people with multiple sclerosis (MS) receiving physiotherapy services at a range of locations to determine their characteristics and the amount of intervention received. A standardized data-collection sheet was developed, and data were collected over a 3-month period. The lower-extremity section of the Guys Neurological Disability Scale was used to classify mobility level, which varied widely. A total of 295 people received physiotherapy at 17 services during the 3-month period. Of these, 72% were female, and most had relapsing-remitting (43%) or secondary progressive MS (39%). Those using walking aids made up the largest proportion of participants (47.5%). On average, participants received 3.6 hours of physiotherapy over the 3-month period, with 36% of participants receiving 1 hour or less and 9.5% of participants receiving more than 8 hours. The main problems cited were balance, fatigue, walking, mobility, and strength. Further research is required to determine whether the small amount of physiotherapy being received by MS patients in Ireland is sufficient to bring about improvement or prevent further deterioration in functional status.
Pulmonary Dysfunction, Assessment, and Treatment in Multiple Sclerosis
Authors: Fry Donna , Chiara Toni
Published: May 2012

Pulmonary muscle weakness is a symptom of multiple sclerosis (MS) that begins early in the disease process, although it is often not recognized by health-care providers until later stages. Standard pulmonary function tests are not effective in detecting this reduction in pulmonary muscle strength. Maximal inspiratory and expiratory pressures are indirect measures of pulmonary muscle strength that are effective in detecting early changes. Once detected, pulmonary muscle weakness is effectively treated with pressure threshold load inspiratory and expiratory muscle exercises that can be implemented using inexpensive handheld pressure threshold load muscle training devices. These exercises require little time and are effective in patients with any level of disability.
Optimizing Immunomodulatory Therapy with Interferon Beta in Patients with Multiple Sclerosis
Authors: Masri Said , Blodau Andreas , Zessack Norbert , Lang Michael ,   for the High Dose, High Frequency Study Group
Published: May 2012

Patients with multiple sclerosis (MS) may change immunomodulatory therapies if efficacy is considered inadequate or if adverse drug reactions occur. Identifying potential candidates for therapy adjustment is an important aspect of treatment optimization. This study aimed to evaluate the safety and efficacy of interferon beta-1a (IFNβ-1a), 44 μg subcutaneously (SC) three times weekly, in patients with relapsing MS following a change from another long-term therapy and to identify potential candidates for therapy adjustment. Patients were followed for 12 months. Candidates for therapy adjustment were identified using a three-scale model of treatment efficacy (relapses, disability progression, and magnetic resonance imaging). For 76.4% of patients, insufficient efficacy of the previous therapy was the main reason for changing to IFNβ-1a 44 μg. At baseline, 70.6% of patients fulfilled the criteria for recommendation for therapy adjustment; after 12 months on IFNβ-1a 44 μg, this percentage decreased to 16.6%. The incidence of adverse events (AEs) decreased between week 4 (40.6% of patients) and month 12 (12.8%). Influenza-like symptoms were the most common AE, occurring in 28.3% of patients. This study supports IFNβ-1a, 44 μg SC three times weekly, as a therapeutic option for patients in need of therapy adjustment.
Lipoatrophy in Canadian Multiple Sclerosis Patients Receiving Glatiramer Acetate
Authors: Gaspari Anthony A. , Harris Colleen
Published: May 2012

