bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability-Based Dynamic Programming for E-Learning User Profile Assessment
Authors: Fazlollahtabar Hamed
Published: May 2012

Electronic learning (E-learning) has been adopted as a new learning tool overcoming time and place limitations. Although the success of e-learning architectures has been investigated by researchers, little work has been conducted to assess the success and/or effectiveness of E-learning systems. The on-line training environment enables users to undertake customized training at any time and any place. Moreover, information technology allows the users to be decoupled in terms of time, place, and space. Here, the author proposes an assessment procedure applying a dynamic programming approach to model the problem of optimal path in the user profile and using reliability to measure the inter connections among users in an e-learning network. A dynamic program is used to find the optimal path for the user in the E-learning environment. The validity and effectiveness of the proposed model are illustrated by an example.
Arthroscopic and Low-Field MRI (0.25 T) Evaluation of Meniscus and Ligaments of Painful Knee
Authors: Lokannavar Harish S , Yang Xiaochun , Guduru Harsha
Published: May 2012

Objective:

Magnetic resonance imaging (MRI) is an accurate, non-invasive, cost-effective technique for examination of the soft tissue and osseous structures of the knee. The purpose of this study was to evaluate the accuracy of low-field MRI by comparing the results with subsequent arthroscopy.

Materials and Methods:

MR imaging study of 146 patients was done using 0.25 T ESTOATE G-SCAN and the sequence used were SE, FSE and GRE in all the three planes. The comparison was based on five parameters: accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.

Result:

Our study showed high accuracy (98.08%) and negative predictive value (98.62%) for MRI in comparison with arthroscopy.

Conclusion:

Low-field MRI alleviates the need of arthroscopy for detection of meniscus tears and ligament tears.
CT Manifestations of Osler-Weber-Rendu Syndrome in Liver: Report of Three Cases
Authors: Chuan-Qiang Qu , Shou-Gang Guo , Yan He , Yu-Xin Chen
Published: May 2012

Osler-Weber-Rendu syndrome is characterized by widespread telangiectasias. Its clinical manifestations depend on position and scope of the abnormal vessels. The clinical and CT data of 3 patients with Osler-Weber-Rendu syndrome were retrospectively analyzed. CT features reviewed include the change of volume and configuration of liver, presence of tortuous and irregular vessels, opacified vessel mass, arteriovenous shunt, and splenomegaly. CT is helpful for diagnosis, treatment, and follow-up of Osler-Weber-Rendu syndrome.
A New Approach to Implement Sigma Coordinate in a Numerical Model
Authors: Li Yiyuan , Wang Donghai , Wang Bin
Published: May 2012

This study shows a new way to implement terrain-following σ-coordinate in a numerical model, which does not lead to the well-known “pressure gradient force (PGF)” problem. First, the causes of the PGF problem are analyzed with existing methods that are categorized into two different types based on the causes. Then, the new method that bypasses the PGF problem all together is proposed. By comparing these three methods and analyzing the expression of the scalar gradient in a curvilinear coordinate system, this study finds out that only when using the covariant scalar equations of σ-coordinate will the PGF computational form have one term in each momentum component equation, thereby avoiding the PGF problem completely. A convenient way of implementing the covariant scalar equations of σ-coordinate in a numerical atmospheric model is illustrated, which is to set corresponding parameters in the scalar equations of the Cartesian coordinate. Finally, two idealized experiments manifest that the PGF calculated with the new method is more accurate than using the classic one. This method can be used for oceanic models as well, and needs to be tested in both the atmospheric and oceanic models.
Numerical Simulation of a Weakly Nonlinear Model for Internal Waves
Authors: Canning Gregory Robyn , Nicholls David P.
Published: May 2012

Internal waves arise in a wide array of oceanographic problems of both theoretical and engineering interest. In this contribution we present a new model, valid in the weakly nonlinear regime, for the propagation of disturbances along the interface between two ideal fluid layers of infinite extent and different densities. Additionally, we present a novel high-order/spectral algorithm for its accurate and stable simulation. Numerical validation results and simulations of wave-packet evolution are provided.
A Compressed Sensing Approach for Partial Differential Equations with Random Input Data
Authors: Mathelin L. , Gallivan K. A.
Published: May 2012

In this paper, a novel approach for quantifying the parametric uncertainty associated with a stochastic problem output is presented. As with Monte-Carlo and stochastic collocation methods, only point-wise evaluations of the stochastic output response surface are required allowing the use of legacy deterministic codes and precluding the need for any dedicated stochastic code to solve the uncertain problem of interest. The new approach differs from these standard methods in that it is based on ideas directly linked to the recently developed compressed sensing theory. The technique allows the retrieval of the modes that contribute most significantly to the approximation of the solution using a minimal amount of information. The generation of this information,viamany solver calls, is almost always the bottle-neck of an uncertainty quantification procedure. If the stochastic model output has a reasonably compressible representation in the retained approximation basis, the proposed method makes the best use of the available information and retrieves the dominant modes. Uncertainty quantification of the solution of both a 2-D and 8-D stochastic Shallow Water problem is used to demonstrate the significant performance improvement of the new method, requiring up to several orders of magnitude fewer solver calls than the usual sparse grid-based Polynomial Chaos (Smolyak scheme) to achieve comparable approximation accuracy.
Model evaluation of marine primary organic aerosol emission schemes
Authors: Gantt B. , Johnson M. S. , Meskhidze N. , Sciare J. , Ovadnevaite J. , Ceburnis D. , O'Dowd C. D.
Published: May 2012

