bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey of a domiciliary stroke rehabilitation service
Authors: Gladman Jrf , Juby LC , Clarke PA , Jackson JM , Lincoln NB
Published: July 2008

A previous randomized controlled comparison of hospital-based and domiciliary rehabilitation for stroke patients discharged from hospital (the DOMINO study) found home therapy to be beneficial in a subgroup who had been in hospital on a stroke unit before entering the trial, whereas no benefit was seen in patients who had been on ordinary geriatric or general medical wards. In this study, to explain the findings of the DOMINO study further, the therapy records kept during the DOMINO study of the amount and type of rehabilitation provided by the domiciliary rehabilitation team were examined.

More patients who had been on the stroke unit before entering the trial received therapy and they received more and longer visits than those who had been on geriatric or medical wards. The group from the stroke unit were more likely to receive practice in activities of daily living (ADL), assessment for and instruction in the use of aids and appliances, gait re-education, mobility practice and facilitation of normal muscle tone.

One possible deduction is that home rehabilitation services should aim to deliver an average of 15-20 visits in six months, since only this amount of therapy was associated with a measurable benefit. The active components of home therapy may be ADL practice, assessment for and instruction in the use of aids and appliances, gait re-education, mobility, mobility practice and facilitation of normal muscle tone.
A randomized controlled trial of leisure rehabilitation after stroke
Authors: Drummond Aer , Walker MF
Published: July 2008

A three-group pre-test-post-test design was used to evaluate the effectiveness of a leisure rehabilitation programme. Subjects were randomly allocated to the leisure rehabilitation group, the conventional occupational therapy group, or the control group. Baseline assessments of leisure were carried out on admission to the study and at three months and six months after discharge from hospital. The results showed an increase in the leisure scores for the leisure rehabilitation group only. There was an age imbalance in the study but, after analysis of co- variance, the results were upheld.
A survey of predischarge occupational therapy home assessment visits for stroke patients
Authors: Clarke PA , Gladman Jrf
Published: July 2008

Home assessment visits are a part of inpatient stroke rehabilitation programmes, but surprisingly little has been written about how often they are used or what they achieve. This study describes the use of home visits in 327 patients in a study of stroke rehabilitation after discharge from hospital.

Home visits were noted in 149 (50%). A median of five problems were identified, most commonly involving mobility inside the property and the height of furniture hampering transfers. A median of four solutions were recorded, most commonly the provision of aids and equipment. Representatives of the community social and nursing services were present in a minority of visits. An occupational therapist (OT) from the Social Services was present in half the home visits in addition to the hospital OT.

The study concludes that several important problems are identified on home visits and that simple solutions can be found in most cases. Social and health services, in Nottingham at least, should develop more rational working practices for home visits, so that liaison between hospital and community services is improved and duplication of work is avoided.
The relationship between the severity of Alzheimer's disease and recovery of independent mobility after treatment for proximal femoral fracture
Authors: Eastwood HD
Published: July 2008

A case-controlled study of previously mobile female patients with Alzheimer's disease who had sustained a proximal femoral fracture was carried out to determine the influence of the degree of mental impairment on the prospects of regaining independent mobility after treatment. Matched groups of 46 female patients (one group remaining immobile a month after surgery, the other successfully remobilizing) were evaluated for the degree of mental impairment by means of the Blessed Mental Test Score.

Patients with severe mental impairment were 17 times (95% confidence interval, 10-27) more likely to remain immobile as compared with those with moderate impairment scores. Two-thirds of the severely impaired had failed to remobilize a month after surgical treatment of their proximal femoral fracture. For patients with severe mental impairment who came from residential care, failure to remobilize was of major importance in precluding return to the same home. Current results of treatment are poor in this group of patients if measured by the return of mobility and the chances of being relocated on leaving hospital.
Changes in paravertebral EMG spectrum parallel to strength increases after rehabilitation in chronic low back pain patients
Authors: Capodaglio Paolo , Nilsson Jan , Jurisic Daniela H
Published: July 2008

The aim of this preliminary report was to identify parameters related to functional improvement in healthy subjects and in patients with chronic low back pain (LBP) undergoing an intensive rehabilitation programme. Four healthy controls and four chronic LBP patients were evaluated before and after a four-week rehabilitation programme. Dynamic and static strength tests, namely sustained isometric contractions, and trunk flexion-extension movements were performed in conjunction with surface electromyographic (EMG) measurements. Significant pre-rehabilitation differences were found between the two groups. Measured forces and the ratio between EMG amplitude values during extension and during flexion changed significantly in LBP patients immediately after rehabilitation. No significant changes were found in the control subjects after the rehabilitation programme. After rehabilitation, the slope of decay of the median frequency of the EMG power spectrum at L4 level, during a 60-second isometric submaximal (60% MVC) contraction, decreased significantly ( p < 0.02), indicating a lower fatigue level.
The effects of a stroke unit on activities of daily living
Authors: Drummond Aer , Miller N. , Colquohoun M. , Logan PC
Published: July 2008

Objective: To determine whether specific daily activities are improved more by treatment in a specialized stroke unit for patients seen after stroke.