Glatiramer acetate (GA) is indicated for use in patients with relapsing-remitting multiple sclerosis (RRMS). One of the side effects of GA is lipoatrophy, a localized loss of subcutaneous fat around the injection site. A Canadian postmarketing observational study on MS patients receiving GA was designed to provide further insight on lipoatrophy and to assess the utility of using digital images of lipoatrophic lesions to confirm diagnosis and define severity. From a Teva Canada Innovation–sponsored MS support program, with a total population size at the time of the study of 5770 patients receiving GA, patients with self-reported lipoatrophy were identified by a nurse who took photographs of possible lipoatrophic lesions and recorded patient demographic and clinical data during a home visit. Photographs were then assessed by an immunodermatologist (AAG) to confirm lipoatrophy and grade severity. The patients with self-reported lipoatrophy who consented to participate in the study (N = 206) had a mean age of 47.2 years; 98.1% were female, and 54.4% had been taking GA for more than 5 years. Clinical images from 192 patients were available for review. Lipoatrophy was confirmed in 85% of patients. Lesions occurred at all injection sites with equal frequency, with no significant differences in severity. This study demonstrates that most GA-treated patients with lipoat-rophy can correctly diagnose the condition and that digital photographs can play a role in confirming the presence of lipoatrophy, allowing nurses to initiate timely and appropriate interventions.
Best Practices in Skin Care for the Multiple Sclerosis Patient Receiving Injectable Therapies
Authors: McEwan Lynn , Brown Janet , Poirier Josée , Spring Janene , Brouillette Judith , Carr Kathleen , Guérette Christine , Harris Colleen , Howard Donna , Lowden Diane , Richard Nicolee
Published: May 2012

Although a cure for multiple sclerosis (MS) has not yet been discovered, a number of treatment options are available to help control symptoms, slow disease progression, and improve quality of life in patients with relapsing-remitting MS (RRMS). These include disease-modifying therapies (DMTs) such as beta-interferons, glatiramer acetate, and natalizumab. Disease-modifying therapies requiring frequent, self-administered injections can be particularly troublesome for some patients, as they may result in localized skin reactions at the injection site. A variety of injection-site reactions (ISRs) have been reported, including pain and erythema, lipoatrophy, abscesses and infections, necrosis, rash, swelling, and lumps. In order to appropriately distinguish between normal and abnormal reactions and to determine when further intervention is required, nurses involved in the care of patients with MS should be knowledgeable about the potential ISRs associated with DMTs. This best practices document was developed by a panel of Canadian MS clinic nurses in order to increase recognition among nurses that MS patients are at high risk for skin-site reactions with injectable therapies, and to provide the basis for skin-care practices in these patients. It reviews the risk factors associated with adverse skin reactions in MS patients treated with injectable therapies; the current attitudes and beliefs of nurses with respect to skin care; and the optimal skin-care interventions for MS patients at risk for adverse skin reactions when treated with injectable therapies. Areas requiring further research are discussed.
Enrollment in a Multiple Sclerosis Clinical Trial: The EVIDENCE Experience
Authors: Monaghan Edward , Basile Marylou , Hadjimichael Olympia , Vollmer Timothy L. , Francis Gordon S.
Published: May 2012

This paper describes the methods used to recruit patients for the EVIDENCE (EVidence for Interferon Dose-Effect: European-North American Comparative Efficacy) study, and the results of that recruitment. The majority of enrolled patients came from the investigators' clinic populations, with an additional 30% entering the study as a result of specific recruitment efforts. Local efforts, including referrals from colleagues, postings on bulletin boards, contacts with local Multiple Sclerosis Society chapters and newspaper advertisements, were the most successful recruitment tools. Mass mailings to local neurologists, referrals from a national multiple sclerosis registry, Web sites, and radio or television spots were less effective in recruiting eligible patients.
Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment
Authors: Rao Stephen M.
Published: May 2012

Cognitive impairment is common in multiple sclerosis (MS), with up to 65% of patients exhibiting some type of neuropsychological dysfunction. The cognitive domains most affected by MS are learning and memory, attention, information processing, visuospatial abilities, and executive functioning. It is difficult to detect cognitive dysfunction in patients with MS during routine neurologic examinations because conventional measures of neurologic disability are not sensitive enough to detect cognitive impairment. Furthermore, cognitive dysfunction is only weakly correlated with the type of MS, disease duration, or physical disability. However, brain imaging studies show that a relatively strong correlation exists between cognitive dysfunction and overall lesion burden and brain atrophy in MS. This paper reviews the natural history of cognitive dysfunction, areas of cognition affected, the correlation between MRI measures and cognitive dysfunction, issues related to neuropsychological assessment, and treatment of cognitive impairment with disease-modifying MS drugs.
Group-Based Psychotherapy for Military Veterans with Multiple Sclerosis
Authors: Williams Rhonda M.
Published: May 2012

