bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping Patient-Specific Functional Scale (PSFS) Items to the International Classification of Functioning, Disability and Health (ICF)
Authors: Fairbairn Kate , May Kate , Yang Yvonne , Balasundar Sharan , Hefford Cheryl , Abbott J. Haxby
Published: November 2011

Background

The International Classification of Functioning, Disability and Health (ICF) provides a common framework for clinical outcome measurement. Because the Patient-Specific Functional Scale (PSFS) is widely used for documenting change over time in individual patients receiving musculoskeletal physical therapy, investigation of the extent to which PSFS items reflect the ICF is needed.

Objective

The study objective was to investigate the extent to which patient-generated PSFS items reflect ICF domains.

Design

This investigation was an observational content validity study.

Methods

A total of 2,911 PSFS items from 1,050 files for patients with musculoskeletal disorders were analyzed. The data were from a random sample of participants in the Otago Outcome Measures Project at 4 clinics of the School of Physiotherapy, University of Otago, situated in 3 New Zealand cities. Patient-nominated PSFS items were categorized and mapped with thematic analysis techniques to ICF components, chapters, and categories. Subgroup analyses were conducted for body region of injury and age ranges.

Results

All (100%) of the analyzed items could be mapped to the ICF. Most patient-nominated items mapped to the activity component (80.0%), some items mapped to the participation component (7.7%), other items were related to impairment (7.4%), and the fourth group contained items that overlapped the activity and participation components (4.9%). Similar results were found for each of the 5 body regions and across age ranges in subgroup analyses.

Limitations

These results are limited to individual patients seeking musculoskeletal physical therapy. Patient-generated PSFS items were investigated.

Conclusions

The ICF activity component was most commonly represented by patient-nominated PSFS items, the participation component was moderately represented, and impairment was least represented. Hence, the PSFS would complement impairment-based clinical outcome measures.
Impact of Climate, Climate Change and Modern Technology on Wheat Production in Nepal: A Case Study at Bhairahawa
Authors: Nayava Janak Lal , Singh Rabi , Bhatta Madan Raj
Published: November 2011

The relation between climate and wheat production in Nepal was studied for the period 1970/71-2007/08. Due to the topographical differences within short north-south span of the country, Nepal has wide variety of climatic condition. About 70 to 90% of the rainfall occurs during the summer monsoon months (June to September) in Nepal and the rest of the months are almost dry. Wheat is cultivated during the dry winter period and therefore, the supplementary irrigation plays a vital role in its cultivation. Varieties of wheat have been developed to suit the local climatic conditions. Due to the availability of improved seeds, modern cultivation practice and a supplementary irrigation; the wheat cultivation has increased substantially throughout Nepal. The national area and production of wheat has remarkably increased from 228,000 ha to 706,481 ha and 193360 mt to 1,572,065 mt during 1970/71 to 2007/2008 respectively. Future planning to increase the wheat production in Nepal should give due consideration to the effect of global warming also. The present rate of annual increase of temperature was 0.06°C in Nepal. Trends of temperature rise were not uniform in Nepal. An increase of annual temperature at Bhairahawa during 1970-2008 was only 0.018°C. However, the wheat growing seasons at Bhairahawa, the trend of annual maximum temperature during November to April was -0.0068°C during the study period. Though modern facilities such as irrigation, improved seeds and fertilizers are available to some extent, weather and climate still plays an important role in the increase of area and production of wheat in Nepal Key words: climate change; plain low land (phant); global warming; trendDOI: http://dx.doi.org/10.3126/jhm.v6i1.5479 Journal of Hydrology and Meteorology, Vol. 6, No. 1 1-14
Snow Cover and Glacier Change Study in Nepalese Himalaya Using Remote Sensing and Geographic Information System
Authors: Shrestha Arun Bhakta , Joshi Sharad Prasad
Published: November 2011

Snow cover and glaciers in the Himalaya play a major role in the generation of stream flow in south Asia. Various studies have suggested that the glaciers in the Himalaya are in general condition of retreat. The snowline is also found to be retreating. While there are relatively more studies on glaciers fluctuation in the Himalaya, studies on snow cover is relatively sparse. In this study, snow cover and glacier fluctuation in the Nepalese Himalaya were studied using remote sensing techniques and geographic information system. The study was carried out in two spatial scales: catchments scale and national scale. In catchments scale two catchments: Langtang and Khumbu were studied. Intermittent medium resolution satellite imageries (Landsat) were used to study the fluctuation in snow cover and glacier area in the two catchments. In the national scale study coarse resolution (MODIS) imageries were used to derive seasonal variations in snow cover. An indication of decreasing trend in snow cover is shown by this study, although this result needs verification with more data. The snowline elevation is in general higher in Khumbu compared to Langtang. In both catchments, snowline elevation are higher in east, south-east, south and south-west aspects. The areas of snow cover in those aspects are also greater. The study provides the first multi-year temporal variation in snow cover extent in Nepal. According to the analysis of MODIS data, the snow cover extent over the country is highest during late winter and spring, while it is lowest during summer monsoon season. The snow cover area shows dynamic nature and the variability during late winter and spring is quite large. The snow covered territory of Nepal was divided into four subsections: east, central, west and far-west, and snow line elevations for these subsections were derived from MODIS data. Generally, the snowline elevation is lower in the west than in the east, although the central region shows relatively lower snowline elevation, not following the general zonal trend. Key Words: Snow cover; glacier fluctuation; satellite imageries; trend; snowline DOI: http://dx.doi.org/10.3126/jhm.v6i1.5481 Journal of Hydrology and Meteorology, Vol. 6, No. 1 26-36
Relating Hydrological Extremes with Area - A Case on Extreme Floods in South Central Nepal
Authors: Marahatta Suresh , Bhusal Jagat Kumar
Published: November 2011

