bluuebunny/crossref_metadata_2025 huggingface dataset:
Vibration analysis of a three-layer magnetorheological elastomer embedded sandwich beam with conductive skins using finite element method
Authors: Nayak Biswajit , Dwivedy Santosha K , Murthy KSRK
Published: June 2012

In this article, the free and forced vibration analyses of a three-layered magnetorheological elastomer embedded viscoelastic cored sandwich beam with conductive and non-conductive skins have been carried out using finite element method. The finite element method formulation is validated by conducting experiments for a viscoelastic cored sandwich cantilever beam. For an adaptive magnetorheological elastomer embedded viscoelastic cored sandwich beam, results have been compared with those obtained from analytical method. The natural frequencies and loss factors of the magnetorheological elastomer embedded viscoelastic cored sandwich beam have been determined for various system parameters. The forced vibration responses of the magnetorheological elastomer embedded sandwich beam are also evaluated under harmonic force excitations. The results suggest that the natural frequencies and transverse displacement response of the magnetorheological elastomer embedded sandwich beams are strongly influenced by the strength of the applied magnetic field, the location, the length of the magnetorheological elastomer patch and the magnetoelastic loads due to the conductive skins.
A train air brake force model: Locomotive automatic brake valve and brake pipe flow formulations
Authors: Specchia Stefano , Afshari Ali , Shabana Ahmed A , Caldwell Nelson
Published: June 2012

The goal of this study is to integrate an air brake model with efficient algorithms for train longitudinal force calculation that are based on trajectory coordinate formulations. The air brake model, developed in this investigation and presented in this paper and a companion paper, consists of the locomotive automatic brake valve, air brake pipe and car control unit (CCU). The proposed air brake force model accounts for the effect of the air flow in long train pipes as well as the effect of leakage and branch pipe flows. This model can be used to study the dynamic behavior of the air flow in the train pipe and its effect on the longitudinal train forces during brake application and release. The governing equations of the air pressure flow are developed using the general fluid continuity and momentum equations, simplified using the assumptions of one-dimensional isothermal flow. Using these assumptions, one obtains two coupled air velocity/pressure partial differential equations that depend on time and the longitudinal coordinate of the brake pipes. The partial differential equations are converted to a set of first-order ordinary differential equations using the finite element method. The resulting air brake ordinary differential equations are solved simultaneously with the train’s second-order non-linear dynamic differential equations of motion that are based on the trajectory coordinates. The train car non-linear dynamics is defined using a body track coordinate system that follows the car motion. The body track coordinate system translation and orientation are defined in terms of one parameter that describes the distance traveled by the car. The configuration of the car with respect to its track coordinate system is described using two translation coordinates and three Euler angles. The operation modes of the brake system considered in this investigation are the brake release mode and the brake application mode that includes service and emergency brakes. A detailed model of the locomotive automatic brake valve is presented in this investigation and used to define the inputs to the air brake pipe during the simulation. A simplified model of this valve is also proposed in order to reduce the computational time of the simulation. In a companion paper, the detailed CCU formulation is presented. The coupling between the air brake, locomotive automatic brake valve, CCUs and train equations is established and used in the companion paper in the simulation of the non-linear dynamics of long trains. The air brake formulations presented in the two companion papers are implemented in a computer code called Analysis of Train/Track Interaction Forces (ATTIF) which is developed for the analysis of longitudinal train forces.
Nonviolent communication: A dialogical retrieval of the ethic of authenticity
Authors: Nosek Marcianna
Published: June 2012

Charles Taylor called for a retrieval of the ethic of authenticity that has been distorted in modern notions of autonomy and self-fulfillment. Via exchanges with others who matter to us, he proposed that human identities develop through the use of rich language draped in shared horizons of significance. The fostering of these dialogical ties beyond purely instrumental purposes, along with the recognition of the human dignity in all, may avert the fallen ideal of authenticity. Nonviolent communication affords the skillful dialogue with others cradled in a shared sense of significance and supports the development of a meaningful identity—one that is formed through the realization of what exists beyond the self. The purpose of this article is to argue that nonviolent communication facilitates the retrieval of the ethic of authenticity. Narratives from nursing students’ journals on the use of nonviolent communication skills will be used to support the argument.
A nonlinear formulation of piezoelectric plates
Authors: Pasquali Michele , Gaudenzi Paolo
Published: June 2012

A nonlinear piezoelectric plate model capable of accurately expressing the direct and converse piezoelectric effects is presented. The developed semi-intrinsic theory is meant to encompass large strains, displacements, and rotations that can occur in the plate as a consequence of a complete coupling between the mechanical and the electrical fields. Based on the assumption that a linear dependence of the electric potential on the plate thickness is not adequate to represent the potential electric energy, a specific structure to the field of admissible displacement is taken into account. A nonlinear regression technique is successively developed to detect the nonlinear dependence of the obtained solutions on the through-the-thickness coordinate. Particular warping functions characterized by the use of an ad hoc polynomial expansion adopted to express their dependence on the plate thickness direction are here considered to describe the shear and the extensional deformability of the plate transverse fibers. Linear constitutive relations for a transversely isotropic continuum are considered. The governing equations of motions for the model are finally obtained.
Structural vibration control using a tunable hybrid shape memory material vibration absorber
Authors: Lee Chun-Ying , Chen Chien-Chang , Yang Tze-Hung , Lin Chih-Jer
Published: June 2012

