bluuebunny/crossref_metadata_2025 huggingface dataset:
Routine Chest X-ray: Still Valuable for the Assessment of Left Ventricular Size and Function in the Era of Super Machines?
Authors: Morales Maria-Aurora , Prediletto Renato , Rossi Giuseppe , Catapano Giosuè , Lombardi Massimo , Rovai Daniele
Published: May 2012

Objectives:

The development of technologically advanced, expensive techniques has progressively reduced the value of chest X-ray in clinical practice for the assessment of left ventricular (LV) dilatation and dysfunction. Although controversial data are reported on the role of this widely available technique in cardiac assessment, it is known that the cardio-thoracic ratio is predictive of risk of progression in the NYHA Class, hospitalization, and outcome in patients with LV dysfunction. This study aimed to evaluate the reliability of the transverse diameter of heart shadow [TDH] by chest X-ray for detecting LV dilatation and dysfunction as compared to Magnetic Resonance Imaging (MRI) performed for different clinical reasons.

Materials and Methods:

In 101 patients, TDH was measured in digital chest X-ray and LV volumes and ejection fraction (EF) by MRI, both exams performed within 2 days.

Results:

A direct correlation between TDH and end-diastolic volumes (r = .75, P<0.0001) was reported. TDH cut-off values of 14.5 mm in females identified LV end-diastolic volumes >150 mL (sensitivity: 82%, specificity: 69%); in males a cut-off value of 15.5 mm identified LV end-diastolic volumes >210 mL (sensitivity: 84%; specificity: 72%). A negative relation was found between TDH and LVEF (r = -.54, P<0.0001). The above cut-off values of TDH discriminated patients with LV systolic dysfunction – LVEF <35% (sensitivity and specificity: 67% and 57% in females; 76% and 59% in males, respectively).

Conclusions:

Chest X-ray may still be considered a reliable technique in predicting LV dilatation by the accurate measurement of TDH as compared to cardiac MRI. Technologically advanced, expensive, and less available imaging techniques should be performed on the basis of sound clinical requests.
Honda Sign On 18-FDG PET/CT in a Case of Lymphoma Leading to Incidental Detection of Sacral Insufficiency Fracture
Authors: Joshi Prathamesh , Lele Vikram , Gandhi Rozil , Parab Anil
Published: May 2012

Sacral insufficiency fracture (SIF) is an important and treatable cause of low back pain in at-risk groups and the elderly. We report rare demonstration of ‘Honda sign’ in fluoro-deoxy-glucose positron emission tomography-computed tomography (FDG PET-CT) in a case of lymphoma, which led to incidental diagnosis of SIF. Honda sign, which is classically described in bone scans in cases of SIF, was found in FDG PET-CT in our case. This suggests SIF should be suspected when similar FDG uptake pattern is encountered and may help in early detection and management of SIF.
Prenatal and Postnatal Schizencephaly Findings by 2D and 3D Ultrasound: Pictorial Essay
Authors: Rios Lívia Teresa Moreira , Araujo Edward , Nardozza Luciano Marcondes Machado , Caetano Ana Carolina Rabachini , Moron Antonio Fernandes , Martins Marília da Glória
Published: May 2012

Schizencephaly is a brain-destructive lesion relating to clefts in the fetal brain that usually communicate with the ventricular system, subarachnoid space, or both. It presents as two types: Type I (closed) and Type II (open). During pregnancy, it may be suspected in the course of ultrasonography, which highlights ventricular dilatation and brain abnormalities. Usually, the diagnosis is confirmed postnatally using trans-fontanel ultrasonography. The etiology of schizencephaly is still unknown, but it may be derived from a primary disorder of brain development or from bilateral middle cerebral artery occlusion. Many causative agents including vascular insult, infections, toxins, and medications have been associated with this malformation. We present a pictorial essay of six cases of schizencephaly that were suspected on prenatal ultrasound scans and confirmed postnatally by trans-fontanel, two-dimensional and three-dimensional ultrasonography.
A Strong Stability-Preserving Predictor-Corrector Method for the Simulation of Elastic Wave Propagation in Anisotropic Media
Authors: Yang D. H. , Wang N. , Liu E.
Published: May 2012