Design: Randomized controlled study allocating patients to management in a stroke unit or on conventional hospital wards.

Setting: District general hospital medical or geriatric wards, or a hospital stroke unit.

Subjects: Patients who within five weeks of acute stroke were considered suitable for intensive stroke unit rehabilitation (if so randomized).

Interventions: Standard rehabilitation as delivered in the medical/geriatric wards or as delivered in the stroke unit.

Outcome measures: All individual items from the Barthel activities of daily living (ADL) scale, all items from the Rivermead ADL scales (self-care and household sections) and all items from the Nottingham Extended ADL scale were analysed.

Results: One hundred and seventy-six patients were seen in the stroke unit and 139 on the conventional wards. At entry the stroke unit had more women and stroke unit patients had less good arm function; otherwise the groups were comparable. The main differences were in the areas of feeding, dressing and household activities.

Conclusions: Stroke unit rehabilitation seems to improve feeding, dressing and household activities more than occurs on conventional wards; mobility was improved equally in both settings.
The efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis on spasticity of the leg in stroke patients: results of a randomized clinical trial
Authors: Beckerman H. , Becher J. , Lankhorst GJ , Verbeek Alm , Vogelaar TW
Published: July 2008

Objective: To investigate the efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis (AFO) on spasticity of the leg in stroke patients with a spastic equinus or equinovarus foot.

Design: A placebo-controlled randomized clinical trial with a 2 x 2 factorial design.

Setting: Outpatient clinic, Department of Rehabilitation Medicine, Academisch Ziekenhuis Vrije Universiteit Amsterdam.

Subjects: 60 stroke patients (17 women, 43 men), with a median age of 58 years and a median period of 34 months poststroke, with at least independent walking capacities at home.

Main outcome measures: Change in spasticity, muscle tone, ankle clonus, Achilles tendon reflex, ankle range of motion (ROM), motor function of the leg, and balance, measured six and 15 weeks after randomization.

Results: Thermocoagulation, rather than the AFO, reduced spasticity, muscle tone, Achilles tendon hyperexcitability, and ankle clonus. At six-week follow- up, the effects on Achilles tendon reflex and ankle clonus were the most pronounced; reflex excitability was reduced in 59% of the patients treated with thermocoagulation, as compared to 14% of the placebo-treated patients, whereas ankle clonus was reduced in 55% and 0% of the patients, respectively. Reduced spasticity was found in 35% of the actively treated, as compared to 10% of the placebo-treated patients. For muscle tone, the percentages of improved patients in each group were 45% and 24%, respectively. After 15 weeks the differences between the groups were smaller. No clinically relevant improvement was found with regard to ROM, the Fugl-Meyer lower extremity and balance scores, walking ability and walking speed.

Conclusion: Thermocoagulation is effective for the reduction of spasticity in stroke patients with a spastic equinus or equinovarus foot. No effect on spasticity of the AFO could be demonstrated. When the efficacy of thermocoagulation and the AFO are judged in terms of functional abilities, however, the effects seem of little value.
Barthel revisited: making guidelines work
Authors: Novak Stephen , Johnson Julia , Greenwood Richard
Published: July 2008

The Barthel Index (Bl) is a weighted and summed index designed to reflect a patient's dependency on carers. The aims of this study were first, to establish the validity of the Bl in a patient group whose disability resulted from cognitive as well as physical impairment, a combination frequently encountered in patients with brain injuries other than simple stroke. Secondly, a way was desired of using the Bl which, in a rehabilitation unit with both experienced and inexperienced staff, was less contentious and thus reliable. It was found that issuing guidelines along with the standard definitions did not wholly achieve this end. Instead, through discussions as a multidisciplinary team, scoring definitions were evolved which, although including the original definitions, were more comprehensive and specifically addressed those areas which had hitherto been contentious in respect of the patient group. As a measure of validity the amount of carer time each patient required in a 24- hour period was recorded and correlated against the Bl score. Preliminary data demonstrate that the Bl, in this form, retains validity and inter-rater reliability when used with patients after brain injuries of all sorts.
Subjective burden on carers of patients with neurological problems as a consequence of precise objective symptoms (objective burden)
Authors: Kausar Rukhsana , Powell Graham E
Published: July 2008

Carers of patients with neurological problems (n = 27) were interviewed four to nine and 12-18 months post-onset to assess objective burden (number and severity of post-onset symptoms as perceived by the carer) and subjective burden on them. Patients were reported to manifest a variety of physical, emotional, behavioural and cognitive problems at both assessment times. The carers' subjective burden was associated with objective symptoms, and the number of objective symptoms which related to carers' subjective burden increased over time. It was concluded that, although carers' burden was related to both psychological and physical symptoms, their burden was predicted more by psychological problems such as behavioural problems, emotional disturbances and subjective symptoms.
The Barthel Index: an ordinal score or interval level measure?
Authors: Tennant Alan , Geddes Joanna ML , Chamberlain M Anne
Published: July 2008