Abstract. In this study, five different marine primary organic aerosol (POA) emission schemes have been evaluated using the GEOS-Chem chemical transport model in order to provide guidance for their implementation in air quality and climate models. These emission schemes, categorized in two groups based on varying dependences of chlorophyll a concentration ([chl a]) and 10 m wind speed (U10), have large differences in their magnitude, spatial distribution, and seasonality. Model comparison with weekly and monthly mean values of the organic aerosol mass concentration at two coastal sites shows that the source function exclusively related to [chl a] does a better job replicating surface observations. Sensitivity simulations of the sea spray-based parameterizations show that improved predictions of the seasonality of the marine POA concentrations can be achieved by varying the U10 and [chl a] dependence of the organic mass fraction of sea spray aerosol. A top-down estimate of submicron marine POA emissions based on the parameterization that compares best to the observed weekly and monthly mean values of marine organic aerosol surface concentrations has a global average emission rate of 6.3 Tg yr−1. Evaluation of existing marine POA source functions against a case study during which marine POA contributed the major fraction of submicron aerosol mass shows that none of the existing parameterizations are able to reproduce the hourly-averaged observations. Our calculations suggest that in order to capture episodic events in submicron marine POA concentration over the ocean, new source functions need to be developed that are grounded in the physical processes unique to the organic fraction of sea spray aerosol.
Preformed and regenerated phosphate in ocean general circulation models: can right total concentrations be wrong?
Authors: Duteil O. , Koeve W. , Oschlies A. , Aumont O. , Bianchi D. , Bopp L. , Galbraith E. , Matear R. , Moore J. K. , Sarmiento J. L. , Segschneider J.
Published: May 2012

Abstract. Phosphate distributions simulated by seven state-of-the-art biogeochemical ocean circulation models are evaluated against observations of global ocean nutrient distributions. The biogeochemical models exhibit different structural complexities, ranging from simple nutrient-restoring to multi-nutrient NPZD type models. We evaluate the simulations using the observed volume distribution of phosphate. The errors in these simulated volume class distributions are significantly larger when preformed phosphate (or regenerated phosphate) rather than total phosphate is considered. Our analysis reveals that models can achieve similarly good fits to observed total phosphate distributions for a~very different partitioning into preformed and regenerated nutrient components. This has implications for the strength and potential climate sensitivity of the simulated biological carbon pump. We suggest complementing the use of total nutrient distributions for assessing model skill by an evaluation of the respective preformed and regenerated nutrient components.
Topo-edaphic controls over woody plant biomass in South African savannas
Authors: Colgan M. S. , Asner G. P. , Levick S. R. , Martin R. E. , Chadwick O. A.
Published: May 2012

Abstract. The distribution of woody biomass in savannas reflects spatial patterns fundamental to ecosystem processes, such as water flow, competition, and herbivory, and is a key contributor to savanna ecosystem services, such as fuelwood supply. While total precipitation sets an upper bound on savanna woody biomass, the extent to which substrate and terrain constrain trees and shrubs below this maximum remains poorly understood, often occluded by local-scale disturbances such as fire and trampling. Here we investigate the role of hillslope topography and soil properties in controlling woody plant aboveground biomass (AGB) in Kruger National Park, South Africa. Large-area sampling with airborne Light Detection and Ranging (LiDAR) provided a means to average across local-scale disturbances, revealing an unexpectedly linear relationship between AGB and hillslope-position on basalts, where biomass levels were lowest on crests, and linearly increased toward streams (R2 = 0.91). The observed pattern was different on granite substrates, where AGB exhibited a strongly non-linear relationship with hillslope position: AGB was high on crests, decreased midslope, and then increased near stream channels (R2 = 0.87). Overall, we observed 5-to-8-fold lower AGB on clayey, basalt-derived soil than on granites, and we suggest this is due to herbivore-fire interactions rather than lower hydraulic conductivity or clay shrinkage/swelling, as previously hypothesized. By mapping AGB within and outside fire and herbivore exclosures, we found that basalt-derived soils support tenfold higher AGB in the absence of fire and herbivory, suggesting high clay content alone is not a proximal limitation on AGB. Understanding how fire and herbivory contribute to AGB heterogeneity is critical to predicting future savanna carbon storage under a changing climate.
On the uncertainties associated with using gridded rainfall data as a proxy for observed
Authors: Tozer C. R. , Kiem A. S. , Verdon-Kidd D. C.
Published: May 2012

