bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship of Lower-Limb Muscle Force to Walking Ability in Patients With Amyotrophic Lateral Sclerosis
Authors: Jette Diane U , Slavin Mary D , Andres Patricia L , Munsat Theodore L
Published: February 2017

Background and Purpose. The purpose of this study was to determine the level of muscle force associated with ability to walk in the community without assistance, in the community with assistance, or at home only in individuals with amyotrophic lateral sclerosis (ALS). Subjects and Methods. Percentage of predicted maximal muscle force (%PMF) of lower-extremity muscles was determined, and walking ability was categorized in 118 patients with ALS during periodic visits to the Neuromuscular Research Unit. Data were derived from consecutive visits in which subjects demonstrated declines in walking ability. Means for %PMF of each muscle group and a limb average were calculated at each consecutive visit. Results. The mean lower-extremity average %PMF was: (1) 54.01% (SD=12.76%) for subjects who walked independently in the community and 50.19% (SD=14.38%) during the next visit when these same subjects required assistance in the community (difference=3.82%, 95% confidence interval [CI][=] 2.45−5.19);(2) 37.52% (SD=15.17%) during the last visit that subjects walked with assistance in the community and 32.18% (SD=13.83%) during the next visit when they walked only at home (difference=5.33%, 95% CI=3.61–7.06); and (3) 19.12% (SD=9.08%) during the visit when subjects were last able to ambulate at home versus 13.70% (SD=7.36%) when they became unable to walk (difference=5.42%, 95% CI=2.97−7.96). Conclusion and Discussion. The findings suggest there are required levels of lower-extremity muscle force for various categories of walking ability. Variations in forces within and between categories of walking ability, however, indicate the complexity of this relationship.
Contributions of Lower-Limb Muscle Power in Gait of People Without Impairments
Authors: Sadeghi Heydar , Allard Paul , Duhaime Morris
Published: February 2017

Background and Purpose. Although gait asymmetry in rehabilitation has been documented, little is known about propulsion and control tasks performed by each limb and how these tasks are managed between the lower limbs. The purpose of this study was to test the hypothesis that the leading limb contributes mainly to forward progression, whereas the trailing limb provides control and propels the lower limb to a lesser extent. Subjects. Nineteen men with an average age of 26.2 years (SD=3.2, range=21–34) and no history of orthopedic ailments participated in the study. Methods. Muscle power was determined using an 8-camera high-speed video system synchronized with 2 force plates. The principal-component analysis method was applied to reduce and classify 52 gait variables for each limb, and Pearson correlations were used to determine the interactions within the data sets for each limb. Results. Gait propulsion was initiated by the hip of the leading limb shortly after heel-strike and was maintained throughout the stance phase. Control was the main task of the trailing limb, as evidenced by the power absorption bursts at the hip and knee. Conclusion and Discussion. Within-limb interaction further emphasized the functional relationship between forward progression and control tasks and highlighted the importance of frontal- and transverse-plane actions during gait.
Detrimental Effects of Short-term Glucocorticoid Use on the Rat Diaphragm
Authors: Eason Jane M , Dodd Stephen L , Powers Scott K , Martin A Daniel
Published: February 2017

Background and Purpose. The purpose of this study was to determine the effect of short-term, high doses of glucocorticoids on both body and diaphragm weights as well as contractile characteristics of the rat diaphragm. Subjects. Adult, female Sprague-Dawley rats were divided into 2 groups: a control group (n=16) and a prednisolone group (n=16). Methods. The prednisolone group received prednisolone at a dosage of 5 mg/kg, and the control group received sham saline injections for 5 days. Animals were weighed prior to and after completion of the drug injection period. At the completion of the drug injection period, the animals were sacrificed, and the diaphragm, soleus, and extensor digitorum longus muscles were removed and weighed. A small strip of the costal diaphragm was connected to a force transducer, and the following contractile characteristics were measured: maximal specific isometric tetanic tension, peak isometric twitch specific tension, one-half relaxation time, and time to peak tension. Results. Both body and diaphragm weights decreased by 15% in the prednisolone group as compared with the control group. Maximal specific isometric tetanic tension was reduced 13% in the prednisolone group as compared with the control group. There was no difference in any twitch contractile characteristics between the 2 groups. Conclusion and Discussion. These data support the hypothesis that glucocorticoid treatment over a 5-day period results in a decrease in specific tension as well as diaphragm and body weight. These results may have implications for the treatment of patients receiving high doses of glucocorticoids for acute medical conditions.
Examining Diagnostic Tests: An Evidence-Based Perspective
Authors: Fritz Julie M , Wainner Robert S
Published: February 2017