In this paper, we propose a strong stability-preserving predictor-corrector (SSPC) method based on an implicit Runge-Kutta method to solve the acoustic- and elastic-wave equations. We first transform the wave equations into a system of ordinary differential equations (ODEs) and apply the local extrapolation method to discretize the spatial high-order derivatives, resulting in a system of semi-discrete ODEs. Then we use the SSPC method based on an implicit Runge-Kutta method to solve the semi-discrete ODEs and introduce a weighting parameter into the SSPC method. On top of such a structure, we develop a robust numerical algorithm to effectively suppress the numerical dispersion, which is usually caused by the discretization of wave equations when coarse grids are used or geological models have large velocity contrasts between adjacent layers. Meanwhile, we investigate the performance of the SSPC method including numerical errors and convergence rate, numerical dispersion, and stability criteria with different choices of the weighting parameter to solve 1-D and 2-D acoustic- and elastic-wave equations. When the SSPC is applied to seismic simulations, the computational efficiency is also investigated by comparing the SSPC, the fourth-order Lax-Wendroff correction (LWC) method, and the staggered-grid (SG) finite difference method. Comparisons of synthetic waveforms computed by the SSPC and analytic solutions for acoustic and elastic models are given to illustrate the accuracy and the validity of the SSPC method. Furthermore, several numerical experiments are conducted for the geological models including a 2-D homogeneous transversely isotropic (TI) medium, a two-layer elastic model, and the 2-D SEG/EAGE salt model. The results show that the SSPC can be used as a practical tool for large-scale seismic simulation because of its effectiveness in suppressing numerical dispersion even in the situations such as coarse grids, strong interfaces, or high frequencies.
Conforming Hierarchical Basis Functions
Authors: Bluck M. J.
Published: May 2012

A unified process for the construction of hierarchical conforming bases on a range of element types is proposed based on an ab initio preservation of the underlying cohomology. This process supports not only the most common simplicial element types, as are now well known, but is generalized to squares, hexahedra, prisms and importantly pyramids. Whilst these latter cases have received (to varying degrees) attention in the literature, their foundation is less well developed than for the simplicial case. The generalization discussed in this paper is effected by recourse to basic ideas from algebraic topology (differential forms, homology, cohomology, etc) and as such extends the fundamental theoretical framework established by the work of Hiptmair and Arnold et al. for simplices. The process of forming hierarchical bases involves a recursive orthogonalization and it is shown that the resulting finite element mass, quasi-stiffness and composite matrices exhibit exponential or better growth in condition number.
A Fast Direct Solver for a Class of 3-D Elliptic Partial Differential Equation with Variable Coefficient
Authors: Huang Beibei , Tu Bin , Lu Benzhuo
Published: May 2012

We propose a direct solver for the three-dimensional Poisson equation with a variable coefficient, and an algorithm to directly solve the associated sparse linear systems that exploits the sparsity pattern of the coefficient matrix. Introducing some appropriate finite difference operators, we derive a second-order scheme for the solver, and then two suitable high-order compact schemes are also discussed. For a cube containing N nodes, the solver requires arithmetic operations and memory to store the necessary information. Its efficiency is illustrated with examples, and the numerical results are analysed.
Galerkin-Laguerre Spectral Solution of Self-Similar Boundary Layer Problems
Authors: Auteri F. , Quartapelle L.
Published: May 2012

In this work the Laguerre basis for the biharmonic equation introduced by Jie Shen is employed in the spectral solution of self-similar problems of the boundary layer theory. An original Petrov-Galerkin formulation of the Falkner-Skan equation is presented which is based on a judiciously chosen special basis function to capture the asymptotic behaviour of the unknown. A spectral method of remarkable simplicity is obtained for computing Falkner-Skan-Cooke boundary layer flows. The accuracy and efficiency of the Laguerre spectral approximation is illustrated by determining the linear stability of nonseparated and separated flows according to the Orr-Sommerfeld equation. The pentadiagonal matrices representing the derivative operators are explicitly provided in an Appendix to aid an immediate implementation of the spectral solution algorithms.
A Conservative Lagrangian Scheme for Solving Compressible Fluid Flows with Multiple Internal Energy Equations
Authors: Cheng Juan , Shu Chi-Wang , Zeng Qinghong
Published: May 2012

Lagrangian methods are widely used in many fields for multi-material compressible flow simulations such as in astrophysics and inertial confinement fusion (ICF), due to their distinguished advantage in capturing material interfaces automatically. In some of these applications, multiple internal energy equations such as those for electron, ion and radiation are involved. In the past decades, several staggered-grid based Lagrangian schemes have been developed which are designed to solve the internal energy equation directly. These schemes can be easily extended to solve problems with multiple internal energy equations. However such schemes are typically not conservative for the total energy. Recently, significant progress has been made in developing cell-centered Lagrangian schemes which have several good properties such as conservation for all the conserved variables and easiness for remapping. However, these schemes are commonly designed to solve the Euler equations in the form of the total energy, therefore they cannot be directly applied to the solution of either the single internal energy equation or the multiple internal energy equations without significant modifications. Such modifications, if not designed carefully, may lead to the loss of some of the nice properties of the original schemes such as conservation of the total energy. In this paper, we establish an equivalency relationship between the cell-centered discretizations of the Euler equations in the forms of the total energy and of the internal energy. By a carefully designed modification in the implementation, the cell-centered Lagrangian scheme can be used to solve the compressible fluid flow with one or multiple internal energy equations and meanwhile it does not lose its total energy conservation property. An advantage of this approach is that it can be easily applied to many existing large application codes which are based on the framework of solving multiple internal energy equations. Several two dimensional numerical examples for both Euler equations and three-temperature hydrodynamic equations in cylindrical coordinates are presented to demonstrate the performance of the scheme in terms of symmetry preserving, accuracy and non-oscillatory performance.
The Space-Time CE/SE Method for Solving Reduced Two-Fluid Flow Model
Authors: Qamar Shamsul , Ahmed Munshoor , Ali Ishtiaq
Published: May 2012