Abstract. Gridded rainfall datasets are used in many hydrological and climatological studies, in Australia and elsewhere, including for hydroclimatic forecasting, climate attribution studies and climate model performance assessments. The attraction of the spatial coverage provided by gridded data is clear, particularly in Australia where the spatial and temporal resolution of the rainfall gauge network is sparse. However, the question that must be asked is whether it is suitable to use gridded data as a proxy for observed point data, given that gridded data is inherently "smoothed" and may not necessarily capture the temporal and spatial variability of Australian rainfall which leads to hydroclimatic extremes (i.e. droughts, floods). This study investigates this question through a statistical analysis of three monthly gridded Australian rainfall datasets – the Bureau of Meteorology (BOM) dataset, the Australian Water Availability Project (AWAP) and the SILO dataset. The results of the monthly, seasonal and annual comparisons show that not only are the three gridded datasets different relative to each other, there are also marked differences between the gridded rainfall data and the rainfall observed at gauges within the corresponding grids – particularly for extremely wet or extremely dry conditions. Also important is that the differences observed appear to be non-systematic. To demonstrate the hydrological implications of using gridded data as a proxy for gauged data, a rainfall-runoff model is applied to one catchment in South Australia initially using gauged data as the source of rainfall input and then gridded rainfall data. The results indicate a markedly different runoff response associated with each of the different sources of rainfall data. It should be noted that this study does not seek to identify which gridded dataset is the "best" for Australia, as each gridded data source has its pros and cons, as does gauged data. Rather, the intention is to quantify differences between various gridded data sources and how they compare with gauged data so that these differences can be considered and accounted for in studies that utilise these gridded datasets. Ultimately, if key decisions are going to be based on the outputs of models that use gridded data, an estimate (or at least an understanding) of the uncertainties relating to the assumptions made in the development of gridded data and how that gridded data compares with reality should be made.
Spatio-temporal impact of climate change on the groundwater system
Authors: Dams J. , Salvadore E. , Van Daele T. , Ntegeka V. , Willems P. , Batelaan O.
Published: May 2012

Abstract. Given the importance of groundwater for food production and drinking water supply, but also for the survival of groundwater dependent terrestrial ecosystems (GWDTEs) it is essential to assess the impact of climate change on this freshwater resource. In this paper we study with high temporal and spatial resolution the impact of 28 climate change scenarios on the groundwater system of a lowland catchment in Belgium. Our results show for the scenario period 2070–2101 compared with the reference period 1960–1991, a change in annual groundwater recharge between −20% and +7%. On average annual groundwater recharge decreases 7%. In most scenarios the recharge increases during winter but decreases during summer. The altered recharge patterns cause the groundwater level to decrease significantly from September to January. On average the groundwater level decreases about 7 cm with a standard deviation between the scenarios of 5 cm. Groundwater levels in interfluves and upstream areas are more sensitive to climate change than groundwater levels in the river valley. Groundwater discharge to GWDTEs is expected to decrease during late summer and autumn as much as 10%, though the discharge remains at reference-period level during winter and early spring. As GWDTEs are strongly influenced by temporal dynamics of the groundwater system, close monitoring of groundwater and implementation of adaptive management measures are required to prevent ecological loss.
Transient analysis of fluctuations of electrical conductivity as tracer in the streambed
Authors: Schmidt C. , Musolff A. , Trauth N. , Vieweg M. , Fleckenstein J. H.
Published: May 2012

Abstract. Magnitudes and directions of water flux in the streambed are controlled by hydraulic gradients between the groundwater and the stream and by bedform-induced hyporheic exchange flows. These water fluxes vary over time driven by for instance by short term flood events or seasonal variations in stream flow and groundwater level. Variations of electrical conductivity (EC) are used as a natural tracer to detect transient travel times and flow velocities in an in-stream-gravel bar. We present a method to estimate travel times between the stream and measuring locations in the gravel bar by non-linearly matching the EC signals in the time domain. The amount of temporal distortion required to obtain the optimal matching is related to the travel time of the signal. Our analysis revealed that the travel-times increased at higher stream flows because lateral head gradients across the gravel bar are leveled at the time.
Review Article "Valuating the intangible effects of natural hazards – review and analysis of the costing methods"
Authors: Markantonis V. , Meyer V. , Schwarze R.
Published: May 2012

Abstract. The "intangible" or "non-market" effects are those costs of natural hazards which are not, or at least not easily measurable in monetary terms, as for example, impacts on health, cultural heritage or the environment. The intangible effects are often not included in costs assessments of natural hazards leading to an incomplete and biased cost assessment. However, several methods exist which try to estimate these effects in a non-monetary or monetary form. The objective of the present paper is to review and evaluate methods for estimating the intangible effects of natural hazards, specifically related to health and environmental effects. Existing methods are analyzed and compared using various criteria, research gaps are identified, application recommendations are provided, and valuation issues that should be addressed by the scientific community are highlighted.
What Characterizes Effective Operations?
Authors: Beverly Richard P.
Published: May 2012