Diagnosis is an important aspect of physical therapist practice. Selecting tests that will provide the most accurate information and evaluating the results appropriately are important clinical skills. Most of the discussion in physical therapy to date has centered on defining diagnosis, with considerably less attention paid to elucidating the diagnostic process. Determining the best diagnostic tests for use in clinical situations requires an ability to appraise evidence in the literature that describes the accuracy and interpretation of the results of testing. Important issues for judging studies of diagnostic tests are not widely disseminated or adhered to in the literature. Lack of awareness of these issues may lead to misinterpretation of the results. The application of evidence to clinical practice also requires an understanding of evidence and its use in decision making. The purpose of this article is to present an evidence-based perspective on the diagnostic process in physical therapy. Issues relevant to the appraisal of evidence regarding diagnostic tests and integration of the evidence into patient management are presented.
Reliability of Measurements Obtained With the Modified Ashworth Scale in the Lower Extremities of People With Stroke
Authors: Blackburn Marjan , van Vliet Paulette , Mockett Simon P
Published: February 2017

Background and Purpose. Abnormal muscle tone is a common motor disorder following stroke, which may require rehabilitation. The Modified Ashworth Scale is a 6-point rating scale that is used to measure muscle tone. The interrater and intrarater reliability of measurements obtained with the scale remain equivocal. The purpose of this study was to investigate the reliability of measurements obtained with the scale in the lower limb of patients with stroke. Subjects. Twenty patients were tested 2 weeks after their stroke, and 12 patients were tested 12 weeks after their stroke. Methods. Gastrocnemius, soleus, and quadriceps femoris muscles on the hemiplegic side were tested. Results. Interrater reliability for 2 raters was poor, with a Kendall tau-b correlation for the combined muscle group of .062 (P=.461). For intrarater reliability, the Kendall tau-b correlation was .567 (P<.001). The agreement within one rater occurred mostly on the grade of 0. Discussion and Conclusion. The Modified Ashworth Scale yielded reliable measurements in the lower limb for a single examiner, and agreement was best on the grade of 0. The reliability between examiners was not good, which may bring into question the validity of measurements obtained with the scale.
Loads on an Internal Spinal Fixation Device During Physical Therapy
Authors: Rohlmann Antonius , Graichen Friedmar , Bergmann Georg
Published: February 2017

Background and Purpose. Modified internal spinal fixation devices allow the measurement of the forces and moments acting on the implants. The aim of this study was to measure the loads on internal fixation devices for selected body positions and movements during physical therapy. Subjects and Methods. Loads on an internal spinal fixation device were measured in 10 patients with degenerative instability or compression fractures using a telemeterized implant. Results. Relatively low implant loads were found in the recumbent body positions. Most exercises performed in a lying position caused implant loads less than that measured for standing and are therefore not likely to increase the risk of screw breakage. Fixation device loads were lower for sitting relaxed than for standing. The highest implant loads (128% of the value for standing) were measured during walking. Standing up, sitting down, and lateral bending and axial rotation of the upper body while standing led to fixation device loads between 111% and 120% related to the value for standing. Even higher fixation device loads were measured for ventral flexion and extension of the upper body while standing. Kneeling on hands and knees, and flexing and extending the back in this position, caused implant loads that were lower than for standing. Discussion and Conclusion. Standing up, sitting down, and lateral bending and axial rotation of the upper body while standing may slightly increase the risk of pedicle screw breakage, whereas ventral flexion and extension of the upper body while standing may increase this risk considerably if the region bridged by the implant is distracted (the distance between upper and lower screws was increased) during surgery. However, walking is the exercise that plays the major role concerning pedicle screw breakage because it causes the highest bending moments of all exercises studied and it loads the fixation devices most frequently.
Body Weight Support Treadmill and Overground Ambulation Training for Two Patients With Chronic Disability Secondary to Stroke
Authors: Miller Ellen Winchell , Quinn Matthew E , Seddon Patricia Gawlik
Published: February 2017

Background and Purpose. Body weight support (BWS) treadmill training has recently been shown to be effective for gait training following stroke, but few researchers have measured the usefulness of this intervention in enhancing function, and there are no reports in which BWS overground ambulation was studied. The purposes of this case report were (1) to report the feasibility and patient tolerance for using a BWS system for overground ambulation, (2) to measure the function of patients with chronic stroke (2 years post-stroke) prior to and following BWS treadmill and overground ambulation training, and (3) to describe a protocol used for patient treatment progression using BWS treadmill training. Case Descriptions. The participants were 2 women, aged 87 and 93 years, who had strokes more than 2 years before data collection. A 10-m timed walk test, the Berg Balance Scale, the gait portion of the Tinetti Gait and Balance Assessment, and a measure of step length were administered. Intervention consisted of BWS ambulation training 3 times a week for 6 to 7 weeks. Each day there was BWS treadmill and overground training. Outcomes. Participant A improved most in 10-m walking time and Berg Balance Scale score. Participant B exhibited improvements in step length and 10-m walking time. Discussion. The outcomes suggest that very old patients with chronic functional deficits secondary to cerebrovascular accident tolerated BWS treadmill and overground ambulation training and made improvements following this intervention.
“Look Forward, Walk Tall”: Exploring Our “What If” Questions
Authors: Wolf Steven L
Published: February 2017

