bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of Urinary Albumin-to-Creatinine Ratio as a Predictor of Type 2 Diabetes in Pre-Diabetic Individuals
Authors: Friedman Allon , Marrero David , Ma Yong , Ackermann Ronald , Narayan K.M. Venkat , Barrett-Connor Elizabeth , Watson Karol , Knowler William C. , Horton Edward S. ,   for the Diabetes Prevention Program Research Group
Published: September 2008

OBJECTIVE—The albumin-to-creatinine ratio (ACR) reflects urinary albumin excretion and is increasingly being accepted as an important clinical outcome predictor. Because of the great public health need for a simple and inexpensive test to identify individuals at high risk for developing type 2 diabetes, it has been suggested that the ACR might serve this purpose. We therefore determined whether the ACR could predict incident diabetes in a well-characterized cohort of pre-diabetic Americans.

RESEARCH DESIGN AND METHODS—A total of 3,188 Diabetes Prevention Program (DPP) participants with a mean BMI of 34 kg/m2 and elevated fasting glucose, impaired glucose tolerance, and baseline urinary albumin excretion measurements were followed for incident diabetes over a mean of 3.2 years.

RESULTS—Of the participants, 94% manifested ACR levels below the microalbuminuria range and 21% ultimately developed diabetes during follow-up. Quartiles of ACR (median [range] within quartiles: 1, 3.0 [0.7–3.7]; 2, 4.6 [3.7–5.5]; 3, 7.1 [5.5–9.7]; and 4, 16.5 [9.7–1,578]) were positively associated with age, markers of adiposity and insulin secretion and resistance, blood pressure, and use of antihypertensive agents with antiproteinuric effects and inversely related to male sex and serum creatinine. An elevated hazard rate for developing diabetes with doubling of ACR disappeared after adjustment for covariates. Within the DPP intervention groups (placebo, lifestyle, and metformin), we found no consistent trend in incident diabetes by quartile or decile of ACR.

CONCLUSIONS—An ACR at levels below the microalbuminuria range does not independently predict incident diabetes in adults at high risk of developing type 2 diabetes.
Inflammation and Progressive Nephropathy in Type 1 Diabetes in the Diabetes Control and Complications Trial
Authors: Lin Julie , Glynn Robert J. , Rifai Nader , Manson JoAnn E. , Ridker Paul M. , Nathan David M. , Schaumberg Debra A.
Published: September 2008

OBJECTIVE—Progressive nephropathy represents a substantial source of morbidity and mortality in type 1 diabetes. Increasing albuminuria is a strong predictor of progressive renal dysfunction and heightened cardiovascular risk. Early albuminuria probably reflects vascular endothelial dysfunction, which may be mediated in part by chronic inflammation.

RESEARCH DESIGN AND METHODS—We measured baseline levels of four inflammatory biomarkers (high-sensitivity C-reactive protein, soluble intercellular adhesion molecule-1 [sICAM-1], soluble vascular cell adhesion molecule-1, and soluble tumor necrosis factor-α receptor-1) in stored blood samples from the 1,441 participants of the Diabetes Control and Complication Trial (DCCT). We used mixed-effects regression models to determine the average annual change in urinary albumin excretion rate (AER) by tertiles of each biomarker. We also used Cox proportional hazards models to estimate the relative risk of incident sustained microalbuminuria according to levels of each biomarker.

RESULTS—After adjustment for baseline age, sex, duration of diabetes, A1C, and randomized treatment assignment, we observed a significantly higher 5.9 μg · min−1 · year−1 increase in AER among those in the highest compared with the lowest tertile of baseline sICAM-1 (P = 0.04). Those in the highest tertile of sICAM-1 had an adjusted relative risk of 1.67 (95% CI 0.96–2.92) of developing incident sustained microalbuminuria (Ptrend = 0.03).

CONCLUSIONS—Higher baseline sICAM-1 levels predicted an increased risk of progressive nephropathy in type 1 diabetes and may represent an early risk marker that reflects the important role of vascular endothelial dysfunction in this long-term complication.
Tobacco Use Among Youth: Findings from the Global Youth Tobacco Survey in Montenegro
Authors: Ljaljević Agima , Zvrko Elvir , Stojiljković Marija
Published: September 2008

Tobacco Use Among Youth: Findings from the Global Youth Tobacco Survey in Montenegro

Smoking is a burning healthcare and economy issue, especially in underdeveloped countries. The aim of this study was to determine the number of smokers among elementary school students in Montenegro and to assess the correlates of tobacco use. The study was done in 2003 using the World Health Organization Global Youth Tobacco Survey. Our data showed that children as young as ten years smoked. There were 3.6 % permanent smokers and one in three students (30.6 %) experimented with smoking. More than two thirds who smoked agreed that they should quit smoking, and three fourths tried to quit. This study has also shown that children talk too little about smoking in schools and are exposed to passive smoking at home and elsewhere. Activities to solve the elementary school smoking problem should include preventive programs to be introduced into regular school curricula because this is the only way to address the issue properly. In addition, legislation prohibiting indoor tobacco smoking should be implemented rigorously to protect children from passive smoking in public places.
Health Education and Communication in Occupational Health Services in Finland
Authors: Palmgren Helena , Jalonen Päivi , Kaleva Simo
Published: September 2008