This month's question asks about characteristics of effective treatment plant operations. The article discusses two basic characteristics necessary for an operator to accurately perform the necessary tasks: maximum operational flexibility, and adequate instrumentation to identify and evaluate why process changes occur.
Wheat Thief Makes Quick Work of Filter‐Coring Operation
Authors: Meyer Bill
Published: May 2012

This article discusses how a commercially available grain probe (used in the grain industry to sample hauled grain for quality) was modified to create a filter‐coring device called the wheat thief. Filter media are collected in the wheat thief, emptied on the acrylic board according to media depth, and analyzed.
Mitoxantrone-Associated Leukemia in Multiple Sclerosis: Case Studies
Authors: Woo Douglas A. , Collins Robert H. , Rossman Howard S. , Stüve Olaf , Frohman Elliot M.
Published: May 2012

This article describes four new cases from our clinical practices of therapy-related acute leukemia after use of mitoxantrone in the treatment of patients with multiple sclerosis (MS) and reviews the mechanisms that predispose to this serious complication of treatment. The study consisted of a retrospective case series. Four previously unreported cases of secondary leukemia arising after mitoxantrone therapy in MS patients were identified, out of a combined cohort of 152 patients treated at our institutions. Three of the patients developed the acute promyelocytic leukemia subtype, after varying doses and latencies of mitoxantrone therapy. One of the study patients died. Characteristics of these patients and 10 previously reported cases are summarized. MS patients treated with mitoxantrone remain at risk for therapy-related leukemia, particularly acute promyelocytic leukemia. Strategies for minimization and prompt identification of this adverse event are needed.
Dietary Practices of People With Multiple Sclerosis
Authors: Goodman Susan , Gulick Elsie E.
Published: May 2012

Good nutrition is important for good health, but little is known about current dietary practices of people with multiple sclerosis (MS). The purpose of this study was to determine current dietary practices and see how they relate to disability level, MS symptoms, dietary adequacy, and body mass index. The study sample consisted of 123 people with MS grouped according to mild-moderate or severe disability level. Participants completed a self-report mailed instrument regarding dietary practices and sources of nutrition information. Both disability groups reported food labels as their primary source of nutrition information; only 20% received information from a registered dietitian. The average intake for all food groups was less than recommended by Dietary Guidelines for Americans 2005 (US Departments of Health and Human Services and of Agriculture). Higher intake of whole-grain foods was shown to decrease elimination symptoms. Most respondents reported taking at least one supplement daily, especially multivitamins. Fatigue sometimes limited cooking by mild-moderately disabled and chewing by severely disabled patients. More than 50% of both groups were overweight or obese. The participants' current intake was suboptimal. Increased use of registered dietitians to educate people with MS, their care partners, and members of their health care team might result in improved dietary intake.
Validation of NARCOMS Depression Scale
Authors: Marrie Ruth Ann , Cutter Gary , Tyry Tuula , Campagnolo Denise , Vollmer Timothy
Published: May 2012

Participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry report depression with one question. We aimed to validate the NARCOMS depression scale against the Center for Epidemiologic Studies Depression Scale (CESD) and self-reported diagnoses of depression. The NARCOMS scale correlated with the CESD (r = 0.73; 95% confidence interval 0.72–0.74), and a score ≥2 had a sensitivity of 87% and specificity of 92% for depression. Correlations between the NARCOMS scale and age and body mass index were low, indicating divergent validity, whereas correlations with pain and fatigue were moderate, indicating convergent validity. The NARCOMS depression scale has adequate criterion and construct validity in MS.
Neuropsychologist
Authors: Fuchs Kathleen L.
Published: May 2012

It has been estimated that at least half of individuals with multiple sclerosis (MS) experience some degree of cognitive dysfunction, which can negatively affect employment status and quality of life. Many MS patients are referred for neuropsychological evaluation to assess their cognitive abilities. This article describes the evaluation process and the role of the neuropsychologist on a multidisciplinary MS health-care team. A neuropsychologist is trained in relationships between brain functioning and behavior and can administer cognitive tests and provide feedback on the individual's cognitive strengths and weaknesses. The findings can be used to recommend specific types of compensation strategies or other interventions that may help the patient maintain employment and independent functioning.
Why Depression Goes Unrecognized in Multiple Sclerosis Patients
Authors: Majmudar Shirine , Schiffer Randolph B.
Published: May 2012