Vibration absorber has been used as an effective tool in the vibration reduction of structure-suffered single-frequency excitation. However, for structures subjected to excitation with varying frequency, an absorber with actively tunable frequency capability may offer more powerful solution. In this study, an absorber that consisted of a spring element made of hybrid shape memory materials was proposed. A cantilevered beam fabricated by superelastic core and shape memory polymer sleeves was employed as the spring element of the absorber. By controlling the electric current through the superelastic core, and thereby the temperature of the shape memory polymer sleeves, the natural frequency of the absorber was tunable. The fabricated hybrid shape memory material absorber was capable of changing its natural frequency by more than 45%. Finally, vibration reduction of a cantilever structure subjected to different harmonic excitations was demonstrated using gain-scheduling control algorithm.
Temperature stability and fabrication of Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 fibers with Pt core
Authors: Luo Jun , Qiu Jinhao , Zhu Kongjun , Du Jianzhou , Ji Hongli , Pang Xuming
Published: June 2012

In order to improve the electrical properties of metal-core piezoelectric ceramic fibers at high temperature, Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 piezoelectric ceramics with high Curie temperature were selected. The Pb(Zn1/3Nb2/3) O3–Pb(Zr,Ti)O3 metal-core piezoelectric ceramic fibers were successfully fabricated by extrusion Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 powder around a platinum wire. The microstructure and electrical properties of Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 ceramics with different calcining and sintering temperatures were investigated. Compared with the previous metal-core piezoelectric ceramic fibers, the Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 fibers showed lower piezoelectric and dielectric properties ([Formula: see text], k31 = 0.253, and d31 = −120 pC N−1). However, the Curie temperature of Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 ceramics is about 295°C, much higher than that of 0.55Pb(Ni1/3Nb2/3)O3–0.45Pb(Zr0.3Ti0.7)O3 ceramics (110°C). The Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 fibers can be used at the highest temperature of 150°C, and the temperature stability of Pb(Zn1/3Nb2/3)O3–Pb(Zr,Ti)O3 fibers is much better than that of 0.55Pb(Ni1/3Nb2/3)O3–0.45Pb(Zr0.3Ti0.7)O3 fibers.
Performance, Emotion Work, and Transition
Authors: Fixsen Alison , Ridge Damien
Published: June 2012

Few researchers have explored the clinical experiences of complementary and alternative medical practitioners and students, including the emotion work they perform. In this article, using a constant comparison approach and a heuristic framework (a dramaturgical perspective), we analyze semistructured interviews with 9 undergraduate practitioners in training to examine challenges experienced when students first attend to patients. A feature of students’ learning about clinical work concerned performance in a public arena and associated demands placed on the inchoate practitioner. Preliminary patient consultations represented a dramatic rite of passage and initiation into a transitional phase in professional identity. Juggling the roles of student and practitioner within an observed consultation led to anticipatory anxiety, impression management strategies, and conflict with other individuals. Of the coping strategies, participants regarded sharing and feedback from peer groups as most effective in examining and resolving the challenges of becoming a practitioner.
Perception and Needs in Health Education Curriculum Among School Nurses as Health Teachers in Korea
Authors: Lee Gyu Young , Ham Ok Kyung
Published: June 2012

The study investigated perceived effectiveness and perceived barriers to health education curriculum targeting school nurses as health teachers in Korea. A total of 741 health teachers participated. The questionnaire included perceived effectiveness and perceived barriers to health education curriculum, future roles of health teachers, and needs for in-service training programs. The most frequently selected perceived barrier was a lack of personnel to serve in the health clinic when the nurse was teaching, although 60.9–61.7% wanted to continue both duties of health education and school health services. Perceived effectiveness of health education was positively associated with duration of teaching career ( p < .05). Elementary school health teachers had higher perceived effectiveness than those in middle and high schools, while those with bachelor’s degrees had lower perceived effectiveness than those with master’s degrees ( p < .05). In-service training and efforts to decrease the perceived barriers would help to offer effective health education.
Validating the Future Career Autobiography as a Measure of Narrative Change
Authors: Rehfuss Mark C. , Di Fabio Annamaria
Published: June 2012

This study examined the validity of the Future Career Autobiography (FCA; Rehfuss, 2009), a qualitative instrument designed to capture change or stability in individuals’ life and occupational narratives across time as a result of narrative career interventions. Italian female entrepreneurs ( N = 82) were randomly assigned into either an experimental group ( n = 40) that received career counseling consistent with the Life Design paradigm or a control group ( n = 42) that received no intervention. The results indicated a significant narrative movement or change in the post-FCAs of the experimental group, moving from general to more specific life and occupational themes, while the control group’s pre- and post-FCAs remained similar across the same time period. In addition, word count analysis revealed expanded narrative expression within the experimental group’s post-FCAs. Together, these findings support the validity of this qualitative instrument.
A two-dimensional problem of a mode I crack in a type III thermoelastic medium
Authors: Prasad Rajesh , Das Subir , Mukhopadhyay Santwana
Published: June 2012

