Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome?

Title: Does Patient Self-Efficacy at Intake Predict the Therapeutic Outcome? Authors: Molly Geiger SPT1, Stephanie Juhnke SPT1, Ellen Maloney SPT1, Danny McMillian DSc.1 Affiliation: 1. School of Physical Therapy, University of Puget Sound Purpose: Several studies have linked psychosocial factors, such as depression, self-efficacy, and fear-avoidance to poor outcomes, increased disability, and the development of chronic pain. In a primary care setting, Foster has shown self-efficacy to be the most important for determining outcomes. The aim of this study is to examine the relationship between self-efficacy (SE) levels and physical therapy (PT) outcomes. We believe a patient’s SE levels will be positively correlated with PT outcomes. Specifically, higher SE levels will be associated with successful outcomes. Subjects: 11 Subjects (5 females and 6 males, ages 21-76 years old) from the University of Puget Sound’s outpatient musculoskeletal clinic participated in this study. Patients presented with a wide range of musculoskeletal impairments. Materials & Methods: Subjects from the University of Puget Sound’s musculoskeletal clinic were recruited for the study. Subjects completed the General Self-Efficacy Questionnaire prior to their initial evaluation and a specified relevant outcome measure and the Numeric Pain Rating Scale on both the initial and final treatments. Changes in outcomes were compared to the minimal clinically important difference (MCID) and then correlated with the GSE score. Results: The results of this study reveal no statistically significant relationship between SE levels and physical therapy outcome. A Point Biserial Correlation showed that the initial GSE score was only moderately correlated with the pain scale, r=0.589 p-value=0.296, and with the results on the outcome measures, r=0.503 p=0.114. Notably, for all subjects the average GSE score was high at 79.8%. The average GSE scores for those who saw improvement (met MCID or not) versus those who saw no change or worse outcomes was 85.0% and 65.8% respectively. Conclusion: While this study only shows a moderate correlation between SE levels and PT outcomes, it does shine a light on the uniqueness of PT performed in an educational setting. Because student physical therapists were treating patients under supervision of the clinical instructors, it is conceivable patients pursuing treatment in this setting have high SE levels. This could explain the lack of variability in the data collected as well as indicate a need to expand the psychosocial parameters measured. Although significant results were not achieved, a comparison of SE averages between groups (improved or not) does suggest the potential for a relationship between psychosocial factors and therapeutic outcomes to exist. Clinical Relevance: The lack of variability obtained in this study indicates the need for larger sampling and an expansion of the psychosocial factors measured. Additionally, when collecting data in an educational setting, clinical researchers should acknowledge that generalizability might be limited by the unique characteristic of patients receiving care in that setting. References: Tijou I, Yardley L, Sedikides C, Bizo L. Understanding adherence to physiotherapy: Findings from an experimental simulation and an observational clinical study. Psych Health. 2010;25(2). Foster NE, Thomas E, Bishop A, Dunn KM, Main CJ. Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care. Pain. 2010;148(3):398-406. Bergbom S, Boersma K, Overmeer T, Linton SJ. Relationship among pain catastrophizing, depressed mood, and outcomes across physical therapy treatments. PHYS THER. 2011;91:754-764. Linton SJ, Shaw WS. Impact of psychological factors in the experience of pain. PHYS THER. May 2011;91:700-711. Overmeer T, Boersma K, Denison E, Linton SJ. Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? A randomized controlled trial. PHYS THER. 2011;91(5):804-819. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: Integration of psychosocially informed management principles into physical therapist practice--challenges and opportunities. PHYS THER. 2011;91:790-803

Invertebrate Diet of Breeding and Nonbreeding Crested Caracaras (Caracara cheriway) in Florida