Steven L Wolf, PT, PhD, FAPTA

Dr Wolf has given much to the physical therapy profession through his teaching, research, and service. He has an extensive publication record of more than 100 peer-reviewed publications that reflect his interest and expertise in biofeedback, neuromuscular re-education, and management of patients with chronic pain, among others. His work spanned the basic science areas early in his career and has shifted more recently to large-scale clinical research that corresponds to the most urgent need within the profession of physical therapy. Dr Wolf's influence has reached beyond the United States, and he is a much sought-after lecturer internationally. As a researcher, he has had a profound effect as one of the most consistent and productive researchers. Over his career, he has been a part of 37 funded peer-reviewed grant proposals, and he is listed in more than half as either the Principal or Co-Principal Investigator. The funding totals an astounding $30 million.

His profound experience as one of the cutting-edge researchers in physical therapy and as a superb educator and his international reputation—in addition to his many contributions to the professional association—have qualified him for this highest award the Association can provide.

Dr Wolf's distinguished career is highlighted by numerous awards, including the Marian Williams Research Award, Gold Pen Award, Catherine Worthingham Fellow of the APTA, Lucy Blair Service Award, Helen J Hislop Award for Excellence in Contributions to Professional Literature, the Foundation for Physical Therapy's Robert C Bartlett Recognition Award, the Section on Geriatrics Outstanding Published Paper Award, and the Neurology Section Outstanding Research Award.
A Calibration Study of Therapeutic Ultrasound Units
Authors: Artho Paul A , Thyne Jason G , Warring Barry P , Willis Chris D , Brismée Jean-Michel , Latman Neal S
Published: February 2017

Background and Purpose. Physiological effects of therapeutic ultrasound (US) are dependent on the intensity and duration of application. The purpose of this study was to test US machines used in clinical settings for proper calibration of time and power output. Methods. Measurements of power output and timer accuracy were obtained from 83 US units in clinical use. The machines were tested at 4 intensity settings (0.5, 1.0, 1.5, and 2.0 W/cm2) using a continuous waveform and a 1-MHz frequency. The measured intensities were converted to percentages of error and compared with the ±20% standard. Results. Of the machines tested, 32 (39%) were outside the calibration standard for at least one output setting. Of these machines, 15 (18%) were above the +20% standard, and 17 (21%) were below the −20% standard for at least one output setting. Of the 32 machines outside the standard, 26 (31%) were outside the standard for 2 or more settings, and 3 (4%) produced no output at any of the settings. Of the mechanical timers tested, 7 (28%) were outside of the ±10% standard for timer accuracy at the 5-minute interval, and 6 (24%) were outside of the standard at the 10-minute interval. All digital timers tested were within the standard. Discussion and Conclusion. More than one third of machines tested in this study were outside the standard for power output, and approximately one fourth of the mechanical timers were outside the standard. Therefore, further improvements in the accuracy of US machine calibration are needed.
The Use of Casts in the Management of Joint Mobility and Hypertonia Following Brain Injury in Adults: A Systematic Review
Authors: Mortenson Patricia A , Eng Janice J
Published: February 2017

Many controversies exist regarding the practicality, the theoretical premises, and the supporting evidence for the use of casts in the management of joint hypomobility and hypertonia (ie, increase in joint resistance to passive movement resulting from hyperactivity of the stretch reflex and/or changes in the muscles and connective tissues). The purpose of this review was to determine current best practice for the use of casting in the rehabilitation of adults with brain injury. A systematic review was undertaken to find studies that quantified the effectiveness of casting in adults with brain injury. Thirteen articles that presented experimental or case report evidence on casting were analyzed using Sackett's levels of evidence and were examined for scientific rigor. A grade B recommendation is given for the use of casting to increase passive range of motion or to prevent its loss, and implications for further research are provided.
Effect of Seat Inclination on Seated Pressures of Individuals With Spinal Cord Injury
Authors: Maurer Christine L , Sprigle Stephen
Published: February 2017