The present work is concerned with resolving a dynamical problem of an infinite type III thermoelastic space weakened by a finite linear mode I crack. The material of the medium is considered to be homogeneous and isotropic. The boundary of the crack is subjected to a prescribed stress distribution and temperature. The thermoelasticity theory of type III developed by Green and Naghdi has been employed, and integral transforms have been used to obtain the solution to the problem. A system of four dual integral equations have been obtained, the solution of which is shown to be equivalent to the solution of a Fredholm’s integral equation of the first kind. These integral equations are solved numerically by the regularization method. The inversion of the Laplace transform is also carried out numerically, and numerical values of the displacement components, temperature and stresses in the physical domain are computed for copper material by considering particular cases. The results are presented graphically.
The role of the symmetry group in the non-uniqueness of a uniform reference. Case study: An isotropic solid body
Authors: Sfyris Dimitris
Published: June 2012

According to the theory of materially uniform but inhomogeneous bodies, when the symmetry group of a material is continuous it induces a non-uniqueness to the uniform reference. Therefore, it is possible, that by manipulating the symmetry group the inhomogeneity of the material – namely, the dislocations – may cancel out. A solid mathematical framework is constructed in order to describe this situation using the language of exterior calculus. We set down a system of exterior differential equations which when solved render the totality of the uniform references that may be healed by a given symmetry group. From a mathematical point of view these equations have the form of Cartan’s equations of structure. We present the generic set of solutions of these equations and then specialize to the particular case of an isotropic solid body.
Anxiety in Young People With ADHD
Authors: Tsang Tracey W. , Kohn Michael R. , Efron Daryl , Clarke Simon D. , Clark C. Richard , Lamb Christopher , Williams Leanne M.
Published: June 2012

Objective: (a) To determine the prevalence of comorbid anxiety disorder in ADHD, defined by diagnostic criteria and (b) to compare anxiety as reported by parents and participants with clinician assessment. Method: Children with ADHD were assessed for comorbid anxiety disorder using the Anxiety Disorder Interview Schedule for Children. Parent report (Conners’ Parent Rating Scale–Revised: Long version) and self-report (State-Trait Anxiety Inventory and Brain Resource Inventory for Screening Cases–Child version) scales were used to assess anxiety. The ADHD–Rating Scale IV was used to measure ADHD symptoms. Results: Of 134 participants (11.0 ± 2.6 years), 31.3% had comorbid anxiety disorder. Comorbid anxiety disorder was associated with greater severity of ADHD. Anxiety symptoms from parent reports ( p < .05) but not from child/self-report ( p > .05) correlated with clinician assessment. Conclusion: Assessment for comorbid anxiety disorder and inclusion of parent rating in this assessment are important components of ADHD treatment in children and adolescents.
Prepulse Inhibition of Acoustic Startle and the Influence of Methylphenidate in Children With ADHD
Authors: Schulz-Juergensen Sebastian , Thiemann Anja , Gebhardt Julia , Baumgarten-Walczak Alexander , Eggert Paul
Published: June 2012

Objective: ADHD is common among children with comorbidity of enuresis. Findings concerning prepulse inhibition (PPI) of startle reflexes are controversial. Although PPI is improved through desamino-arginine vasopressin (dDAVP) in enuresis, some patients also improve concomitant ADHD through dDAVP. This study aims to evaluate whether methylphenidate (MPH) also improves PPI in ADHD. Method: Nineteen ADHD patients were investigated in a prospective, double-blind, crossover study with MPH versus placebo. PPI was measured as a reduction of acoustic startle reflexes. Subgroups of gender, ADHD subtype, and baseline PPI were analyzed. Results: Median baseline PPI of ADHD patients (51.7%) was below the value of age-matched normal controls (73%, p = .090). MPH showed no improvement in the whole group, or the subgroups gender or subtype. Reduced baseline PPI was significantly improved (22.5%-39.3%, p = .039). Conclusion: Heterogeneity of ADHD is confirmed with a wide range of baseline PPI. The improvement of reduced baseline PPI through MPH suggests impaired sensorimotor gating in this subgroup.
Numerical and experimental research of bidirectional thrust bearings used in pump-turbines
Authors: Huang B , Wu ZD , Wu JL , Wang LQ
Published: June 2012

A three-dimensional thermo-elasto-hydro-dynamic model for bidirectional thrust bearings used in pump-turbines taking into account the temperature-viscosity effect as well as thermal-elastic deformations in the pad and runner surface was set up. The finite difference method was employed to solve the thermo-hydro-dynamic model, and the thermal-elastic deformations in the pad and runner were obtained by the finite element software ANSYS11.0. The data transfer between the thermo-hydro-dynamic model and ANSYS11.0 was carried out automatically by an interface program. Laboratory test was performed on the Harbin Electric Machinery 3000 ton thrust bearing test rig. A detailed comparison between the experimental results and numerical predictions showed quite good overall agreement on the oil film thickness, pressure and temperature, which provided an evidence of validation of the three-dimensional thermo-elasto-hydro-dynamic model coupled with finite difference method and finite element method developed in this article.
Cultural intimacy in International Relations
Authors: Subotic Jelena , Zarakol Ayşe
Published: June 2012