We compared the invertebrate component of the diet of breeding and nonbreeding northern Crested Caracaras (Caracara cheriway) during the breeding season, January through April, in Florida, using pellet analysis. Pellets from breeding adults were collected at active nests and pellets of nonbreeding caracaras were collected from beneath a communal roost. During the breeding season, breeding and nonbreeding caracaras consumed invertebrate prey from a minimum of 61 genera and a total of 33 families from eight orders. Nonbreedingcaracaras consumed greater total numbers of invertebrates, more different prey types, and a greater diversity of invertebrates than did breeding caracaras. Pellets of nonbreeding caracaras contained more invertebrates per pellet, and carrion insects occurred more frequently in pellets of nonbreeding caracaras. Our findings suggest hypotheses regarding the possible role of intraspecific competition in the use of particular habitats and food resources by breeding and nonbreeding caracaras in Florida. Breeding pairs of caracaras are highly territorial and primarily feed nestlings larger-sized vertebrate prey, and field observations indicated that territorial adults can exclude young (nonbreeding) birds from their breeding areas; thus, diet differences may reflect social structure within this population. If pairs of breeding adults exclude conspecifics from important food resources or foraging habitats, nonbreeders may hunt arthropods or rely on carrion by necessity, especially if nonbreeders occur in suboptimal habitat in which other prey are less available

Correlation regimes in fluctuations of fatigue crack growth

This paper investigates correlation properties of fluctuations in fatigue crack growth of polycrystalline materials, such as ductile alloys, that are commonly encountered in structures and machinery components of complex electromechanical systems. The model of crack damage measure indicates that the fluctuations of fatigue crack growth are characterized by strong correlation patterns within short time scales and are uncorrelated for larger time scales. The two correlation regimes suggest that the 7075-T6 aluminum alloy, analyzed in this paper, is characterized by a micro-structure which is responsible for an intermittent correlated dynamics of fatigue crack growth within a certain scale. The constitutive equations of the damage measure are built upon the physics of fracture mechanics and are substantiated by Karhunen-Lo\`{e}ve decomposition of fatigue test data. Statistical orthogonality of the estimated damage measure and the resulting estimation error is demonstrated in a Hilbert space setting.Comment: 30 pages, 8 figures, to appear in Physica

Replacement of Hydrochlorofluorocarbon (HCFC) -225 Solvent for Cleaning and Verification Sampling of NASA Propulsion Oxygen Systems Hardware, Ground Support Equipment, and Associated Test Systems

Since the 1990's, NASA's rocket propulsion test facilities at Marshall Space Flight Center (MSFC) and Stennis Space Center (SSC) have used hydrochlorofluorocarbon-225 (HCFC-225), a Class II ozone-depleting substance, to safety clean and verify the cleanliness of large scale propulsion oxygen systems and associated test facilities. In 2012 through 2014, test laboratories at MSFC, SSC, and Johnson Space Center-White Sands Test Facility collaborated to seek out, test, and qualify an environmentally preferred replacement for HCFC-225. Candidate solvents were selected, a test plan was developed, and the products were tested for materials compatibility, oxygen compatibility, cleaning effectiveness, and suitability for use in cleanliness verification and field cleaning operations. Honewell Soltice (TradeMark) Performance Fluid (trans-1-chloro-3,3, 3-trifluoropropene) was selected to replace HCFC-225 at NASA's MSFC and SSC rocket propulsion test facilities

Perinatal Environmental Tobacco Smoke Exposure in Rhesus Monkeys: Critical Periods and Regional Selectivity for Effects on Brain Cell Development and Lipid Peroxidation

