Reliability of measures of impairments associated with patellofemoral pain syndrome

BACKGROUND: The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS. METHODS: A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements. RESULTS: Thirty patients (age 29 +/- 8; 17 female) with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97); moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79); and poor for femoral anteversion (ICC of .45). Standard error of measurement (SEM) for measures of muscle length ranged from 1.6 degrees to 4.3 degrees. SEM for Q-angle, tibial torsion, and femoral anteversion were 2.4 degrees, 2.9 degrees, and 4.5 degrees respectively. SEM for foot pronation was 1 mm. SEM for measures of muscle strength was 1.8 Kg for abduction and 2.4 Kg for external rotation. CONCLUSION: Several of the impairments associated with PFPS had sufficient reliability and low measurement error. Further investigation is needed to test if these impairment measurements are related to physical function and whether or not they are useful for decision-making

Longterm trends in carnivore abundance using distance sampling

Abstract: 1. Carnivores can have critical impacts on ecosystems, provide economic value through tourism and are often important flagships. However, their biological traits (e.g. low density, cryptic colouration and behaviour) make them difficult to monitor and hence wildlife managers rarely have access to reliable information on population trends, and long-term information at the community level is almost completely lacking. 2. We use data from transect counts in the Serengeti ecosystem in Tanzania to examine trends in abundance for seven co-existing carnivore species. Distance-based transect counts between 2002 and 2005 are compared with adjusted data from fixed-width transect counts across the same area in 1977 and 1986. 3. Distance-based methods provided density indices for the seven most commonly seen carnivores: lion Panthera leo, spotted hyaena Crocuta crocuta, golden jackal Canis aureus, black-backed jackal Canis mesomelas, cheetah Acinonyx jubatus, side-striped jackal Canis audustis and bat-eared fox Otocyon megalotis. Detection curves were used to correct estimates fromearlier fixed-width transect counts. 4. Trend analyses detected significant declines in densities of golden and blackbacked jackal and bat-eared fox, but found no significant changes in spotted hyaena, lion, cheetah and side-striped jackal. 5. Overall, despite wide confidence intervals, we show that distance-based data can be used effectively to detect long-term trends and provide critical information for conservation managers. Power analysis demonstrated that for the most frequently seen species, spotted hyaena, golden jackal and lion, abrupt declines of up to 20% may be detectable through long-term monitoring; however, for the remaining species, declines of 50%may only be detected half the time. 6. Synthesis and applications. Distance methods provide a tool for rapid counts and monitoring of several species of carnivores simultaneously in suitable habitats and can be combined with historical fixed-width transect counts to test for changes in density. The method can provide key information to managers on long-term population trends and sudden abrupt changes in population size across a carnivore community. Long-term trends in carnivore abundance using distance sampling in Serengeti National Park, Tanzania 1. Carnivores can have critical impacts on ecosystems, provide economic value through tourism and are often important flagships. However, their biological traits (e.g. low density, cryptic colouration and behaviour) make them difficult to monitor and hence wildlife managers rarely have access to reliable information on population trends, and long-term information at the community level is almost completely lacking. 2. We use data from transect counts in the Serengeti ecosystem in Tanzania to examine trends in abundance for seven co-existing carnivore species. Distance-based transect counts between 2002 and 2005 are compared with adjusted data from fixed-width transect counts across the same area in 1977 and 1986. 3. Distance-based methods provided density indices for the seven most commonly seen carnivores: lion Panthera leo, spotted hyaena Crocuta crocuta, golden jackal Canis aureus, black-backed jackal Canis mesomelas, cheetah Acinonyx jubatus, side-striped jackal Canis audustis and bat-eared fox Otocyon megalotis. Detection curves were used to correct estimates from earlier fixed-width transect counts. 4. Trend analyses detected significant declines in densities of golden and black-backed jackal and bat-eared fox, but found no significant changes in spotted hyaena, lion, cheetah and side-striped jackal. 5. Overall, despite wide confidence intervals, we show that distance-based data can be used effectively to detect long-term trends and provide critical information for conservation managers. Power analysis demonstrated that for the most frequently seen species, spotted hyaena, golden jackal and lion, abrupt declines of up to 20% may be detectable through long-term monitoring; however, for the remaining species, declines of 50% may only be detected half the time. 6. Synthesis and applications. Distance methods provide a tool for rapid counts and monitoring of several species of carnivores simultaneously in suitable habitats and can be combined with historical fixed-width transect counts to test for changes in density. The method can provide key information to managers on long-term population trends and sudden abrupt changes in population size across a carnivore community

Dealing with Alcohol-related problems in the Night-Time Economy: A Study Protocol for Mapping trends in harm and stakeholder views surrounding local community level interventions

<p>Abstract</p> <p>Background</p> <p>This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms.</p> <p>Methods/Design</p> <p>This study will gather existing police data (assault, property damage and drink driving offences), Emergency Department presentations and Ambulance attendance data. Further, the research team will conduct interviews with licensed venue patrons and collect observational data of licensed venues. Key informant interviews will assess expert knowledge from key industry and government stakeholders, and a community survey will assess community experiences and attitudes towards alcohol-related harm and harm-reduction strategies. Overall, the project will assess: the extent of alcohol-related harm in the context of harm-reduction interventions, and the need for and acceptability of further intervention.</p> <p>Discussion</p> <p>These findings will be used to improve evidence-based practice both nationally and internationally.</p> <p>Ethical Approval</p> <p>This project has been approved by Deakin University HREC.</p

Was an increase in cocaine use among injecting drug users in New South Wales, Australia, accompanied by an increase in violent crime?