Health Education and Communication in Occupational Health Services in Finland

This article discusses health education and communication in Occupational Health Services (OHS) based on a questionnaire study conducted in Finnish OHS in 2005. The study focused on educational activities carried out by OH professionals and directed at individual employees, work communities and groups, and representatives of client organisations. The questionnaire was sent to 1132 OH professionals - physicians, nurses, physiotherapists and psychologists - working in 130 OHS units, and representing different OHS providers in Finland. 635 respondents (162 physicians, 342 nurses, 96 physiotherapists, 35 psychologists) returned the questionnaire. The overall response rate was 58 %. There were statistically significant differences in educational activities by different professional groups; differences were also related to the length of working experience in OHS. For all OH professionals, individual employees were the primary clients of health education and communication. Education was less often directed at work communities and representatives of client organisations. However, many issues related to health and well-being at work are not within the reach of individual employees. The impact of health education would be more evident if it also reached those organisational stakeholders with discretion in decision-making. Furthermore, OH personnel should pay attention to the social aspect of learning and work more with groups and work communities.
Skeletal Muscle Insulin Resistance: Roles of Fatty Acid Metabolism and Exercise
Authors: Turcotte Lorraine P , Fisher Jonathan S
Published: September 2008

The purpose of this review is to provide information about the role of exercise in the prevention of skeletal muscle insulin resistance, that is, the inability of insulin to properly cause glucose uptake into skeletal muscle. Insulin resistance is associated with high levels of stored lipids in skeletal muscle cells. Aerobic exercise training decreases the amounts of these lipid products and increases the lipid oxidative capacity of muscle cells. Thus, aerobic exercise training may prevent insulin resistance by correcting a mismatch between fatty acid uptake and fatty acid oxidation in skeletal muscle. Additionally, a single session of aerobic exercise increases glucose uptake by muscle during exercise, increases the ability of insulin to promote glucose uptake, and increases glycogen accumulation after exercise, all of which are important to blood glucose control. There also is some indication that resistance exercise may be effective in preventing insulin resistance. The information provided is intended to help clinicians understand and explain the roles of exercise in reducing insulin resistance.
Exercise and Glycemic Control in Diabetes: Benefits, Challenges, and Adjustments to Pharmacotherapy
Authors: Gulve Eric Arthur
Published: September 2008

Exercise, along with dietary intervention, represents first-line therapy for diabetes mellitus. Aerobic exercise is recommended for its beneficial effects on glucose control as well as its abilities to retard the progression of other comorbidities common in patients with diabetes, such as cardiovascular disease. The capability of aerobic exercise to improve glycemic control in diabetes is well documented, although adherence to exercise regimens is problematic. More recently, the glucose-lowering effects of resistance training have also been documented; this form of exercise has additional benefits, such as the capability to counteract sarcopenia, which is common in older people with type 2 diabetes. Exercise in people with diabetes, however, also can present significant challenges to glycemic control. Excessive glucose lowering can occur under certain conditions, enhancing the threat of hypoglycemia; in other situations, hyperglycemia can be accentuated. An understanding of the interactions between specific antidiabetic medications and various forms and intensities of exercise is essential to optimizing glycemic control while minimizing the potential for acute derangements in plasma glucose levels. Exogenous forms of insulin and agents that stimulate insulin secretion in a glucose-independent manner (such as sulfonylureas and glinides) increase the propensity for hypoglycemia during low- to moderate-intensity aerobic exercise. In contrast, exercise protocols characterized by high intensity are more likely to result in episodes of hyperglycemia. Strategies to minimize inappropriate swings in glycemic control are reviewed.
Perceived Entrepreneurial Success and Social Power
Authors: Aguinis Herman , Ansari Mahfooz A. , Jayasingam Sharmila , Aafaqi Rehana
Published: September 2008

Based on the leadership, entrepreneurship, and issue selling literature, we hypothesized that entrepreneurs who are perceived to be successful can be differentiated from unsuccessful entrepreneurs based on their degree and type of social power. We conducted a field experiment including 305 Malaysian managers with considerable experience in working with entrepreneurs and in entrepreneurial environments. Entrepreneurs perceived to be successful were ascribed greater referent, information, expert, connection, and reward power; less coercive power; and similar legitimate power than unsuccessful entrepreneurs. These results provide evidence in support of social power as a distinguishing individual characteristic of successful entrepreneurs and make a contribution to theories linking social capital with entrepreneurial success. Aspiring entrepreneurs need to be aware that their social power profile is associated with various degrees of perceived success. Our paper points to the need to investigate variables beyond personality and that are more directly relevant to social and interpersonal interactions that may differentiate entrepreneurs perceived to be successful from those who are not.
A Comparative Analysis of the Influence that Different Fit Perspectives Have On Firm Performance
Authors: Pertusa‐Ortega Eva M. , Molina‐Azorín José F. , Claver‐Cortés Enrique
Published: September 2008

The contingency theory holds that organizations in fit have higher performance levels than those in misfit. However, the results obtained in previous research works are far from homogeneous. The purpose of this study is to compare various fit perspectives seeking to check whether or not the divergence in results might derive from the use of different types of fit. The findings in this paper largely fail to confirm the fit‐performance links described in the traditional contingency theory. Some arguments are proposed in an attempt to explain this fact.
Predictors of Home Exercise Adherence in Older People with Osteoarthritis
Authors: Schoo Adrian M. M. , Morris Meg E. , Bui Quang M.
Published: September 2008

Purpose: To identify factors associated with adherence to prescribed exercises in elderly, community-dwelling people with knee and/or hip osteoarthritis.

Methods: Logistic regression was used to investigate associations among variables at the beginning of a home exercise program, after 4 weeks of performing exercises (test 2), and at the end of the 8-week program (test 3). Outcome measures were self-reported home exercise adherence at tests 2 and 3, and the predictors were exercise adherence behaviour in the clinic, concurrent physical activity, perception of being physically inactive, and correctness of exercise performance.

Results: Home exercise adherence at test 2 was associated with “in-clinic” exercise adherence behaviour at test 2 (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.09–2.01). There were significant associations between home exercise adherence at test 3 and (1) home exercise adherence at test 2 (OR = 19.86; 95% CI = 4.84–81.56); (2) concurrent physical activity at test 3 (OR = 5.58; 95% CI = 1.15–27.05); and (3) the perception of not being physically active at test 1 (OR = 0.07; 95% CI = 0.01–0.52). No associations were found between home exercise adherence and correctness of exercise performance or between home exercise adherence at test 2 and concurrent physical activity at test 2.

Conclusions: People who closely adhered to prescribed exercises in the clinic were more likely to adhere at home. Home exercise adherence in weeks 1 to 4 was the strongest predictor of home exercise adherence in weeks 5 to 8. Participants who were physically active at the time of the home program were more likely to perform their home exercises, whereas those who perceived themselves to be inactive at the time of exercise prescription were less likely to maintain exercise at home.
Comparison of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lower Extremity Functional Scale (LEFS) Questionnaires in Patients Awaiting or Having Undergone Total Knee Arthroplasty
Authors: Jogi Pankaj , Kramer John F. , Birmingham Trevor
Published: September 2008

Purpose: The purpose of this study was to determine the relationship between two functionally oriented health status measures, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lower Extremity Functional Scale (LEFS), in patients awaiting or having undergone total knee arthroplasty (TKA).

Methods: Patients who were on the waiting list for TKA (n = 150) or who had undergone TKA (n = 150) received a mailed questionnaire.

Results: Responses were tabulated for 187 completed questionnaires. Although correlations of r = .87 to .89 were observed between scores on the WOMAC physical function and the LEFS questionnaires, the standard error of estimate associated with using one questionnaire to predict scores on the other was large (F6 to F8). The relative efficiency of the WOMAC and the LEFS was similar, as were their relationships with the patients' ability to walk and ascend or descend stairs. Respondents indicated no clear preference for either questionnaire.

Conclusions: Although related, scores from the WOMAC and the LEFS were not directly interchangeable. Both the WOMAC and the LEFS have advantages. Clinicians' use of one or both of these health status measures in patients with TKA depends on their anticipated use of the information.
Test–Retest and Interrater Reliability of Goniometric Tibial Rotation Range of Motion Measurements
Authors: Makowski Agnes , Birmingham Trevor , Kramer John , Jogi Pankaj , Forwell Lorie , Obright Kathy
Published: September 2008

Purpose: Although suggested to be an important component of physiologic knee function, the ability to accurately assess tibial rotation range of motion (ROM) is currently limited by a lack of reliability data for clinically practical measurement tools. The purpose of the present study was to estimate the reliability of tibial rotation ROM measurements taken with subjects in sitting and supine positions.

Methods: Thirty healthy subjects (mean age 37 ± 12 years) completed maximal active internal and external tibial rotation movements in sitting and supine positions. ROM was assessed on two occasions and by two raters using a gravity- and magnetic-referenced goniometer.

Results: There were significant differences between internal and external rotation ROM values (p < .05) and between values obtained with subjects in sitting and supine positions (p < .05). Intraclass correlation coefficients (ICCs) suggested that test–retest reliability for all measurements was excellent (ICC = 0.83–0.93), whereas interrater reliability was poor to excellent (ICC = 0.39–0.81). Standard errors of measurement ranged from approximately 1 to 2°.

Conclusions: These findings suggest that tibial rotation ROM can be assessed reliably by one rater using one test position. However, caution must be adopted when comparing ROM measurements assessed by different raters or in different test positions.
Home-Based Physiotherapy for the Elderly: A Different World
Authors: Heckman Kristine A. , Cott Cheryl A.
Published: September 2008

Purpose: Recent changes in health service delivery have resulted in a shift in provision of services from the hospital to the community. These changes require an examination of the knowledge and skills used by physiotherapists working in the home setting. The purpose of this study is to understand the practice of physiotherapy within the context of the elderly client's home.

