Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

Background: Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design: We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms) who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care) will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse events between intervention groups. Conclusion: The results of this study will provide the public, clinicians and policy makers much needed evidence on the effectiveness of common approaches used to manage whiplash-associated disorders. © 2008 Côté et al; licensee BioMed Central Ltd

Prevention and Mitigation of Acute Radiation Syndrome in Mice by Synthetic Lipopeptide Agonists of Toll-Like Receptor 2 (TLR2)

Bacterial lipoproteins (BLP) induce innate immune responses in mammals by activating heterodimeric receptor complexes containing Toll-like receptor 2 (TLR2). TLR2 signaling results in nuclear factor-kappaB (NF-κB)-dependent upregulation of anti-apoptotic factors, anti-oxidants and cytokines, all of which have been implicated in radiation protection. Here we demonstrate that synthetic lipopeptides (sLP) that mimic the structure of naturally occurring mycoplasmal BLP significantly increase mouse survival following lethal total body irradiation (TBI) when administered between 48 hours before and 24 hours after irradiation. The TBI dose ranges against which sLP are effective indicate that sLP primarily impact the hematopoietic (HP) component of acute radiation syndrome. Indeed, sLP treatment accelerated recovery of bone marrow (BM) and spleen cellularity and ameliorated thrombocytopenia of irradiated mice. sLP did not improve survival of irradiated TLR2-knockout mice, confirming that sLP-mediated radioprotection requires TLR2. However, sLP was radioprotective in chimeric mice containing TLR2-null BM on a wild type background, indicating that radioprotection of the HP system by sLP is, at least in part, indirect and initiated in non-BM cells. sLP injection resulted in strong transient induction of multiple cytokines with known roles in hematopoiesis, including granulocyte colony-stimulating factor (G-CSF), keratinocyte chemoattractant (KC) and interleukin-6 (IL-6). sLP-induced cytokines, particularly G-CSF, are likely mediators of the radioprotective/mitigative activity of sLP. This study illustrates the strong potential of LP-based TLR2 agonists for anti-radiation prophylaxis and therapy in defense and medical scenarios

Remote detection of invasive alien species

The spread of invasive alien species (IAS) is recognized as the most severe threat to biodiversity outside of climate change and anthropogenic habitat destruction. IAS negatively impact ecosystems, local economies, and residents. They are especially problematic because once established, they give rise to positive feedbacks, increasing the likelihood of further invasions and spread. The integration of remote sensing (RS) to the study of invasion, in addition to contributing to our understanding of invasion processes and impacts to biodiversity, has enabled managers to monitor invasions and predict the spread of IAS, thus supporting biodiversity conservation and management action. This chapter focuses on RS capabilities to detect and monitor invasive plant species across terrestrial, riparian, aquatic, and human-modified ecosystems. All of these environments have unique species assemblages and their own optimal methodology for effective detection and mapping, which we discuss in detail

DECONSTRUCTIONS AND RECONSTRUCTIONS OF WOMANIST AND BLACK RELIGIOUS DISCOURSES: A SOCIAL JUSTICE FRAMEWORK

This study is a conceptual project which explores ways in which U. S. black epistemologies can provide new understandings of oppression and new strategies for transcending hierarchical relationships of power and domination. Specific epistemologies developed by enslaved Africans in the U. S. and their descendents have enabled U. S. black Americans to navigate the paradoxes and contradictions of living under conditions of oppression in a society founded on freedom and equality. It is hypothesized that these U. S. black epistemologies, which make sense of and provide strategies for managing existential feelings of alienation, displacement, and despair that accompany experiences of oppression, can be useful for the majority of people in our society who, due to the postmodern condition, are now experiencing similar existential feelings. The U. S. black epistemology chosen for this exploration is black theology. It is believed that this discipline’s struggles to deal with issues of oppression, within-group heterogeneity, the complex role of Christianity in black liberation, and issues of appropriation and authenticity provide a microcosm of issues facing black Americans in the U. S. The context and history of the development of black theology is provide