In anthropology, the concept of cultural intimacy expresses those aspects of a cultural identity that are considered a source of international criticism for the state, but are nevertheless used to provide insiders with a sense of national comfort, understanding, and self-reflexive, ontological security. Cultural intimacy helps illuminate how states present themselves internationally and how they understand themselves domestically. It can also explain the seeming discrepancies and contradictions between a state’s domestic and international identities. Cultural intimacy, in other words, explains the mutual reproduction of different levels of identity. Using the concept of cultural intimacy as a departure point, this article develops a framework for understanding incongruities in the domestic and international facades of state identity. We argue that there is a structural component to the level of discomfort caused by negative international appraisals of a given state. Structural position determines whether the domestic sources of cultural intimacy will cause shame, embarrassment, or guilt, and therefore also indicate how that negative international image will be handled by the state. The theoretical argument is illustrated with reference to the cases of Serbia, Croatia, and the Netherlands, and their distinctive responses to the Balkan conflict of the 1990s.
Preeclampsia and angiotensin converting enzyme (ACE) I/D and angiotensin II type-1 receptor (AT1R) A1166C polymorphisms: association with ACE I/D polymorphism
Authors: Rahimi Zohreh , Rahimi Ziba , Mozafari Hadi , Parsian Abbas
Published: June 2012

Background:

The aim of the present study was to investigate the association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) and angiotensin II type-1 receptor (AT1R) A1166C polymorphisms with the risk of preeclampsia and lipid peroxidation in preeclamptic women from Western Iran.

Methods:

One hundred and ninety-eight preeclamptic women (128 women with mild and 70 with severe forms) and 100 age- and parity-matched controls were enrolled in this case-control study.

Results:

The presence of D allele of ACE was associated with a 1.8-fold increased risk of preeclampsia ( p=0.002) in total preeclamptic patients. The frequency of AT1R AC+CC genotypes was higher in mild preeclamptic women (32%) compared to controls (27.2%) ( p>0.05). In mild preeclamptic women with ID genotype, the level of total antioxidant capacity (TAC) was significantly decreased compared to those with II genotype. Also, there was a trend toward increasing malondialdehyde (MDA) and decreasing TAC levels in mild and severe preeclamptic women with AT1R AA through CC genotypes.

Conclusions:

Our study indicates that lipid peroxidation and oxidative stress are involved in the development of preeclampsia that might be influenced by polymorphism in the renin-angiotensin-aldosterone system genes.
Identifying Patients With AAA With the Highest Risk Following Endovascular Repair
Authors: Cadili Ali , Turnbull Robert , Hervas-Malo Marilou , Ghosh Sunita , Chyczij Harold
Published: June 2012

Introduction: It has been demonstrated that endovascular repair of arterial disease results in reduced perioperative morbidity and mortality compared to open surgical repair. The rates of complications and need for reinterventions, however, have been found to be higher than that in open repair. The purpose of this study was to identify the predictors of endograft complications and mortality in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair; specifically, our aim was to identify a subset of patients with AAA whose risk of periprocedure mortality was so high that they should not be offered endovascular repair. Methods: We undertook a prospective review of patients with AAA receiving endovascular therapy at a single institution. Collected variables included age, gender, date of procedure, indication for procedure, size of aneurysm (where applicable), type of endograft used, presence of rupture, American Society of Anesthesiologists (ASA) class, major medical comorbidities, type of anesthesia (general, epidural, or local), length of intensive care unit (ICU) stay, and length of hospital stay. These factors were correlated with the study outcomes (overall mortality, graft complications, morbidity, and reintervention) using univariate and multivariate logistic regression. Results: A total of 199 patients underwent endovascular AAA repair during the study period. The ICU stay, again, was significantly correlated with the primary outcomes (death and graft complications). In addition, length of hospital stay greater than 3 days, also emerged as a statistically significant predictor of graft complications in this subgroup ( P = .024). Survival analysis for patients with AAA revealed that age over 85 years and ICU stay were predictive of decreased survival. Statistical analysis for other subgroups of patients (inflammatory AAA or dissection) was not performed due to the small numbers in these subgroups. Conclusions: Patients with AAA greater than 85 years of age are at a greater risk of mortality following endovascular repair. In addition, patients who are expected to require postprocedure ICU admission are also at an increased risk of mortality following endovascular repair.
Prevalence of Depressive and Other Central Nervous System Symptoms in HIV-Infected Patients Treated with HAART in Spain
Authors: Bayón Carmen , Ribera Esteban , Cabrero Esther , Griffa Laura , Burgos Ángel
Published: June 2012