Perinatal environmental tobacco smoke (ETS) exposure in humans elicits neurobehavioral deficits. We exposed rhesus monkeys to ETS during gestation and through 13 months postnatally, or postnatally only (6–13 months). At the conclusion of exposure, we examined cerebrocortical regions and the midbrain for cell damage markers and lipid peroxidation. For perinatal ETS, two archetypal patterns were seen in the various regions, one characterized by cell loss (reduced DNA concentration) and corresponding increases in cell size (increased protein/DNA ratio), and a second pattern suggesting replacement of larger neuronal cells with smaller and more numerous glia (increased DNA concentration, decreased protein/DNA ratio). The membrane/total protein ratio, a biomarker of neurite formation, also indicated potential damage to neuronal projections, accompanied by reactive sprouting. When ETS exposure was restricted to the postnatal period, the effects were similar in regional selectivity, direction, and magnitude. These patterns resemble the effects of prenatal nicotine exposure in rodent and primate models. Surprisingly, perinatal ETS exposure reduced the level of lipid peroxidation as assessed by the concentration of thiobarbituric acid reactive species, whereas postnatal ETS did not. The heart, a tissue that, like the brain, has high oxygen demand, displayed a similar but earlier decrease (2–3 months) in lipid peroxidation in the perinatal exposure model, whereas values were reduced at 13 months with the postnatal exposure paradigm. Our results provide a mechanistic connection between perinatal ETS exposure and neurobehavioral anomalies, reinforce the role of nicotine in these effects, and buttress the importance of restricting or eliminating ETS exposure in young children

Two distinct sequences of blue straggler stars in the globular cluster M30

Stars in globular clusters are generally believed to have all formed at the same time, early in the Galaxy's history. 'Blue stragglers' are stars massive enough that they should have evolved into white dwarfs long ago. Two possible mechanisms have been proposed for their formation: mass transfer between binary companions and stellar mergers resulting from direct collisions between two stars. Recently, the binary explanation was claimed to be dominant. Here we report that there are two distinct parallel sequences of blue stragglers in M30. This globular cluster is thought to have undergone 'core collapse', during which both the collision rate and the mass transfer activity in binary systems would have been enhanced. We suggest that the two observed sequences arise from the cluster core collapse, with the bluer population arising from direct stellar collisions and the redder one arising from the evolution of close binaries that are probably still experiencing an active phase of mass transfer.Comment: Published on the 24th December 2009 issue of Natur

CEBS—Chemical Effects in Biological Systems: a public data repository integrating study design and toxicity data with microarray and proteomics data

CEBS (Chemical Effects in Biological Systems) is an integrated public repository for toxicogenomics data, including the study design and timeline, clinical chemistry and histopathology findings and microarray and proteomics data. CEBS contains data derived from studies of chemicals and of genetic alterations, and is compatible with clinical and environmental studies. CEBS is designed to permit the user to query the data using the study conditions, the subject responses and then, having identified an appropriate set of subjects, to move to the microarray module of CEBS to carry out gene signature and pathway analysis. Scope of CEBS: CEBS currently holds 22 studies of rats, four studies of mice and one study of Caenorhabditis elegans. CEBS can also accommodate data from studies of human subjects. Toxicogenomics studies currently in CEBS comprise over 4000 microarray hybridizations, and 75 2D gel images annotated with protein identification performed by MALDI and MS/MS. CEBS contains raw microarray data collected in accordance with MIAME guidelines and provides tools for data selection, pre-processing and analysis resulting in annotated lists of genes of interest. Additionally, clinical chemistry and histopathology findings from over 1500 animals are included in CEBS. CEBS/BID: The BID (Biomedical Investigation Database) is another component of the CEBS system. BID is a relational database used to load and curate study data prior to export to CEBS, in addition to capturing and displaying novel data types such as PCR data, or additional fields of interest, including those defined by the HESI Toxicogenomics Committee (in preparation). BID has been shared with Health Canada and the US Environmental Protection Agency. CEBS is available at http://cebs.niehs.nih.gov. BID can be accessed via the user interface from https://dir-apps.niehs.nih.gov/arc/. Requests for a copy of BID and for depositing data into CEBS or BID are available at http://www.niehs.nih.gov/cebs-df/

Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9-10 year old children from deprived neighbourhoods: a cross-sectional study.

BACKGROUND: Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods. METHODS: Cross-sectional data was collected from 9-10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level. RESULTS: Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is 'definitely' bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to 'definitely' believe that the smoke from other people's cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to 'definitely' believe that smoking is bad for health. CONCLUSION: This study indicates that sibling and friend smoking may represent important influences on 9-10 year old children's cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed