bluuebunny/crossref_metadata_2025 huggingface dataset:
A New Proposal for Setting Parameter Values in Restricted Randomization Methods
Authors: Kundt G.
Published: July 2007

Objectives:
Complete randomization could result in an undesirable imbalance in the number of patients assigned to each treatment, especially in small trials. Therefore, a variety of restricted randomization procedures has been developed. By varying parameters it is possible to appropriately modify the balancing characteristics of these designs. However, there is little information on what are sensible choices for the parameters. Therefore, we suggest a new method for suitable determination of parameter values of restricted randomization rules.

Methods:
For restriction to be effective, it need not yield exact equality. As the reliability of a test is not very sensitive to slight deviations from equal sample sizes we define that a given maximum tolerable imbalance d can be achieved or exceeded with a given probability p*. By using this condition, parameter values of restricted procedures are determinable.

Results:
For permuted-block, biased-coin, urn, and big-stick randomization we investigated the impact of parameters on balancing properties. For different extents of restriction and by using the submitted condition, the values of parameters to be chosen are determined.

Conclusions:
Up to now choice of parameter values has often occurred at random. Now it is possible to determine values of parameters by specifying the tolerable degree of imbalance and the risk to be worse. As a consequence restriction will, as much as possible, not be imposed and not imposed more than necessary in order to preserve the intrinsic quality of randomization.
Split Bundle Detection in Polarimetric Images of the Human Retinal Nerve Fiber Layer
Authors: Reus N. J. , Vos F. M. , Lemij H. G. , Vossepoel A. M. , Vermeer K. A.
Published: July 2007

Objectives:
One method for assessing pathological retinal nerve fiber layer (NFL) appearance is by comparing the NFL to normative values, derived from healthy subjects. These normative values will be more specific when normal physiological differences are taken into account. One common variation is a split bundle. This paper describes a method to automatically detect these split bundles.

Methods:
The thickness profile along the NFL bundle is described by a non-split and a split bundle model. Based on these two fits, statistics are derived and used as features for two non-parametric classifiers (Parzen density based and k nearest neighbor). Features were selected by forward feature selection. Three hundred and nine superior and 324 inferior bundles were used to train and test this method.

Results:
The prevalence of split superior bundles was 68% and the split inferior bundles’ prevalence was 13%. The resulting estimated error of the Parzen density-based classifier was 12.5% for the superior bundle and 10.2% for the inferior bundle. The k nearest neighbor classifier errors were 11.7% and 9.2%.

Conclusions:
The classification error of automated detection of split inferior bundles is not much smaller than its prevalence, thereby limiting the usefulness of separate cut-offvalues for split and non-split inferior bundles. For superior bundles, however, the classification error was low compared to the prevalence. Application of specific cut-offvalues, selected by the proposed classification system, may therefore increase the specificity and sensitivity of pathological NFL detection.
Nursing Information Systems
Authors: Yu P. , Qiu Y.
Published: July 2007

Objective:
In order to ensure the successful implementation of a nursing information system (NIS), nurses and nursing students must be adequately trained. In order to do this effectively, it is essential to understand their training needs. This study focuses on the training needs of nursing students in particular through the identification of the usage problems they encounter. Usability testing, which involves observing users’ interaction with an NIS, overcomes the deficiencies of traditional approaches of training needs analysis such as interviewand survey. The study applied usability test to assess training needs of nursing students to learn to use a specific NIS, the “Care Planning Assessment Tool” (CPAT).

Methods:
An experiment in which novice CPAT users were expected to learn to use the software through task-based exploration was conducted. Eight nursing undergraduate students who had never used the software were recruited. Participants’ interactionswith the system were captured by screen capture software. Meanwhile, participants’ “think aloud” verbal expression of their usage problems was audio-taped.

Results:
A coding schemewas used in analysing the captured audio and video data. Ten common usage problems were identified. From these problems, three areas of knowledge gap that this cohort of novice users experienced were identified.

Conclusion:
The training needs of nursing students learning to use an NIS was conceptualised in a model consisting of three types of knowledge, i.e. computer skills, knowledge about the NIS and knowledge about procedure of nursing documentation. The knowledge gap must be filled in order to ensure effective training.
An Informatics Benchmarking Statement
Authors: Pigott K. , Rapley A. , Robinson J. , Pritchard-Copley A. , Lusignan S. de
Published: July 2007

Objectives:
Benchmarking statements provide a mechanism for making academic standards explicit within a subject area. They allow comparisons between courses to be based on learning outcomes rather than by defining a curriculum. No such statement has been produced for informatics. In the absence of any established benchmarking statements for informatics a new biomedical informatics course at St. George’s has developed a first benchmarking statement — which defines the skills knowledge and understanding a biomedical informatics student should acquire by the time they completethe course.