The Barthel Index is one of the most widely used activities of daily living (ADL) measures in stroke rehabilitation and there has been some debate recently about whether or not the Index is an ordinal score or an interval level measure. An audit of 192 consecutive patients undergoing inpatient rehabilitation following stroke has provided the opportunity to examine this question with recently developed mathematical techniques based on the work of George Rasch. Rasch models define the criteria which data must follow to produce an interval level measure. It thus becomes possible to test the data derived from the audit against the Rasch model.

Calibration of the 10 items in the Index shows considerable differences in the degree of difficulty (weight), and these differences are not compensated for by the current scoring. Thus adding together the items produces a scale whose intervals vary considerably, particularly between intervals at the lower or upper ends of the scale, and those at the centre. This can give rise to considerable differences between the change score based on the Rasch transformation (taking into account item difficulty) and the change score based on raw scores. These findings confirm the ordinal nature of the Barthel Index. Further questions are raised about the unidimensionality of the Index, and the context in which it should be used.
Identification of stroke carers 'at risk': a preliminary study of the predictors of carers' psychological well-being at one year post stroke
Authors: Hodgson Susan P , Wood Victorine A , Langton-Hewer Richard
Published: July 2008

Background: A third of carers of people who have had a stroke experience poor psychological health. Early prediction of carers' later well-being would allow interventions to be targeted at carers most at risk of a poor outcome.

Aim: To develop a predictive model for the identification of stroke carers at risk of developing poor psychological well-being in the first year post stroke.

Method: Fifty consecutive one-year survivors of a stroke and their carers were assessed on a range of demographic, environmental and psychosocial variables at three months post stroke. The carers' psychological well-being at 12 months post stroke was assessed using the General Well-Being Index (GWBI). Multiple regression analysis was performed to identify the best early predictors of carers' later well-being.

Results: The regression analysis identified three significant predictors of carers' well-being: carers' appraisal of caregiving stress; carers' physical health; and carers' satisfaction with service provision ( r2 = 0.53). Using this model, 72% of carers' predicted well-being scores fell within nine points of their actual 12-month GWBI score.

Conclusion: Findings from this preliminary study indicate that it may be possible to identify carers most likely to experience poor psychological well- being. In order to develop a clinically usable 'carer risk prediction instrument' further research to test this model is essential.
An evaluation of the Alexander Technique for the management of disability in Parkinson's disease- a preliminary study
Authors: Stallibrass C.
Published: July 2008

Objective: To test the effect of the Alexander Technique (AT) on the management of disability and feelings of depression in patients with Parkin son's disease (PD).

Design: Subjects completed four self-report questionnaires, one set before the course of lessons and a repeat set when the lessons were ended. The postal questionnaires were mailed directly to the subject's home from the university with a stamped addressed envelope.

Subjects: Seven volunteers, with no previous experience of the Alexander Technique, diagnosed by consultant neurologists to have idiopathic Parkin son's disease.

Setting: The subjects were contacted by the nearest registered AT teacher and were taught in the individual teacher's practice rooms, in the same way as other pupils.

Interventions: Subjects received a median of 12 lessons.

Main outcome measures: The self-report measures were the BECK Depression Inventory, activities in daily living, body concept, and social functioning disability questionnaires.

Results: Post-lessons the subjects were significantly (p < 0.05) less depressed. They had a significantly more positive body concept and had significantly less difficulty in performing daily activities, and significantly less difficulty on the fine movement and gross movement subscales of the activities in daily living questionnaire.

Conclusions: The statistically significant results are consistent with the hypothesis that for PD patients on drug therapy, the Alexander Technique reduces depression and improves the management of disability, but in the absence of a control group and a larger sample, they cannot be said to confirm the hypothesis. The likelihood of the AT being effective in the management of disability for many PD patients, as shown in this study, makes further controlled research desirable.
Test-retest and inter-method reliability of the self-rating Barthel Index
Authors: Hachisuka Kenji , Ogata Hajime , Ohkuma Hidenobu , Tanaka Shoichi , Dozono Koichiro
Published: July 2008

Objective: To develop a self-rating Barthel Index questionnaire (SB) for assessing stroke patients living at home, the test-retest reliability of SB versions 1 and 2 and the inter-method reliability of SB version 3 were examined.

Design: Case series.

Setting: Clinics of the Department of Rehabilitation Medicine at the University Hospital and two affiliated hospitals.

Patients: Thirty-one, 140 and 65 chronic stroke patients living at home, being seen for regular follow-up, and having no severe aphasia for SB versions 1, 2 and 3, respectively.