This paper describes the development of a program of group-based psychosocial services offered to patients with multiple sclerosis at a Veteran's Health Administration facility. Four groups are currently offered: “Living Well with MS,” “Enhancing Cognitive Skills,” “Enhancing Interpersonal Relationships and Managing Mood,” and “Caregiver Support.” The theoretical and practical evolution of these groups is discussed, along with suggestions to assist mental health professionals in designing similar group programs at their facilities. The principles described are appropriate for persons with a variety of physical and cognitive impairments.
Sensory Abnormalities in MS
Authors: Galey Timothy , Miller Colleen , Nazareth Michael , Bakshi Rohit , Brownscheidle Carol M. , Weinstock-Guttman Bianca , Moise Cathia , Jacobs Lawrence
Published: May 2012

Sensory abnormalities such as numbness, paresthesias, and altered sensations of pain or temperature are common in MS. Using phenomenologic methodology, patient interviews were conducted to assess the occurrence of sensory abnormalities termed “macrosomatic illusions” in MS. These were defined as sensations of “largeness” accompanied by banding and/or tightness in specific body regions. These sensations were reported by 72 MS patients with mean disease duration of 4.7 years and mean EDSS score of 2.9. The phenomena usually affected more than one site: lower extremity (58 reports), torso (36 reports), upper extremity (26 reports), face (9 reports), and entire side of the body (4 reports). The sensations were variously described as “toes are like sausages,” “feels like I'm wearing clown shoes,” “like I have a tight corset on,” or “fingers feel swollen.” In five of seven patients for whom cervical MRI was available at the time of symptoms, lesions were identified in the spinal cord that correlated anatomically with the macrosomatic illusions. Longitudinal prospective studies are warranted to further characterize the prevalence and cause of these phenomena, their impact on disability and quality of life, and association with spinal cord disease.
Clinical Stabilization of a Multiple Sclerosis Patient After Tonsillectomy
Authors: Levin Michael C. , Wren Terry
Published: May 2012

Exacerbations of multiple sclerosis (MS) are associated with viral and bacterial infections. This case report is of a patient who experienced multiple exacerbations associated with recurrent upper respiratory infections and pharyngitis. She was diagnosed with pharyngotonsillitis. After tonsillectomy, her relapse rate, brain magnetic resonance imaging scan, and neurological examination stabilized.
Living With Multiple Sclerosis in New South Wales, Australia, at the Beginning of the 21st Century: Impact of Mobility Disability
Authors: Tribe K.L. , Longley W.A. , Fulcher G. , Faine R.J. , Blagus L. , Pearce G. , Hope A.D. , Henderson E.M.
Published: May 2012

This article is the initial report on the Multiple Sclerosis (MS) Society of New South Wales (NSW) Client Census Database study, a telephone-based cohort study of registered clients of the society in 2001. The final database sample comprised 2618 respondents with a diagnosis of MS from the registered client database, representing 73% of this target client population and an estimated 70% of all people with MS in NSW, Australia. The mean age was 49 years, and mean time since diagnosis was 11 years, with 36% diagnosed in the past 5 years. Approximately three-quarters (74%) were women. The mobility disability profile of the sample covered the entire spectrum, with half reporting being able to walk without a mobility aid and only 17% being confined to a wheelchair. The average age of respondents confined to a wheelchair was 56 years. Most respondents reported other MS symptoms they felt were disabling, such as fatigue and abnormal sensory symptoms. Most were living with a partner or spouse but were less likely to be living with children in the family home than the general NSW population. Only 5% were living in supported accommodations. Only a third of respondents were employed, with greater levels of disability leading to greater levels of unemployment—full-time employment being more adversely affected than part time and men being more disadvantaged than women with MS compared with their general NSW population counterparts. Essential medical care and personal support needs were mostly well met but less reliably so for the most severely disabled respondents and those living farther from major cities. The most frequently reported unmet needs were for breaks from home and employment support. Less than half of the sample reported being on immunotherapy. Those who were on immunotherapy were more likely to be women, employed part time, and experiencing only mild or moderate mobility disability.