The Treatment of Chronic Athletic Injuries of the Low Back and Lower Extremity Utilizing Manipulation

The purpose of this study was to determine whether spinal manipulation and/or lower extremity manipulation could be effective in a specific clinical situation -the treatment of chronically injured athletes. It was deemed important to set up a small pilot study that reflected exactly how a practitioner would deal with an injured athlete. Past trials of manipulation have been criticized because they did not resemble what actually occurs in a clinical situation. Participants were restricted to a few standard manipulations. They were not allowed to treat the participating patient as they normally would have(l)

Aerothermal modeling program, Phase 2, Element C: Fuel injector-air swirl characterization

The main objectives of the NASA sponsored Aerothermal Modeling Program, Phase 2, Element C, are to collect benchmark quality data to quantify the fuel spray interaction with the turbulent swirling flows and to validate current and advanced two phase flow models. The technical tasks involved in this effort are discussed

Using Curb and Figure-Eight Skills Tests to Compare Maneuverability of the user assistant team in the Motivation Rough Terrain Wheelchair and the Whirlwind RoughRider Wheelchair

ABSTRACT Some wheelchair users who cannot self-propel use powered chairs. In less-resourced settings powered chairs may not be available and users may rely on assistants to push them. In these environments, obstacles similar to curbs are common and living spaces are small1,2. Efficiency and maneuverability are two key aspects of wheelchair performance in such settings1 .Validated skills tests for measuring wheelchair performance over obstacles and in tight spaces include timed exercises involving curbs and figure-eight patterns3. We hypothesized that some chairs designed for less-resourced settings would be easier than others for assistants to push in tight spaces and over curbs. College-aged participants (n=29) serving as assistants completed two three minute skills tests with two models of wheelchairs designed for less-resourced settings, the Motivation Rough Terrain and the Whirlwind RoughRider chair. The two skills tests consisted of three minute timed walk tests (TWT) with each chair on two short tracks, one encompassing a curb and the other in a figure eight around chairs. PolarPro heart rate monitors were used to collect heart rates. Distance traveled was measured and physiological cost index (PCI) was calculated. Subject feedback was obtained through visual analogue scale (VAS) questions and written comments for each exercise. Two-way within subject ANOVA analysis and post hoc paired t-tests were used to evaluate data. Within subject ANOVA indicated that the Motivation chair significantly outperformed the Whirlwind chair in PCI, TWT, and VAS responses. Post hoc paired t-tests of PCI values and VAS responses indicated that the differences between the Motivation and the Whirlwind were significant for both tracks. This data was normal and showed interaction but no crossover. The post hoc t-test analysis of TWT data, however, showed significant difference for the curb but only nearly significant difference for the figure-eight. In the written comments, subjects indicated a preference for the design of the Motivation chair mentioning certain features such as the single front castor wheel and the position of the handle bars. Our data indicates that the Motivation Rough Terrain chair may provide superior mobility to assistants serving people with disabilities in less-resourced settings specifically while maneuvering through tight spaces and over obstacles. Through this research, we hope wheelchair manufacturers will be encouraged to make improvements in wheelchair functionality for assistant pushers in less-resourced settings

THE DIFFERENCES IN SPINAL KINEMATICS AND LOADING IN HIGH PERFORMANCE FEMALE ROWERS DURING ERGOMETER AND ON WATER ROWING

Low back pain (LBP) is the most prevalent injury in rowing. The high use of ergometers have been associated win increased LBP and sliding ergometers has proposed to reduce this stress. The purpose of this study was to examine the lumbar flexion angles on fixed and sliding ergometers versus on water conditions. Four elite female adult rowers volunteered for this study and completed a 1,000 meter maximal test on the stationary and fixed ergometers and then on water. Lumbar curvature (% flexion) was calculated) for the first 0.47 s following the catch position. Standardized mean differences (effect size) were calculated to examine differences in %ROM over time for each condition and between conditions. Results found that fixed rowers ergometers induced the greatest amount if lumbar flexion, with some reduction for sliding ergometers compared to on water

Work-integrated learning (WIL) supervisors and non-supervisors of allied health professional students.

Published version made in accordance with Publisher policy. Authors retain copyright for articles published in Rural and Remote Health, published version may be used with author permission. ‘First published in the journal, Rural and Remote Health [http://www.rrh.org.au]’Introduction: This study sought to characterise the allied health professional (AHP) workforce of the Northern Territory (NT), Australia, in order to understand the influence of student supervision on workload, job satisfaction, and recruitment and retention. Methods: The national Rural Allied Health Workforce Study survey was adapted for the NT context and distributed through local AHP networks. Valid responses (n=179) representing 16 professions were collated and categorised into ‘supervisor’ and ‘non- supervisor’ groups for further analysis. Results: The NT AHP workforce is predominantly female, non-Indigenous, raised in an urban environment, trained outside the NT, now concentrated in the capital city, and principally engaged in individual patient care. Allied health professionals cited income and type of work or clientele as the most frequent factors for attraction to their current positions. While 62% provided student supervision, only half reported having training in mentoring or supervision. Supervising students accounted for an estimated 9% of workload. Almost 20% of existing supervisors and 33% of non-supervising survey respondents expressed an interest in greater supervisory responsibilities. Despite indicating high satisfaction with their current positions, 67% of respondents reported an intention to leave their jobs in less than 5 years. Student supervision was not linked to perceived job satisfaction; however, this study found that professionals who were engaged in student supervision were significantly more likely to report intention to stay in their current jobs (>5 years; p<0.05)

