Borg's rating of perceived exertion scales: do the verbal anchors mean the same for different clinical groups?

Objective: To examine the interpretation of the verbal anchors used in the Borg rating of perceived exertion (RPE) scales in different clinical groups and a healthy control group. Design: Prospective experimental study. Setting: Rehabilitation center. Participants: Nineteen subjects with brain injury, 16 with chronic low back pain (CLBP), and 20 healthy controls. Interventions: Not applicable. Main Outcome Measures: Subjects used a visual analog scale (VAS) to rate their interpretation of the verbal anchors from the Borg RPE 6-20 and the newer 10-point category ratio scale. Results: All groups placed the verbal anchors in the order that they occur on the scales. There were significant within-group differences (P > .05) between VAS scores for 4 verbal anchors in the control group, 8 in the CLBP group, and 2 in the brain injury group. There was no significant difference in rating of each verbal anchor between the groups (P > .05). Conclusions: All subjects rated the verbal anchors in the order they occur on the scales, but there was less agreement in rating of each verbal anchor among subjects in the brain injury group. Clinicians should consider the possibility of small discrepancies in the meaning of the verbal anchors to subjects, particularly those recovering from brain injury, when they evaluate exercise perceptions.

A randomised clinical trial to assess the effect of total enteral and total parenteral nutritional support on metabolic, inflammatory and oxidative markers in patients with predicted severe acute pancreatitis (APACHE II >= 66)

Background: Total enteral nutrition (TEN) within 48 h of admission has recently been shown to be safe and efficacious as part of the management of severe acute pancreatitis. Our aim was to ascertain the safety of immediate TEN in these patients and the effect of TEN on systemic inflammation, psychological state, oxidative stress, plasma glutamine levels and endotoxaemia. Methods: Patients admitted with predicted severe acute pancreatitis (APACHE II score 15) were randomised to total enteral (TEN; n = 8) or total parenteral nutrition (TPN; n = 9). Measurements of systemic inflammation (C-reactive protein), fatigue ( visual analogue scale), oxidative stress ( plasma thiobarbituric acid- reactive substances), plasma glutamine and anti-endotoxin IgG and IgM antibody concentrations were made on admission and repeated on days 3 and 7 thereafter. Clinical progress was monitored using APACHE II score. Organ failure and complications were recorded. Results: All patients tolerated the feeding regime well with few nutrition-related complications. Fatigue improved in both groups but more rapidly in the TEN group. Oxidative stress was high on admission and rose by similar amounts in both groups. Plasma glutamine concentrations did not change significantly in either group. In the TPN group, 3 patients developed respiratory failure and 3 developed non-respiratory single organ failure. There were no such complications in the TEN group. Hospital stay was shorter in the TEN group [ 7 (4-14) vs. 10 (7-26) days; p = 0.05] as was time to passing flatus and time to opening bowels [1 (0-2) vs. 2 (1-5) days; p = 0.01]. The cost of TEN was considerably less than of TPN. Conclusion: Immediate institution of nutritional support in the form of TEN is safe in predicted severe acute pancreatitis. It is as safe and as efficacious as TPN and may be beneficial in the clinical course of this disease. Copyright (C) 2003 S. Karger AG, Basel and IAP.

Dyspnea-related cues engage the prefrontal cortex - evidence from functional brain imaging in COPD

Dyspnea is the major source of disability in chronic obstructive pulmonary disease (COPD). In COPD, environmental cues (e.g. the prospect of having to climb stairs) become associated with dyspnea, and may trigger dyspnea even before physical activity commences. We hypothesised that brain activation relating to such cues would be different between COPD patients and healthy controls, reflecting greater engagement of emotional mechanisms in patients. Methods: Using FMRI, we investigated brain responses to dyspnea-related word cues in 41 COPD patients and 40 healthy age-matched controls. We combined these findings with scores of self-report questionnaires thus linking the FMRI task with clinically relevant measures. This approach was adapted from studies in pain that enables identification of brain networks responsible for pain processing despite absence of a physical challenge. Results: COPD patients demonstrate activation in the medial prefrontal cortex (mPFC), and anterior cingulate cortex (ACC) which correlated with the visual analogue scale (VAS) response to word cues. This activity independently correlated with patient-reported questionnaires of depression, fatigue and dyspnea vigilance. Activation in the anterior insula, lateral prefrontal cortex (lPFC) and precuneus correlated with the VAS dyspnea scale but not the questionnaires. Conclusions: Our findings suggest that engagement of the brain's emotional circuitry is important for interpretation of dyspnea-related cues in COPD, and is influenced by depression, fatigue, and vigilance. A heightened response to salient cues is associated with increased symptom perception in chronic pain and asthma, and our findings suggest such mechanisms may be relevant in COPD.

B2B service brand identity: scale development and validation

Several brand identity frameworks have been published in the B2C and the B2B brand marketing literature. A reliable, valid and parsimonious service brand identity scale that empirically establishes the construct's dimensionality in a B2B market has yet to be developed. This paper reports the findings of a study conducted amongst 421 senior executives working in the UK IT Service sector to develop and validate a B2B Service Brand Identity Scale. Following established scale development procedures support is provided for a B2B Service Brand Identity Scale comprising five dimensions; employee and client focus, visual identity, brand personality, consistent communications and human resource initiatives. Concluding remarks discuss theoretical and managerial implications with limitations and directions for future research.