Flash floods, debris flows and landslide disaster on the steep sloping terraces of hilly region are so challenging that even a real time hydro-meteorological forecasting system would not be applicable for all cases in Nepal. Flash floods are localized in short ranges with respect to time and distance; and it is very difficult to measure these flash floods in time. On the other hand, such phenomena need to be assessed for sustainable design of hydro- structures and for relocating the settlements from risk areas. A study was carried out to find the suitable relationship between area and extreme flood as well as area and extreme rainfall depth. Analysis is mainly based on the case of torrential rains in July 1993 over south central Nepal, which caused floods and debris torrents those were probably the worst in the disaster history of Nepal damaging lives and properties in Nepal during the 20th century. A relation for rainfall depth and other relation for specific flood are presented in this paper.Keywords: South-central Nepal; specific discharge; rainfall intensity; depth area duration.DOI: http://dx.doi.org/10.3126/jhm.v6i1.5487Journal of Hydrology and Meteorology, Vol. 6, No. 1 44-48
Water Quality Assessment and Associated Stressing Factors of the Seti River Basin, Pokhara Sub Metropolitan City
Authors: Shrestha Mandira , Pradhan Bandana , Tachamo Ram Devi , Shah Deep Narayan , Sharma Subodh , Moog Otto
Published: November 2011

The ASSESS-HKH Field Screening Methodology was carried out to assess the ecological river water quality status of nineteen small to medium sized rivers of the Seti River basin within Pokhara sub-metropolitan city during the lean flow period in March 2007. Multi habitat qualitative samplings for forty-six sites were conducted with 100 m stretch in each study river section. Five river water quality classes; class I (high), class II (good), class III (moderate), class IV (poor) and class V (bad) have been used to describe the effect of organic degradable pollution (saprobic approach). The response of benthic macroinvertebrates varied with organic pollution, sediment extraction and river crossings. The Harpan and Orlan (inlets) and Boksira (outlet) rivers of Phewa lake have water quality class III (moderately polluted) except Phirke river (outlet) which has class V. Most of the rivers outside the municipal boundaries have been identified as Class II indicating good water quality. The whole stretches of the Phusre and the Seti Rivers are still in good ecological condition. A total of 19 stressing factors have been identified along the river stretches, which have been grouped into five broad groups i.e., solid waste, effluent factors, activities and facilities, hydro-morphological degradation and ecological disturbances, and sanitation activity. The results are visualized by a colored water quality map which indicates the present ecological status of the Seti River basin. This map serves as an easy readable tool to identify hot spots and to show where immediate action is required. It also attracts the attention of the decision makers and enables timely measures to be taken for improving the deteriorating water quality of the rivers.Key words: screening methodology; benthic macroinvertebrates; water quality; Seti River basin; river pollutionDOI: http://dx.doi.org/10.3126/jhm.v6i1.5488Journal of Hydrology and Meteorology, Vol. 6, No. 1 49-57
Analysis of Channel Geometry and Sediment Transport in Palung and Chitlang Watersheds Using GIS
Authors: Dhakal Bhola Nath
Published: November 2011

Channel geometry and sediment transport have been analyzed using Geographic Information System and statistical methods in Palung and Chitlang sub-watershed of Kulekhani watershed located in the Central Hills of Nepal, which covers 87.9 sq. km of land surface.The study demonstrates that the channel geometry and sediment transport changes abnormally in downstream distance for both rivers, though there are some controlling factors i.e. lithology, land use, climate, vegetation cover etc.Key words: Channel geometry; discharge; GIS; landscape; River morphologyDOI: http://dx.doi.org/10.3126/jhm.v6i1.5490Journal of Hydrology and Meteorology, Vol. 6, No. 1 66-75
Resilient Modulus Characterization of Alaska Granular Base Materials
Authors: Li Lin , Liu Juanyu , Zhang Xiong , Saboundjian Stephan
Published: November 2011

The resilient modulus (MR) of base course material is an important material input for pavement design. Although extensive research efforts have been directed toward MR characterization and modeling, less effort has been spent on factors important for cold-region pavements. Most MR values of granular base materials available in the database of the Alaska flexible pavement design software were obtained from in-service roadways through nondestructive testing and backcalculation. The predictive models provided in the current Mechanistic–Empirical Pavement Design Guide cannot be confidently applied to Alaska materials because of the peculiar conditions for material properties and climatic differences. Hence, a systematic study was carried out to investigate the resilient behavior of granular base materials obtained from all three regions in Alaska, as presented in this paper. Effects of temperature, freeze–thaw cycle, and moisture and fines contents on the MR of Alaska base materials were experimentally evaluated, from which equations for MR prediction were developed and compared with those based on the Long-Term Pavement Performance data.
Association fibers connecting the Broca center and the lateral superior frontal gyrus: a microsurgical and tractographic anatomy
Authors: Kinoshita Masashi , Shinohara Harumichi , Hori Osamu , Ozaki Noriyuki , Ueda Fumiaki , Nakada Mitsutoshi , Hamada Jun-ichiro , Hayashi Yutaka
Published: November 2011