The space-time conservation element and solution element (CE/SE) method is proposed for solving a conservative interface-capturing reduced model of compressible two-fluid flows. The flow equations are the bulk equations, combined with mass and energy equations for one of the two fluids. The latter equation contains a source term for accounting the energy exchange. The one and two-dimensional flow models are numerically investigated in this manuscript. The CE/SE method is capable to accurately capture the sharp propagating wavefronts of the fluids without excessive numerical diffusion or spurious oscillations. In contrast to the existing upwind finite volume schemes, the Riemann solver and reconstruction procedure are not the building block of the suggested method. The method differs from the previous techniques because of global and local flux conservation in a space-time domain without resorting to interpolation or extrapolation. In order to reveal the efficiency and performance of the approach, several numerical test cases are presented. For validation, the results of the current method are compared with other finite volume schemes.
Study on General Governing Equations of Computational Heat Transfer and Fluid Flow
Authors: Li Wang , Yu Bo , Wang Yi , Wang Xin-Ran , Wang Qing-Yuan , Tao Wen-Quan
Published: May 2012

The governing equations for heat transfer and fluid flow are often formulated in a general form for the simplification of discretization and programming, which has achieved great success in thermal science and engineering. Based on the analysis of the popular general form of governing equations, we found that energy conservation cannot be guaranteed when specific heat capacity is not constant, which may lead to unreliable results. A new concept of generalized density is put forward, based on which a new general form of governing equations is proposed to guarantee energy conservation. A number of calculation examples have been employed to verify validation and feasibility.
A Reconstructed Discontinuous Galerkin Method for the Euler Equations on Arbitrary Grids
Authors: Luo Hong , Luo Luqing , Nourgaliev Robert
Published: May 2012

A reconstruction-based discontinuous Galerkin (RDG(P1P2)) method, a variant of P1P2 method, is presented for the solution of the compressible Euler equations on arbitrary grids. In this method, an in-cell reconstruction, designed to enhance the accuracy of the discontinuous Galerkin method, is used to obtain a quadratic polynomial solution (P2) from the underlying linear polynomial (P1) discontinuous Galerkin solution using a least-squares method. The stencils used in the reconstruction involve only the von Neumann neighborhood (face-neighboring cells) and are compact and consistent with the underlying DG method. The developed RDG method is used to compute a variety of flow problems on arbitrary meshes to demonstrate its accuracy, efficiency, robustness, and versatility. The numerical results indicate that this RDG(P1P2) method is third-order accurate, and outperforms the third-order DG method (DG(P2)) in terms of both computing costs and storage requirements.
First-Principles Calculations of Shocked Fluid Helium in Partially Ionized Region
Authors: Wang Cong , He Xian-Tu , Zhang Ping
Published: May 2012

Quantum molecular dynamic simulations have been employed to study the equation of state (EOS) of fluid helium under shock compressions. The principal Hugoniot is determined from EOS, where corrections from atomic ionization are added onto the calculated data. Our simulation results indicate that principal Hugoniot shows good agreement with gas gun and laser driven experiments, and maximum compression ratio of 5.16 is reached at 106 GPa.
Influence of changing carbonate chemistry on morphology and weight of coccoliths formed by Emiliania huxleyi
Authors: Bach L. T. , Bauke C. , Meier K. J. S. , Riebesell U. , Schulz K. G.
Published: May 2012

Abstract. The coccolithophore Emiliania huxleyi is a marine phytoplankton species capable of forming small calcium carbonate scales (coccoliths) which cover the organic part of the cell. Calcification rates of E. huxleyi are known to be sensitive to changes in seawater carbonate chemistry. It is, however, not yet understood how these changes are reflected in the morphology of coccoliths. Here, we compare data on coccolith size, weight, and malformation from a~set of five experiments with a large diversity of carbonate chemistry conditions. This diversity allows distinguishing the influence of individual carbonate chemistry parameters such as carbon dioxide (CO2), bicarbonate (HCO3−), carbonate (CO32−), and protons (H+) on the measured parameters. Measurements of fine-scale morphological structures reveal an increase of coccolith malformation with decreasing pH suggesting that H+ is the major factor causing malformations. Coccolith distal shield area varies from about 5 to 11 μm2. Changes in size seem to be mainly induced by varying [HCO3−] and [H+] although influence of [CO32−] cannot be entirely ruled out. Changes in coccolith weight were proportional to changes in size. Increasing CaCO3 production rates are reflected in an increase in coccolith weight and an increase of the number of coccoliths formed per unit time. The combined investigation of morphological features and coccolith production rates presented in this study may help to interpret data derived from sediment cores, where coccolith morphology is used to reconstruct calcification rates in the water column.
Supersaturation calculation in large eddy simulation models for prediction of the droplet number concentration
Authors: Thouron O. , Brenguier J.-L. , Burnet F.
Published: May 2012