Main outcome measure: Kappa coefficients of items in SB versions 1 and 2 for test-retest reliability; intra-class correlation coefficients of the self-care index, mobility index and total score, kappa coefficients of items and Friedman's two-way ANOVAs of ranking in SB version 3 among the self-ratings, family ratings and occupational therapist (OT) ratings; a regression analysis of age, gender, duration, time for filling in the SB, OT ratings, Mini-Mental State score and aphasia.

Results: Kappa coefficients in SB version 2 were higher than those in version 1. Intra-class correlation coefficients in SB version 3 among the three ratings were good, and kappa coefficients in each item were also good or excellent. By Friedman's two-way ANOVA, all the items except walking up/down stairs had no significant difference in ranking. Regression analysis revealed that OT ratings and time for filling in the SB affected the absolute difference of scores between the self-ratings and OT ratings.

Conclusion: SB version 3 is sufficiently reliable for practical use.
Satisfaction with information and advice received by stroke patients
Authors: O'Mahony Paul G , Rodgers Helen , Thomson Richard G , Dobson Ruth , James Oliver FW
Published: July 2008

Objective: To determine levels of satisfaction with information and advice received about stroke disease and relevant issues by community-dwelling stroke survivors.

Design: An interview questionnaire survey.

Setting: A family health services authority area in northern England.

Subjects: Stroke survivors identified by a valid screening questionnaire from a stratified random sample of 2000 subjects aged 45 years and over.

Main outcome measure: Proportion of subjects interviewed responding positively to the question 'Do you think you have received enough advice and information on ... ?' eighteen topics considered relevant to stroke survivors.

Results: The screening process identified 116 stroke survivors, of whom 76 agreed to be interviewed. The majority (> 80%) of patients were satisfied with information and advice received on lifestyle and health promotion issues, incontinence and their current treatment. However, satisfaction was poor for the areas of stroke disease in general, its effects, available services, and legal and financial affairs (range, 28-75% satisfied).

Conclusion: Deficits in the provision of adequate information and advice to stroke patients on relevant issues have been identified in this study of a representative sample of community-dwelling stroke survivors. These deficits need to be addressed by those providing care for stroke patients in order to improve patient satisfaction.
Aspiration following stroke: is it related to the side of the stroke?
Authors: Smithard DG , O'Neill PA , Martin DF , England R.
Published: July 2008

Objective: To investigate the relationship between the side of stroke and the presence of aspiration on videofluoroscopy.

Design: Observational prospective study.

Subjects: Eighty-seven patients (50% female) admitted with an acute stroke to the University Hospital of South Manchester.

Methods: Patients admitted to the study underwent brain CT scanning and repeated videofluoroscopy.

Results: CT scanning was performed within a median three days (interquartile range 2-4 days) following stroke and videofluoroscopic (VF) examination (median 2, interquartile range 1-4 days following stroke) of their swallow. Seventeen (19.5%) patients were noted to be aspirating. There were no significant relationships at this time between side or site of lesion and the presence of aspiration. A second assessment was carried out at a median time of 29 days (interquartile range 26-45) following acute stroke. Nine of 69 (13.5%) patients were noted to be aspirating, seven of whom had right hemisphere lesions ( p < 0.01).

Conclusions: Continuing aspiration may be related to the side of the cerebral lesion.
Evaluation of cognitive behavioural treatment for depression after stroke: a pilot study
Authors: Lincoln NB , Flannaghan T. , Sutcliffe L. , Rother L.
Published: July 2008

Objective: To evaluate cognitive behavioural therapy in the treatment of depressed stroke patients.

Design: A series of AB single case experimental design studies.

Subjects: Stroke patients who had been admitted to hospital.

Methods: Patients were identified from a hospital register of stroke patients and sent the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale to determine whether they were depressed. Those who were depressed were sent the BDI weekly during a four-week baseline period. They were then treated and continued to complete the BDI weekly over a three-month treatment period. Patients were also assessed pre- and post-treatment on measures of functional independence. Intervention: Cognitive behaviour therapy.

Results: Of the 626 patients on the Stroke Register, 373 returned questionnaires and 155 were identified as depressed. Of these 136 were visited and 19 agreed to take part. The outcome was evaluated using three methods: visual inspection, comparison of patients during baseline and treatment phases and proportion of scores below lowest baseline. This showed that four patients consistently showed beneficial treatment effects, six patients showed some benefit and nine no benefit. For the group as a whole there was a significant decrease in depression during the treatment period on the BDI (p = 0.02) but no significant change in functional abilities. Conclusion: Cognitive behaviour therapy is an appropriate treatment for some depressed stroke patients and beneficial for some patients. Further evaluation of this treatment with stroke patients is warranted.
Development of a neurological rehabilitation environment: an observational study
Authors: Newall Jayne T , Wood Victorine A , Hewer Richard Langton , Tinson Deborah J
Published: July 2008

Background: Engagement in therapeutic activity among stroke inpatients is advocated by many rehabilitation professionals. However, there is a lack of published evidence to indicate whether this is currently being achieved.