Method: Using semistructured interviews with 12 home-based physiotherapists, a focussed ethnographic approach was used to explore the practice of home care physiotherapy in Ontario. Data were analyzed using a coding/categorizing approach.

Results: The client's home as the context in which physiotherapy services are provided has meaning beyond merely the location where the therapeutic intervention occurs. Practicing in the world of the client requires a broad array of knowledge and skills that go far beyond notions of traditional physiotherapy. Physiotherapists in the community rely heavily on their tacit, professional craft knowledge, but, ironically, they often feel that these skills are not “really” physiotherapy.

Conclusions: The findings highlight the need to expand our notions of professional knowledge beyond traditional propositional knowledge to include professional craft knowledge.
Influence of Age and Gender of Healthy Adults on Scoring Patterns on the Community Balance and Mobility Scale
Authors: Rocque Rohini , Bartlett Doreen , Brown Janet , Garland S. Jayne
Published: September 2008

Purpose: The purpose of the study was to describe and compare scoring patterns on the Community Balance and Mobility Scale (CB&M) in healthy men and women between 30 and 59 years of age.

Methods: Following criterion testing on 5 individuals, 90 healthy volunteers who met the inclusion criteria and consented to participate in the study were tested on the CB&M. The subjects were recruited through quota sampling in three age categories: 30 to 39 years, 40 to 49 years, and 50 to 59 years, with 15 men and 15 women in each age category. The groups were not matched for any anthropometric variables.

Results: Women within the age category of 50 to 59 years had significantly lower scores on the CB&M compared with all other age and gender categories.

Conclusions: The results from this study indicate that although the items on the CB&M were appropriate for the 30- to 59-year age categories, some items still posed a challenge to healthy participants because most were unable to score full points on the CB&M. The normative data from the present study could help clinicians put the CB&M scores of middle-aged patients into context. These data may also be useful in making recommendations regarding the safe integration of patients back into the community following mild stroke.
Influence of Exercise-Induced Injury on Knee Extension Torque in the Presence of Long-Standing Quadriceps Atrophy: Case Report
Authors: Mathur Sunita , MacIntyre Donna L. , Forster Bruce B. , Reid W. Darlene
Published: September 2008

Purpose: The purposes of this case report were (1) to describe muscle volume and torque-generating capacity of the quadriceps muscle in a 46-year-old woman 16 years following tibial plateau fracture and (2) to compare the decline and recovery of quadriceps torque following exerciseinduced muscle damage between the affected and unaffected lower extremity (LE).

Methods: Magnetic resonance imaging was used to determine quadriceps volume. Repeated measures of concentric, eccentric, and isometric torque and muscle soreness were acquired for quadriceps bilaterally during four baseline tests, as well as 2 hours and 1, 2, 11, 12, and 13 days after exerciseinduced muscle damage (eccentric exercise).

Results: At baseline, the affected quadriceps showed profound atrophy (74% of unaffected quadriceps volume) and deficits in all torque measures. Exercise-induced muscle damage resulted in slight delayed-onset muscle soreness and a decrease in all torque measures bilaterally. In the affected LE at 13 days after exercise, eccentric torque did not recover and isometric torque on the affected side recovered only partially.

Conclusions: Quadriceps atrophy and torque deficit can be substantial long after tibial plateau fracture. Eccentric torque was the most sensitive measure of torque deficit, showing only partial recovery after exercise-induced muscle damage.
A Descriptive Survey of Injury Patterns in Canadian Premier Highland Dancers
Authors: Henderson Jaclyn , MacIntyre Donna
Published: September 2008

Purpose: This descriptive study investigated patterns of injury in various age groups of Canadian Premier-level Highland dancers.

Methods: Highland dance teachers were mailed questionnaires to distribute to their students. The questionnaire covered three major topics: demographics, practice habits and non-dance activities, and pain and injury. Dancers were required to be of Premier level and registered under ScotDance Canada.

Results: Of the 333 questionnaires distributed, 136 (41%) were returned and completed correctly. Eighty-four percent (n = 114) of the respondents reported experiencing pain and injury as a result of Highland dancing. The number of dancers with pain and injury increased to 100% in the top two age groups (p < .001). The knee, lower leg, ankle, and foot were the most common sites of reported injury.

Conclusions: This study suggests that Canadian Highland dancers are at high risk of pain and injury. Further research is required to assist dancers and health professionals in preventing and treating these injuries.
Cardiovascular Fitness and Adaptations to Aerobic Training after Stroke
Authors: MacKay-Lyons Marilyn J. , Macko Richard , Howlett Jonathan
Published: September 2008

Purpose: This article presents an overview of the current state of knowledge of physiological indicators of cardiovascular fitness after stroke. Clinical tips are presented regarding training protocols appropriate for persons post-stroke.

Summary of Key Points: Application of the principles of exercise physiology to stroke rehabilitation has begun to attract the attention of clinicians owing to increased awareness of the profoundly poor fitness levels of persons in the early and chronic post-stroke periods. Contributors to the low exercise capacity range from personal and environmental factors to cardiovascular, neuromuscular, and respiratory dysfunction associated with stroke. Low fitness levels, in turn, negatively influence these factors and, ultimately, health-related quality of life. Nevertheless, there is growing evidence that persons in both the early and chronic post-stroke periods can make cardiovascular adaptations to aerobic training.