Background and Purpose. Manual wheelchair configurations commonly include “squeezing” the wheelchair frame to improve balance for users with spinal cord injuries. This squeezing is achieved by lowering the rear portion of the seat relative to the front of the seat while maintaining the same back angle. The study's purpose was to examine the effect of increasing posterior seat inclination on buttock interface pressures. Subjects. Nine male and 5 female subjects (mean age=37 years, SD=11.2, range=19–55) with complete thoracic or lumbar spinal cord injury were tested. Methods. Subjects sat on a pressure mat placed over a foam cushion. Pressure readings were taken at seat angles reflecting seat height decreases of 0, 5.1, 7.6, and 10.2 cm (0, 2, 3, and 4 in) of the rear of the seat relative to the front of the seat. An analysis of variance and a Duncan multiple range test were used for data analysis. Results. No meaningful differences were found in measurements of interface pressure (dispersion index, contact area, and seat pressure index), total force on seat, or peak pressure index with posterior seat inclination. Discussion and Conclusion. The data indicate no meaningful evidence that squeezing a wheelchair frame increases seat interface pressures.
Management of Postsurgical Hyperhidrosis With Direct Current and Tap Water
Authors: Gillick Bernadette T , Kloth Luther C , Starsky Andrew , Cincinelli-Walker Laura
Published: February 2017

Background and Purpose. Excessive sweating, known as hyperhidrosis, involves the eccrine sweat glands of the axillae, soles, palms, and/or forehead. The use of iontophoresis to reduce or eliminate excessive sweating has been described since 1952. The purpose of this case report is to describe the use of tap water galvanism (TWG) using direct current (DC) with a patient who had postsurgical hyperhidrosis. Case Description. The patient was a 36-year-old male electrician with traumatic phalangeal amputation and postsurgical development of hyperhidrosis. Tap water galvanism was administered using a DC generator, 2 to 3 times per week for 10 treatments. The patient's hands were individually submerged in 2 containers of tap water with the electrodes immersed directly into the containers. Each hand was treated with 30 minutes of TWG at 12 mA. Hyperhidrosis was measured by a 5-second imprint and subsequent tracing of the left hand placed on dry paper toweling. Outcomes. The patient's hyperhidrosis decreased from the full left palmar pad, with a surface area of 10.3×12.0 cm, to a reduced area of wetness that covered a 2.2-×2.7-cm area. The patient returned to work as an electrician without needing absorbent gloves, which had prevented him from performing electrical work. Discussion. Following use of TWG, the patient's palmar hyperhidrosis returned to normhidrosis.
Effects of Live, Videotaped, or Written Instruction on Learning an Upper-Extremity Exercise Program
Authors: Reo Julie Allen , Mercer Vicki Stemmons
Published: February 2017

Background and Purpose. Today's health care environment encourages cost containment in many aspects of patient care, including exercise instruction in physical therapy. The purpose of this study was to determine whether different modes of instruction affect the learning of an exercise program, as measured by retention test performance immediately after the instruction and practice and after a 1-day delay. Subjects. Subjects were 40 people, aged 26 to 51 years (X̄=38.4, SD=7.4), with no known shoulder pathology. Methods. Subjects were instructed in a series of 5 shoulder exercises by 1 of 4 modes of instruction: (1) live modeling, (2) corrected-error videotape, (3) error-free videotape, and (4) handout alone. Results. Subjects who received instruction from handout materials alone (handout group) exhibited poorer performance accuracy than subjects who received live or videotaped modeling and exercise instruction. In addition, the total number of errors of the handout group was more than twice the average of the live instruction and videotape instruction groups. No differences were found between the live instruction group and the 2 groups that received videotaped instruction. Discussion and Conclusion. Live and videotaped modeling are more effective than a handout alone for achieving performance accuracy of a basic exercise program, as measured by immediate and delayed retention tests.
The Muscular Dystrophies: From Genes to Therapies
Authors: Lovering Richard M , Porter Neil C , Bloch Robert J
Published: February 2017

The genetic basis of many muscular disorders, including many of the more common muscular dystrophies, is now known. Clinically, the recent genetic advances have improved diagnostic capabilities, but they have not yet provided clues about treatment or management. Thanks to better management strategies and therapeutic interventions, however, many patients with a muscular dystrophy are more active and are living longer. Physical therapists, therefore, are more likely to see a patient with a muscular dystrophy, so understanding these muscle disorders and their management is essential. Physical therapy offers the most promise in caring for the majority of patients with these conditions, because it is unlikely that advances in gene therapy will significantly alter their clinical treatment in the near future. This perspective covers some of the basic molecular biological advances together with the clinical manifestations of the muscular dystrophies and the latest approaches to their management.
Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy
Authors: Bekkering Geertruida E , van Tulder Maurits W , Hendriks Erik JM , Koopmanschap Marc A , Knol Dirk L , Bouter Lex M , Oostendorp Rob AB
Published: February 2017

Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.
Mandatory Continuing Education in Physical Therapy: Survey of Physical Therapists in States With and States Without a Mandate
Authors: Landers Merrill R , McWhorter James W , Krum Laura L , Glovinsky David
Published: February 2017