Methods:
Review of national biomedical science and computing subject benchmarking statements and academic educational objectives and national occupational competencies in informatics.

Results:
We have developed a twenty-item benchmarking statement and this is available on-line at: http://www.gpinformatics.org/benchmark2006/. This benchmarking statement includes a definition and justification for all twenty statements. We found international educational objectives and national informatics competencies useful and these are mapped to each one. National subject benchmarks for computing and biomedical science were less useful and have not been systematically mapped.

Conclusions:
Benchmarking the skills, knowledge and understanding that a student should acquire during their course of study may be more useful than setting a standard curriculum. This benchmarking statement is a first step towards defining the learning outcomes and competencies a student of this discipline should acquire. The international informatics community should consider moving from a standard curriculum to an agreed subject benchmarking statement for medical, health and biomedical informatics.
Local, Regional and National Interoperability in Hospital-level Systems Architecture
Authors: Korpela M. , Ripatti S. , Rannanheimo J. , Sorri J. , Mykkänen J.
Published: July 2007

Objectives:
Interoperability of applications in health care is faced with various needs by patients, health professionals, organizations and policy makers. A combination of existing and new applications is a necessity. Hospitals are in a position to drive many integration solutions, but need approaches which combine local, regional and national requirements and initiatives with open standards to support flexible processes and applications on a local hospital level.

Methods:
We discuss systems architecture of hospitals in relation to various processes and applications, and highlight current challenges and prospects using a service-oriented architecture approach. We also illustrate these aspects with examples from Finnish hospitals.

Results:
A set of main services and elements of service-oriented architectures for health care facilities are identified, with medium-term focus which acknowledges existing systems as a core part of service-oriented solutions. The services and elements are grouped according to functional and interoperability cohesion.

Conclusions:
Atransition towards service-oriented architecture in health care must acknowledge existing health information systems and promote the specification of central processes and software services locally and across organizations. Software industry best practices such as SOA must be combined with health care knowledge to respond to central challenges such as continuous change in health care. A service-oriented approach cannot entirely rely on common standards and frameworks but it must be locally adapted and complemented.
Using Web Services for Linking Genomic Data to Medical Information Systems
Authors: Crespo J. , Calle G. de la , Barreiro J. , Garcia-Remesal M. , Maojo V.
Published: July 2007

Objectives:
To develop a new perspective for biomedical information systems, regarding the introduction of ideas, methods and tools related to the new scenario of genomic medicine.

Methods:
Technological aspects related to the analysis and integration of heterogeneous clinical and genomic data include mapping clinical and genetic concepts, potential future standards or the development of integrated biomedical ontologies. In this clinicomics scenario, we describe the use of Web services technologies to improve access to and integrate different information sources. We give a concrete example of the use of Web services technologies: the Onto Fusion project.

Results:
Web services provide new biomedical informatics (BMI) approaches related to genomic medicine. Customized workflowswill aid research tasks by linking heterogeneous Web services. Two significant examples of these European Commission-funded efforts are the INFOBIOMED Network of Excellence and the Advancing Clinico-Genomic Trials on Cancer (ACGT) integrated project.

Conclusions:
Supplying medical researchers and practitioners with omicsdata and biologists with clinical datasets can help to develop genomic medicine. BMI is contributing by providing the informatics methods and technological infrastructure needed for these collaborative efforts.
The Camden Schizophrenia Surveys III: Five-Year Outcome of a Sample of Individuals From a Prevalence Survey and the Importance of Social Relationships
Authors: Harvey Carol A. , Jeffreys Siobhan E. , McNaught Alan S. , Blizard Robert A. , King Michael B.
Published: July 2007

Background: Most studies of outcome in schizophrenia have focused on incidence cohorts or samples identified through specialist mental health services; population-based samples provide a more complete picture of the effectiveness of community services.

Aims: To examine whether outcome predictors, derived from studies of selected patients with prolonged schizophrenia, would emerge in a largely community-dwelling population sample.

Methods: A follow-up sample of 114 adults with schizophrenia was identified via two censuses of key informants conducted for two prevalence surveys in North London, five years apart. Symptomatic, clinical and functional outcomes were assessed after five years. A composite score was derived for each individual. Multiple Linear Regression analyses were conducted in two phases to derive a best subset of predictors for global outcome.

Results: After five years, 33% were worse and 62% were better overall. The four best predictors (social isolation, living apart from relatives, longer illness and being an inpatient at first census) accounted for 32% of the variance in outcome of those with schizophrenia and related diagnoses.

Conclusions: Social relationships during the course of illness are an important predictor of overall outcome and relationships with friends and family each seem to make a positive contribution. Policy and service developments should focus on improving participation in community life for people with schizophrenia, particularly their social connectedness.
Burnout and Job Satisfaction in New Zealand Psychiatrists: a National Study
Authors: Kumar Shailesh , Fischer Jesse , Robinson Elizabeth , Hatcher Simon , Bhagat R.N.
Published: July 2007

Objectives: To estimate the prevalence of burnout and the level of job satisfaction among New Zealand psychiatrists, and to ascertain relationships between socio-demographic variables, job satisfaction and burnout in the target population.