This study was conducted to assess the prevalence of depressive symptoms, sleep disturbances, and subjective cognitive complaints in patients with HIV receiving highly active antiretroviral therapy. Participants completed the “Center for Epidemiological Studies Depression Scale” (CES-D) and a questionnaire on sleep disturbances and subjective cognitive complaints. Mean age of the 799 participants was 43.7 years and 67% were men. Adjusted prevalence of CES-D was 35.4% (95% confidence interval [CI]: 32.0-38.7), with no significant differences between gender and age groups. Sleep disturbances were more prevalent in older versus younger participants (74.0% [95% CI: 70.4-77.7] versus 63.3% [95% CI: 56.8-69.8]). Cognitive complaints were more prevalent in women (52.3% [95% CI: 46.4-58.2]) when compared with men (48.2% [95% CI: 44.7-51.6]). Hepatitis C virus coinfection was a strong predictor of depressive symptoms. Male gender and detectable viral load were independent risk factors for sleep disturbance. A higher CES-D score was an independent risk factor for sleep disturbance and cognitive complaints.
Ocular Complications of Cryptococcal Meningitis in Patients with HIV
Authors: Duggan Joan , Walls Heather M.
Published: June 2012

AIDS-related cryptococcal meningitis can result in significant vision loss, but the risk factors, prognostic features, and optimal management of patients with ocular complications is unknown. We present 2 cases of blindness associated with cryptococcal meningitis and review the literature for associated cases. Twenty-six additional cases of vision deterioration or loss as a result of HIV-associated cryptococcal meningitis were reviewed. Irreversible and complete loss of vision occurred in 14 patients (50%). Permanent vision loss was more likely to occur in patients with ocular symptoms and neurologic signs at presentation. Nearly all patients with permanent visual loss experienced blindness within the first week after hospital admission. Visual complications are not uncommon in cryptococcal meningitis, and once vision loss occurs, it is often irreversible regardless of control of infection or intracranial pressure. Visual complaints in cryptococcal meningitis should be considered a potentially poor prognostic sign.
Exploring the Efficacy of Constraint in Animal Models of Stroke
Authors: Janssen Heidi , Speare Sally , Spratt Neil J. , Sena Emily S. , Ada Louise , Hannan Anthony J. , McElduff Patrick , Bernhardt Julie
Published: June 2012

Background. Constraint-induced movement therapy (CIMT) is used to counteract learned nonuse observed following stroke in humans and has been shown to improve function. Variations of CIMT used in animal models of stroke have the potential to inform and improve our understanding of this intervention. Objective. To conduct a systematic review of studies investigating constraint in experimental stroke. The authors aimed to assess the quality and establish the efficacy of constraint on neurobehavior, cognitive function, infarct size, and stress and mortality and to determine the optimal dose or time to administration. Methods. Systematic review with meta-analysis was used. Data were analyzed using DerSimonian and Laird weighted-mean-difference random effects meta-analysis. Results. The quality scores of the 8 articles (15 studies) included were moderate (median 5/10; interquartile range, 4.8-6.0). There was a trend for animals with constraint to have worse neurobehavioral scores (−10% worse; 95% confidence interval [CI] = −20 to 0; P = .06). Infarct volumes were not significantly different between groups (−3% larger with constraint; 95% CI = −15 to 9; P = .63). Cognitive function was significantly better after constraint, although this estimate was based on only 28 animals from 2 studies. Insufficient data prevented analysis of the effect of constraint on stress and mortality. Conclusions. This meta-analysis showed no benefit of constraint on neurobehavioral scores, which is at odds with some human studies. Animal models may help us efficiently explore the biological basis of rehabilitation interventions; however, review of the data in this study raise uncertainty about its effectiveness in humans.
Athletes’ Perceptions Toward Substance Use in Baghdad City
Authors: Habeeb Mohammed Baqer , Kasim Wissam Jabbar , Khamees Leith Abbas , Hawi Mohammed Mukheilef , Khashoom Qais Nea’amah
Published: June 2012

The majority of men’s sports need high levels of strength and power. The effects of any given type of performance-enhancing substance are mostly directly related to its ergogenic effects (enhanced strength, higher energy production, and better recovery), anabolic potential (increased protein synthesis, especially in muscles), and/or stimulating properties (increased attention and loss of fear), which give a competitive advantage to athletes. A descriptive correlational study was conducted to identify bodybuilders’ and athletes’ perception toward substance use and to identify the relationship between substance use and those athletes’ sociodemographic characteristics of age, level of education, social status, and monthly income. A purposive “nonprobability” sample of 172 bodybuilding athletes were recruited from gym users of Baghdad city. The study found that two fifths of those who used anabolic-androgenic steroids (AAS) were 19 years old or younger, less than one half were overweight (body mass index = 25-29.9), two fifths of participants enjoyed exercise/training to an extreme level, two fifths of study participants highly perceived the improvement of athletic performance, two fifths of the study participants highly perceived the importance of improving athletic performance, less than half of the study participants used AAS, one quarter of the study participants who used AAS had been influenced by their coaches to use such substances, and more than one third of the study participants who used AAS were using such substances in the form of oral tablets and intramuscular injection together.
Supplement Use in the Prevention and Treatment of Cardiovascular Disease in the Aging Population
Authors: Reilly Ruth A. , Janson-Sand Colette
Published: June 2012