Cost of Rolling on Rough and Smooth Ground for Assistants Pushing the Motivation Rough Terrain and Whirlwind RoughRider Wheelchairs

In less-resourced settings, powered wheelchairs are rarely available for users who cannot self-propel[1]. These users must rely on somebody, usually family members or friends, for assistance to push them across variable terrain[2],[3]. In situations where people with disabilities are grouped together, assistants may themselves be disabled. Provision of mobility for the wheelchair user may be a great physiological cost for the assistant. Objective outcomes measures can provide valuable feedback to manufacturers which can constructively influence wheelchair design modification3,4. We hypothesized that measuring the energy cost for an assistant pushing two types of wheelchairs on rough and smooth ground would allow us to differentiate between the chairs and provide useful feedback to manufacturers. This study compared the Motivation Rough Terrain and Whirlwind RoughRider, wheelchairs designed for less-resourced settings. Able-bodied volunteer college-aged students (n=29: 16M, 13F, age 19±1.3) completed six-minute timed walk tests (TWT) with both wheelchair types on smooth and rough ground courses, the smooth course on a paved parking lot and the rough course on a gravel parking lot. Exercise and non-exercise heart rate was collected for each subject using Polar Pro monitors. Exercise heart rate consisted of the last four minutes of heart rate collected during the TWT. The physiological cost index (PCI) was then calculated4. Subjects completed a visual analog scale (VAS) question for each TWT. Two-way within-subject ANOVA and post-hoc paired t-tests were used to compare data. Results showed the Motivation Rough Terrain outperformed the Whirlwind RoughRider in most categories. ANOVA showed significant results with the Whirlwind chair having a higher PCI. Post-hoc paired t-tests showed a significantly higher PCI for the Whirlwind chair on both smooth and rough ground. There was no significance found between the two chairs for the TWT. VAS results indicated subjects perceived significantly greater difficulty with the Whirlwind chair than the Motivation chair on both smooth and rough ground. Comments revealed that subjects favored the single front castor of the Motivation chair. Based on the results of this study, it seems as though the design of the Motivation chair utilizes important features that could be of potential benefit to assistants pushing wheelchair users in less-resourced settings. These features may also have a positive impact on the production of efficient rough terrain wheelchairs

DUCAT (Dutch inventory of invasive Coronary Atherosclerosis Treatments)

Het DUCAT (Dutch inventory of invasive Coronary Atherosclerosis Treatments) project had tot doel te bepalen hoe passend behandelbeslissingen (beleidsbeslissingen) zijn bij patiënten met vernauwing van een of meer kransslagaders rond het hart (coronairlijden). DUCAT bestond uit drie delen: a) bepaling van de passendheid van behandelindicaties door een panel van deskundigen, uitgaande van drie behandelvormen: coronaire-omleidingsoperatie (CABG), 'dotteren' (PTCA), en medicamenteuze of andere niet-invasieve therapie (conservatieve behandeling); b) toetsing van de beleidsbeslissingen in tien hartcentra in Nederland aan de paneloordelen; c) het volgen van de lotgevallen van patiënten met passende en niet-passende beleidsbeslissingen. Dat laatste is beperkt gebleven tot een periode van een jaar. Hoe kan men vaststellen of een indicatie voor een ingreep passend is of niet? Ideaal zou zijn als de wetenschappelijke literatuur geen twijfel toelaat over wat de beste benadering is, maar dat is niet zo. De literatuur biedt voor vele toepassingen van CABG en vooral PTCA onvoldoende zekerheid. Er moet daarom ook een beroep worden gedaan op de ervaring van deskundigen die de indicaties in de praktijk stellen. Een aanpak - maar zeker niet de enige - om die ervaring te laten meetellen is ontwikkeld door het Amerikaanse instituut RAND in samenwerking met de Universiteit van California in Los Angeles (UCLA). De RAND/UCLA methode houdt in dat vele modelpatiënten, en bijpassende indicaties voor behandeling, worden onderscheiden op basis van combinaties van klinische kenmerken. Deskundige leden van een panel geven, op grond van de literatuur en aanvullende medische inzichten, voor elk van die modelpatiënten aan of een behandelindicatie passend, onzeker of niet-passend is. DUCAT is het eerste onderzoek in Nederland waarin deze methode is toegepast. DUCAT kende een theorie- en een praktijkdeel. In het theoriedeel kwamen twee vragen aan de orde. Hoe passend waren volgens het DUCAT-panel de vele indicaties voor behandeling bij coronairlijden en welke klinische en niet-klinische factoren hadden invloed op de oordelen van het panel? Het panel koos bij bijna de helft van de modelpatiënten voor invasieve behandeling en bij ruim een op de vijf voor conservatieve therapie, terwijl het in de rest van de gevallen geen voorkeur had voor de ene of andere benadering. Het panel vond CABG-indicaties vaker passend dan PTCA-indicaties. Het baseerde zich daarbij vooral op medische overwegingen, zoals het actuele klinische beeld en vooral de ernst van de anatomische afwijkingen. Anatomische kenmerken wogen in de oordeelsvorming zwaarder dan andere karakteristieken, zoals medicatie en de uitslag van een inspanningsproef. DUCAT richtte zich op patiënten die in het hartcentrum werden besproken op initiatief van een verwijzend cardioloog waarbij de bespreking leidde tot een beleidsbeslissing. Onze primaire belangstelling ging uit naar 3647 mensen met anatomisch gedefinieerd significant coronairlijden. De desbetreffende DUCAT-populatie bestond in doorsnee uit niet al te jonge mannen en vrouwen van wie velen zich presenteerden met een uitgebreide geschiedenis of actuele uiting van risicofactoren, ziekteverschijnselen, vatafwijkingen en behandelingen, dus met ernstige pathologie. Dat gold niet over de hele linie. Opvallend was het grote aantal mensen met eenvatslijden. Bij verreweg de meeste patiënten met significant coronairlijden opteerden de interventieartsen voor invasieve behandeling (CABG of PTCA); bij 13 procent viel de keus op conservatieve therapie. CABG kr