Abstract. A new parameterization scheme is described for calculation of supersaturation in LES models that specifically aims at the simulation of cloud condensation nuclei (CCN) activation and prediction of the droplet number concentration. The scheme is tested against current parameterizations in the framework of the Meso-NH LES model. It is shown that the saturation adjustment scheme, based on parameterizations of CCN activation in a convective updraft, overestimates the droplet concentration in the cloud core, while it cannot simulate cloud top supersaturation production due to mixing between cloudy and clear air. A supersaturation diagnostic scheme mitigates these artefacts by accounting for the presence of already condensed water in the cloud core, but it is too sensitive to supersaturation fluctuations at cloud top and produces spurious CCN activation during cloud top mixing. The proposed pseudo-prognostic scheme shows performance similar to the diagnostic one in the cloud core but significantly mitigates CCN activation at cloud top.
An ecohydrological sketch of climate change impacts on water and natural ecosystems for The Netherlands: bridging the gap between science and society
Authors: Witte J. P. M. , Runhaar J. , van Ek R. , van der Hoek D. C. J. , Bartholomeus R. P. , Batelaan O. , van Bodegom P. M. , Wassen M. J. , van der Zee S. E. A. T. M.
Published: May 2012

Abstract. For policy making and spatial planning, information is needed about the impacts of climate change on natural ecosystems. To provide this information, commonly hydrological and ecological models are used. We give arguments for our assessment that modelling only is insufficient for determining the impacts of climate changes on natural ecosystems at regional scales. Instead, we proposed a combination of hydrological simulations, a literature review and process-knowledge on climate-hydrology-vegetation interactions, to compile a sketch-map that indicates climate change effects on a number of ecosystems in The Netherlands. Soon after its introduction, copies of our sketch-map appeared in policy documents and in a commercial and popular atlas of The Netherlands. Moreover, the map led to a question in the Dutch parliament about the survivability of bog reserves in the future climate. Apparently, there was an urgent need for the information provided by the map. The map shows that climate change will presumably have the largest influence on ecosystems in The Netherlands that depend on precipitation as the major water source, like heathlands, dry grasslands, rain-fed moorland pools and raised bogs. Also highly susceptible are fens in reserves surrounded by deeply drained polders, because such fens depend on the inlet of surface water, of which quality is likely to deteriorate upon climate change. While the map is indicative for directions of change, in view of the uncertainties of our study no conclusions should be drawn that may have far-reaching consequences, such as giving up certain nature targets that might no longer be feasible in the future climate. Instead, we advise to anticipate on the potential threats from climate change by taking a number of adaptation measures that enhance the robustness of nature reserves. To improve climate change projections on hydrology and ecosystems, future research should especially focus on feedbacks of vegetation on the water balance, on processes that directly influence plant performance and on the ecological effects of weather extremes.
Health beliefs and practices of Qatari women: A qualitative study
Authors: Kridli Suha Al-Oballi , Ilori Olufunke M , Goeth Jessica
Published: May 2012

The purpose of this study was to understand health beliefs and practices of Qatari women by exploring puberty and sexual relations. A qualitative descriptive research design, using focus groups, was used in this study. Purposive sampling was used to recruit college-age Qatari women from six universities in Qatar. A total of 43 Qatari women participated in this study. NVivo 8 qualitative analysis software was used to analyze collected data. Participants reported that Qatari women lacked information about puberty and did not feel prepared for their first menstrual period (menarche). Participants also reported a lack of information about sexual relations due to their mothers’ and schools’ discomfort with the topic. Recommendations related to the investigated areas were elicited from the participants. There is a urgent need to conduct educational programs in Qatar.
Decision Tool Aids Musty, Earthy Taste‐and‐Odor Assessment
Authors: Mackey Erin D.
Published: May 2012

Controlling taste‐and‐odor problems in source water reservoirs and at water treatment plants can be difficult and expensive. Fortunately, a decision‐support tool from the Water Research Foundation is making the task easier.
Become a Lean Operation
Authors: Boyette Randy , Scholpp Chuck , Miles Gabi
Published: May 2012

Taking a lean approach to the water industry provides utility managers with a clear roadmap for improving organizationwide performance. For the water/ wastewater industry, going lean means automating processes, using technology, and optimizing the business. Four principles of lean operation provide opportunities and challenges.
Treatment of Multiple Sclerosis–Related Cognitive Problems With Adjunctive Modafinil
Authors: Wilken Jeffrey A. , Sullivan Cynthia , Wallin Mitchell , Rogers Catherine , Kane Robert L. , Rossman Howard , Lawson Sonda , Simsarian James , Saunders Carol , Quig Mary Elizabeth
Published: May 2012