Objective: To investigate the extent and types of 'rehabilitation' activities on a new neurological rehabilitation ward, and examine change in patients' behaviour related to the new environment and new initiatives.

Design: Five one-week observation periods were conducted over two years, with a total of 67 patients being observed. A comparison was made with results of an earlier study of stroke patients' activities conducted at the same hospital.

Results: Patients spent an average 43 min per day with therapists (9% of the working day) and this was only marginally supplemented by self-exercise (2% of the working day - approximately 10 min). However, the provision of a new rehabilitation environment was associated with a marked decrease in the time patients spent at their bedsides, and a decrease in time spent passively gazing or watching others.

Conclusions: Overall there was some positive change in patients' behaviour. We suggest that structured guidance is required from the whole multidisciplinary team to stimulate more self-directed therapy practice and recreation.
Improvement in gait parameters following late intervention in traumatic brain injury: a long-term follow-up report of a single case
Authors: Butler PB , Farmer SE , Major RE
Published: July 2008

Objective: To evaluate the effect of using an optimally adjusted fixed ankle foot orthosis to control knee pain and promote improvement in gait parameters in a subject with hemiplegia following a traumatic brain injury 11 years previously.

Design: This is the report of a single case, using gait laboratory facilities to monitor force alignment relative to the knee and single leg balance time with the subject barefoot.

Subject: A 35-year-old woman with a right hemiplegia seen 11 years after onset.

Intervention: A polypropylene fixed ankle foot orthosis was supplied to the hemiplegic limb and shoe modifications were made to optimize the position of the ground reaction force relative to the knee during stance phase of gait. This orthosis was used on a daily basis for one year.

Results: Knee pain was controlled after three months use of the orthosis. Graphical results of force alignment during stance phase of gait are presented for initial assessment and at one and four years postorthotic supply. A large knee-extending effect was noted on the hemiplegic limb at initial assessment and this was reduced by 67% of its initial value at one year. A compensatory early heel lift was initially noted on the opposite limb and this was reduced by 42% of the initial height at one year. These results were maintained at four years. Right leg standing balance was not initially possible but was recorded as 5 s duration at three months and this was maintained at one and at four years.

Conclusions: The use of an optimally adjusted ankle foot orthosis was effective in controlling knee pain and improving barefoot gait parameters with maintenance of the improvement after use of the orthosis was discontinued. Further research is required to fully establish the potential of this approach in subjects with traumatic brain injury.
Community integration of wheelchair-bound athletes: a comparison before and after onset of disability
Authors: Pluym Saskia MF , Keur Tessa JA , Gerritsen Johan , Post Marcel WM
Published: July 2008

Objectives: (1) To assess to what extent wheelchair-bound athletes living independently in the community were able to return to their premorbid level of functioning in the community; (2) to investigate how they value their current way of functioning in comparison to that before disability; and (3) to examine the factors that hamper their return to their premorbid life in four domains.

Methods: Forty-four wheelchair-bound athletes participated in this study. Data were collected by means of a self-administered semi-structured questionnaire which was divided into four domains: vocational status, leisure time activities, social functioning and relationship with partner.

Results: Return to premorbid level of functioning in the community in the long term was reasonably well achieved for the domains 'leisure activities', 'social contacts' and 'relationship with partners', but not for 'vocational situation'. Between 60% and 80% of the participants reported satisfaction with their current level of functioning for all domains. However, about 50% of the respondents reported that they were currently less satisfied with their functioning on the domains 'vocational situation' and 'leisure activities', compared to before the onset of disability. Factors limiting integration were principally access to buildings and physical health problems (pain and fatigue).

Conclusion: It appeared that wheelchair-bound athletes were able to live a life on a level comparable to that before onset of disability for three of the four domains. It was emphasized that pain treatment in late rehabilitation and improving access for the disabled can contribute to the further integration of wheelchair-bound people into the community.
Routing through the health care system and level of functioning of lower limb amputees
Authors: Uiterwijk Aem , Remerie SC , Rol M. , Sier JC , Terburg M.
Published: July 2008

Objectives: To describe the routing through the health care system and the level of functioning of a consecutive series of lower limb amputees at a general Dutch hospital.

Methods: A descriptive cohort study (medical records examination) with a follow-up interval of 11.7 months. All 124 major lower limb amputations (ankle to hip) between 1 July 1989 and 31 December 1992 are included in the study: 123 patients, average age 73.8 years, 96% vascular disease. Amputation levels are 55.3% transfemoral, 12.2% knee disarticulation and 32.5% transtibial. At follow-up two patients are missing.