IN A POSTMODERN AGE

Awareness of the ecological crisis has undeniably increased during the past three or four decades. Nevertheless, despite some local and regional improvements, the global crisis has worsened over this period. This paradoxical situation of pervasive awareness of environmental problems and predominantly cosmetic, ineffectual responses to them is attributable, at least in part, to the social and cultural conditions associated with postmodernity. This study is a theoretical investigation of the social and cultural context of the ecological crisis. It involves an exploration of three interrelated narratives that have become dominant in postmodernity—the end of history myth, neoliberalism, and the rhetoric of economic globalization—and demonstrates how each contributes to ongoing social and environmental degradation. This study also shows how these postmodern narratives inform the prevailing assumption that the primary purpose of education and the proper function of schools (especially the public schools) is to promote economic competitiveness in the new global economy. But if the new global economy is accelerating the pace of environmental destruction, and if much of the instruction tha

High and Dry: New Observations of Tropospheric and Cloud Properties above the Greenland Ice Sheet

Cloud and atmospheric properties strongly influence the mass and energy budgets of the Greenland Ice Sheet (GIS). To address critical gaps in the understanding of these systems, a new suite of cloud- and atmosphere-observing instruments has been installed on the central GIS as part of the Integrated Characterization of Energy, Clouds, Atmospheric State, and Precipitation at Summit (ICECAPS) project. During the first 20 months in operation, this complementary suite of active and passive ground-based sensors and radiosondes has provided new and unique perspectives on important cloud?atmosphere properties. High atop the GIS, the atmosphere is extremely dry and cold with strong near-surface static stability predominating throughout the year, particularly in winter. This low-level thermodynamic structure, coupled with frequent moisture inversions, conveys the importance of advection for local cloud and precipitation formation. Cloud liquid water is observed in all months of the year, even the particularly cold and dry winter, while annual cycle observations indicate that the largest atmospheric moisture amounts, cloud water contents, and snowfall occur in summer and under southwesterly flow. Many of the basic structural properties of clouds observed at Summit, Greenland, particularly for low-level stratiform clouds, are similar to their counterparts in other Arctic regions. The ICECAPS observations and accompanying analyses will be used to improve the understanding of key cloud?atmosphere processes and the manner in which they interact with the GIS. Furthermore, they will facilitate model evaluation and development in this data-sparse but environmentally unique region

Idoso vítima de queimaduras: identificação do diagnóstico e proposta de intervenção de enfermagem Anciano con quemadura: identificación del diagnóstico y propuesta de intervención de enfermería Aged victim of burns: identification of diagnosis and proposal of nursing interventions

Estudo de caso que objetivou identificar os Diagnósticos de Enfermagem (DE) conforme taxonomia II da Nursing American Nursing Association (NANDA), em idoso vítima de queimaduras de 2° e 3° graus e elaborar as intervenções de Enfermagem. Foram identificados oito DE, sendo cinco com presença de características definidoras e fatores relacionados (atuais) e três de risco. Elaborou-se propostas de intervenção iniciando pelas necessidades relacionadas aos sistemas vitais, fisiológicos, base da hierarquia das necessidades humanas básicas. Ao final, observou-se a importância da aplicabilidade do processo de enfermagem na implementação do cuidado e a necessidade do mesmo no exercício do fazer cotidiano.<br>Estúdio de caso cuyo objetivo fué identificar los Diagnósticos de Enfermería (DE) según la taxonomia II de North Ameircan Nursing Diagnosis Association (NANDA), de lo anciano com quemadura de 2° e 3° grado. Fueron identificados ocho DE de los más, cinco con presencia de características definidoras y factores relacionados (reales), y três de riesgos. Posteriomente, fueron elaboradas las porpuestas de intervención comenzado por la aplicabilidad del proceso de enfermería em la implementación del cuidado y la necessidad del mismo en el ejercício del hacer diário de enfermería.<br>This case study aimed at identifying the Nursing Diagnosis (ND) in agreement with the taxonomy II of the North-American Nursing Diagnosis Association (NANDA) of a patient victim of burning of 2nd e 3th degrees and to elaborate the nursing interventions. Eight ND were identified being five with the presence of defining characteristics and related factors (real), and three of risk. Intervention proposal was elaborated starting by the needs related to the vital and physiologic signs, the base of human basic needs hierarchy. Finally, it was observed the relevance of nursing process applicability in the implementation of care and its need in daily nursinga activitiies