Background and Purpose Although formal continuing education (CE) in physical therapy is one part of professional development, its value for renewing licensure is not shared by all states. The purpose of this study was to explore the differences in how physical therapists pursue formal continuing education on the basis of state mandate, sex, years of experience, practice specialty, American Physical Therapy Association membership, motivation, and perception of the benefits of CE. Subjects and Methods A survey questionnaire was sent to 3,000 physical therapists in 7 states—1,500 to physical therapists in states with mandatory CE and 1,500 to physical therapists in states without a requirement. A total of 1,145 usable survey questionnaires were returned, for a response rate of 38.2%. Results Physical therapists in states with mandatory CE averaged 33.8 hours of CE per year, whereas physical therapists in states without a mandate averaged 28.3 hours per year; 5.9% of therapists in states without a mandate reported taking no CE at all, and 10.8% reported taking 2 or fewer hours of CE within the preceding 5 years. No statistically significant relationships were observed between the amount of CE taken and years of experience, sex, or practice specialty. Therapists who reported membership in the American Physical Therapy Association participated in 7.2 more hours of CE per year than therapists who did not report membership. Significant motivational variables that respondents noted for taking CE were state mandate, increased clinical competence, and certification. Therapists overwhelmingly (96.2%) believed that CE had a beneficial effect on their clinical practice. Discussion and Conclusion Results from this study suggest that mandatory CE does have a significant association with the number of formal CE hours taken by physical therapists.
Is there evidence that phonophoresis is more effective than ultrasound in treating pain associated with lateral epicondylitis?
Authors: Hoppenrath Terri , Ciccone Charles D
Published: February 2017

A48-year-old woman was referred to our clinic with pain in the lateral epicondyle region of her right elbow. She is right-hand dominant. This pain started about 1 year ago, and the pain gradually increased throughout the past summer. During the warmer months she rides a motorcycle almost every day. The right hand is responsible for controlling the throttle of her motorcycle, and the wrist extensor muscles must contract to maintain active wrist extension for long periods of time. The right hand also controls the front brake lever, which is squeezed to apply the brake. This action also requires that the wrist extensor muscles contract to stabilize the wrist as the finger flexor muscles contract to squeeze the lever. The patient, therefore, uses her right wrist extensors continuously when riding a motorcycle, and these muscles might be overused during frequent or lengthy rides.
Rating Scale, Standard Gamble, and Time Trade-off for People With Traumatic Spinal Cord Injuries
Authors: Lin Mau-Roung , Hwang Hei-Fen , Chung Kuo-Piao , Huang Chingchaw , Chen Chih-Yi
Published: February 2017

Background and Purpose. The rating scale (RS), standard gamble (SG), and time trade-off (TTO) for people with traumatic spinal cord injuries (SCIs) have not been reported. This study compared psychometric performances of these preference-based measures among people with SCIs in Taiwan. Subjects and Methods. In total, 187 subjects from a nationwide registry of people with traumatic SCIs were interviewed by telephone. Score distributions, interrater reliability, discriminant ability, and convergent validity for the RS, SG, and TTO were compared. Results. The mean (median) values of the RS, SG, and TTO were 0.67 (0.70), 0.64 (0.75), and 0.53 (0.50), respectively, and their corresponding intraclass correlation coefficients for intrarater and interrater test-retest reliability were .92 and .89, .78 and .73, and .91 and .78. Compared with the SG and TTO, the RS had fewer floor and ceiling values as well as percent changes, more missing observations, a larger effect size, and better discrimination ability. The results of Spearman correlation and factor analysis showed that the SG strongly converged with the TTO (r=.65, and in a single common factor), but they weakly converged with the RS (r=.33 with the SG and r=.27 with the TTO). In the linear regression models, the RS was significantly associated with neurological severity, employment, educational level, and self-care ability; the SG was associated with neurological severity and employment; and the TTO was associated only with neurological severity. Discussion and Conclusion. The RS generally performed better than the SG and TTO among people with traumatic SCIs; however, the underlying construct measured by the RS differed considerably from those measured by the SG and TTO. [Lin MR, Hwang HF, Chung KP, et al. Rating scale, standard gamble, and time trade-off for people with traumatic spinal cord injuries.
Estimates of Quality and Reliability With the Physiotherapy Evidence-Based Database Scale to Assess the Methodology of Randomized Controlled Trials of Pharmacological and Nonpharmacological Interventions
Authors: Foley Norine C , Bhogal Sanjit K , Teasell Robert W , Bureau Yves , Speechley Mark R
Published: February 2017