Method: In phase one of the study a postal survey was mailed out to every practising psychiatrist on record as well as all doctors working in psychiatry without specialist qualifications (MOSS). Three questionnaires were used: a socio-demographic questionnaire, the Maslach Burnout Inventory (MBI) and a Job Diagnostic Survey (JSS). Regression analysis was performed on returned data sets using socio-demographic characteristics as explanatory variables and score components of the MBI and JDS as the outcome measures.

Results: The results showed that the prevalence of burnout in New Zealand psychiatrists is cause for concern. Two-thirds of all psychiatrists described moderate to severely high levels of emotional exhaustion, with a similar proportion describing low levels of personal accomplishment. Depersonalisation did not appear to be a major problem in the population. Job satisfaction remained relatively high despite the high prevalence of burnout, although there was a relationship between burnout and job satisfaction scores.

Conclusions: This study has demonstrated a high prevalence of burnout and factors associated with it among New Zealand psychiatrists. Further research is needed to ascertain why job satisfaction remains high in the presence of burnout, and factors predisposing to, or protective of, burnout.
The Needs of Parents with a Mental Illness Who Have Young Children: an Australian Perspective On Service Delivery Options
Authors: Alakus Carmel , Conwell Rebecca , Gilbert Monica , Buist Anne , Castle David
Published: July 2007

Background and aims: This article discusses a collaborative approach to assisting parents with a mental illness who have children aged 5 years and under and explores themes found in the literature, focus groups with consumers and workshops with clinicians working with parents who have a mental illness.

Method: Focus groups and workshops were held for consumers and clinicians. The workshops included information about a proposed group intervention and discussions about themes found in the literature review and previous focus groups.

Results: Using thematic analysis, the gaps identified in the focus groups and workshops were classified into five main categories — namely, interagency collaboration, a need for accessible support groups, a need for information and resources about mental illness, and parenting issues related to mental illness and independence. This information informed the development of a treatment package.

Conclusion: The content of the proposed treatment package has been informed by the findings of the literature review, focus groups and workshops. The sessions focus on topics about parenting and managing mental health and consumers are actively involved at the outset in their own care and the care of their child. The intervention will be trailed in clinical settings to establish efficacy and effectiveness.
Analyzing Vocational Outcomes of Individuals With Psychiatric Disabilities Who Received State Vocational Rehabilitation Services: a Data Mining Approach
Authors: Rosenthal David A. , Dalton Jacquelyn A. , Gervey Robert
Published: July 2007

This study examines factors affecting vocational outcomes in the vocational rehabilitation process for individuals experiencing psychiatric disabilities who had received state vocational rehabilitation (VR) services. A data mining approach was used to analyze the Rehabilitation Services Administration FY 2001 Case Service Report (RSA-911). Receiving job placement services was found to be the most important variable differentiating individuals who were working from those who were not working. Results regarding vocational outcomes suggest a positive effect for persons receiving job placement services.
Attachment Representations in 6-Year-Old Children from One and Two Parent Families in Germany
Authors: Gloger-Tippelt Gabriele , König Lilith
Published: July 2007

Viewed from the perspective of attachment theory, coping with the separation and divorce of parents requires that children reorganize their mental model of attachment. Secure attachment models may be disrupted, while insecure attachment models may be strengthened. According to findings from research on divorce, this process of family reorganization takes about two years. Attachment representations in middle childhood can be assessed by new methods that rely on the symbolic medium of story completion in doll play. Based on five coded attachment story narratives, the Attachment Story Completion Task (ASCT) by Bretherton and Ridgeway, and the German Coding and Classification System by Gloger-Tippelt and König, permits the assessment of secure, avoidant, ambivalent and disorganized attachment representations reliably, and to rate attachment security on a four-point-scale. In this study we compare the attachment representations in ASCT of 51 children from two parent families with 60 six-year-old children from one parent, all mother families who experienced separation/divorce, and were still in the phase of family reconstruction. The children of single mothers demonstrated fewer secure and more insecure attachment representations, in particular more avoidant ones. Moreover, in the children from one parent, but not from two parent families a significant gender effect emerged. Results have been discussed considering further risk factors in the one parent families and possible influences of children's attachment representations in the school setting.
Relationships Between Teachers and Urban African American Children
Authors: Rey Rick B. , Smith Ami L. , Yoon Jina , Somers Cheryl , Barnett Douglas
Published: July 2007