In patients with multiple sclerosis (MS), attention and information-processing-speed impairment contribute to dysfunction in other cognitive domains (learning, memory). Treatment for MS-related attention and processing-speed deficits may have dual benefits: improvement of function in these domains and in overall cognitive efficiency. The objective of this study was to determine whether adjunctive treatment of fatigue with modafinil ameliorates deficits in attention and cognitive domains reliant on attention. Relapsing-remitting MS patients receiving intramuscular interferon beta-1a (IM IFNβ-1a) were screened for attention problems with four well-validated, reliable, standardized neurocognitive measures sensitive to attention impairment. Those scoring at least 1 standard deviation below normative expectations on at least two of the measures were eligible for continued participation. Participants with normal values on all physical screening measures were randomized to one of two groups: continued IM IFNβ-1a alone or plus modafinil. Significant mean group differences were found at 4 months on multiple measures of fatigue and cognitive functioning. Patients on combination therapy reported significantly less fatigue (P <.05) and performed significantly better (P <.05) than those in the monotherapy group on measures tapping simple attention span, working memory, and phonemic verbal fluency. Combination therapy was generally well tolerated. No serious adverse events were reported by patients in either treatment arm. This study was developed as a proof of concept that attention-enhancing medications could be used to address fatigue, cognition, and mood in MS patients. The results demonstrate the need for a larger study to determine relative safety and efficacy.
Primary and Nonprimary Fatigue in Multiple Sclerosis
Authors: Forwell Susan J. , Brunham Sandra , Tremlett Helen , Morrison Wendy , Oger Joel
Published: May 2012

Using the fatigue algorithm described in the Clinical Practice Guidelines for Fatigue and Multiple Sclerosis (MS), this study aimed to determine the frequency of fatigue related directly to the MS disease process (primary fatigue) versus that related to disease symptoms such as depression (nonprimary fatigue), differentiate primary from nonprimary MS fatigue, and identify any characteristics unique to primary MS fatigue. Consecutive clinically definite MS patients from the University of British Columbia MS clinic were invited to participate. The screening assessment included standardized scales and questionnaires. In total, 50 patients completed the study. Nonprimary fatigue was present in 36 individuals (72%), of whom all but 2 had multiple factors contributing to fatigue. The most common factors contributing to nonprimary fatigue were sleep problems (58%), mobility limitations (52%), and depression (40%). Compared with patients with nonprimary fatigue, those with isolated primary fatigue had lower fatigue scores and reported fatigue onset at midday (P < .05). Any attempt to study or manage MS fatigue should be preceded by identification and amelioration of treatable nonprimary fatigue factors before focusing on primary fatigue in MS.
Doctor of Nursing Practice
Authors: Sammarco Carrie Lyn
Published: May 2012

Multiple sclerosis (MS) is a complex neurological disease that often requires a multidisciplinary approach to its management. The health care team treating MS patients is comprised of nurses, physicians, and therapists, many of whom are specialists in MS. As members of the MS care team, advanced practice nurses are prime candidates for addressing both MS-specific concerns and unmet primary care needs of their patients. Current discussion in the health care community has focused on the doctor of nursing practice (DNP). This article discusses the potential role of the DNP in caring for the MS patient.
Job Satisfaction of Multiple Sclerosis Certified Nurses
Authors: Gulick Elsie E. , Halper June , Namey Marie
Published: May 2012

Nurse certification became available to nurses working in the practice area of multiple sclerosis (MS) in 2002. However, the impact of certification on the MS nurse's role and both satisfaction and dissatisfaction with the certified role have not yet been determined, which was the purpose of this study. With a qualitative study design and an international sample of 168 certified MS nurses, data from open-ended questions were analyzed regarding role change, job satisfaction, and job dissatisfaction. Findings indicated enhanced role change and job satisfaction regarding increased autonomy, colleagueship, leadership roles, and primary care nursing. Dissatisfaction for some was attributed to insufficient resources and benefits, along with administrator failure to recognize the value and importance of certified nurses.
Neurologist Versus Nonneurologist Care of Multiple Sclerosis Patients
Authors: Buchanan Robert J. , Kaufman Michael , Zhu Li , James Wesley
Published: May 2012

The purpose of this study was to identify differences between people with multiple sclerosis (MS) who are treated by someone other than a neurologist and those treated by neurologists or specialists at MS clinics. Factors studied included demographics, disease characteristics, and patient perceptions of care. We surveyed 1518 people with MS, organizing respondents into four groups based on who provided their care: a nonneurologist group, two neurologist groups, and an MS clinic group. We analyzed survey results via SPSS, using analysis of variance to identify statistically significant differences. The nonneurologist group was significantly older, had lower income, and had more patients without health insurance than the other three groups. This group was also significantly less satisfied with access to MS-focused care and the quality of that care. The most striking observation was the significantly smaller proportion (18%) of people in the nonneurologist group who were treated with disease-modifying therapies compared with the other three groups (67–72%). Significant and interesting differences were observed for a range of characteristics between the nonneurologist group and groups receiving care from neurologists or at an MS clinic. A carefully constructed outreach program for nonneurologists is suggested as a way of increasing the use of MS therapies.
Review: Optimizing Adherence to Multiple Sclerosis Therapies
Authors: Singer Barry , Lucas Sylvia , Kresa-Reahl Kiren , Ross Amy Perrin , Blake Patricia
Published: May 2012