Background and Purpose. Systematic reviews and meta-analyses often include an evaluation of the methodological quality of the individual studies that have been included, and are usually conducted by at least 2 individuals. The objective of this study was to assess the methodological quality and reliability of a series of randomized controlled trials (RCTs) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence-Based Database (PEDro) Scale. Methods. Two abstractors independently reviewed 81 RCTs assessing a variety of interventions. The Cohen kappa statistic and the intraclass correlation coefficient (ICC) were used to assess agreement between abstractors. Results. The average total PEDro scores were 5.94 (SD=1.43) for all studies combined, 6.88 (SD=1.2) for pharmacological studies, and 5.29 (SD=1.26) for nonpharmacological studies. The median score for pharmacological studies was significantly higher than that for nonpharmacological studies (7 versus 5). Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement (1.00) for randomization and reporting of results from between-group comparisons. The ICCs associated with the cumulative PEDro score were .91 (95% confidence interval [CI]=.83–.94) for all studies, .89 (95% CI=.78–.95) for pharmacological studies, and .91 (95% CI=.84–.952) for nonpharmacological studies. Discussion and Conclusion. The methodological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions. There was good agreement between raters at an individual item level and in total PEDro scores. A lack of reporting clarity, poor organization of the report, or the failure to include salient details contributed to less-than-perfect agreement between raters. [Foley NC, Bhogal SK, Teasell RW, et al. Estimates of quality and reliability with the Physiotherapy Evidence-Based Database Scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions.Phys Ther. 2006;86:817 – 824.]
Effects of Short-Term CPAP Withdrawal on Neurobehavioral Performance in Patients With Obstructive Sleep Apnea
Authors: Yang Qiao , Phillips Craig L. , Melehan Kerri L. , Rogers Naomi L. , Seale J. Paul , Grunstein Ronald R.
Published: February 2017

Study Objective:

Changes in sleep parameters and neurobehavioral functioning were systematically investigated after an acute (1 night) and short-term (7 nights) period of withdrawal from continuous positive airway pressure (CPAP) treatment and 1 subsequent night of CPAP reintroduction in patients with obstructive sleep apnea.

Design:

Repeated-measurement within-subject design.

Setting:

Sleep laboratory, university teaching hospital.

Participants:

Twenty participants receiving optimal CPAP therapy for ≥ 12 months.

Interventions:

CPAP withdrawal.

Measurements and Results:

Polysomnograms were performed on Night 0 (with CPAP), Night 1 and Night 7 (without CPAP) and Night 8_R (with CPAP). Acute CPAP withdrawal resulted in the recurrence of sleep-disordered breathing with sleep disruption, hypoxemia, and increased subjective sleepiness. Short-term CPAP withdrawal exacerbated hypoxemia, increased subjective and objective sleepiness and poor mood ratings. Neurobehavioral functioning assessed using the Psychomotor Vigilance Task was impaired following Night 7 and associated with hypoxemia and changes in morning levels of tumor necrosis factor-alpha. However, other neurobehavioral measures were not affected. Autonomic arousals measured via respiratory-related reductions in finger blood volume by peripheral arterial tonometry decreased from Night 1 to Night 7. On Night 8_R, reintroduction of CPAP treatment eliminated most airway obstruction, maintained oxygenation, and reversed daytime sleepiness and some vigilance decrements.

Conclusion:

Despite recurrence of sleep-disordered breathing with increased sleepiness and impaired vigilance, most neurobehavioral variables were unaffected by CPAP withdrawal. The reduction in vigilance appeared to be associated with worsened hypoxemia and changed levels of tumor necrosis factor-alpha. Resumption of CPAP treatment had immediate benefits on sleep consolidation and subjective sleepiness.

Citation:

Yang Q; Phillips CL; Melehan KL et al. Effects of short-term CPAP withdrawal on neurobehavioral performance in patients with obstructive sleep apnea.
An Evaluation of Provincial Infectious Disease Surveillance Reports in Ontario
Authors: Chan Ellen , Barnes Morgan E. , Sharif Omar
Published: February 2017

Context:

Public Health Ontario (PHO) publishes various infectious disease surveillance reports, but none have yet been formally evaluated.

Objective:

PHO evaluated its monthly and annual infectious disease surveillance reports to assess public health stakeholders' current perception of the products and to develop recommendations for improving future products.

Design:

An evaluation consisting of an online survey and a review of public Web sites of other jurisdictions with similar annual reports.

Setting:

For the online survey, stakeholder organizations targeted were the 36 local public health units and the Health health ministry in Ontario, Canada.

Participants:

Survey participants included epidemiologists, managers, directors, and other public health practitioners from participating organizations.

Main Outcome Measures:

Online survey respondents' awareness and access to the reports, their rated usefulness of reports and subsections, and suggestions for improving usefulness; timeliness of select annual reports from other jurisdictions based on the period from data described to report publication.

Results:

Among 57 survey respondents, between 74% and 97% rated each report as useful; the most common use was for situational awareness. Respondents ranked timeliness as the most important attribute of surveillance reports, followed by data completeness. Among 6 annual reports reviewed, the median time to publication was 11.5 months compared with 23.2 months for PHO.