Object

Recently, intraoperative mapping has disclosed that, in addition to the classic language centers (that is, the Broca and Wernicke centers), other cortical regions may also play an important role in language organization. In the prefrontal cortex, although the lateral superior frontal gyrus (LSFG) could have language-related functions, there are no detailed reports that demonstrate the anatomical connection between the LSFG and other well-known language cortices, such as the Broca center. To show the existence of the structural connection, white matter association fibers between the inferior frontal gyrus (IFG) and the LSFG were examined using fiber dissection (FD) and diffusion tensor (DT) imaging–based tractography.

Methods

Eight cadaveric cerebral hemispheres were dissected to reveal the association fibers between the IFG and LSFG. The DT imaging–based tractography studies targeting the prefrontal cortex were obtained in 53 right-handed patients who had no organic cerebral lesions.

Results

The association fiber tract between Brodmann area 44/45 (the Broca center in the dominant hemisphere) and LSFG were detected in all specimens by FD. In the DT imaging–based tractography studies, the tract was identified in all patients bilaterally, except for the 4 in whom the tract was detected only in the left hemisphere. This tract was spread significantly wider in the left than in the right hemisphere, and left lateralization was evident in male patients.

Conclusions

Based on its character, this tract was named the Broca-LSFG pathway. These findings suggest a close relationship between this pathway and language organization. The structural anatomy of the Broca-LSFG pathway may explain speech disturbances induced by LSFG stimulation that are sometimes observed during intraoperative language mapping.
Stereotactic radiosurgery for arteriovenous malformations, Part 1: management of Spetzler-Martin Grade I and II arteriovenous malformations
Authors: Kano Hideyuki , Lunsford L. Dade , Flickinger John C. , Yang Huai-che , Flannery Thomas J. , Awan Nasir R. , Niranjan Ajay , Novotny Josef , Kondziolka Douglas
Published: November 2011

Object

The aim of this paper was to define the outcomes and risks of stereotactic radiosurgery (SRS) for Spetzler-Martin Grade I and II arteriovenous malformations (AVMs).

Methods

Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs, including 217 patients with AVMs classified as Spetzler-Martin Grade I or II. The median maximum diameter and target volumes were 1.9 cm (range 0.5–3.8 cm) and 2.3 cm3 (range 0.1–14.1 cm3), respectively. The median margin dose was 22 Gy (range 15–27 Gy).

Results

Arteriovenous malformation obliteration was confirmed by MR imaging in 148 patients and by angiography in 100 patients with a median follow-up of 64 months (range 6–247 months). The actuarial rates of total obliteration determined by angiography or MR imaging after 1 SRS procedure were 58%, 87%, 90%, and 93% at 3, 4, 5, and 10 years, respectively. The median time to complete MR imaging–determined obliteration was 30 months. Factors associated with higher AVM obliteration rates were smaller AVM target volume, smaller maximum diameter, and greater marginal dose. Thirteen patients (6%) suffered hemorrhages during the latency period, and 6 patients died. Cumulative rates of AVM hemorrhage 1, 2, 3, 5, and 10 years after SRS were 3.7%, 4.2%, 4.2%, 5.0%, and 6.1%, respectively. This corresponded to rates of annual bleeding risk of 3.7%, 0.3%, and 0.2% for Years 0–1, 1–5, and 5–10, respectively, after SRS. The presence of a coexisting aneurysm proximal to the AVM correlated with a significantly higher hemorrhage risk. Temporary symptomatic adverse radiation effects developed in 5 patients (2.3%) after SRS, and 2 patients (1%) developed delayed cysts.

Conclusions

Stereotactic radiosurgery is a gradually effective and relatively safe option for patients with smaller volume Spetzler-Martin Grade I or II AVMs who decline initial resection. Hemorrhage after obliteration did not occur in this series. Patients remain at risk for a bleeding event during the latency interval until obliteration occurs. Patients with aneurysms and an AVM warrant more aggressive surgical or endovascular treatment to reduce the risk of a hemorrhage in the latency period after SRS.
Stereotactic radiosurgery for arteriovenous malformations, Part 3: outcome predictors and risks after repeat radiosurgery
Authors: Kano Hideyuki , Kondziolka Douglas , Flickinger John C. , Yang Huai-che , Flannery Thomas J. , Awan Nasir R. , Niranjan Ajay , Novotny Josef , Lunsford L. Dade
Published: November 2011

Object

The object of this study was to evaluate the outcomes and risks of repeat stereotactic radiosurgery (SRS) for incompletely obliterated cerebral arteriovenous malformations (AVMs).

Methods

Between 1987 and 2006, Gamma Knife surgery was performed in 996 patients with AVMs. During this period, repeat SRS was performed in 105 patients who had incompletely obliterated AVMs at a median of 40.9 months after initial SRS (range 27.5–139 months). The median AVM target volume was 6.4 cm3 (range 0.2–26.3 cm3) at initial SRS but was reduced to 2.3 cm3 (range 0.1–18.2 cm3) at the time of the second procedure. The median margin dose at both initial SRS and repeat SRS was 18 Gy.