Transcriptional Regulation of Latent Feline Immunodeficiency Virus in Peripheral CD4+ T-lymphocytes

Feline immunodeficiency virus (FIV), the lentivirus of domestic cats responsible for feline AIDS, establishes a latent infection in peripheral blood CD4+ T-cells approximately eight months after experimental inoculation. In this study, cats experimentally infected with the FIV-C strain in the asymptomatic phase demonstrated an estimated viral load of 1 infected cell per approximately 103 CD4+ T-cells, with about 1 copy of viral DNA per cell. Approximately 1 in 10 proviral copies was capable of transcription in the asymptomatic phase. The latent FIV proviral promoter was associated with deacetylated, methylated histones, which is consistent with a condensed chromatin structure. In contrast, the transcriptionally active FIV promoter was associated with histone acetylation and demethylation. In addition, RNA polymerase II appeared to be paused on the latent viral promoter, and short promoter-proximal transcripts were detected. Our findings for the FIV promoter in infected cats are similar to results obtained in studies of human immunodeficiency virus (HIV)-1 latent proviruses in cell culture in vitro studies. Thus, the FIV/cat model may offer insights into in vivo mechanisms of HIV latency and provides a unique opportunity to test novel therapeutic interventions aimed at eradicating latent virus

Quality of life after infrainguinal bypass grafting surgery

AbstractPurpose: The purpose of this study was to compare quality of life in patients with and without various ischemic complications after infrainguinal bypass grafting surgery for occlusive vascular disease. Methods: A sample of patients (n = 746) randomized in the Dutch BOA study (n = 2645), a multicenter trial that compared the effectiveness of oral anticoagulant therapy with aspirin in the prevention of infrainguinal bypass graft occlusions, was entered in this study. On the basis of clinical outcomes of the trial, the patients were grouped as follows: patients with patent grafts (n = 409); patients with nontreated graft occlusions, subdivided into an asymptomatic group (n = 32) and a symptomatic group (n = 65); patients with subsequent revascularizations (n = 194); patients with amputations (n = 36); and patients with failed secondary revascularizations followed by secondary amputation (n = 38). In case an outcome event occurred, the patients were regrouped accordingly. Every half year, the patients completed a Short Form–36 and a EuroQol questionnaire. A multilevel model was used for repeated measure analysis. Results:The mean follow-up time was 21 months. The quality of life in patients with nontreated asymptomatic occlusions was roughly similar to the quality of life in patients with patent grafts. Patients with symptomatic nontreated occlusions had the lowest outcome with regard to pain as compared with the other groups. Furthermore, physical and social functioning was lower for these patients than for patients with patent grafts. Revascularizations, successful or not, negatively affected pain, social functioning, and physical and emotional role. After successful revascularization, some improvement was observed in pain, physical and social functioning, and general and mental health as compared with the group with nontreated symptomatic occlusions. Amputation deteriorated physical functioning strikingly, especially after failed secondary revascularization. These patients also had the lowest scores of all the groups in the dimensions of social functioning, physical and emotional role, and mental health. EuroQol score showed deterioration of quality of life after all events, except for asymptomatic occlusions. The same patterns emerged if we stratified our analysis according to the indication for the initial operation: claudication or limb salvage. Quality of life was constant over time in all the groups in the observed period. Conclusion: Quality of life in patients with asymptomatic occluded grafts is similar to quality of life in patients with patent grafts. Revascularization of symptomatic occluded grafts improves quality of life to a certain extent. Amputation, in particular after failed secondary revascularization, seemed to be the lowest possible outcome. The results of the Short Form-36 and EuroQol measurements were in line with the clinical expectations. The association of disease severity with scores on the instruments supports the construct validity of these outcome measures for an objective assessment of quality of life in controlled studies. (J Vasc Surg 1999;29:913-9.