Conclusions: Given that persons post-stroke respond positively to aerobic exercise if appropriate screening and training protocols are used, implementation of training makes practical sense. However, there is limited information on specific evidence-based guidelines for stroke rehabilitation in clinical and community settings to improve exercise capacity and to protect against further cardiovascular morbidity and mortality.
Validation of Three Shortened Versions of the Chedoke Arm and Hand Activity Inventory
Authors: Barreca Susan R. , Stratford Paul W. , Masters Lisa M. , Lambert Cynthia L. , Griffiths Jeremy , McBay Catherine
Published: September 2008

Purpose: To estimate the reliability and validity of three shortened versions of the Chedoke Arm and Hand Activity Inventory (CAHAI).

Method: The study sample consisted of 39 individuals who had had a stroke. Twenty-four individuals were classified as acute and 15 as chronic. The CAHAI-13 was administered three times: an initial assessment, a second assessment within 36 hours, and a final assessment two to six weeks after the initial assessment. The Action Research Arm Test (ARAT) and the Chedoke-McMaster Stroke Assessment were administered at the first and third time points. Based on the clinical judgment of four therapists, seven-, eight-, and nine-item versions of the CAHAI were produced. Test–retest reliability and cross-sectional and longitudinal validity (sensitivity to change) were evaluated.

Results: Test–retest reliability varied from 0.96 for the CAHAI-7 to 0.97 for the CAHAI-8 and CAHAI-9. Cross-sectional validity for the ARAT was 0.95, 0.95, and 0.94, and longitudinal validity was 0.97, 0.93, and 0.94 for the seven-, eight-, and nine-item versions of the CAHAI, respectively.

Conclusions: All shortened versions maintained the same high degree of reliability and construct and longitudinal validity as the original CAHAI-13. Therapists and researchers may select from three valid, shorter versions of a new upper limb functional measure to facilitate effective standardized assessment within limited time and resources.
Physiotherapy Internship: An Alternative Collaborative Learning Model
Authors: Miller Alison , Pace Theresa , Brooks Dina , Mori Brenda
Published: September 2008

Purpose: The purposes of this article are to (1) present a descriptive qualitative field report of a collaborative learning internship of four students assigned to two clinical instructors (CIs) (4:2 ratio) in the area of cardiorespiratory physiotherapy practice and (2) provide recommendations to CIs and universities based on this field study.

Summary of Key Points: From the perspective of the students, the main advantages of this collaborative internship included increased peer support, knowledge sharing, problem solving, and a comfortable learning environment. The CIs found advantages to include more instructor peer support, increased student collaboration with assessment and treatment planning, and more opportunity for group discussion. The main disadvantages from the perspectives of both the students and the CIs were accommodating various learning styles and personalities and having less 1:1 time with the CIs.

Conclusion: This collaborative learning model did not impede the quality of student education or patient care and was shown to be an educational experience appropriate for implementation in student internships. Given the positive outcomes and the recommendations provided, this 4:2 collaborative learning internship could be implemented to help meet the growing demands of increased enrolment and “hard-to-find” internships and to foster stronger supervisory skills for clinicians.
Reliability of Four Functional Tests and Rating of Perceived Exertion in Persons with Multiple Sclerosis
Authors: Fry Donna K. , Pfalzer Lucinda A.
Published: September 2008

Purpose: Test-retest reliability and convergent and discriminant validity for four commonly used clinical tests of physical function were examined in persons with multiple sclerosis (MS).

Method: Twelve ambulatory adults with clinically diagnosed MS (Expanded Disability Status Scale scores: mean = 3.6, range = 2.0−6.5) participated in a test-retest reliability study with a one-week interval between testing sessions. Functional tests included the 6-Minute Walk Test (6MWT), Functional Stair Test (FST), Static Standing Balance Test (BAL), and six-repetition Sit-to-Stand Test (SST). Distance was recorded for the 6MWT. All other tests were timed. Rating of perceived exertion (RPE) was recorded following each test. Intraclass correlation coefficients and Spearman rho correlation coefficients were used to examine agreement between test sessions.

Results: Test-retest reliability for best trial of each test was significant for all tests (p < .01): the 6MWT (r2 = .97), FST (r2 = .97), BAL (r2 = .81), and SST (r2 = .94). Subjects rated RPE consistently each week for all tests (p < .05). RPE was significantly correlated with the associated test for only the BAL and FST.

Conclusion: The 6MWT, FST, BAL, and SST are highly reliable tests in ambulatory persons with MS. Although subjects were consistent in the RPE following each of the functional tests, RPE did not always correlate well with performance on functional tests.
Inspiratory Muscle Training for Individuals with Cervical Spinal Cord Injury or Chronic Obstructive Pulmonary Disease: A Survey of Canadian Physical Therapists
Authors: Crowe Jean , Geddes E. Lynne , Brooks Dina , Reid W. Darlene
Published: September 2008

Purpose: The objective of this study was to describe the current practice of Canadian physical therapists (PTs) using inspiratory muscle training (IMT) in the management of patients with cervical spinal cord injury (CSCI) or chronic obstructive pulmonary disease (COPD).