Results

The actuarial rate of total obliteration by angiography or MR imaging after repeat SRS was 35%, 68%, 77%, and 80% at 3, 4, 5, and 10 years, respectively. The median time to complete angiographic or MR imaging obliteration after repeat SRS was 39 months. Factors associated with a higher rate of AVM obliteration were smaller residual AVM target volume (p = 0.038) and a volume reduction of 50% or more after the initial procedure (p = 0.014). Seven patients (7%) had a hemorrhage in the interval between initial SRS and repeat SRS. Seventeen patients (16%) had hemorrhage after repeat SRS and 6 patients died. The cumulative actuarial rates of new AVM hemorrhage after repeat SRS were 1.9%, 8.1%, 10.1%, 10.1%, and 22.4% at 1, 2, 3, 5, and 10 years, respectively, which translate to annual hemorrhage rates of 4.05% and 1.79% of patients developing new post–repeat-SRS hemorrhages per year for Years 0–2 and 2–10 following repeat SRS. Factors associated with a higher risk of hemorrhage after repeat SRS were a greater number of prior hemorrhages (p = 0.008), larger AVM target volume at initial SRS (p = 0.010), larger target volume at repeat SRS (p = 0.002), initial AVM volume reduction less than 50% (p = 0.019), and a higher Pollock-Flickinger score (p = 0.010). Symptomatic adverse radiation effects developed in 5 patients (4.8%) after initial SRS and in 10 patients (9.5%) after repeat SRS. Prior embolization (p = 0.022) and a higher Spetzler-Martin grade (p = 0.004) were significantly associated with higher rates of adverse radiation effects after repeat SRS. Delayed cyst formation occurred in 5 patients (4.8%) at a median of 108 months after repeat SRS (range 47–184 months).

Conclusions

Repeat SRS for incompletely obliterated AVMs increases the eventual obliteration rate. Hemorrhage after obliteration did not occur in this series. The best results for patients with incompletely obliterated AVMs were seen in patients with a smaller residual nidus volume and no prior hemorrhages.
Stereotactic radiosurgery for arteriovenous malformations, Part 4: management of basal ganglia and thalamus arteriovenous malformations
Authors: Kano Hideyuki , Kondziolka Douglas , Flickinger John C. , Yang Huai-che , Flannery Thomas J. , Niranjan Ajay , Novotny Josef , Lunsford L. Dade
Published: November 2011

Object

The authors conducted a study to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the basal ganglia and thalamus.

Methods

Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 56 patients had AVMs of the basal ganglia and 77 had AVMs of the thalamus. In this series, 113 (85%) of 133 patients had a prior hemorrhage. The median target volume was 2.7 cm3 (range 0.1–20.7 cm3) and the median margin dose was 20 Gy (range 15–25 Gy).

Results

Obliteration of the AVM eventually was documented on MR imaging in 78 patients and on angiography in 63 patients in a median follow-up period of 61 months (range 2–265 months). The actuarial rates documenting total obliteration after radiosurgery were 57%, 70%, 72%, and 72% at 3, 4, 5, and 10 years, respectively. Factors associated with a higher rate of AVM obliteration included AVMs located in the basal ganglia, a smaller target volume, a smaller maximum diameter, and a higher margin dose. Fifteen (11%) of 133 patients suffered a hemorrhage during the latency period and 7 patients died. The rate of post-SRS AVM hemorrhage was 4.5%, 6.2%, 9.0%, 11.2%, and 15.4% at 1, 2, 3, 5, and 10 years, respectively. The overall annual hemorrhage rate was 4.7%. When 5 patients with 7 hemorrhages occurring earlier than 6 months after SRS were removed from this analysis, the annual hemorrhage rate decreased to 2.7%. Larger volume AVMs had a higher risk of hemorrhage after SRS. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 6 patients (4.5%), and in 1 patient a delayed cyst developed 56 months after SRS. No patient died of AREs. Factors associated with a higher risk of symptomatic AREs were larger target volume, larger maximum diameter, lower margin dose, and a higher Pollock-Flickinger score.

Conclusions

Stereotactic radiosurgery is a gradually effective and relatively safe management option for deep-seated AVMs in the basal ganglia and thalamus. Although hemorrhage after obliteration did not occur in the present series, patients remain at risk during the latency interval between SRS and obliteration. The best candidates for SRS are patients with smaller volume AVMs located in the basal ganglia.
Stereotactic radiosurgery for arteriovenous malformations, Part 5: management of brainstem arteriovenous malformations
Authors: Kano Hideyuki , Kondziolka Douglas , Flickinger John C. , Yang Huai-che , Flannery Thomas J. , Niranjan Ajay , Novotny Josef , Lunsford L. Dade
Published: November 2011

Object

In this paper, the authors' goal was to define the long-term outcomes and risks of stereotactic radiosurgery (SRS) for arteriovenous malformations (AVMs) of the medulla, pons, and midbrain.