As the elderly population grows, so does the incidence of cardiovascular disease and the use of medications. Because of the side effects and cost of prescribed medicine, many aging individuals are seeking out alternative treatment options. Complementary and alternative medicine is gaining popularity, with about a third of people older than 60 years currently using one or more of these therapies. Many individuals are using herbs and nutritional supplements to prevent and treat a variety of cardiovascular diseases and their symptoms. Herbs and nutritional supplements are considered food by the Food and Drug Administration and are exempt from mandatory testing for their safety or efficacy. Also, many individuals consider these products as natural and do not recognize the negative impact that these alternative treatments may have on the efficacy of prescribed medications and overall health. To date, research has reported conflicting evidence as to the beneficial effects of these products; health care providers should exercise caution in recommending their use to avoid drug interactions and side effects.
Probiotics and Immune Response to Exercise
Authors: Pyne David B. , West Nicholas P. , Cripps Allan W.
Published: June 2012

Probiotics are live microorganisms present in several foods and nutritional supplements that may prevent or limit the effects of various illnesses and infections and elicit a range of health benefits in physically active individuals. The primary clinical areas of interest with probiotics include metabolism; gastrointestinal, inflammatory, and functional disorders; the respiratory system; and a range of infections and allergies. The gastrointestinal tract is a key element controlling and regulating adaptation to exercise and physical activity. Gut symptomatology such as nausea, bloating, cramping, pain, diarrhea, and bleeding occurs in some highly active individuals such as athletes, particularly in prolonged exhaustive events. A small number of studies examining probiotic supplementation in highly active individuals indicate modest clinical benefits in terms of reduced frequency, severity, and/or duration of respiratory and gastrointestinal illness. The purported mechanisms of action for probiotics include direct interaction with the gut microbiota, interaction with the gut epithelium and mucosal immune system, and via immune signaling to organs and systems including the liver, brain, and respiratory tract. Future research will identify additional biologically and clinically beneficial strains, validate multicomponent formulations, clarify dose–response issues, and inform the development of guidelines for clinicians, health care practitioners, and the general community.
Cross-cultural adaptation and validation of the Italian version of the patient-rated wrist/hand evaluation questionnaire
Authors: Fairplay T. , Atzei A. , Corradi M. , Luchetti R. , Cozzolino R. , Schoenhuber R.
Published: June 2012

An Italian version of the patient-rated wrist/hand evaluation (PRWHE) questionnaire was obtained through the standardized process of cross-cultural adaptation. The PRWHE-Italian (IT) was tested on 63 patients in order to evaluate comprehension, reliability and validity as correlated to the validated version of the disabilities of the arm shoulder and hand (DASH)-IT and SF-36. No patients had difficulty completing the PRWHE-IT questionnaire. Psychometric testing demonstrated high reliability (Cronbach’s alpha coefficient = 0.9607) and internal and external validity (Pearson correlation coefficient r = 0.927 with PRWHE, r < 0.810 with DASH and r < −0.476 with SF-36). The Italian version of the PRWHE has equivalent evaluation capacities to the original English version and is a reliable functional outcome measurement instrument for wrist and hand disorders.
Comparison of pain perceived when using pneumatic or silicone ring tourniquets for local anaesthetic procedures in the upper limb
Authors: Smith O. J. , Heasley R. , Eastwood G. , Royle S. G.
Published: June 2012

The aim of this study was to evaluate the level of pain felt when silicone ring and pneumatic tourniquets were applied to the upper arm and to determine which was more suitable for use in local anaesthetic procedures. Pain was measured using a visual analogue score pain scale on application and at 1, 5, and 10 minutes in 30 volunteers. Volunteers experienced significantly more pain on application and at 1 and 5 minutes with the silicone ring tourniquet. This difference in pain was most marked on application. Two volunteers could not tolerate application of the silicone ring tourniquet. We conclude that the silicone ring tourniquet would not be suitable for local anaesthetic procedures in the upper limb due to the severe pain experienced on application, which may reduce the patients’ confidence and adversely affect their experience of the procedure. The pneumatic tourniquet is more suitable for local procedures.
Acellular Fetal Bovine Dermal Matrix for Treatment of Chronic Ulcerations of the Midfoot Associated With Charcot Neuroarthropathy
Authors: Kavros Steven J.
Published: June 2012