The purpose of this study was to examine students' and teachers' perceptions of their relationship. Eighty-nine African American children in Grades 3 through 6 and their teachers independently rated the quality of the teacher—child relationship and completed a range of questionnaires regarding the children's school-related adjustment. Teacher and child reports on the quality of the relationship were correlated significantly ( r = 0.33, p < 0.01). Positive teacher—child relationships, as reported by children, predicted several school outcome variables above and beyond teacher ratings of the relationship. Specifically, they predicted better classroom rule compliance, more interest in school, more feelings of connectedness towards school and more involvement in school-related activities. Generally teachers' perceptions of the relationships were best at predicting teacher rated outcomes and children's perceptions of the relationships were best at predicting children's rated outcomes, highlighting the importance of considering both children's and teachers' points of view as well as the likely contributions of shared method and informant variances. Findings suggest that teacher efforts to improve their sensitivity to child needs and supportiveness of students can have a broader influence on children's overall school functioning. This study also calls for the development of intervention studies to enhance the quality of teacher—child relationships and better examine the direction of the effects suggested by this study.
New Practice Creation: An Institutional Perspective on Innovation
Authors: Lounsbury Michael , Crumley Ellen T.
Published: July 2007

Neoinstitutionalists have developed a rich array of theoretical and empirical insights about how new practices become established via legitimacy and diffusion, but have paid scant attention to their origins. This blind spot has been reinforced by recent work on institutional entrepreneurship which has too often celebrated the actions of a single or small number of actors, and deflected attention away from the emergent, multilevel nature of how new kinds of activities emerge and provide a foundation for the creation of a new practice. In this paper, we examine the case of the creation of active money management practice in the US mutual fund industry, drawing on both institutional and practice scholarship, to develop a process model of new practice creation that redirects attention toward the multiplicity of actors that interactively produce change.
A Dark Side of Institutional Entrepreneurship: Soccer Balls, Child Labour and Postcolonial Impoverishment
Authors: Khan Farzad R. , Munir Kamal A. , Willmott Hugh
Published: July 2007

Institutional entrepreneurship is typically portrayed in a positive light in the institutional theory literature, frequently symbolizing ideals of progress and innovation. In this paper, we explore a `darker' side of institutional entrepreneurship by considering how the long-standing institutional practice of child labour was eliminated from the world's largest soccer ball manufacturing cluster in Sialkot, Pakistan. Our focus is upon the operation of power rather than the agency of the coalition of entrepreneurs. We show how power operated hegemonically in solving and reporting the issue of child labour in a way that deflected attention from `darker' problematic aspects of this seemingly progressive and benign institutional reform. Consideration of these dynamics presents a challenge to conventional representations of institutional entrepreneurship and suggests the relevance of developing a more critical perspective when studying instances of institutional work.
Charles Taylor's `imaginary' and `best account' in Latin America
Authors: Morello Gustavo
Published: July 2007

Imaginary is, in Taylor's thought, a category of understanding social praxis and the reasons people give to make sense of these practices. The ultimate reason is the hypergood, which influences the strong decisions. Those strong evaluations outline the moral framework from which people address their own lives and the lives of others. We only recognize our cultural framework as an `imaginary' — challenging the supposition it is something `objective' — when others make their apparition in our lives. After the encounter nobody remains the same; something in our imaginary has changed. The outcome of this process is the `best account' we have to make sense of our life. If we accept the category of `imaginary' and the process of `best account' as accurate enough to address Latin American reality, the problem we have to solve is how we can find out a Latin American social imaginary.
Pulse wave analysis to assess systemic blood flow during mechanical biventricular support
Authors: Scolletta Sabino , Gregoric Igor D , Muzzi Luigi , Radovancevic Branislav , Frazier O Howard
Published: July 2007

Measurement of systemic blood flow is of crucial importance in patients on mechanical circulatory support (MCS). We reported the case of a 65-year-old female patient in severe cardiogenic shock undergoing left (Jarvik 2000 axial flow pump) and right (Levitronix-Centrimag centrifugal pump) ventricular assist device implant. Evaluation of blood flow was obtained by ultrasonic flowmetry, continuous thermodilution technique, and pressure recording analytical method (PRAM). This pulse contour system allows beat-by-beat systemic blood flow assessment from the analysis of radial artery pressure waveform. At a Jarvik pump speed ≤ 10 000 rotations per minutes (rpm), thermodilution and PRAM showed similar blood flow values. At a Jarvik pump speed ≥11 000 rpm, the aortic valve did not open and PRAM did not provide blood flow values due to nonpulsatile blood flow. The present paper describes the first experience with PRAM in a single patient on MCS. Further studies are required to assess the validity of PRAM as an additional monitoring system in the setting of ventricular assist device support. Perfusion (2007) 22, 63-66.
Successful use of bivalirudin for cardiopulmonary bypass in a patient with heparin allergy
Authors: Pappalardo F. , Franco A. , Crescenzi G G. , Poli A. , Zangrillo A. , Koster A.
Published: July 2007