Disease-modifying drugs (DMDs) have transformed the treatment of relapsing-remitting multiple sclerosis (RRMS). Several studies have shown the benefits of long-term treatment in RRMS; however, all multiple sclerosis (MS) therapies are associated with treatment-related tolerability and safety issues that may challenge patient compliance with therapy. Tolerability issues include flulike symptoms and injection-site reactions for interferon β(IFNβ) and lipoatrophy and systemic postinjection reactions for glatiramer acetate (GA). Altered blood cell counts, depression, and elevated liver enzymes, including rare cases of acute liver injury, are safety issues that have been associated with IFNβand, rarely, systemic anaphylactoid reactions with glatiramer acetate. Common tolerability issues associated with natalizumab are hypersensitivity and postinfusion reactions, and mitoxantrone may cause amenorrhea, nausea, and alopecia. Serious safety issues that have limited the use of natalizumab and mitoxantrone as first-line treatments are progressive multifocal leukoencephalopathy for natalizumab and cardiotoxicity and leukemia for mitoxantrone. Although both tolerability and safety issues can affect patient adherence to therapy, numerous strategies are available to manage tolerability and monitor safety issues. Through careful monitoring of treatment-related safety issues, patient education, and tolerability management strategies, treatment nonadherence can be minimized, thereby maximizing the treatment benefits of DMDs.
Assessment of Postural Balance in Multiple Sclerosis
Authors: Fjeldstad Cecilie , Pardo Gabriel , Frederiksen Christine , Bemben Debra , Bemben Michael
Published: May 2012

Compromised postural balance is a common manifestation of multiple sclerosis (MS). Effective quantitative methods of assessing postural imbalance are needed to help clinicians evaluate progression of this impairment. The primary objective of this study was to compare postural balance in MS patients and healthy controls using a standard screening tool, the Berg Balance Scale (BBS), as well as a more technically sophisticated device, the NeuroCom SMART Balance Master (NeuroCom International, Inc, Clackamas, OR). The study participants consisted of 14 individuals diagnosed with MS and 10 healthy controls. Each participant was assessed with the BBS and also underwent six different balance tests using the NeuroCom, most comprising several subcomponent measures. Assessment with the BBS showed significantly more postural instability in the MS group than in the control group (P < .05). Testing with the NeuroCom showed significantly more postural instability in the MS group than in the control group on two of the six tests (four specific balance measures) (P < .05). Moderate-to-high correlations (0.50–0.80) were found between the postural assessments using the standard BBS and the NeuroCom balance tests for the MS group. These results indicate that the BBS is an effective screening instrument for balance problems in people with MS.
Comparison of Quality of Life in Clinically Isolated Syndrome Patients Who Convert and Do Not Convert to Clinically Definite Multiple Sclerosis
Authors: Miller Deborah M. , Kollman Craig , Kalajian Andrea , O'Connor Paul W. , Kinkel R. Philip
Published: May 2012

A secondary analysis was undertaken to compare patient-reported outcomes (PROs) of individuals who did and did not convert to clinically definite multiple sclerosis (CDMS) approximately 5 years after their first clinically isolated syndrome (CIS). Patients included in the analysis were participating in a long-term extension (called CHAMPIONS) of the Controlled High-Risk Avonex® Multiple Sclerosis Prevention Study (CHAMPS). The Multiple Sclerosis Quality of Life Inventory (MSQLI), a battery including the Short Form Health Status Survey (SF-36) and nine disease-specific scales, was administered to participants 5 years after their initial symptoms suggestive of MS (randomization into the CHAMPS study). Of 203 CHAMPIONS patients, 188 (93%) completed the MSQLI at enrollment into this extension study. Of these, 79 (42%) converted to CDMS. Statistically significant differences (P < .001) between those who did and did not convert to CDMS were found for 4 of the 11 MSQLI scales: the SF-36 Physical Component Summary, the Modified Fatigue Impact Scale, the Pain Effects Scale, and the Bladder Control Scale. Trends not meeting our criteria for statistical significance (P > .001 but < .01) were observed for the SF-36 Mental Component Summary, the Perceived Deficits Questionnaire, and the Mental Health Inventory. SF-36 scores for patients not converting to CDMS over 5 years were similar to those reported for age-matched normal controls. No other demographic or disease-related factors were associated with these PROs. When stratified by Expanded Disability Status Scale score, patients who converted to CDMS demonstrated statistically significant differences on the same four scales defined above that differentiated those who did and did not convert to CDMS. These data show that individuals who have CDMS but limited disability demonstrate clear evidence of diminished health-related quality of life.
Toward a Consensus on Rehabilitation Outcomes in MS: Gait and Fatigue
Authors: Hutchinson Brian , Forwell Susan J. , Bennett Susan , Brown Theodore , Karpatkin Herb , Miller Deborah
Published: May 2012