Methods

Between 1987 and 2006, the authors performed Gamma Knife surgery in 996 patients with brain AVMs; 67 patients had AVMs in the brainstem. In this series, 51 patients (76%) had a prior hemorrhage. The median target volume was 1.4 cm3 (range 0.1–13.4 cm3). The median margin dose was 20 Gy (range 14–25.6 Gy).

Results

Obliteration of the AVMs was eventually documented in 35 patients at a median follow-up of 73 months (range 6–269 months). The actuarial rates of documentation of total obliteration were 41%, 70%, 70%, and 76% at 3, 4, 5, and 10 years, respectively. Higher rates of AVM obliteration were associated only with a higher margin dose. Four patients (6%) suffered a hemorrhage during the latency period, and 2 patients died. The rate of AVM hemorrhage after SRS was 3.0%, 3.0%, and 5.8% at 1, 5, and 10 years, respectively. The overall annual hemorrhage rate was 1.9%. Permanent neurological deficits due to adverse radiation effects (AREs) developed in 7 patients (10%) after SRS, and a delayed cyst developed in 2 patients (3%). One patient died at an outside institution with symptoms of AREs and unrecognized hydrocephalus. Higher 12-Gy volumes and higher Spetzler-Martin grades were associated with a higher risk of symptomatic AREs. Ten of 22 patients who had ocular dysfunction before SRS had improvement, 9 were unchanged, and 3 were worse due to AREs. Eight of 14 patients who had hemiparesis before SRS improved, 5 were unchanged, and 1 was worse.

Conclusions

Although hemorrhage after obliteration did not occur in this series, patients remained at risk during the latency interval until obliteration occurred. Thirty-eight percent of the patients who had neurological deficits due to prior hemorrhage improved. Higher dose delivery in association with conformal and highly selective SRS is required for safe and effective radiosurgery.
Accurate Quantification of Lipid Species by Electrospray Ionization Mass Spectrometry — Meets a Key Challenge in Lipidomics
Authors: Yang Kui , Han Xianlin
Published: November 2011

Electrospray ionization mass spectrometry (ESI-MS) has become one of the most popular and powerful technologies to identify and quantify individual lipid species in lipidomics. Meanwhile, quantitative analysis of lipid species by ESI-MS has also become a major obstacle to meet the challenges of lipidomics. Herein, we discuss the principles, advantages, and possible limitations of different mass spectrometry-based methodologies for lipid quantification, as well as a few practical issues important for accurate quantification of individual lipid species. Accordingly, accurate quantification of individual lipid species, one of the key challenges in lipidomics, can be practically met.
Threshold Particle Diameters in Miniemulsion Reversible-Deactivation Radical Polymerization
Authors: Tobita Hidetaka
Published: November 2011

Various types of controlled/living radical polymerizations, or using the IUPAC recommended term, reversible-deactivation radical polymerization (RDRP), conducted inside nano-sized reaction loci are considered in a unified manner, based on the polymerization rate expression, Rp = kp[M]K[Interm]/[Trap]. Unique miniemulsion polymerization kinetics of RDRP are elucidated on the basis of the following two factors: (1) A high single molecule concentration in a nano-sized particle; and (2) a significant statistical concentration variation among particles. The characteristic particle diameters below which the polymerization rate start to deviate significantly (1) from the corresponding bulk polymerization, and (2) from the estimate using the average concentrations, can be estimated by using simple equations. For stable-radical-mediated polymerization (SRMP) and atom-transfer radical polymerization (ATRP), an acceleration window is predicted for the particle diameter range, . For reversible-addition-fragmentation chain-transfer polymerization (RAFT), degenerative-transfer radical polymerization (DTRP) and also for the conventional nonliving radical polymerization, a significant rate increase occurs for . On the other hand, for the polymerization rate is suppressed because of a large statistical variation of monomer concentration among particles.
Contemporary Considerations for the Use of Digoxin for Heart Failure in Older Patients
Authors: Rojas-Fernandez Carlos H. , Viana Luis , Dadfar Farzan
Published: November 2011

Background:

Digoxin has been used in older people for over 200 years to treat heart failure. Research over the past 15 years has caused the place of digoxin in therapy to evolve. This review was conducted in order to describe the role of digoxin in the care of older patients with heart failure.

Methods:

This review was conducted by systematically searching the literature using MEDLINE via Ovid, Cochrane Library, Pub Med and EMBASE, with the search terms “heart failure” and “digoxin.” Studies published after publication of the Digitalis Investigation Group (DIG) trial (conducted from February 1997 to October 2010) were selected for possible inclusion in the review.

Results:

The majority of data regarding the use of digoxin for heart failure in older people originates from the DIG trial and the various post-hoc analyses of this dataset. When considered in unison with evidence for other heart failure therapies (e.g., angiotensin-converting enzyme inhibitors), the place of digoxin is clear, in that it should be used for patients in sinus rhythm who are symptomatic despite therapy with first-line agents or for those with concomitant atrial fibrillation whose heart rate is not well controlled by, or cannot tolerate, beta-adrenergic blockers. There are various safety and monitoring parameters that should be considered in older people when using this drug.