Method: A postal survey was sent to all Canadian acute-care hospitals (. 250 beds) and to all centres providing rehabilitation for patients with CSCI or COPD. PTs were asked whether they used IMT and, if so, to describe patients for whom IMT was appropriate, as well as the devices and training protocols used. They were asked to list any contraindications to IMT.

Results: One hundred nineteen questionnaires were sent to PTs treating patients with CSCI and 145 to PTs treating patients with COPD. The response rates were 70.6 per cent (CSCI) and 65.5 per cent (COPD). The rates of IMT use were 17.4 per cent (CSCI) and 4.7 per cent (COPD). The reasons for non-use included no knowledge about or training in IMT, a lack of resources, patients who were inappropriate for this treatment and no evidence of effectiveness.

Conclusions: Few PTs are using IMT for patients with either CSCI or COPD. Little evidence exists of the effectiveness of IMT with CSCI patients, with stronger evidence of effectiveness in patients with COPD. A potentially effective modality for patients with COPD and CSCI, IMT appears to be underused by Canadian PTs.
Acustim in the Treatment of Knee Osteoarthritis: A Single-Subject Research Design
Authors: O'Sullivan Sinéad
Published: September 2008

Purpose: Acustim provides a non-invasive means for controlling pain and restoring function. The following research question was addressed in this study: Does stimulation of specific acupuncture points via acustim reduce impairment and functional limitation among patients with knee osteoarthritis (OA)?

Methods: A single-subject research design was employed and replicated across three subjects. Data were collected over two specified time periods, baseline and intervention, for measures of pain, stiffness and function (as assessed by two items on the Patient Specific Functional Scale). During the intervention phase, acustim was administered. Celeration lines and two standard deviation methods were used to analyze the data. In addition, the Lower Extremity Functional Scale (LEFS) was administered at three time points: prebaseline, pre-intervention and post-intervention.

Results: During the intervention phase, pain and stiffness were considerably reduced in all subjects (. 228 mm on a visual analog scale). A clinically important difference in function (decrease of .9 points on the LEFS) was demonstrated for all subjects between pre-baseline and post-intervention.

Conclusions: Acustim may be an effective treatment for knee OA. Given the ease with which acustim can be administered, this modality may be promising for treating other joints affected by OA.
Safety and Effectiveness of Breath Stacking in Management of Persons with Acute Atelectasis
Authors: Crowe Jean , Rajczak Judi , Elms Brad
Published: September 2008

Purpose: Atelectasis is frequently observed in acutely ill, intubated patients. One technique for management of the secretion retention is breath stacking, a two-part procedure comprising manual hyperinflation using a resuscitation bag and a one-way valve, followed by a manually assisted cough and suctioning as required. The purpose of this preliminary study was to compare the safety and effectiveness of breath stacking combined with conventional physiotherapy (PT) care (PT composed of modified postural drainage combined with percussions, vibrations and suctioning) compared with PT alone in the management of acute atelectasis.

Method: Intubated subjects with acute (, 72 hours) major atelectasis (lobar or greater) were randomized to receive breath stacking plus PT or PT alone twice daily for 3 days.

Results: Twenty subjects entered the study. There was no difference between the groups on chest radiograph (p 5 .94) or volume of sputum suctioned. There were no respiratory or cardiac complications.

Conclusions: Although this study had less than adequate power, the results demonstrated that breath stacking plus PT was no more effective than conventional PT alone for these patients. Breath stacking was a safe procedure as practised in this study.
Influence of Symptom Longevity on Outcomes Following a Customized Rehabilitation Program for Painful Temporomandibular Disorders
Authors: Badke Mary Beth , Dussault Lisa , Boissonnault William
Published: September 2008

Purpose: To assess the impact of symptom longevity on functional outcomes, pain and patient perception of recovery following a rehabilitation program for temporomandibular disorders (TMDs) and to determine which variables were associated with improved function.

Methods: Forty-eight patients who received TMD rehabilitation in an outpatient setting at a tertiary care facility were divided into acute, subacute and chronic groups based on symptom duration. A customized intervention program was developed for each patient according to assessment results and included the following interventions: manual therapy, neuromuscular re-education, orthotic and other modalities and self-management training. Functional indices, perceived pain and perceived improvement in the CareConnections Outcomes System were measured using a self-report questionnaire at initiation and completion of the therapy program.

Results: Within each group, the average functional improvement score and pain score improved significantly from pre-treatment to post-treatment (p ≤ .05). Among the groups, no differences were noted for functional improvement, per cent decrease in pain and patient perception of improvement. In regression analyses, a model with initial pain intensity score (p = .002) and symptom longevity (p = .05) fit the data well and explained 25 per cent of the variance in functional outcome score.