A multidisciplinary consensus conference was held on November 28–29, 2007, by the Consortium of Multiple Sclerosis Centers (CMSC) to determine the most appropriate outcome measures for gait and fatigue in people with multiple sclerosis (MS). The goals of this conference were to 1) improve understanding of gait and fatigue outcome measures being used by rehabilitation professionals treating people with MS; 2) establish consensus on outcome measures; and 3) establish consensus on required follow-up for transfer of this knowledge to rehabilitation professionals. The consensus conference and this document are the initial steps toward achieving the stated goals. Although many measures of fatigue exist, it was recommended that a global outcome measure for fatigue be developed that would 1) include a screen for the functional ramifications of fatigue for activities and participation; 2) be quick and easy to administer; 3) demonstrate psychometric integrity for MS; and 4) examine fatigue over a continuum of the MS disease course. In addition, it was recommended that an assessment battery for fatigue be developed. With respect to gait outcome measures, it was agreed that the following tools should be included in a preliminary chart for use in a clinical setting: the Timed 25-Foot Walk, Timed Up and Go test, Dynamic Gait Index, 6-Minute Walk, and self-reported 12-item Multiple Sclerosis Walking Scale. The global outcome fatigue measure and assessment battery are currently being developed, and work on a detailed gait outcome measures chart and additional research on commonly used gait outcome measures are in progress.
Multiple Sclerosis Patients' Interest in and Likelihood of Using Online Health-Care Services
Authors: Wardell Lucy , Hum Stanley , Laizner Andréa Maria , Lapierre Yves
Published: May 2012

Multiple sclerosis (MS) patients are known to have high rates of Internet use. Thus they are likely to be receptive to and benefit from online communications with health-care providers. Although a few well-known MS clinics have implemented online health-care services for this patient group, little is known about the types of online communications that would be most beneficial to patients and the likelihood that patients would actually use these services. The aim of this study was to explore MS patients' satisfaction with traditional modes of communication with health-care providers, their interest in having access to different types of online health-care services, and their likelihood of using such services. A self-report questionnaire was developed and distributed to 263 MS patients diagnosed with clinically definite MS at our tertiary-care center. Although the vast majority of patients were satisfied with the frequency of their clinic visits, patients who called the clinic more frequently reported lower levels of satisfaction with clinic access than those who called less often. Over 73% of patients reported a high level of interest in having access to online health-care services, and over 80% of patients surveyed reported a high likelihood of using these services. Patients who reported the greatest likelihood of using online health-care services included those who surf the Internet more than 5 hours per week, who have sought health information online in the past year, and who perceive themselves as having high Internet navigational skills. The study findings highlight the importance of developing online health-care services for this cohort of patients.
Development of a Group Educational Intervention for Sexual Functioning and Intimacy Concerns in Patients with Multiple Sclerosis
Authors: Wright Dustin E. , Stepleman Lara M. , Davis Kimberly N. , Hughes Mary D.
Published: May 2012

Sexual functioning problems are disproportionately frequent among individuals with multiple sclerosis (MS) and are associated with reduced sexual activity and satisfaction. Although effective treatments are available, patients often do not communicate with physicians or partners as openly and frequently as needed to optimize sexual functioning. The purpose of this study was to examine the effectiveness of a group-level educational intervention to increase perceived knowledge and communication ability regarding MS-related sexual health and intimacy concerns. Patients with MS and their partners attended a workshop that included didactic presentations, a multidisciplinary panel discussion, and a presentation by a sexual health consultant. Participants (N = 33) completed questionnaires before and after the workshop describing their sexual functioning, perceived knowledge of MS-related sexual problems, and willingness to communicate with partners and health-care providers about these issues. The results indicated a high frequency of sexual problems. Intention to discuss problems with one's significant other and health-care providers was associated with race and gender. Participants reported a significant increase in their knowledge of MS-related sexual problems and sexual satisfaction. Moreover, a trend was observed with regard to participants' likelihood of discussing these issues with partners. This study provides valuable information on the benefits of a multidisciplinary, real-world intervention for sexual/intimacy problems.
The Role of the Primary-Care Physician in Treating Relapses in Multiple Sclerosis Patients
Authors: Morrow Sarah A. , Kremenchutzky Marcelo
Published: May 2012

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.
Effect of Physical Comorbidities on Risk of Depression in Multiple Sclerosis
Authors: Marrie Ruth Ann , Cutter Gary , Tyry Tuula , Campagnolo Denise , Vollmer Timothy
Published: May 2012