Results: Before admission to hospital 75.6% of patients are able to walk and 79.9% live independently. Discharge destinations from hospital are 22.5% home, 42.3% inpatient rehabilitation and 32.4% nursing home. At follow-up, 59% of surviving patients have a prosthesis, 47.7% are able to walk and 70.5% live independently. Mortality after one year is 28.5%. Poor preoperative walkers seem to die more often within the first year and have less chance of being fitted with a prosthesis. Poor walkers, older than 75, with diabetes mellitus and a transfemoral amputation seem to stay more often in a nursing home after one year.

Discussion: Although the results are largely comparable with other studies, there appear to be differences in age, amputation level and course and duration of treatment. The predicting factors found here may help the rehabilitation specialist in advising on the best moment and level of amputation and course of treatment.
A qualitative study of specialist nurse support for stroke patients and care-givers at home
Authors: Dowswell G. , Lawler J. , Young J. , Forster A. , Hearn J.
Published: July 2008

Background: The involvement of five specialist nurses in providing a stroke support service was evaluated quantitatively in a recent randomized controlled trial. This complementary study used qualitative methods to evaluate trial outcomes more comprehensively.

Aims: To identify whether the nurses' intervention may have influenced the process of stroke recovery.

Method: A purposefully selected subsample of 30 patients and 15 care-givers were interviewed within 1-3 months of their final quantitative assessment (12 months after recruitment to the randomized trial). Fifteen of the patients and eight of the care-givers had received visits from a specialist nurse. A semi- structured interview was designed to include questions on perceptions of the recovery process and evaluation of services received.

Results: Some differences were evident between the accounts of control and intervention group subjects. The less tangible aspects of nurses' interventions - concern, attention, empathy and interest, when combined with sound professional knowledge, had identifiable value to the patients and care-givers. It appeared that the nurses had employed considerable sensitivity and skill in identifying and responding to particular needs at appropriate times.

Conclusion: The qualitative evaluation offers a different picture to the quantitative results of the randomized controlled trial. In general, the findings of the qualitative study are more positive and encouraging than the quantitative results. The majority of patients and care-givers in the intervention group believed that they had benefited from the specialist nurse's visits.
A study of the attitudes of a rural Indian community toward people with physical disabilities
Authors: Bakheit Amo , Shanmugalingam V.
Published: July 2008

Objective: To examine the attitudes of a rural community in southern India toward its disabled members.

Design: Prospective cross-sectional study

Method: One hundred and twenty randomly selected villagers around the town of Vellore in southern India were invited to take part in the study. The attitudes towards individuals with physical disabilities were examined using a modified version of the Scale of Attitudes Toward Disabled Persons (SADP). The questionnaire was administered in its original English format with simultaneous translation into Tamil.

Results: Data were complete in 111 cases, 82% of whom showed a positive attitude toward people with disability. Gender and employment status did not appear to have an influence on whether the respondent regarded disabled people in a positive or negative way but most older individuals expressed prejudice and/or challenged the rights of disabled people to equal opportunities in education, employment and social integration. Further data analysis demonstrated that more subjects with than without a disabled family member supported the rights of disabled individuals to education, employment and social integration. By contrast, the items of SADP which described the personal attributes of disabled people did not discriminate between the two groups.

Conclusion: The attitudes of the rural community studied toward people with disabilities were unrelated to the sex or educational status of the respondents but was influenced by their age. This suggests that older subjects in rural communities in developing countries should be the main target for educational programmes which promote positive images of disability.
Emergency day hospital assessments
Authors: Black David A
Published: July 2008

Objective: To describe the use of a geriatric day hospital for emergency multidisciplinary assessment as an alternative to immediate hospital admission for some groups of frail older people.

Design: Retrospective study of change in clinical practice.

Setting: District general hospital.

Intervention: Immediate multidisciplinary assessment of selected patients instead of requested emergency hospital admission.

Outcomes: (1) Data were collected on 67 consecutive referrals. In 63% the patient needs could be met without emergency hospital admission on the day of assessment. (2) Of the 42 patients originally not admitted only 29% were subsequently admitted within the next three months.

Conclusions: Emergency day hospital assessments can be used as an alternative to immediate hospital admission for some frail older people.
Conflict Avoiders and Compromisers: Toward an Understanding of their Organizational Communication Style
Authors: Morley Donald Dean , Shockley-Zalabak Pamela
Published: July 2008

This study examines the organizational communication style of individuals with different conflict-style preferences and the relation-ship of conflict-style preferences to organizational position, employment expectations, and communication satisfaction. The results indicated that individuals with preferences for conflict avoidance and compromising exhibited identifiable organizational communi-cation styles. Furthermore, managers were more likely to use a competitive conflict style than nonmanagers, while those who expected to stay in their present position were more likely to use a compromising style.
Controversies around a Universal Model
Authors: Albagli Claude
Published: July 2008