Conclusion:

Recommendations based on this evaluation have already been applied to the monthly report (eg, focusing on the most useful sections) and have become key considerations when developing future annual reports and other surveillance reporting tools (eg, need to provide more timely reports). Other public health organizations may also use this evaluation to inform aspects of their surveillance report development and evaluation. The evaluation results have provided PHO with direction on how to improve its provincial infectious disease surveillance reporting moving forward, and formed a basis for future work in surveillance product development and evaluation.
Mindfulness and dynamic functional neural connectivity in children and adolescents
Authors: Marusak Hilary A. , Thomason Moriah E. , Elrahal Farrah , Peters Craig A. , Kundu Prantik , Lombardo Michael V. , Calhoun Vince D. , Goldberg Elimelech K. , Cohen Cindy , Taub Jeffrey W. , Rabinak Christine A.
Published: February 2017

Background

Mindfulness is a non-judgmental, present-centered awareness and acceptance of one’s thoughts, feelings, and bodily sensations. Interventions that promote mindfulness consistently show salutatory effects on cognition and psychological wellbeing in adults, and more recently, in children. Understanding the neurobiological mechanisms underlying mindfulness in children may allow for more judicious application of these techniques in clinical and educational settings.

Methods

Using multi-echo/multi-band fMRI, we measured resting-state connectivity and tested the hypothesis that the association between mindfulness and anxiety in children (N=42) will relate to static and dynamic interactions between large-scale neural networks considered central to neurocognitive functioning and implicated in mindfulness in adults (default mode [DMN], salience and emotion [SEN], and central executive networks [CEN]).

Results

Mindfulness was related todynamicbut notstaticconnectivity in children. Specifically, more mindful children transitioned more between brain states over the course of the scan, spent overall less time in a certain connectivity state (state 2), and showed a state-specific reduction in SEN-right CEN connectivity (state 4). Results of a separate measure of present-focused thought during the resting-state were consistent with these results, suggesting state-trait convergence. Finally, the number of state transitions mediated the link between higher mindfulness and lower anxiety, suggesting that flexibility in transitioning between neural states may bridge the well-established link between mindfulness and anxiety in children.

Conclusions

Results provide new insights into neural mechanisms underlying benefits of mindfulness on psychological health in children, and suggest that mindfulness relates to functional neural dynamics and interactions between neurocognitive networks, over time.
An inducible CRISPR-ON system for controllable gene activation in human pluripotent stem cells
Authors: Guo Jianying , Ma Dacheng , Huang Rujin , Ming Jia , Ye Min , Kee Kehkooi , Xie Zhen , Na Jie
Published: February 2017

Human pluripotent stem cells (hPSCs) are an important system to study early human development, model human diseases, and develop cell replacement therapies. However, genetic manipulation of hPSCs is challenging and a method to simultaneously activate multiple genomic sites in a controllable manner is sorely needed. Here, we constructed a CRISPR-ON system to efficiently upregulate endogenous genes in hPSCs. A doxycycline (Dox) inducible dCas9-VP64-p65-Rta (dCas9-VPR) transcription activator and a reverse Tet transactivator (rtTA) expression cassette were knocked into the two alleles of theAAVS1locus to generate an iVPR hESC line. We showed that the dCas9-VPR level could be precisely and reversibly controlled by addition and withdrawal of Dox. Upon transfection of multiplexed gRNA plasmid targeting theNANOGpromoter and Dox induction, we were able to controlNANOGgene expression from its endogenous locus. Interestingly, an elevatedNANOGlevel did not only promote naïve pluripotent gene expression but also enhanced cell survival and clonogenicity, and it enabled integration of hESCs with the inner cell mass (ICM) of mouse blastocystsin vitro. Thus, iVPR cells provide a convenient platform for gene function studies as well as high-throughput screens in hPSCs.
`NMR Crystallization':in-situNMR techniques for time-resolved monitoring of crystallization processes
Authors: Harris Kenneth D. M. , Hughes Colan E. , Williams P. Andrew , Edwards-Gau Gregory R.
Published: February 2017

Solid-state NMR spectroscopy is a well-established and versatile technique for studying the structural and dynamic properties of solids, and there is considerable potential to exploit the power and versatility of solid-state NMR forin-situstudies of chemical processes. However, a number of technical challenges are associated with adapting this technique forin-situstudies, depending on the process of interest. Recently, anin-situsolid-state NMR strategy for monitoring the evolution of crystallization processes has been developed and has proven to be a promising approach for identifying the sequence of distinct solid forms present as a function of time during crystallization from solution, and for the discovery of new polymorphs. The latest development of this technique, called `CLASSIC' NMR, allows the simultaneous measurement ofbothliquid-stateandsolid-state NMR spectra as a function of time, thus yielding complementary information on the evolution of both the liquid phase and the solid phase during crystallization from solution. This article gives an overview of the range of NMR strategies that are currently available forin-situstudies of crystallization processes, with examples of applications that highlight the potential of these strategies to deepen our understanding of crystallization phenomena.
Barriers to enter in foreign markets: evidence from SMEs in emerging market
Authors: Rahman Mahfuzur , Uddin Moshfique , Lodorfos George
Published: February 2017

Purpose

Foreign market entry is considered as a key strategy to grow and survive over longer period of time for small and medium enterprises (SMEs). The decision to enter a foreign market is not a straightforward story. Considering resource limitation, SMEs need to analyse the key barriers to entry in foreign markets very carefully. The purpose of this paper is to identify these barriers for the SMEs in a developing country.