Conclusions: Patients with TMD showed improvements in function and pain after a customized rehabilitation program. Baseline pain scores and symptom longevity were highly associated with functional outcomes.
The Effects of Early Continuous Passive Motion after Total Knee Arthroplasty
Authors: Léonard Guillaume M. , Tremblay Louis E. , Chabot Madeleine , Larivière Julien , Papadopoulos Platon
Published: September 2008

Purpose: Continuous passive motion (CPM) is a common intervention following total knee arthroplasty (TKA). However, CPM efficacy remains controversial and its application parameters have not been clearly established. This study's purpose was to investigate whether early application of CPM (initiated 6 hours following surgery) would increase knee range of motion (ROM) more rapidly than conventional CPM application (initiated 52 hours following surgery).

Methods: Sixty participants were alternately assigned to a conventional group (CPM initiated 52 hours after surgery) or an early group (CPM initiated 6 hours after surgery). During the course of the study, 17 participants in the early group were reassigned to a third, intermediate group (CPM 24 hours after surgery) owing to medical concerns, for example, nausea and extreme joint pain. All participants received CPM twice daily for two hours.

Results: Five, six and seven days following surgery, a statistically significant increase in flexion ROM occurred in the early group compared with the conventional group (p <.05). There was no significant difference between the two groups after day 7 (p >.05).

Conclusions: Our results suggest that early CPM provides short-term ROM benefits in patients following TKA. Due to methodologic limitations, however, the present results should be considered exploratory. Further studies are needed to examine the benefits of early CPM on patient function, length of hospital stay and hospital costs.
Effectiveness of a Modified Constraint-Induced Movement Therapy Regimen for Upper Limb Ability after Stroke: A Retrospective Case Series
Authors: Stevenson Ted J. , Thalman Leyda P.
Published: September 2008

Purpose: To examine the responses of individuals living with the effects of stroke to the modified regimen of constraint-induced movement therapy (CIMT) provided at our facility.

Method: The charts of 12 individuals who had completed our facility's modified CIMT regimen were reviewed. This regimen is composed of four hours per day of supervised training of upper limb activities for 10 consecutive weekdays concurrent with restraint of the less involved limb for a goal of 90 per cent of waking hours. Before beginning training, all participants were able to pick up and release a water glass. Pre-training, post-training and followup assessments were performed using the Canadian Occupational Performance Measure, a modified version of the Box and Block test and the 30-item Motor Activity Log.

Results: Repeated measures analysis of variance revealed statistically significant improvements over the treatment period with maintenance of these improvements six months later. Clinically significant improvements were seen for 10 of the 12 participants after the training period. Eight of these 10 participants continued to show clinically significant improvements at the six-month assessment.

Conclusions: This project provides preliminary evidence that this CIMT regimen, modified for routine clinical application, may be effective.
Transmission of Light through Human Skin Folds during Phototherapy: Effects of Physical Characteristics, Irradiation Wavelength, and Skin-Diode Coupling
Authors: Nussbaum Ethne L. , Van Zuylen Jeffrey , Jing Fang
Published: September 2008

Purpose: There are no available guidelines for adjusting radiant exposure of phototherapy to accommodate for certain patient characteristics, as well as for the light source being used. We examined factors that affect light transmission using light-emitting diodes (LEDs).

Methods: Age, gender, height, and weight were recorded. Skin colour, skin-fold thickness, and light transmission through a skin fold were measured over biceps and triceps muscles and at the waistline. Light was generated using LED arrays at 840 and 660 nm. Transmission was measured using three skin-diode coupling conditions.

Results: Transmission was greatest when diodes were coupled directly to skin with pressure, with transmission of infrared light 2.5 times that of red light. As body mass index (BMI) increased, transmission decreased. Transmission of red light decreased with increasing skin darkness. Skin colour did not affect transmission of infrared light. There was a gender difference for infrared light transmission in individuals with a low BMI.

Conclusions: Radiant exposure of LED phototherapy should be adjusted based on patient characteristics, as well as on laser system characteristics, to ensure that the needed fluence reaches the target tissue.
Rail Transit Impacts on Land Use
Authors: Pan Haixiao , Zhang Ming
Published: September 2008

China has experienced a major boom in rail transit development in the past 10 years. Yet the evidence that rail transit is shaping urban travel and land development in Chinese cities has been scarcely studied and reported to the outside world. This paper attempts to fill the knowledge gap through a Shanghai case study. Evidence from Shanghai on changes in land use associated with rail transit is consistent with what the classical urban economics theory suggests: higher development intensity and more capital-intensive land uses occur in more accessible areas near train stations. Hedonic price modeling shows that the transit proximity premium amounts to approximately 152 yuan/m2 for every 100 m closer to a metro station. In Shanghai, rail transit is a magnet that attracts new development or redevelopment to areas that the system covers. The rail transit system is therefore shaping urban expansion and restructuring Shanghai; this will in turn lead to efficient use of the limited urban land resources.
Effects of Attitudes and Socioeconomic and Travel Characteristics on Stated Route Diversion
Authors: Choocharukul Kasem
Published: September 2008

At present, the application of the variable message sign (VMS) is considered an undeniably practical tool for providing travel information to motorists. Several studies have attempted to examine the effects of socioeconomic and travel characteristics on diversion behavior; however, the direct investigation of the extent of motorists’ attitudes, in conjunction with the aforementioned variables, has not been given much attention. Therefore, the primary objective of the present study is to gain a better understanding of the interrelationships between the likelihood of route diversion, attitudinal variables, and several exogenous factors such as motorists’ socioeconomic status and travel habits. In this study, a structural equation model is developed based on empirical data on road users in Bangkok, Thailand. Derived from factor analysis, three attitudinal variables, namely, awareness of the VMS, VMS comprehension, and perceived VMS usefulness, are extracted and incorporated into the structural equation modeling framework. Modeling results suggest a direct relationship between stated route diversion and two of the attitudinal variables, that is, VMS comprehension and perceived usefulness of the VMS; the awareness of VMS is not found to be a direct determinant of the decision to divert a route. Exogenous variables that appear to be of statistical significance include education, gender, age, daily mileage, and trip purpose. Unlike those in past studies, none of the socioeconomic variables in this study appears to directly influence plans to divert a route. The model estimation results are discussed and practical implications are provided.
Glacial changes of five southwest British Columbia icefields, Canada, mid-1980s to 1999
Authors: VanLooy Jeffrey A. , Forster Richard R.
Published: September 2008

This study adjusts and compares digital elevation models (DEMs) created from photogrammetric and interferometric synthetic aperture radar techniques to determine volume and surface elevation changes of five icefields in a remote region of southwest British Columbia, Canada, between the mid-1980s and 1999. Preliminary differences between the DEMs in ice-free and vegetation-free areas indicated variable elevation offsets with increasing altitude (11 m km−1) and with increasing slope (2.7 m (10°)−1). Results indicate a surface elevation change of −6.0 ± 2.7 m (−0.5 ± 0.2 m a−1) and a total volume loss of −19.4 ± 8.8 km3 (−1.5 ± 0.7 km3 a−1), which represents a potential sea-level rise contribution of 0.004 ± 0.002 mm a−1. Temperature and snowfall data from four nearby meteorological stations indicate that increased temperatures and decreased snowfall throughout the late 1980s and 1990s are a likely cause of the thinning. Glacier terminus positions were compared between a historical map (1927) and satellite images (1974, 1990/91 and 2000/01). All observed glaciers were in retreat between 1927 and 1974, as well as between 1990/91 and 2000/01, but many glaciers advanced or significantly slowed in their retreat between 1974 and 1990/91.
Secular trend of the equilibrium-line altitude on the western side of the southern Andes, derived from radiosonde and surface observations
Authors: Carrasco Jorge F. , Osorio Roberto , Casassa Gino
Published: September 2008

The altitude of the 0°C isotherm obtained from radiosonde data of the aerological Chilean stations Antofagasta, Quintero/Santo Domingo, Puerto Montt and Punta Arenas are analyzed, along with surface temperature and precipitation records from nearby stations. The strong effect of the 1976/77 climate shift due to a change in the Pacific Decadal Oscillation is evident in the temperature and precipitation data. The data are used as input for an empirical model which reconstructs annually the equilibrium-line altitude (ELA) for the last 49 years on the western side of the southern Andes. The model takes air temperature, precipitation and altitude as the main parameters, and was first developed by Fox (1993) and applied by Condom and others (2007). From the radiosonde data, a significant positive trend of the 0°C isotherm has occurred in the northern, central and southern regions, indicating an ELA rise due to regional warming. General glacier retreat, ice thinning and negative mass balance observed during the past few decades in virtually all the Chilean Andes concur with the observed ELA reconstruction. In the Punta Arenas radiosonde record there is slight evidence for precipitation increase but no evidence for significant warming in the past few decades. This results in a slight lowering of the ELA according to the model reconstruction, which does not agree with the strong and increased glacier retreat observed in recent decades in Patagonia.
Glaciological and volumetric mass-balance measurements: error analysis over 51 years for Glacier de Sarennes, French Alps
Authors: Thibert E. , Blanc R. , Vincent C. , Eckert N.
Published: September 2008

The mass balance of Glacier de Sarennes, French Alps, has been measured since 1949, using the glaciological method based on core and ablation stake data, and area extrapolations, to find the overall glacier balance. The cumulative balance obtained in this way is very dependent on systematic errors that can increase linearly with the number, N, of measurement years, whereas random errors rise with . The volumetric-balance method based on aerial photogrammetry provides results whose errors do not depend on the number of years. This method was used to test field measurements for the period 1952–2003 and gives a mass balance of −32.30 ± 1.04 m w.e. compared to −34.89 ± 1.15 m w.e. based on field data. The discrepancy between the two methods is discussed on the basis of a careful error analysis. Moreover, the possibility of using the volumetric method to detect biases in field measurements is evaluated in terms of two types of errors. The number and locations of measurement sites required to account for all the spatial and temporal variabilities of the mass balance is discussed by variance analysis. Methodological implications and recommendations are presented to provide mass-balance measurements of the best possible accuracy.