Since Magellan's round-the-world voyage (1521), international issues have been embroiled in universalist claims. This paper investigates the controversial nature of a new economic universalism in the light of the social deficiencies and the limits of the available resources. The model of a global consumerism turns out to be inaccessible for billions of people. The market conceals a social dimension which ethics, equity, governance and identity are attempting to reintroduce. Consumerist universalism is faltering. The search for an alternative development model is crucial. It will need to be technically sustainable, socially more equitable, culturally more diverse and politically more participative.
Effect of Iron Deficiency Anemia On Lead Distribution After Intravenous Dosing in Rats
Authors: Wright Robert O. , Hu Howard , Maher Timothy J. , Amarasiriwardena Chitra , Chaiyakul Pasarapa , Woolf Alan D. , Shannon Michael W.
Published: July 2008

Objective: To determine the effect of iron deficiency anemia on blood and tissue lead distribution.Methods: 24 weanling rats were divided into 2 groups. One group received an iron replete diet (200 ppm); the other received a low iron diet (20 ppm). After 24 days, each group was further subdivided into two doses of lead (5 mg/kg and 10 mg/kg) which was administered intravenously. Rats were continued on their respective diets for 7 days post-lead injection to allow tissue distribtrtion, then sacrificed and blood and tissue lead concentration measured. Results: Prior to lead administration, baseline blood lead concentrations were not significantly different between groups. At sacrifice, whole blood lead levels were significantly higher in iron deficient animals than in iron replete at both 5 and 10 mg/kg administered lead. Iron deficient animals had comparable lead concentrations to iron replete animals in brain, kidney and liver. Femur lead concentrations were higher at 10 mg/kg administered lead. Conclusion: Iron deficiency alters lead distribution such that increased lead is found in blood for a given exposure.
Autism: Xenobiotic Influences
Authors: Edelson Stephen B. , Cantor David S.
Published: July 2008

The advances in medical technology during the last four decades has provided evidence for an underlying neurological basis for autism. The etiology for the variations of neurofunctional anomalies found in the autistic spectrum behaviors appears inconclusive as of this date but growing evidence supports the proposal that chronic exposure to toxic agents, i.e., xenobiotic agents, to a developing central nervous system may be the best model for defining the physiological and behavioral data found in these populations. A total of 20 subjects (15 males and 5 females) who received a formal diagnosis of autism by a developmental pediatrician, pediatric neurologist, or licensed psychologist were included.. The mean age for the sample was 635 yrs (range = 3-12 years). This study employed several measures that collectively would provide evidence of burden levels of xenobiotic agents and abnormal liver detoxication processes. These included: (1) Glucaric Acid Analysis, (2) blood analyses for identification of specific xenobiotic agents, and (3) Comprehensive Liver Detoxification Evaluation. Kolmogorov-Smirnov testing for a chi-square and Normal distribution for the Glucaric Acid findings indicates that each of these distributions is significantly different from expected distributions (p <.01). It is most noteworthy that of the 20 cases examined for this study, 100% of the cases showed liver detoxication profiles outside of normal. An examination of 18 autistic children in blood analyses that were available showed that 16 of these children showed evidence of levels of toxic chemicals exceeding adult maximum tolerance. In the two cases where toxic chemical levels were not found, there was abnormal D-glucaric acid findings suggesting abnormal xenobiotic influences on liver detoxication processes. A proposed mechanism for the interaction of xenobiotic toxins with immune system dysfunction and continuous and/or progressive endogenous toxicity is presented as it relates to the development of behaviors found in the autistic spectrum.
Large-scale washover sedimentation in a freshwater lagoon from the southeast Australian coast: sea-level change, tsunami or exceptionally large storm?
Authors: Switzer Adam D. , Jones Brian G.
Published: July 2008

A distinct lens of marine sand, up to 90 cm thick, confined vertically by peat, is found in the upper fill of a closed freshwater back-barrier lagoon on the southeast Australian coast. Coring of the deposit suggests it extends continuously up to 600 m inland and tapers landward rising to ~1.6 m above principle datum. In places the sand is overlain by accumulations of organic-rich silt that contain charophytes, indicating re-establishment of lagoon conditions. Hypotheses considered for the deposition of the sandsheet are higher Holocene sea level, storms and tsunami. Ground-penetrating radar transects of the seaward dune system suggest a penecontemporaneous erosional contact between a series of truncated pre-event dunes and several small overlying post-event dunes. Dating the sandsheet was problematic but it is confined to the last 800 years. The young age combined with a lack of associated beach deposits and evidence of wave scouring suggest that a higher sea-level hypothesis is unlikely. This sand lens is attributed to a large-scale washover event from the southeast. Based on comparisons with modern storm deposits from the same coast and sedimentological diagnostic criteria derived from studies of modern storm- and tsunami-deposited sandsheets, it is concluded that this sand deposit is the product of a short-lived, large-scale overwash event attributed to a late-Holocene tsunami.
Environmental changes since 8.4 ka reflected in the lacustrine core sediments from Nam Co, central Tibetan Plateau, China
Authors: Liping Zhu  , Yanhong Wu  , Junbo Wang  , Xiao Lin  , Jianting Ju  , Manping Xie  , Minghui Li  , Mäusbacher Roland , Schwalb Antje , Daut Gerhard
Published: July 2008