Conclusions:

Digoxin is a drug that still demonstrates value for heart failure in older patients when used appropriately, and after first-line agents have been maximized.
A Systematic Approach to Stroke Prevention for Patients with Atrial Fibrillation
Authors: Bungard Tammy J. , Bucci Claudia , Kertland Heather , Leblanc Kori , Pickering Jennifer , Semchuk William M.
Published: November 2011

Strokes occurring as a result of atrial fibrillation are common and typically result in severe disability or death. Over the past half century, therapeutic options for stroke prophylaxis, based on either antiplatelet (typically acetylsalicylic acid) or warfarin therapy, have remained virtually unchanged. However, as of mid-2011, promising data have emerged and Health Canada has approved a novel oral anticoagulant, dabigatran. This article provides a systematic 4-step process to guide clinicians in assessing, implementing and monitoring stroke prophylaxis for individual patients. First, identify the patient's risk of stroke with user-friendly scoring systems (CHADS2 and CHA2DS2-VASc). Second, determine the patient's risk of major bleeding with a validated scoring system (HAS-BLED) and ongoing clinical evaluation. Third, balance these benefits and the risks of available agents as they pertain to the individual patient. Fourth, select the appropriate antithrombotic therapy, with an understanding of the key features of available agents, as well as the patient's characteristics and preferences. Regular monitoring and patient adherence with therapy are necessary to ensure the long-term appropriateness of therapy, given that most patients with atrial fibrillation will require lifelong stroke prophylaxis and an individual's stroke risk generally increases with age. The pharmacist is in an excellent position to provide this type of assessment and follow-up.
Role of food availability in the bathymetric distribution of the starfish Marthasterias glacialis (Lamk.) on reefs of northern Portugal
Authors: Tuya Fernando , Duarte Pedro
Published: November 2011

We examined whether the abundance and size of the starfish Marthasterias glacialis (Lamk.) exhibit a depthdependent partitioning on subtidal reefs. We tested the hypothesis that differences in food availability can result in habitat partitioning along a depth gradient. The abundance and size of M. glacialis was registered at 4 depth strata: 0-4 m, 4-8 m, 8-12 m, and > 12 m; we also recorded the number of food items that they were preying on. The abundance and size of M. glacialis decreased with depth. Mussels (Mytilus galloprivincialis) were the most preyed food item across all depth strata, followed by gastropods, sea urchins and barnacles; M. glacialis also consumed a significantly larger amount of mussels in feeding experiments compared with sea urchins and gastropods. The abundance of M. galloprivincialis beds decreased with depth. The clear link between the decrease in abundance and size of M. glacialis with depth and the decay of the most consumed prey (mussels) suggest that food availability may play an important role in the vertical distribution of this starfish, though wave-associated turbulence in the first few metres of the subtidal could also limit the abundance of M. glacialis.
Stock boundaries for fisheries assessment and management in the Mediterranean: the Balearic Islands as a case study
Authors: Quetglas Antoni , Guijarro Beatriz , Ordines Francesc , Massutí Enric
Published: November 2011

The stock concept plays a pivotal role in fisheries assessment and management. Stocks are defined according to biological, geographical, economic or socio-political factors. The General Fisheries Commission for the Mediterranean (GFCM) has established thirty management geographical sub-areas (GSAs) based on political and statistical considerations rather than biological or economic factors. Here, we present our view on the main biological and ecological aspects that should be considered for delineating different management units in the Mediterranean. We focus on the Balearic Islands (GSA05) as a case study highlighting its specificities compared to the adjacent coast of the Iberian Peninsula (GSA06), but the approach could be generalized to the problem of identifying stock boundaries in other areas. The work is based on published information from different marine disciplines such as geomorphology, ecology and fisheries, combined with the analysis of new data coming from official fishery statistics and scientific surveys. This approach avoids the important drawbacks (inconclusive results, high costs) of other time-consuming techniques used in stock identification, such as genetics. According to the information presented, we conclude that GSA05 should be maintained as an individualized area for assessment and management purposes in the western Mediterranean.
NOCICEPTIVE RESPONSES OF THE LATERAL THALAMIC NUCLEUS EVOKED BY PINCH IN ANESTHETIZED RATS
Authors: Chen Chih-Ping , Jaw Fu-Shan
Published: November 2011

Pinch was used as a noxious stimulus and applied to the tail and hindlimbs of rats to investigate the nociceptive responsiveness of neurons in the lateral thalamus. Pinch stimuli were applied with calibrated pincher, and glass micropipettes filled with 3 M NaCl served as recording electrodes. The lateral thalamus of six rats under ketamine anesthesia was probed, including the ventrobasal (VB) complex and the posterior thalamic nucleus ( Po ), while the noxious stimulus was applied. Neuronal responses in the lateral thalamus were identified with the aid of an audio monitoring device and an oscilloscope, and several inclusion criteria had to be met. A total of 168 neurons were studied across the ventral posterolateral thalamic nucleus (VPL), ventral posteromedial thalamic nucleus (VPM), and Po of the thalamus. Of the neurons assessed in the lateral thalamus, 38 responded to the nociceptive stimuli, and most were located within the Po region of the thalamus. Very few were located in the VB. The number of responsive neurons in the anterior region of the lateral thalamus was significantly greater than the number of responsive neurons in the posterior region of the lateral thalamus. This finding indicates that the anterior region of the lateral thalamus, especially the Po area, may respond more vigorously to noxious stimuli than the posterior region.
Talking about dying and death: a focus group study to explore a local community perspective
Authors: Kirshbaum Marilyn N. Y. , Carey Ian , Purcell Brigid , Nash Seamus
Published: November 2011