Design/methodology/approach

This study has used primary data collected through questionnaires from 212 Bangladeshi SMEs. A mixed method data analysis technique is used to analyse the firms both from micro- and macro-levels. Following the running example-based case study approach, this study has developed and validated a partial least square-based structural model to assess the key barriers to entry in foreign markets.

Findings

This study has identified the key socio-economic barriers faced by the SMEs in a developing country to enter in foreign markets. It has successfully framed the socio-economic barriers to enter in foreign markets for Bangladeshi SMEs as a second-order hierarchical model.

Originality/value

It is often believed that foreign market entry is more affected by social barriers as explained by the existing theories including the Uppsala model. This study, however, revealed that the international market expansions of SMEs in developing countries are more sensitive to the economic barriers.
Explaining the surge in M&A as an entry mode: home country and cultural influences
Authors: Boateng Agyenim , Du Min , Wang Yan , Wang Chengqi , Ahammad Mohammad F.
Published: February 2017

Purpose

The purpose of this paper is to examine the trends, patterns and the impact of cultural and home country macroeconomic influences on Chinese cross-border mergers and acquisitions (CBM&A) as foreign entry strategy for the period of 1998-2011.

Design/methodology/approach

Using three regression models, namely, ordinary least squares, the random effects and fixed effects to examine the impact of home country macroeconomic and cultural factors on CBM&A outflows as an entry mode of Chinese firms. The authors check the robustness of the results using system GMM.

Findings

The findings suggest that CBM&A as a preferred mode of market entry provides a means for obtaining strategic resources to develop competitive advantages for the Chinese emerging market firms. The regression results indicate that home country macroeconomic and cultural variables, including gross domestic product (GDP), liquidity, interest rates, inflation, acquisitions in resource seeking sectors and cultural distance play an important role in explaining the trends of CBM&A outflows by the Chinese firms.

Research limitations/implications

The results imply that government support to emerging market multinational enterprises (EMEs) to acquire strategic assets and economic policies in the home country play an important role in shaping international expansion behaviour of EMEs through CBM&A. The study demonstrates that outward investments of EMEs are partly a function of the level of economic policies and government support at home. The limitation is that most of the Chinese CBM&A transactions took place in Asia/Pacific locations. Future studies appear warranted if new data become available.

Originality/value

The study demonstrates how the institutions, strategic asset seeking with government support and economic policies in the home country play important role in shaping international expansion behaviour of emerging market enterprises through CBM&A thereby contributing to the political economy literature and institutional theory. More importantly, the study shows that the level of economic policies and development such as GDP, money supply, interest rates, inflation of the home country are important for EME growth in the international market.
Standardization versus adaptation of global marketing strategies in emerging market cross-border acquisitions
Authors: Rao-Nicholson Rekha , Khan Zaheer
Published: February 2017

Purpose

The recent increase in the presence of emerging market firms (EMFs) in global markets requires a closer examination of their international marketing strategies (including branding). The purpose of this paper is to examine the factors behind the standardization or adaptation of global marketing strategies adopted by EMFs for their cross-border acquisitions.

Design/methodology/approach

This paper examines the determinants of the marketing strategies adopted by Indian and Chinese firms for their cross-border acquisitions. The drivers of the standardization/adaptation of marketing strategies (including branding) are identified using both quantitative data collected in 168 cross-border acquisitions conducted by the EMFs mentioned above and the institutional theory and organizational identity literature.

Findings

Institutional factors have a stronger effect than organizational identities on global marketing strategies, including branding. The standardization of the EMFs’ marketing strategies is driven by the private statuses of the acquirers, legal distances, target countries’ economic development, and the ethnic ties that exist between the home and host countries. The acquirers’ decisions to retain the targets’ brand identities, thus adapting their global marketing strategies, are related to the cultural distances, economic freedom distances, and sizes of the targets.

Research limitations/implications

In this study, two large emerging markets – India and China – are used to gather the empirical data; future works can expand upon this line of research and examine other EMFs.

Practical implications

The acquiring companies have to decide whether to adopt an adaption marketing strategy, with reference to the acquired targets’ local stakeholder requirements, or to incorporate their targets’ brands into their own global marketing strategies.

Originality/value

Typically, previous work on the adaptation vs standardization of global marketing strategies adopted in the wake of cross-border deals has focussed on acquisitions involving companies from developed countries; this paper extends the field of research to the EMFs of two of the most important developing countries: China and India.