Centennial-scale climate change in Ireland during the Holocene

We examine mid- to late Holocene centennial-scale climate variability in Ireland using proxy data from peatlands, lakes and a speleothem. A high degree of between-record variability is apparent in the proxy data and significant chronological uncertainties are present. However, tephra layers provide a robust tool for correlation and improve the chronological precision of the records. Although we can find no statistically significant coherence in the dataset as a whole, a selection of high-quality peatland water table reconstructions co-vary more than would be expected by chance alone. A locally weighted regression model with bootstrapping can be used to construct a ‘best-estimate’ palaeoclimatic reconstruction from these datasets. Visual comparison and cross-wavelet analysis of peatland water table compilations from Ireland and Northern Britain show that there are some periods of coherence between these records. Some terrestrial palaeoclimatic changes in Ireland appear to coincide with changes in the North Atlantic thermohaline circulation and solar activity. However, these relationships are inconsistent and may be obscured by chronological uncertainties. We conclude by suggesting an agenda for future Holocene climate research in Ireland.

Reflexive stasis, scale reversal and the myth of modern cinema

This chapter looks at three films whose Portuguese urban settings offer a privileged ground for the re-evaluation of the classical-modern-postmodern categorisation with regard to cinema. They are The State of Things (Wim Wenders, 1982), Foreign Land (Walter Salles and Daniela Thomas, 1995) and Mysteries of Lisbon (Raúl Ruiz, 2010). In them, the city is the place where characters lose their bearings, names, identities, and where vicious circles, mirrors, replicas and mise-en-abyme bring the vertiginous movement that had characterised the modernist city of 1920s cinema to a halt. Curiously, too, it is the place where so-called postmodern aesthetics finally finds an ideal home in self-ironical tales that expose the film medium’s narrative shortcomings. Intermedial devices, whether Polaroid stills or a cardboard cut-out theatre, are then resorted to in order to turn a larger-than-life reality into framed, manageable narrative miniatures. The scaled-down real, however, turns out to be a disappointing simulacrum, a memory ersatz that unveils the illusory character of cosmopolitan teleology. In my approach, I start by examining the intertwined and transnational genesis of these films that resulted in three correlated visions of the end of history and of storytelling, typical of postmodern aesthetics. I move on to consider intermedia miniaturism as an attempt to stop time within movement, an equation that inevitably brings to mind the Deleuzian movement-time binary, which I revisit in an attempt to disentangle it from the classical-modern opposition. I conclude by proposing reflexive stasis and scale reversal as the common denominator across all modern projects, hence, perhaps, a more advantageous model than modernity to signify artistic and political values.

Assessing the ability of rural agrarian areas to provide Cultural Ecosystem Services (CES): a Multi Scale Social Indicator Framework (MSIF)

Assessing the ways in which rural agrarian areas provide Cultural Ecosystem Services (CES) is proving difficult to achieve. This research has developed an innovative methodological approach named as Multi Scale Indicator Framework (MSIF) for capturing the CES embedded into the rural agrarian areas. This framework reconciles a literature review with a trans-disciplinary participatory workshop. Both of these sources reveal that societal preferences diverge upon judgemental criteria which in turn relate to different visual concepts that can be drawn from analysing attributes, elements, features and characteristics of rural areas. We contend that it is now possible to list a group of possible multi scale indicators for stewardship, diversity and aesthetics. These results might also be of use for improving any existing European indicators frameworks by also including CES. This research carries major implications for policy at different levels of governance, as it makes possible to target and monitor policy instruments to the physical rural settings so that cultural dimensions are adequately considered. There is still work to be developed on regional specific values and thresholds for each criteria and its indicator set. In practical terms, by developing the conceptual design within a common framework as described in this paper, a considerable step forward towards the inclusion of the cultural dimension in European wide assessments can be made.

The new Hollywood, 1981–1999: special/visual effects

The emergence and development of digital imaging technologies and their impact on mainstream filmmaking is perhaps the most familiar special effects narrative associated with the years 1981-1999. This is in part because some of the questions raised by the rise of the digital still concern us now, but also because key milestone films showcasing advancements in digital imaging technologies appear in this period, including Tron (1982) and its computer generated image elements, the digital morphing in The Abyss (1989) and Terminator 2: Judgment Day (1991), computer animation in Jurassic Park (1993) and Toy Story (1995), digital extras in Titanic (1997), and ‘bullet time’ in The Matrix (1999). As a result it is tempting to characterize 1981-1999 as a ‘transitional period’ in which digital imaging processes grow in prominence and technical sophistication, and what we might call ‘analogue’ special effects processes correspondingly become less common. But such a narrative risks eliding the other practices that also shape effects sequences in this period. Indeed, the 1980s and 1990s are striking for the diverse range of effects practices in evidence in both big budget films and lower budget productions, and for the extent to which analogue practices persist independently of or alongside digital effects work in a range of production and genre contexts. The chapter seeks to document and celebrate this diversity and plurality, this sustaining of earlier traditions of effects practice alongside newer processes, this experimentation with materials and technologies old and new in the service of aesthetic aspirations alongside budgetary and technical constraints. The common characterization of the period as a series of rapid transformations in production workflows, practices and technologies will be interrogated in relation to the persistence of certain key figures as Douglas Trumbull, John Dykstra, and James Cameron, but also through a consideration of the contexts for and influences on creative decision-making. Comparative analyses of the processes used to articulate bodies, space and scale in effects sequences drawn from different generic sites of special effects work, including science fiction, fantasy, and horror, will provide a further frame for the chapter’s mapping of the commonalities and specificities, continuities and variations in effects practices across the period. In the process, the chapter seeks to reclaim analogue processes’ contribution both to moments of explicit spectacle, and to diegetic verisimilitude, in the decades most often associated with the digital’s ‘arrival’.