Heparin-induced IgE-mediated hypersensitivity and anaphylactoid reactions, although rare, can pose a serious clinical problem for patients requiring cardiopulmonary bypass (CPB). Bivalirudin is a bivalent reversible direct thrombin inhibitor, with a half-life of 25 min, eliminated mostly by proteolytic cleavage. There are some reports on the use of bivalirudin for cardiac surgery, particularly for heparin-induced thrombocytopenia (HIT), but none on cases of heparin allergy. We report a case of heparin allergy successfully managed for CPB with bivalirudin anticoagulation. Perfusion (2007) 22, 67-69.
Quality assessment of platelet rich plasma during anti-platelet therapy
Authors: Smith Chad W , Binford Robert S , Holt David W , Webb David P
Published: July 2007

Platelet rich plasma (PRP) is being used with increased frequency in many surgical procedures for its known benefits of accelerated surgical wound site healing. Speculations in its efficacy in the presence of anti-platelet therapy have been proposed. To aid in defining a quality platelet rich plasma product in the presence of acetylsalicylic acid (ASA) and Plavix (clopidogrel bisulfate), we investigated three (3) groups (n=18) of cardiac surgical patients receiving PRP. Platelet function test, platelet concentration, and quantification of growth factors (PDGF-bb and TGF-b1) were evaluated. Results showed no statistical evidence of decreased growth factors delivered to the surgical wound site in the presence of acetylsalicylic acid (ASA) and/or Plavix (clopidogrel bisulfate). Evidence in this pilot study supports the use of PRP for patients receiving Plavix and aspirin therapy without compromising the quantity of specific growth factors delivered to a wound site. Perfusion (2007) 22, 41—50.
Investigation of factors relating to neuropsychological change following cardiac surgery
Authors: Raymond Paul D , Radel Michael , Ray Michael J , Hinton-Bayre Anton D , Marsh Neville A
Published: July 2007

Background. An analysis of neuropsychological impairment following cardiopulmonary bypass was performed in 55 patients undergoing elective coronary artery bypass grafting. Methods. Neurocognitive function was measured preoperatively using the MicroCog: Assessment of Cognitive Functioning computer-based testing tool. Testing was repeated in the postoperative period immediately prior to discharge from hospital. Analysis of significant score decline was performed using the standardised regression-based technique. A patient was classified as overall impaired when ≥20% of test scores were significantly impaired. The proposed marker of neurological damage S-100β was also used. Prothrombin Fragment 1+2 (F1+2) was measured as a marker of thrombin development to test the hypothesis that excessive haemostatic activation may lead to thromboembolic damage to the brain. Results and Conclusions. 32.7% of patients were classified as significantly impaired. No relationship was detected between F1+2 and any neuropsychological test score; however, the study was limited due to small sample size. F1+2 levels were higher in patients undergoing prolonged bypass times. Neuropsychological decline was significantly correlated with patient age, suggesting a degree of caution is warranted when operating on an elderly cohort. An unexpected relationship was detected between higher heparin concentrations and increased risk of neuropsychological impairment; however, this requires re-evaluation. Perfusion (2007) 22, 27—33.
Gender Differences in Health among Older Singaporeans
Authors: Chan Angelique , Jatrana Santosh
Published: July 2007

This article examines gender differences in health status among older adults in Singapore using three measures of health status: self-reported health, the presence of chronic illness and functional disability. Most previous studies focus exclusively on women below retirement age, and are typically based on western data. Women report a higher prevalence of chronic conditions and disabilities compared to men, and assess their health more negatively than men. Less is known about gender differentials in health status among older adults in Asia. Results from multivariate logistic regressions show a significant reduction in gender differences in subjective health status when demographic and socioeconomic characteristics, health risk behaviours and social support variables are controlled for in the models. Gender differences remain, however, in the probability of reporting a chronic illness and functional disability. The policy implications of these findings are discussed, including the negative effects of marriage on older women's health.
Cosmopolitan and Established Resources of Power in the Education Arena
Authors: Weenink Don
Published: July 2007

The main question in this article is whether new cosmopolitan forms of power, on the one hand, and established forms of power, on the other hand, may lead households to make different educational choices for their children. Two types of Dutch secondary education are compared: internationalized education in which English and Dutch are the languages of instruction versus traditional elite schools, the classical gymnasiums. It is claimed that the coexistence of both school types goes together with a diverging process of social reproduction between an upwardly cosmopolitan fraction and an established fraction of the Dutch upper middle class.
Femoroacetabular Impingement in Professional Ice Hockey Players
Authors: Bizzini Mario , Notzli Hubert P. , Maffiuletti Nicola A.
Published: July 2007

Background

Femoroacetabular impingement of the hip joint has been identified as a major cause for hip pain in athletes. Surgical open decompression of the hip has historically been proposed as the first treatment of choice. Functional outcomes in athletes after this procedure are unknown.