Depression is very common among people with multiple sclerosis (MS). Unfortunately, many MS patients with depression do not receive a diagnosis of depression or adequate treatment for the condition. This study was undertaken to investigate screening tools used to assess depression in MS patients as well as the presentation of depression in MS. A total of 20 MS patients from the Texas Tech University Health Sciences Center MS clinic were screened for depression using the Two Question Screen (2QS), Beck Depression Inventory–Short Form (BDI-SF), and Patient Health Questionnaire–9 (PHQ-9). They were also evaluated for a possible major depressive episode (MDE). Results from each screening method were then compared with the corresponding findings from the MDE evaluation for each patient. In addition, each individual's depressive symptoms were quantified, characterized, and compared with screening results. The three depression screening tools yielded inconsistent results. The 2QS correlated best with the MDE evaluation findings. In addition, the number of overlapping symptoms in each patient was proportional to the likelihood of having a positive depression screen. The 2QS appears to be the best diagnostic tool available for detecting depression in MS patients. Clinicians also must be able to identify atypical signs of depression and overlapping symptoms between MS and depression and offer appropriate therapies for their management.
Correlation of Physical Activity with Perceived Cognitive Deficits in Relapsing-Remitting Multiple Sclerosis
Authors: Prakash Ruchika Shaurya , Snook Erin M. , Kramer Arthur F. , Motl Robert W.
Published: May 2012

Cognitive difficulties represent a core symptom experienced by individuals with relapsing-remitting multiple sclerosis (RRMS). The field of gerontology has provided evidence that physical activity may moderate the decline in cognitive functioning that occurs with increasing age. Based on that evidence, we examined the association between physical activity and perceived cognitive impairment in people with RRMS. The study sample consisted of 82 individuals with RRMS who completed an initial battery of questionnaires, including the Perceived Deficits Questionnaire (PDQ), wore an accelerometer for 7 days, and then completed the Godin Leisure-Time Exercise Questionnaire (GLTEQ). Physical activity, measured by either an accelerometer or the GLTEQ, was inversely associated with overall PDQ scores, even after controlling for clinical and demographic factors. Additional studies are needed on physical activity as a modifiable behavior with a potential impact on cognitive impairment in individuals with RRMS.
Group Coaching for Individuals with Multiple Sclerosis
Authors: Heinz Amy , Antolak Jennie
Published: May 2012

The physical, emotional, and mental changes associated with multiple sclerosis (MS) can disrupt patients' lives on many levels and interfere with their pursuit of life goals. Health-care practitioners usually work with people with MS in traditional medical settings—for example, upon initial diagnosis of MS or after an exacerbation of symptoms. Because of the nature of such settings and the current state of health care, it is challenging to provide the ongoing support and guidance that patients need to work toward life goals that were in place before the onset of their illness. Coaching is a talk-based process that uses tools and techniques designed to help individuals make progress toward their life goals. Coaching in a group format is an emerging method for guiding people with similar situations or needs toward their goals. The pilot group coaching project described here provides initial evidence that group coaching may be a valuable service-delivery model for expanding possibilities for individuals with MS living in the community.
Interventions for Upper-Limb Intention Tremor in Multiple Sclerosis
Authors: Hawes Frances , Billups Carley , Forwell Susan
Published: May 2012

Approximately 25% of people with multiple sclerosis (MS) experience upper-limb intention tremor (ULIT), which limits their ability to participate in daily activities. Little research has been conducted on the effectiveness of available treatments for ULIT. The objectives of this study were to investigate the use of occupational therapy interventions to improve eating and handwriting performance in adults with MS and ULIT and, based on these findings, to provide recommendations for the development of a treatment protocol for ULIT. Six adults with MS and ULIT were recruited from an MS clinic. Participants rated their pre- and post-intervention functional performance using the Multi-Dimensional Assessment of Tremor. Interventions included education about tremor, proximal stabilization, hand-over-hand technique, weighted tool, weighted wrist, and splinting. Participants evaluated the techniques using visual analogue scales (VASs). One month after the intervention, participants were interviewed to assess sustainability of the techniques. Pre- and post-intervention functional scores, VAS scores, and qualitative reports were used to evaluate the success of the techniques in improving participants' abilities in eating and handwriting. Preliminary evidence demonstrates the usefulness and sustainability of the behavioral strategies and the use of multiple techniques simultaneously in the treatment of ULIT. Further investigation is needed to support the use of weights and splints. Recommendations for the further development of a ULIT treatment protocol were provided.
Psychosocial Factors That Influence Quality of Life and Potential for Self-Management in Multiple Sclerosis
Authors: Wollin Judy Ann , Fulcher Gary , McDonald Elizabeth , Spencer Nancy , Mortlock Miranda Y. , Bourne Maureen , Simmons Rex D.
Published: May 2012