Background. Gross deformity of the foot in Charcot neuroarthropathy can lead to collapse and subsequent ulceration, infection, amputation, or premature death. This study evaluated healing of midfoot ulcerations of Charcot neuroarthropathy using PriMatrix, a novel acellular fetal bovine dermal matrix. Methods. In this retrospective analysis, 20 patients with ulcerations of the midfoot associated with Charcot neuroarthropathy were treated with either PriMatrix in addition to standard wound care (PriMatrix group,n = 12) or standard wound care alone (control group, n = 8). All patients had chronic, nonhealing foot ulcerations of at least 2250 mm3 for a minimum of 30 days duration. All foot ulcerations were full thickness with subcutaneous involvement. Ankle brachial index ≥0.90 and/or transcutaneous oximetry (TcPo2) ≥40 mm Hg at the periulcer site was necessary for inclusion. Patients were excluded if they had acute or chronic osteomyelitis of the foot. Results. Demography, risk factors, baseline severity of Charcot neuroarthropathy, and wound volume (control 4078 mm3, PriMatrix 3737.5 mm3, P = nonsignificant) were similar between treatment groups. Mean time to healing in the PriMatrix group (116 days, 95% CI = 109-123) was significantly shorter than in the control group (180 days, 95% confidence interval [CI] = 171-188); P < .0001. A significantly faster rate of healing was observed with PriMatrix (87.9 mm3/wk, 95% CI = 115.2% to 60.6%) compared with control (59.0 mm3/wk, 95% CI = 72.8% to 45.3%); P < .0001). Conclusions. The significantly faster rate of healing and steeper slope of volume reduction in the PriMatrix group warrants further investigation into its effects on healing of neuropathic ulcerations and potential limb salvage.

Levels of Evidence: Therapeutic, Level IV
Clinical Efficacy of the Pan Metatarsal Head Resection as a Curative Procedure in Patients with Diabetes Mellitus and Neuropathic Forefoot Wounds
Authors: Armstrong David G. , Fiorito Joseph L. , Leykum Brian J. , Mills Joseph L.
Published: June 2012

Objective. To evaluate the safety and efficacy of the pan metatarsal head resection (PMHR) compared with nonsurgical management of wounds in the forefoot in people with diabetes. Methods. The authors evaluated 92 patients with diabetes (66.3% male), with ulcers classified as University of Texas grade 1A or 2A at the plantar aspect of the forefoot using a case-control model. Cases were patients treated with multiple metatarsal head resections for multiple metatarsal head wounds, and controls received standard nonsurgical care. Both groups received standard off-loading and wound care. Outcomes included time to healing, reulceration, infection, and amputation. Results. Patients in the surgery group (SG) healed significantly faster than those in the standard therapy group (ST; 84.2 ± 39.9 days for the ST vs 60.1 ± 27.9 days for the SG; P = .003) and had fewer recurrent ulcers (39.1% for the ST vs 15.2% for the SG; P = .02; odds ratio [OR] = 3.6; 95% confidence interval [CI] = 1.3-9.7) and infections during 1 year of follow-up (64.5% for the ST vs 35.5% for the SG; P = .047; OR = 2.4; 95% CI = 1.0-6.0). There was no significant difference in the proportion of patients receiving an incident amputation in the follow-up period (13.0% for the ST vs 6.5% for the SG; P = .5). Conclusion. The results of this study suggest that the PMHR may be associated with shorter times to healing and lower morbidity compared with standard care alone in patients without digital gangrene and with multiple plantar forefoot ulcers.

Levels of Evidence: Therapeutic Level III
Subcaptial Oblique Fifth Metatarsal Osteotomy Versus Distal Chevron Osteotomy for Correction of Bunionette Deformity
Authors: Cooper Minton Truitt , Coughlin Michael J.
Published: June 2012

The aim of this study was to compare a distal subcapital oblique fifth metatarsal with a distal chevron osteotomy for correction of bunionette deformity. Materials and methods. Twenty cadaveric feet were randomly assigned to undergo either a subcapital oblique or chevron osteotomy of the distal fifth metatarsal. Radiographic measurements, including 4–5 intermetatarsal angle (IMA), fifth metatarsophalangeal angle (5-MPA) and foot width, were compared between the 2 groups. Results. Foot width and 5-MPA was significantly decreased in both groups with no difference between the groups. The 4–5 IMA was not significantly altered in either group. Conclusion. Decrease in foot width and 5-MPA was similarly achieved with either distal chevron or subcapital oblique osteotomy of the fifth metatarsal in normal cadaveric specimens. No significant difference was found between the 2 techniques in any of the radiographic parameters measured.

Levels of Evidence: Cadaveric, Level V
Tenodesis Reconstruction for Chronic Ankle Instability
Authors: Meacham Benjamin P. , Granata Jaymes D. , Berlet Gregory C.
Published: June 2012

Lateral ankle ligament surgical reconstruction can take many forms, including anatomic and nonanatomic reconstructions. The nonanatomic reconstructions require the use of autograft or allograft tendons to recreate the vectors of the injured anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). The purpose of this study was to determine the minimum, maximum, and average graft length requirements for a modified Chrisman–Snook procedure. The structures at risk during drilling of the bone tunnels were documented to guide recommendations for tunnel placement. Modified Chrisman–Snook lateral ligament reconstructions were performed on 10 cadaveric below-the-knee specimens, with no known pathology. Transosseus tunnels were placed through and through the fibula, talus, and calcaneus at the origin and insertion sites of the ATFL and CFL. The minimum, maximum, and average graft length requirements were 91 mm, 170 mm, and 120.7 ± 23.84 mm, respectively. The overall average graft requirement was approximately 120 mm. The length of graft was correlated with the height of the patient. Medial structures that were directly encountered, in at least one specimen, with the transosseus tunnels included the tibial nerve, tibial artery and flexor hallucis longus tendon. The posterior tibial nerve was the structure at greatest risk. The length of the graft, when performing the modified Chrisman–Snook, should measure approximately 120 mm, but considerable variability exists depending on the size of the patient. To avoid injury to medial structures, the transosseus tunnels should be made using either a blind hole technique or guide wire to avoid perforating the medial cortex.