There is a general perception held by health care practitioners based in hospices, palliative care services and general healthcare services that society is reluctant to talk about dying and death. This avoidance behaviour is observed, noted and expressed in national policy briefings as being detrimental to patient involvement in decision making, effective coping and preparation for death, organ donation, writing a will, and the process of bereavement. The aim of the pilot study was to explore the perceptions of a local community on the broad subject of Talking about Dying and Death. An interactive qualitative methodology using a constructivist approach enabled exploration of a wide range of views from a self-selected group resident within the local community (n=8). Data were collected from a focus group session facilitated by the researcher and an associate researcher. Systematic and analytical coding of transcripts was undertaken using Framework Analysis (Richie and Spencer 1994). Four overriding themes were identified: i) emotions, beliefs and behaviours; ii) coping with adversity; iii) difficulties, barriers and tensions, and iv) fostering a participative future. There were some notions of superstition amongst the participants, but little mention of formal religious beliefs. Within the themes, Coping with Adversity and Difficulties, Barriers and Tensions is the core of the community’s views and needs. The link to the local hospice service is significant for it is the place where practical help, spiritual care, and an appreciation for sensitivity, openness and honesty can be put into action. The importance of communication and language are critical above all else. Dying and death was articulated as an upsetting topic, and remains a taboo in this community in the United Kingdom, with a belief that talking will bring harm. Promotion of talking about dying and death was discussed in relation to the role of the local hospice and several suggestions were put forward.
General Practitioner Advice on Physical Activity—Who Gets it?
Authors: Eakin Elizabeth , Brown Wendy , Schofield Grant , Mummery Kerry , Reeves Marina
Published: November 2011

Purpose.

To evaluate the prevalence and characteristics of patients who received physical activity counseling from a general practitioner.

Methods.

Data presented are from a cross-sectional survey of approximately 2000 Queensland (Australia) adults conducted as part of a multi-strategy, community-based, physical activity intervention (10,000 Steps Rockhampton). The survey included self-reported receipt of general practitioner advice on physical activity as well as demographic, medical, and physical activity questions.

Results.

Receipt of advice on physical activity was reported by 24.2% of respondents, with advice more likely to be given to males, overweight/obese people, those with chronic conditions, and those more frequently visiting their general practitioners.

Discussion.

Rates of physical activity advice and characteristics of patients receiving advice are similar to those reported overseas and suggest that while there is room for improvement, general practitioners are targeting their advice to patients most in need.
Process Evaluation in Occupational Stress Management Programs: A Systematic Review
Authors: Murta Sheila Giardini , Sanderson Kristy , Oldenburg Brian
Published: November 2011

Objective.

To conduct a systematic review of workplace stress management intervention studies that have incorporated process evaluation.

Data Source.

Electronic databases such as PsycINFO and MEDline were searched.

Study Inclusion Criteria.

The inclusion criteria included interventions published in the English language that were focused on either individual- or organizational-level stress management interventions at the workplace, with an outcome evaluation.

Data Extraction.

Each article was coded on key process-relevant variables, including context, recruitment, reach, dose delivered, dose received, fidelity, implementation, and participant's attitudes toward the intervention. Studies that reported on at least one of these process variables were also coded on the following study characteristics: Participants, setting, evaluation design, intervention content, intervention format, and study outcomes.

Data Synthesis.

Statistical Package for the Social Science was used to analyze the data with descriptive statistics.

Results.

Of the 84 studies identified that met the study inclusion criteria, 52 (61.9%) reported findings on at least one of the key relevant process-relevant variables. Variables most frequently included were recruitment (30%), intervention dose received (22%), participants' attitudes toward intervention (19%), and program reach (13%). Fewer than half of the studies presented any findings linking process evaluation and outcome evaluation.

Conclusions.

The incomplete reporting of information relevant to process evaluation makes it difficult to identify reliable determinants of effective intervention implementation or outcomes.
Health Belief Model Variables as Predictors of Progression in Stage of Mammography Adoption
Authors: Menon Usha , Champion Victoria , Monahan Patrick O. , Daggy Joanne , Hui Siu , Skinner Celette Sugg
Published: November 2011

Purpose.

Identify predictors of change in mammography stage for nonadherent women so that appropriate stage-based interventions can be developed.

Design.

Participants were randomly assigned to one of four groups in a randomized clinical trial to increase mammography screening. This report focuses on predictors of stages of change of mammography behavior; intervention results are reported elsewhere.1

Setting.

Indigent clinic and health maintenance organization.

Subjects.

Women, 50 or older, with no breast cancer diagnosis and nonadherent with mammography screening.

Intervention.

The intervention and results are described elsewhere.1

Measures.

Previously validated belief scales.

Results.

Results showed that precontemplators and contemplators differed significantly at baseline and follow-up on all breast cancer beliefs except fear. Changes in barriers, benefits, and self-efficacy scores significantly predicted forward stage movement for women entering the study in precontemplation or contemplation (p = .0009, p = .037, and p = .048, respectively).

Conclusions.