Optimizing quality of life (QOL) and self-management in people with multiple sclerosis (MS) is increasingly seen as a worthwhile goal. This study aimed to investigate factors that affect QOL in MS. A large national sample of Australians with MS (n = 1848) generated from the Australian Multiple Sclerosis Longitudinal Study completed a survey addressing disease duration and severity, self-efficacy, depression, perceived stress, social support, QOL, and self-management. We tested a model of self-help in which antecedent variables are influenced by mediating variables, which in turn affects outcome variables. In the current study, the antecedent variables were disease duration and disease severity; the mediating variables were self-efficacy, depression, perceived stress, and social support; and the outcome variables were QOL and self-management. We also tested the hypothesis that disease severity, depression, and perceived stress would correlate inversely with QOL and potential for self-management, whereas self-efficacy and perceived level of social support would correlate positively with QOL and potential for self-management. The results indicated that the antecedent variables did not correlate with the mediating variables, with one exception: a negative correlation was found between disease severity and social support. No correlations were found between social support and QOL or self-management. However, significant correlations were found between depression, self-efficacy, stress, and social support and QOL. No correlations were found between either the antecedent or the mediating variables and self-management. The results confirm previous findings of statistically significant correlations between psychosocial factors and QOL.
A Novel Application of Acceptance and Commitment Therapy for Psychosocial Problems Associated with Multiple Sclerosis
Authors: Sheppard Sean C. , Forsyth John P. , Hickling Edward J. , Bianchi JeanMarie
Published: May 2012

Multiple sclerosis (MS) is a chronic degenerative disease of the central nervous system for which there is no known cure. The condition is associated with a range of physical, psychological, and emotional difficulties and often results in reduced quality of life (QOL). Acceptance and Commitment Therapy (ACT) is a newer cognitive-behavior therapy that balances 1) mindfulness and acceptance processes with 2) commitment and behavior change processes in the service of reducing suffering while fostering engagement in value-guided actions. The purpose of the present study was to investigate the effectiveness of a half-day ACT workshop focused on teaching mindful acceptance, cognitive defusion, and value-guided action strategies to a group of individuals (N = 15) with MS. The usefulness of the workshop was evaluated in terms of its impact over a 3-month follow-up period on indices of MS-related impairment, emotional distress, and QOL. The results were mixed, with significant improvements observed in the areas of depression, extent of thought suppression, impact of pain on behavior, and QOL but no change in extent of physical symptoms and mindfulness. These results are discussed broadly in terms of developing and improving brief ACT interventions for MS and other chronic illnesses.
The Incidence of Pressure Ulcers in People with Multiple Sclerosis and Persons Responsible for their Management
Authors: Cramp A. Fiona L. , Warke Kim , Lowe-Strong Andrea S.
Published: May 2012

Background: Pressure ulcers are one of many secondary complications which may develop with the progression of disability in MS.

Objective: To establish the incidence of pressure ulcers among people with MS in Northern Ireland (NI) and to identify the professionals responsible for the management.

Methods: Postal questionnaire sent to general practitioners (GPs) within NI (n = 1,083).

Results: The overall response rate was 67.5% (n = 731); of the 722 valid responses, 96.4% (n = 696) of the GPs reported having people with MS registered within their practice (n = 694). Of these GPs, 22.8% (n = 159) indicated that they encounter pressure ulcers amongst this population; 94.3% (n = 150) specified that district nurses were involved in the treatment and management of pressure ulcers. Caregivers, community physiotherapists and nurses based within the GP surgery also appear to have a significant responsibility. Other professionals included surgeons, podiatrists, GPs, nursing home staff and hospital staff.

Conclusion: The results from this study have indicated that pressure ulcers may be a significant problem in people with MS and give an indication of the professionals involved in their management.
Psychosocial Adjustment to Multiple Sclerosis
Authors: Sullivan Cynthia L. , Wilken Jeffrey A. , Rabin Bernard M. , Demorest Marilyn , Bever Christopher
Published: May 2012

Research has suggested that successful adaptation to multiple sclerosis (MS) and its psychological sequelae is affected by a variety of factors, but many questions remain unanswered. This study examined the extent to which certain factors contribute to successful psychosocial adjustment. Subjects were 100 MS outpatients from several MS centers and neurology clinics in the Washington, D.C. metropolitan area. Analysis showed that the following variables contributed significantly to psychosocial adjustment: disease status (i.e., remission versus exacerbation), medication, cognitive disability, and perceived uncertainty. Coping style, social support, and perceived level of physical disability did not contribute significantly to adjustment. The findings suggest that efforts should be made to reduce patients' perceptions of uncertainty regarding their MS and that cognitive functioning be assessed and appropriately accommodated in treatment.
Pharmacologic Therapy for Multiple Sclerosis–Related Fatigue
Authors: Rosenberg Jay H.
Published: May 2012