Levels of Evidence: Cadaveric, Level V
Muscle Impairments in Patients With Knee Osteoarthritis
Authors: Alnahdi Ali H. , Zeni Joseph A. , Snyder-Mackler Lynn
Published: June 2012

Context:

Muscle impairments associated with knee osteoarthritis (OA) are the primary underlying cause of functional limitations. Understanding the extent of muscle impairments, its relationship with physical function and disease progression, and the evidence behind exercise therapy that targets muscle impairments is crucial.

Evidence Acquisition:

An electronic search for relevant articles using MEDLINE and CINHAL databases up to September 2011 was performed. In addition to the electronic search, retrieved articles were searched manually for relevant studies.

Results:

Quadriceps, hamstrings, and hip muscles are significantly impaired in subjects with knee OA compared with age-matched controls. Muscle strength, especially quadriceps, is a major determinant of both performance-based and self-reported physical function. Whether stronger quadriceps is protective against knee OA onset and progression is not clear. Exercise therapy, including global and targeted resistance training, is effective in reducing pain and improving function in subjects with knee OA.

Conclusions:

Subjects with knee OA have significant muscle impairments. These muscle impairments affect physical function and should be targeted in therapy. Further research is needed to explore the relationship between quadriceps strength and knee OA initiation and progression and to determine the optimal exercise prescription that augments outcomes in this patient population.
Therapeutic Exercise for Athletes With Nonspecific Neck Pain
Authors: Durall Christopher J.
Published: June 2012

Context:

Benign neck pain is common in athletes and is usually the result of minor sprains, strains, or contusions. Athletes with neck pain may have deficits in cervical and/or upper thoracic mobility, muscle recruitment, strength and endurance, repositioning acuity, postural stability, and oculomotor control.

Evidence Acquisition:

A Medline search was performed via PubMed to locate articles of any publication date through December 2011 using the search terms cervical pain, neck pain, athlete, athletic, therapeutic exercise, and rehabilitation. Reference lists of retrieved articles were searched for additional relevant references.

Results:

Therapeutic exercise has promise as an intervention for individuals with neck pain, although reports on isolated athletic populations are lacking. To date, recommendations for specific therapeutic exercises have been derived largely from anecdotal or uncontrolled level IV or V evidence.

Conclusion:

Clinicians should consider deficits, functional limitations, irritability level, and the sport’s cervical spine stress profile when selecting exercises for athletes with neck pain.
A Segmental Approach to Imaging of Sports-Related Injuries of the Pediatric Elbow
Authors: Dwek Jerry R.
Published: June 2012

Context:

The imaging of pediatric sports injuries of the elbow requires an understanding of the interaction between biomechanical forces common in sports and the developing skeleton.

Evidence Acquisition:

A PubMed search was performed using the terms elbow, radiology, and sports with the search limited to children up to 18 years of age. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the changing nature of sports injuries about the pediatric elbow.

Results:

A clear progression of injuries about the elbow can be identified as the skeleton matures. Sports most commonly associated with injuries in the pediatric age group were baseball and gymnastics.

Conclusions:

Most pediatric sports injuries result from overhand throwing, especially in baseball or gymnastics. The manifestation of the injuries shifts as the physes progress toward closure.
Creative performance under pressure
Authors: Gutnick Darja , Walter Frank , Nijstad Bernard A. , De Dreu Carsten K. W.
Published: June 2012

Creativity is the cornerstone of organizational success in today’s economy. At the same time, employees face considerable work pressure, which might undermine their creativity. This article integrates theoretical perspectives from the stress and creativity literatures to develop a new model that conceptualizes the effects of work pressure on creative performance. Our model proposes a double-mediated process by which pressure triggers challenge and threat appraisals, which, in turn, influence creativity by shaping employees’ cognitive flexibility and/or persistence. Further, we theorize that available resources and employee commitment are important moderators. We illustrate our model with the potential effects of leadership on the association between pressure and creativity. Implications for further empirical and theoretical research are discussed.
Acetylsalicylic acid for primary prevention of cardiovascular diseases in older patients with diabetes: do the benefits overcome the risks?
Authors: Sirois Caroline , Couture Julie , Grégoire Jean-Pierre
Published: June 2012

Cardiovascular diseases (CVDs) represent a huge health burden for older patients with diabetes. Acetylsalicylic acid (ASA) has long been used as a cardioprotective agent in primary and secondary prevention of CVD. However, there are important issues regarding the benefits and risks of ASA therapy in primary prevention of CVDs, for the older group in general and for individuals of all ages with diabetes. In this review, we summarize the benefits and risks related to ASA therapy by outlining the evidence for older patients and for patients with diabetes. There appear to be significant gaps in knowledge. The balance of benefits and risks is not well defined but ASA treatment seems to be unfavorable in many older patients.