Changes in beliefs predict stage movement, and beliefs differ significantly among stages, leading the way for interventions tailored to both beliefs and stages of behavior adoption. In practical terms, we may be able to cut down on the “bulkiness” of our interventions and the number of tailoring variables, focusing more intensively on tailoring interventions to the beliefs whose changes have now been shown to predict stage advancement. These predictions are in addition to intervention effect which is reported elsewhere.1
The Role of Personal Values, Urban Form, and Auto Availability in the Analysis of Walking for Transportation
Authors: Coogan Matthew A. , Karash Karla H. , Adler Thomas , Sallis James
Published: November 2011

Purpose.

To examine the association of personal values, the built environment, and auto availability with walking for transportation.

Setting.

Participants were drawn from 11 U.S. metropolitan areas with good transit services.

Subjects.

865 adults who had recently made or were contemplating making a residential move.

Measures.

Respondents reported if walking was their primary mode for nine trip purposes. “Personal values” reflected ratings of 15 variables assessing attitudes about urban and environmental attributes, with high reliability (α = 0.85). Neighborhood form was indicated by a three-item scale. Three binary variables were created to reflect (1) personal values, (2) neighborhood form, and (3) auto availability.

Design.

The association with walking was reported for each of the three variables, each combination of two variables, and the combination of three variables. An analysis of covariance was applied, and a hierarchic linear regression model was developed.

Results.

All three variables were associated with walking, and all three variables interacted. The standardized coefficients were 0.23 for neighborhood form, 0.21 for autos per person, and 0.18 for personal values.

Conclusion.

Positive attitudes about urban attributes, living in a supportive neighborhood, and low automobile availability significantly predicted more walking for transportation. A framework for further research is proposed in which a factor representing the role of the automobile is examined explicitly in addition to personal values and urban form.
Promoting Active Community Environments through Land Use and Transportation Planning
Authors: Aytur Semra A. , Rodriguez Daniel A. , Evenson Kelly R. , Catellier Diane J. , Rosamond Wayne D.
Published: November 2011

Purpose.

To examine the role of land use and transportation plans as policy instruments for promoting active community environments.

Design.

Cross-sectional analysis using multilevel models to examine whether active community environment scores were associated with leisure and transportation-related physical activity (PA) and whether associations varied by household income.

Setting.

67 North Carolina counties

Subjects.

Adults (n = 6694) from pooled 2000 and 2002 North Carolina Behavioral Risk Factor Surveillance System (BRFSS) surveys.

Measures.

Active community environment scores, derived from a 2003 survey of planning directors, representing the presence of nonmotorized transportation improvements, mixed land use classification, and comprehensiveness of implementation tools. Dependent variables were self-reported PA measures from the BRFSS. Sociodemographic variables were derived from the 2000 U.S. Census of Population.

Results.

After adjustment for sociodemographic factors, more favorable active community environment scores were significantly associated with leisure PA (p = .001), transportation PA (p < .01), bicycling (p < .05), walking 150 minutes/week (p < .001), and meeting PA recommendations (p < .0001). In stratified analyses, lower-income individuals (<$25,000) living in high scoring counties were three times more likely to participate in transportation PA compared with those living in low scoring counties (95% confidence interval, 1.4, 7.3).

Conclusions.

This study identifies previously unexamined policy and institutional correlates of PA related to land use and transportation planning. Plans may provide a means to incorporate community support for active living into public policy.
An open ocean record of the Toarcian oceanic anoxic event
Authors: Gröcke D. R. , Hori R. S. , Trabucho-Alexandre J. , Kemp D. B. , Schwark L.
Published: November 2011

Abstract. Oceanic anoxic events were time intervals in the Mesozoic characterized by widespread distribution of marine organic matter-rich sediments (black shales) and significant perturbations in the global carbon cycle. These perturbations are globally recorded in sediments as carbon isotope excursions irrespective of lithology and depositional environment. During the early Toarcian, black shales were deposited on the epi- and pericontinental shelves of Pangaea, and these sedimentary rocks are associated with a pronounced (ca. 7 ‰) negative (organic) carbon isotope excursion (CIE) which is thought to be the result of a major perturbation in the global carbon cycle. For this reason, the lower Toarcian is thought to represent an oceanic anoxic event (the T-OAE). If the T-OAE was indeed a global event, an isotopic expression of this event should be found beyond the epi- and pericontinental Pangaean localities. To address this issue, the carbon isotope composition of organic matter (δ13Corg of lower Toarcian organic matter-rich cherts from Japan, deposited in the open Panthalassa Ocean, was analysed. The results show the presence of a major (>6 ‰) negative excursion in δ13Corg that, based on radiolarian biostratigraphy, is a correlative of the lower Toarcian negative CIE known from Pangaean epi- and pericontinental strata. A smaller negative excursion in δ13Corg (ca. 2 ‰) is recognized lower in the studied succession. This excursion may, within the current biostratigraphic resolution, represent the excursion recorded in European epicontinental successions close to the Pliensbachian/Toarcian boundary. These results from the open ocean realm suggest, in conjunction with other previously published datasets, that these Early Jurassic carbon cycle perturbations affected the active global reservoirs of the exchangeable carbon cycle (deep marine, shallow marine, atmospheric).