BACKGROUND: A sharp reduction in heroin supply in Australia in 2001 was followed by a large but transient increase in cocaine use among injecting drug users (IDU) in Sydney. This paper assesses whether the increase in cocaine use among IDU was accompanied by increased rates of violent crime as occurred in the United States in the 1980s. Specifically, the paper aims to examine the impact of increased cocaine use among Sydney IDU upon police incidents of robbery with a weapon, assault and homicide. METHODS: Data on cocaine use among IDU was obtained from the Illicit Drug Reporting System (IDRS). Monthly NSW Police incident data on arrests for cocaine possession/use, robbery offences, homicides, and assaults, were obtained from the Bureau of Crime Statistics and Research. Time series analysis was conducted on the police data series where possible. Semi-structured interviews were conducted with representatives from law enforcement and health agencies about the impacts of cocaine use on crime and policing. RESULTS: There was a significant increase in cocaine use and cocaine possession offences in the months immediately following the reduction in heroin supply. There was also a significant increase in incidents of robbery where weapons were involved. There were no increases in offences involving firearms, homicides or reported assaults. CONCLUSION: The increased use of cocaine among injecting drug users following the heroin shortage led to increases in violent crime. Other States and territories that also experienced a heroin shortage but did not show any increases in cocaine use did not report any increase in violent crimes. The violent crimes committed did not involve guns, most likely because of its stringent gun laws, in contrast to the experience of American cities that have experienced high rates of cocaine use and violent crime

Formative Assessment of ARM-U: A Modular Intervention for Decreasing Risk Behaviors Among HIV-Positive and HIV-Negative Methamphetamine-Using MSM

BACKGROUND: Methamphetamine is a major contributor to HIV transmission among men who have sex with men (MSM). Recent studies show that up to one-third of methamphetamine-using MSM (MUMSM) inject the drug. We developed a behavioral intervention for MUMSM to decrease unprotected anal intercourse and increase awareness of parenteral HIV transmission risk. This 6-session (3 in-person, 3 by telephone) modular intervention was designed to be tailored to participants' HIV (+/-) and injection drug user ([IDU] yes/no) status. We present results of formative research used to evaluate the content and to assess feasibility and acceptability of this individual-level HIV risk-reduction intervention. SETTING: HIV research clinic in a high MSM and methamphetamine prevalence neighborhood. PROJECT: Avoiding Risks from Methamphetamine-Use (ARM-U) is a brief toolbox intervention that allows counselors to select modules that suit a client's individual risk profile and intervention needs employing motivational interviewing and cognitive behavioral theory. We evaluated the format and content of the intervention through focus groups and pre-testing of the entire intervention using volunteers from the target population stratified into four groups (HIV+/IDU, HIV-/IDU, HIV+/non-IDU, HIV-/non-IDU). Four individuals in each stratum were recruited to undergo the intervention and complete a satisfaction survey at the end of each in-person session. RESULTS: In total, 25 MUMSM attended one of five focus groups. Participants thought all proposed intervention topics were important and could aid in reducing sexual risk behaviors among MUMSM. However, the neurocognitive effects of methamphetamine were reported to be a barrier to practicing safer sex, condom use negotiation or HIV status disclosure. Fifteen (94%) of 16 participants completed all 6 sessions and the satisfaction survey. On average, participants felt the intervention was useful for MUMSM, made them contemplate and move toward behavior change, and would recommend the program to their peers. LESSONS LEARNED: Based on our formative research, we revised the ARM-U intervention to emphasize pre-planning to avoid combining methamphetamine use and sex or develop strategies to avoid sex risk following methamphetamine use. We also increased emphasis on referrals for care and other requested services. Future efficacy trials are needed to evaluate the intervention's ability to reduce HIV-associated risk behaviors

Abdominal aortic aneurysm in a patient with low back pain

STUDY DESIGN: Resident\u27s case problem. BACKGROUND: The purpose of this report was to describe (1) the clinical reasoning that led a clinician to identify an abdominal aortic aneurysm (AAA) in a patient with low back pain requiring immediate medical referral, and (2) an evidence-based approach to clinical evaluation of patients with suspected AAA. DIAGNOSIS: The patient was unable to identify a specific mechanism of injury for his low back pain, lacked aggravating/easing factors for his symptoms, and complained of night pain and an inability to ease his symptoms with position changes. While the patient\u27s symptoms remained unchanged during physical examination of the lumbar spine and hip, abdominal palpation revealed a strong, nontender pulsation over the midline of the upper and lower abdominal quadrants. Due to concern for an AAA, the patient was immediately referred to his physician. Subsequent computed tomography imaging revealed a prominent AAA, which measured up to 5.5 cm in greatest dimension and extended from below the renal arteries to the bifurcation of the iliac arteries. The patient initially deferred surgical intervention but eventually consented 6 months later, after repeat computed tomography imaging revealed that the AAA had progressed to 6.7 cm in greatest dimension. DISCUSSION: It is essential for physical therapists to be familiar with a diagnostic pathway to help identify AAA in patients presenting with apparent musculoskeletal complaints. Knowledge of the risk factors for AAA, understanding how to screen for nonmusculoskeletal symptoms, and a basic competence in abdominal palpation and how to interpret findings will help with the clinician\u27s clinical decision making