Purpose

To describe the functional and sport-related outcome 2 years after open surgical hip decompression in a group of young professional ice hockey players suffering from cam femoroacetabular impingement.

Study Design

Case series; Level of evidence, 4.

Methods

Five young professional ice hockey players (mean age, 21.4 y at follow-up) who suffered from cam femoroacetabular impingement were treated with open surgical decompression of the hip. The operation was performed by the same surgeon, and all athletes followed the same rehabilitation guidelines. Mean follow-up time was 2.7 years. Outcome measures were recorded as time to regain symmetrical hip rotation, regain preoperative core/hip muscle strength, return to team practice, and play at competitive level.

Results

Hip rotation range of motion was regained by a mean 10.3 weeks. Core and hip strength values reached preoperative levels by a mean 7.8 months. Return to unrestricted team practice with the ice hockey team was achieved by a mean 6.7 months, and athletes were able to play their first competitive game after a mean 9.6 months. Three athletes were able to perform again at the highest level and in international competitions. Two athletes had to return to minor league ice hockey.

Conclusion

Return to high-level ice hockey after open surgical decompression of the hip was possible in this series of 5 consecutive cases.
Reliability, Precision, Accuracy, and Validity of Posterior Shoulder Tightness Assessment in Overhead Athletes
Authors: Myers Joseph B. , Oyama Sakiko , Wassinger Craig A. , Ricci Robert D. , Abt John P. , Conley Kevin M. , Lephart Scott M.
Published: July 2007

Background

Posterior shoulder tightness with subsequent loss of humeral internal rotation range of motion has been linked to upper extremity lesions in overhead athletes. A valid clinical assessment is necessary to accurately identify posterior shoulder tightness as a contributor to injury.

Purpose

To describe a modified supine assessment of posterior shoulder tightness by establishing the reliability, precision, clinical accuracy, and validity of the assessment.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

Intrasession, intersession, and intertester reliability and precision were established by comparing the commonly used side-lying assessment of posterior shoulder tightness and the described modified supine assessment. Clinical accuracy of both methods was obtained using an electromagnetic tracking device to track humeral and scapular motion. Construct validity was established by identifying posterior shoulder tightness in a group of overhead athletes (baseball pitchers and tennis players) reported in the literature to have limited humeral internal rotation and posterior shoulder tightness.

Results

The side-lying intrasession intraclass correlation coeffecient (standard error of measurement), intersession intraclass correlation coeffecient (standard error of measurement), and intertester intraclass correlation coeffecient (standard error of measurement) were 0.83 cm (0.9), 0.42 cm (1.7), and 0.69 cm (1.4), respectively. The supine intrasession intraclass correlation coeffecient (standard error of measurement), intersession intraclass correlation coeffecient (standard error of measurement), and intertester intraclass correlation coeffecient (standard error of measurement) were 0.91° (1.1°), 0.75° (1.8°), and 0.94° (1.8°), respectively. In side-lying, the clinical accuracy expected was 0.9 ± 0.6 cm of error while, when measured supine, it was 3.5° ± 2.8° of error. Both assessments resulted in minimal scapular protraction (~3.5°). Between groups, baseball pitchers and tennis players had significantly less internal rotation range of motion (P < .0001) and greater posterior shoulder tightness (P = .004) when measured in supine, but not in side-lying (P = .312).

Conclusion

Both methods resulted in good clinician accuracy and precision, suggesting that both can be performed accurately. The supine method can be assessed more reliably than side-lying between both sessions and testers.

Clinical Relevance

Clinicians may want to consider use of the supine method given the higher reliability, validity, and similar precision and clinical accuracy.
Cryptotephra sedimentation processes within two lacustrine sequences from west central Sweden
Authors: Davies Siwan M. , Elmquist Marie , Bergman Jonas , Wohlfarth Barbara , Hammarlund Dan
Published: July 2007

Distal tephra horizons, particularly within lacustrine sequences, are increasingly being used as time-synchronous marker horizons within palaeoclimatic and palaeoenvironmental investigations. As sedimentary features marking the presence of these so-called cryptotephras are absent to the naked eye, it is of some importance that the stratigraphic position representing primary airfall, and likewise the timing of the volcanic event, is accurately and consistently recorded amongst these deposits. Often tephra shards from a cryptotephra deposit can be found spanning several centimetres of sediments within lacustrine and peat sequences. Very few studies, however, have looked in detail at the sedimentation and vertical distribution of cryptotephra deposits within such sequences and, more importantly, the criteria for defining the correct stratigraphic position of the volcanic event. Two sediment cores from Lake Spåime and Lake Getvaltjärnen, west central Sweden are employed to investigate in detail the vertical distribution of the tephra shards derived from the AD 1875 eruption of the Askja volcano in Iceland. Detailed geochemical analysis of shards from both records indicate that products of the Askja eruption are present for at least 120 years and thus emphasize the importance of carefully identifying the correct horizon that marks the timing of the volcanic event rather than shards resulting from a period of reworking or downward migration. Both sites yield contrasting shard concentration profiles and thus raise a number of questions regarding the influence of site-specific processes on cryptotephra sedimentation, particularly the role of snow-beds acting as tephra traps, the possibility of reworking, and downward migration of shards in soft sediment. A second tephra is also identified at Lake Getvaltjärnen and is believed to originate from the AD 1477 Veidivötn eruption and represents the first occurrence of this tephra outside of Iceland.
Reconstruction of Holocene lake-level changes in Lake Xinias, central Greece
Authors: Digerfeldt G. , Sandgren P. , Olsson S.
Published: July 2007