The Tibetan Plateau induces and enhances the Asian monsoon that influences the plateau itself, East China and even the whole of Asia. Pursuing the changing monsoon history and its impact in this environment-sensitive area is a key for understanding the climatic changes. Here, we present the initial results from core sediments in Nam Co, central Tibet, to elucidate the Holocene environment changes in this area. The studied lake (Nam Co) is the second largest lake, with an elevation of 4718 m, water area of 2015 km2 and catchment area of 10 610 km2. By using echo-seismic profiling and hydro-echosounding, we investigated the bathymetric distribution of the whole lake. One 332 cm long PISTON core was successfully taken in the east part of the lake at 60 m water depth. Twelve AMS 14C dates from top to bottom of this core established a good time sequence. TOC, TN, n-alkanes, grain size, clay minerals, Fe/Mn, Sr/Ba and CaCO3 content were analysed with sampling intervals from 1 cm to 10 cm. Results showed that since 8400 yr BP, the environment changes in this region indicate three stages. The early stage (8400—6900 yr BP) was characterized by slight shifting from warm to cold with a cold-dry interval at 8100—7800 yr BP. The middle stage was from 6900 to 2900 yr BP, during which climate changed from warm-humid to cold-dry. However, around 2900 yr BP, the climate once was slightly cold but strongly dry. The late stage, from 2900 yr BP to present, was characterized by a general tendency toward cold-dry: the first temperature decline was around 1700—1500 yr BP, following which temperature increased once, before decreasing again around 600—300 yr BP, which might be the result of the `Little Ice Age'.
Effect of sodium/mercury ratio and amalgam temperature on the efficacy of 400 W high-pressure sodium lamps
Authors: Denbigh P.L.
Published: July 2008

400 W high-pressure sodium arc tubes containing different quantities of mercury in the sodium/mercury amalgam were placed with one end submerged in a bath of molten indium which controlled the temperature of the amalgam. For a series of different amalgam temperatures the following parameters were measured on 240 V supply: voltage, current, power input, self-reversal width and luminous flux. Information taken from these graphs and replotted as a function of the amalgam composition provided the amalgam temperature and amalgam composition for maximum efficacy at 400 W. A broad maximum was observed with a peak of 116:t 1 tm W- 1 at an amalgam temperature of -640°C with a mole fraction of sodium of 0. 7. Now these optimum conditions have been established, higher efficacies still have been obtained using superior arc tube materials.
Midpoint ratio calculations for linear luminaires
Authors: Bellchambers H.E. , Simons R.H.
Published: July 2008

The accurate calculation of midpoint ratio for installations of linear luminaires is a lengthy operation, except when carried out using a computer. A simplified method based on the use of aspect factors is therefore proposed. Its accuracy is compared with the full aspect factor method and a method which treats the luminaire as a symmetrical point source. In all the examples taken, the simplified method is more accurate than the point source method, but shows some differences with the full aspect factor method. It is judged to be sufficiently accurate for practical purposes.
Economic life of incandescent lamps for domestic lighting
Authors: Prais S.J.
Published: July 2008

The length of life of incandescent lamps has been fixed by manufacturers at too low a level as a result of a widely accepted piece of mathematics which, this paper argues, is erroneous. On amending the mathematics it is shown that the length of life should be fixed at about 50% above present values; it is also suggested that, if other elements in the calculation were amended, a further lengthening would be required.
Wounded but Wiser: Reflections on Teaching Ethics to MBA Students
Authors: Liedtka Jeanne
Published: July 2008

This article presents the reflections of a business school professor regarding her experiences teaching an MBA-level business ethics course. It reviews the design and delivery of the course and examines the benefits and pitfalls of the case method and "tool kit" approaches to teaching ethics, the role of the instructor, and the selection of course materials. It concludes with the author's thoughts on specific tactics for enhancing the learning fostered in subsequent ethics courses.
The Legitimacy of Trying to Choose One's Students-or Self-Centeredness and Teaching
Authors: Bartolome Fernando
Published: July 2008

A good match between student and teacher is extremely important to increase the effectiveness of teaching. But it is only under exceptional circumstances-such as advanced seminars or honor courses—that teachers are allowed to choose their students. The author (a) analyzes reasons why most teachers do not discuss this issue; (b) presents the reasons that in his opinion justify a teacher's attempts to choose his or her students; and (c) describes the method he uses to select his students. He argues forcefully about the legitimacy of teachers taking into account their own needs and preferences in selecting their pedagogical style and choosing their students.