Depression in multiple sclerosis (MS) may be due to several factors, including the presence of physical comorbidities. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we examined whether individuals with MS and physical comorbidities have an increased risk of depression compared with those without physical comorbidities and whether they are more likely to remain untreated for depression. In 2006, NARCOMS participants reported their physical and mental comorbidities and completed the Center for Epidemiologic Studies Depression Scale (CESD). We defined a CESD score of 21 or higher as indicating probable major depression. Individuals with elevated CESD scores but no diagnosis of depression were considered undiagnosed. Forty-six percent of participants reported a lifetime history of depression. In a multivariable Cox proportional hazards model, reporting any physical comorbidity was associated with an increased risk of being diagnosed with depression (hazard ratio [HR], 2.20; 95% confidence interval [CI], 2.04–2.38) after MS onset and with an increased risk of diagnosed or undiagnosed depression (HR, 2.37; 95% CI, 2.21–2.54). After adjustment for education, participants with any physical comorbidity were more likely to report treatment for depression (odds ratio [OR], 1.67; 95% CI, 1.24–2.23). Patients with MS and physical comorbidities are at increased risk of depression, but they are more likely to be diagnosed and treated than MS patients without other chronic conditions.
Antidepressant Treatment for Major Depression in Multiple Sclerosis
Authors: Patten Scott B.
Published: May 2012

Major depressive disorder (MDD) is widely acknowledged to be an important clinical issue in multiple sclerosis (MS). Although antidepressant medications are generally regarded as efficacious, few studies have been conducted on their use in MS patients. Recently a randomized controlled trial reported negative results, raising new questions about the efficacy of these medications in this population. The objective of this review was to revisit the question of the efficacy of antidepressant medications in the treatment of MDD in MS. A literature search uncovered only three randomized controlled trials on this topic. These studies differed in their methodology, including the specific antidepressants used (desipramine, sertraline, paroxetine), the approach to the analysis (two of the three used intention-to-treat analyses), measures of depression (two defined response as a 50% reduction in the Hamilton Depression Rating Scale, and two included the Beck Depression Inventory), methodological features (two used blinding, and one included cases of dysthymia), and duration of follow-up (ranging from 1 to 4 months). Nevertheless, all of the results suggested modest therapeutic benefits for the medications evaluated. Although the current literature in this field is inadequate, the best available evidence points toward a modest positive effect of certain medications in the treatment of depression in people with MS.
Psychological Consultation Services at a Multiple Sclerosis Clinic
Authors: Stepleman Lara M. , Jump Rebecca , Shelton Sarah F. , Hughes Mary D.
Published: May 2012

Despite the existence of effective treatments for mental health problems in patients with multiple sclerosis (MS), such problems often go untreated or undertreated because of a variety of patient, provider, and organizational factors. As untreated psychological difficulties can interfere with MS treatment adherence, a collaborative partnership between medical and mental health providers is crucial. In the fall of 2003, the Medical College of Georgia's Augusta MS Center implemented an MS psychological consultation service. The goal of this service is to remove barriers to the emotional well-being of individuals with MS through convenient, collaborative, and coordinated psychological services provided during routine MS medical appointments. To better understand patient use of this new program and the types of problems addressed, we conducted a retrospective review of documentation from 197 consultations held from July 2004 through June 2006. Summary data on demographics, presenting problems, and resultant treatment plans reflect a broad array of concerns for which psychological consultation was sought, including psychiatric symptoms, difficulties with adjustment to illness, and cognitive problems. Given the barriers to mental health care for MS patients and the unique skills psychologists bring to the multidisciplinary MS team, on-site psychological consultation may be an effective method of providing mental health services to the MS population.
Needs and Psychosocial Outcomes of Caregivers of Individuals with Multiple Sclerosis in Guadalajara, Mexico
Authors: Arango-Lasprilla Juan Carlos , Premuda Paola , Aguayo Adriana , Francis Kathryn , Macias Miguel Angel , Villaseñor Teresita
Published: May 2012

Multiple sclerosis (MS) is a chronic, disabling disease that has a major impact on the lives of individuals with MS as well as their families. Little information is available on the needs and psychosocial outcomes of Latin American caregivers of people with MS. The objectives of this study were to 1) outline the needs of Mexican caregivers of individuals with MS and determine the extent to which their needs are met or unmet, 2) describe caregivers' psychosocial functioning, and 3) examine the relationship between caregivers' needs and psychosocial outcomes. Forty-three caregivers (21 parents, 12 spouses, and 10 others) completed the Multiple Sclerosis Needs Assessment tool, Patient Health Questionnaire, Zarit Burden Interview, Satisfaction with Life Scale, and Interpersonal Support Evaluation List–Short Version. Interdependence needs were most commonly reported as unmet by caregivers, whereas self-concept and physical needs were most frequently reported as met. Approximately half of the care-givers reported increased burden and depression, although nearly 75% reported feeling relatively satisfied with their lives. Caregiver physical, role function, and interdependence needs were positively correlated with depression. In addition, physical and interdependence needs were positively correlated with burden. Caregiver physical and role function needs were negatively correlated with self-perceived health status. Moreover, interdependence needs were negatively correlated with satisfaction with life, whereas physical and interdependence needs were negatively correlated with perceived social support. Future interventions should focus on addressing the needs of caregivers of individuals with MS and improving their psychosocial outcomes.