A study of past lake-level changes in Lake Xinias covering the last 40 000 years was presented in an earlier paper. In that paper, changes during the Holocene were only briefly dealt with, because of poor sedimentary representation. In this paper a supplementary transect of cores is described, in which Holocene lake-level changes are better recorded. The correlation of the cores was based on pollen and lithostratigraphic analyses, and a curve was constructed showing recorded lake-level changes. The curve from Lake Xinias was compared with an earlier compilation of lake-level changes from the Balkans, mainly from Greece. The compilation shows rising lake levels during the earlier part of the Holocene, and successively lowered levels during the later part. Most lake levels were high between about 8000 and 5500 cal. yr BP. The reconstruction from Lake Xinias indcates similar changes during the early and late Holocene. However, it differs by indicating a lowering in lake level, culminating around 7000 cal. yr BP, interrupting and dividing the period of mid-Holocene high lake-level stand. Further studies are required to show if this lowering in Lake Xinias was regionally representative and caused by climate change, or was caused by tectonic disturbance locally affecting lake level.
Characterizing carbon isotopic variability in Sphagnum
Authors: Loader N.J. , McCarroll D. , van der Knaap W.O. , Robertson I. , Gagen M.
Published: July 2007

To understand more fully the nature of isotopic fractionation in mosses and to explore the potential of stable isotope analyses of selected peat constituents for palaeoenvironmental research, we present results from a study of inter- and intra-plant δ13C variability in Sphagnum spp. Subdivisions of stem, pendant and horizontal branch elements of modern Sphagnum capillifolium plants revealed consistent and statistically significant differences in their isotopic composition. Sequential (downstem) analysis of a further cohort of four modern Sphagnum capillifolium plants also reveals evidence of common forcing on the isotopic composition of sequentially formed stem and branch increments. This relationship was tested further by analysis of a series of branch and stem samples manually recovered from Sphagnum fuscum preserved within a late Holocene (AD 2003—1970) peat monolith from a European mire. The high degree of isotopic coherence observed between plants supports the analysis of Sphagnum in palaeoecological investigations. However inter- and intra-plant variability between both branch and stem sections emphasize the need for representative sampling, replication and sample homogeneity when conducting palaeoecological studies.
Mind the gap: an absence of valley-fill deposits identifying the Holocene hypsithermal period of enhanced flow regime in southeastern Australia
Authors: Cohen T.J. , Nanson G.C.
Published: July 2007

The Holocene sedimentary record in southeastern Australia is present in a range of landscape settings, such as upland swamps (dells), internally drained lake basins, alluvial fans, and mid-catchment and lowland floodplains. An assessment of the best-constrained basal radiocarbon dates in valley-fill locations between 30 and 42°S and upstream of last-glacial eustatic influences yields an intriguing pattern. The record for fluvial sites with catchment areas > 30 km2 exhibits a distinct gap in the alluvial record between 8 and 4 ka BP (10—4.5 ka). In contrast, data for eleven upland-swamp sites with catchment areas < 50 km2 exhibit a broader spectrum of basal ages, albeit with some reduction of activity during the alluvial gap. We suggest that the period 8—4 ka BP in the sedimentary record at the fluvial sites reflects the early to mid-Holocene climatic optimum independently recognized in proxy climate data in the region. It was a period of enhanced water discharges, stable well-vegetated catchments and low sediment yields, and therefore greatly limited sediment sequestration, and it has been termed the Nambucca Phase. In upland swamps, however, threshold-driven processes produce an episodic landscape responses during much of the Holocene. Contrasting results in upland compared with middle and lower basin locations demonstrate the nonuniform landscape response to climatic changes during the Holocene in southeastern Australia.
Introducing Large-Scale Educational Reform in a Complex Environment: The Role of Piloting and Evaluation in Modernizing Medical Careers
Authors: Swanwick Tim
Published: July 2007