Fatigue is the most common symptom of multiple sclerosis and is perhaps the symptom with the most devastating impact on patient well-being. It is reported by 75% to 95% of individuals, and more than half describe it as the worst symptom of the disease. The mechanisms underlying the development of fatigue remain unclear; although fatigue is believed to be a primary symptom of MS (ie, related to the demyelinating processes of the disease), fatigue may also occur secondarily to factors such as sleep disturbances, depression, or the effects of medications. The highly variable presentation of MS and the number of agents used for disease modification and symptom management make it important for potential contributors to MS-related fatigue to be identified and managed appropriately. If fatigue continues despite elimination or adequate management of secondary causes, pharmacologic therapy may be required. Several agents have been reported to improve MS-related fatigue; however, only three have been investigated in controlled trials. Amantadine has been studied in several small controlled trials, and appears to be effective in one quarter to one third of those with mild-to-moderate fatigue. It has shown efficacy on a number of scales, including the Visual Analog Scale for Fatigue (VAS-F) and the MS-Specific Fatigue Scale (MS-FS). The central nervous system (CNS) stimulant pemoline has demonstrated limited benefit in clinical trials and is often poorly tolerated, especially in higher doses. Recently, the wake-promoting agent modafinil has been shown to significantly improve MS-related fatigue on a number of commonly used fatigue assessment scales, including the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS).
Multiple Sclerosis and Exercise
Authors: Karpatkin Herbert I.
Published: May 2012

Compared with other neurologic disorders, relatively little literature exists to define or support the role of exercise in MS. This review describes issues relating to exercise in patients with MS, discusses relevant literature, offers exercise guidelines for persons with MS, and suggests topics for future research. Unique aspects of MS that affect physical therapy are addressed, including disease progression, fatigue, and thermosensitivity. Review of the literature includes discussion of strength training, aerobic exercise, and respiratory training. While physical activity was once contraindicated in persons with MS, current literature supports its therapeutic benefits in these patients. More research could be focused on the specific types of exercise appropriate for this patient population.
Multiple Sclerosis in Mexican American Population
Authors: Rivera Victor M. , Landero Samuel
Published: May 2012

Multiple sclerosis (MS) prevalence has notably increased in Latin America. Although people of Mexican ancestry make up most of the Hispanic population in the United States, studies addressing MS in US- or foreign-born Latin Americans are scarce. Of the first 3000 consecutive individuals diagnosed with clinically definite MS at a specialized MS clinic in southeast Texas, 128 were identified as Mexican or Mexican American and are discussed in this article. The sample had a wide age distribution (6–71 years), with most patients diagnosed between the third and fifth decades. Of the patients studied, 68.2% had relapsing-remitting MS, 28.9% had secondary progressive MS, and 2.3% had primary progressive MS. The female-to-male ratio was 4.6:1.0; 60.9% of the patients were US born and 28.9% Mexican born. Sixteen patients commuted between countries. The study suggests that increasing frequency of MS among Hispanic people may augment the prevalence of MS in certain areas of the United States. Epidemiological observations, clinical characterizations, and possible genotypic therapeutic responses may derive from further studies.
Role of Advanced Practice Nurse in Management of Multiple Sclerosis
Authors: Halper June
Published: May 2012

The introduction of disease-modifying therapies and the realization that multiple sclerosis (MS) is a treatable disease has seen the emergence of an expanded role for advanced practice nurses (APNs) in the MS arena. Within MS centers, clinics, inpatient settings, and private practices, APNs may function as one or more of the following: administrator, consultant, researcher, advocate, and clinician. Because of the significant roles APNs play in the management of patients with MS, they must embody a core set of competencies delineated by domains specific to MS care. As MS care continues to evolve, APNs remain at the forefront of the multidisciplinary team of health professionals dedicated to optimizing outcomes through research, education, and the identification and implementation of best practices.
Participant Evaluation of Energy Conservation Course for People With Multiple Sclerosis
Authors: Mathiowetz Virgil , Busch Melody L.
Published: May 2012

This article discusses how people with multiple sclerosis (MS) perceive an energy conservation (EC) course. The study included 140 people with MS who reported fatigue secondary to MS and participated in a randomized controlled trial of an EC course. Descriptive data from course evaluations collected during the trial were analyzed to determine how participants perceived the quality and helpfulness of the course and ways to improve it. Descriptive statistics, percentages, and frequency of comments demonstrated that the course was rated highly among participants. Participants found the major concepts of the course and the opportunity to interact with others particularly helpful. Suggestions as to how to improve the course included small modifications to the format. The high rate of participant satisfaction supports the use of this EC course for people with MS.
Communication Problems in Multiple Sclerosis: 9-Year Follow-Up
Authors: Bringfelt Per-Anders , Hartelius Lena , Runmarker Björn
Published: May 2012

The speech of 18 individuals with a long history of multiple sclerosis (MS), assessed 9–10 years earlier, was reinvestigated. The individuals were also interviewed about their experiences of living with MS and how they have handled communication problems and symptoms in general. Findings were related to the degree of neurological deficit. The results showed that neurological deficits increased and certain speech parameters (sustained vowel phonation and speech rate) decreased significantly during this period. Speech intelligibility was not significantly changed (>90% at follow-up). Consequently, speech problems were generally mild. Nevertheless, analysis of the interviews showed that participation in communication and interpersonal relationships was affected by other disease-related (mobility, vision, cognition, and fatigue) and age-related problems. Strategies to reduce the effect of communication and disease-related problems were found to be active rather than adjustment or avoidance, both in specific situations and as an approach to life. In conclusion, the importance of a broader perspective on communication difficulties and a more individual approach to intervention should be emphasized, taking the patient's perceived barriers and self-generated strategies into account.
Practical Guidelines for Administering Natalizumab: A Nursing Perspective
Authors: O'Leary Shirley , Beavin Jill , Bishop Cynthia , Capolino Lisa , Greinel Elida , Hudson Elizabeth
Published: May 2012