Medical education and training in the United Kingdom is undergoing profound change driven by a governmental policy that has attracted the title Modernizing Medical Careers.The role of piloting and evaluation in Modernizing Medical Careers is described and the article argues that, in addition to the previously described rational, cultural and control functions of evaluation, a significant function of evaluation and pilot programmes is to facilitate the implementation of change in a complex system. Once at the `edge of chaos', given minimal direction, complex systems will self-organize and policy and context can be allowed to co-evolve. Pilot programmes and their accompanying evaluation provide a powerful catalyst for that process to occur.
Evaluative Feedback as a Contribution to Learning between Groups of Professionals
Authors: Launsø Laila , Rieper Jonas , Rieper Olaf
Published: July 2007

This article is based on an exploratory research project on the treatment of patients with asthma and allergy.The aim of the project is to develop a model for bridge building (institutionalized cooperation) between medical doctors and alternative therapists.The model might be useful for developing cooperation among other kinds of professionals in areas of services other than health care.The assumption is that the professionals' understanding of disease includes a causal reasoning that legitimates specific treatment methods and specific `outcome optics'.The results, in the form of self-reported experience of learning among the professionals, are analysed on the basis of learning theory. The results indicate that differences in intervention models together with evaluative feedback from users'/recipients' assessments of the intervention can be used to stimulate learning in groups of professionals that hold very opposing views on the `right' treatment model.
Research Design for the Development and Evaluation of Complex Technologies
Authors: Cowley Sarah , Grocott Patricia
Published: July 2007

This article offers for wider discussion a description of the approach used in a situation where the gold standard of a randomized controlled trial (RCT) was not immediately feasible. It explains how the methods and research design of a developmental project known as `WRAP' (Woundcare Research for Appropriate Products) evolved, and discusses their implications for complex wound care evaluations.The project was guided by the UK Medical Research Council (MRC) framework for the development and evaluation of RCTs (MRC and Board, 2000). It is proposed that dressing performance in chronic wound care may best be evaluated by a focus on the first two phases of the framework, theorizing and modelling, to design interventions and measurement tools, before proceeding to the third phase, exploratory trials.When the data generated in such trials are deemed valid and reliable, using specified criteria, alternative forms of evaluation to the randomized controlled trial, such as post-market surveillance studies, can follow. It is also proposed that these adaptations of the MRC framework may apply to complex evaluations more generally.
Recalling Shared vs. Unshared Information Mentioned During Group Discussion: Toward Understanding Differential Repetition Rates
Authors: Larson James R. , Harmon Victoria M.
Published: July 2007

University students participated in structured four-person group discussions in which they described to the group, and heard other group members describe, information pertaining to a to-be-made decision. Beforehand, participants had read all of the information that they themselves described, but only half of the information that they heard others describe. It was predicted and found that, following discussion, participants (a) better remembered the information that they heard others describe if they had already read that information prior to discussion, and (b) remembered best of all the information that they themselves described during discussion. These results suggest that the often-found tendency of groups to repeat more of the shared than unshared information that gets mentioned during unconstrained group discussions may be due in part to differences that exist in group members' ability to recall already-mentioned shared vs. unshared information.
Self-Reference Effect and the Group-Reference Effect in the Recall of Shared and Unshared Information in Nominal Groups and Interacting Groups
Authors: Stewart Dennis D. , Stewart Cheryl B. , Walden Jason
Published: July 2007

We investigated how variables that have been studied at the individual level may apply at the group level. Specifically, we examined how the self-reference effect (SRE) and the group-reference effect (GRE) impacted total information recall by examining the difference between interacting groups and nominal groups. Additionally, we also examined how the SRE and GRE might impact upon the recall of shared and unshared information by comparing nominal and interacting groups. Results were supportive for the SRE affecting the total recall of information as well as the recall of shared and unshared information. However, the impact of the GRE on group recall was mixed. Theoretical and applied implications are considered.
Religious Group Identification and Inter-Religious Relations: A Study Among Turkish-Dutch Muslims
Authors: Verkuyten Maykel
Published: July 2007

Following social identity theory, this research examines the relationship between group identification and intergroup relations by focusing on religion. Religious as well as Dutch national group identification was examined among Turkish-Dutch Muslims. Identification was studied in relation to general affective ratings of multiple religious groups (Muslims, Christians, Hindustanis, Jews and non-believers) and the endorsement of Islamic group rights. The results show that Muslim identification was more like a nominal (high or `total' identification) than a continuous variable, and that many participants showed low identification with the national group. The affective ratings of religious out-groups were quite negative, particularly of the Jews and non-believers. Muslim identification was positively and strongly related to feelings toward the religious in-group and to the endorsement of Islamic group rights. National identification was positively related to feelings toward the religious out-groups, but only for `total' Muslim identifiers, supporting the mutual intergroup differentiation model. The findings are discussed in relation to social psychological thinking about group identification and the importance of religion for intergroup relations.