Natalizumab (Tysabri) was recently reapproved in the United States and the European Union for the treatment of relapsing forms of multiple sclerosis (MS). Natalizumab is administered once every 4 weeks as a 300-mg intravenous infusion given over 1 hour, followed by 1 hour of monitoring. Guidelines for preparing and administering natalizumab infusions are reviewed. In addition, patient monitoring parameters and guidelines for identification and management of infusion-related reactions are discussed. Natalizumab may be administered in various settings, including the hospital, physician's office, and infusion center. Special considerations for these settings are also discussed. Currently, home care is not a consideration for natalizumab infusion.
Effects of Cognition on Quiz Performance, Behavior Change, and Vitality After Energy Conservation Course Among People With Multiple Sclerosis
Authors: Finlayson Marcia , Shevil Eynat , Luo Ping , Chen Hua Yun , Mathiowetz Virgil
Published: May 2012

This secondary analysis of randomized control trial data evaluated the influence of cognitive abilities on the outcomes of people with multiple sclerosis (MS) who participated in a 6-week community-based energy conservation education program. Baseline measures of cognitive status included the four scales from the Neuropsychological Screening Battery for MS: Consistent Long-Term Retrieval Test (CLTR), Word List Generation Test (WLGT), Paced Auditory Serial Addition Test (PASAT), and Spatial Recall Test (SRT). Scores on knowledge quizzes, number of energy conservation strategies used postintervention, and change in SF-36 vitality subscale postintervention were analyzed via multiple regression and generalized estimating equation models. After adjusting for age, education, and sex, only SRT influenced scores on the knowledge quizzes and change in the level of vitality postintervention. CLTR, WLGT, and PASAT scores influenced the use of energy conservation strategies, after similar adjustment. In conclusion, cognitive abilities have a differential influence on outcomes in an energy conservation education program for people with MS. Actual behavior change postintervention was influenced the most by cognitive abilities.
Reproductive Choices of Women With Multiple Sclerosis
Authors: Sponiar Martine , Sharpe Louise , Butow Phyllis , Fulcher Gary
Published: May 2012

A decision aid may be needed for women with multiple sclerosis (MS) in making family-planning choices. Four hundred sixty-one women responded to a mailing asking them where they were in deciding whether to have children. The mailing was sent to female members of the MS Societies in New South Wales and Victoria, Australia, who were between 20 and 40 years of age. Results showed that 46% of respondents were currently unsure about whether they would start, forego, or enlarge their families. More women with relapsing-remitting MS and women who were unsure of their MS type were undecided about motherhood than those with primary progressive and secondary progressive MS. The results indicate that a decision-making tool to assist women with family planning may be useful.
Patient Health Questionnaire-9 to Screen for Depression in Outpatients With Multiple Sclerosis
Authors: Ferrando Stephen J. , Samton Julia , Mor Niv , Nicora Stephanie , Findler Marianne , Apatoff Brian
Published: May 2012

Depression is common in multiple sclerosis (MS), with a reported lifetime prevalence of 25–50% and a median point prevalence of 14%. Identification and validation of brief screening tools is essential. The objective of this study was to determine whether the self-administered Patient Health Questionnaire-9 (PHQ-9) is a potentially useful screening tool for depression in an MS clinic population. The PHQ-9 is an increasingly used clinical tool that is brief and specifically queries the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders IV: Text Revision (DSM-IVTR) depression criteria, making it easier for the clinician to diagnose depressive disorders. It has been validated in multiple medical and neurological populations. A total of 248 patients were given the PHQ-9 in the clinic waiting room, and 225 (mean age 43 years, 69% women) provided full responses. Rates of PHQ-9 depression are reported based on two scoring methods. With syndrome-based PHQ-9 scoring, 26 patients (12%) met criteria for either major depression (n = 15, 7%) or subthreshold major depression (n = 11, 5%). With a cut score of ≥10, 19% met criteria for significant depression. Both results are comparable to reported prevalence rates of depression in the MS literature. Twenty patients meeting syndromal depression criteria on the PHQ-9 were available for formal psychiatric evaluation, and all were diagnosed with a depressive disorder. Depressive symptom profiles revealed a low frequency of frank depressed mood and a preponderance of somatic symptoms, particularly fatigue and sleep disturbance. These preliminary results suggest that the PHQ-9 may be a useful tool in screening for depression in outpatients with MS. A formal validation study is indicated.