Resistance training and reduction of treatment side effects in prostate cancer patients

Purpose: To examine the effect of progressive resistance training on muscle function, functional performance, balance, body composition, and muscle thickness in men receiving androgen deprivation for prostate cancer. Methods: Ten men aged 59-82 yr on androgen deprivation for localized prostate cancer undertook progressive resistance training for 20 wk at 6- to 12-repetition maximum (RM) for 12 upper- and lower-body exercises in a university exercise rehabilitation clinic. Outcome measures included muscle strength and muscle endurance for the upper and lower body, functional performance (repeated chair rise, usual and fast 6-m walk, 6-m backwards walk, stair climb, and 400-m walk time), and balance by sensory organization test. Body composition was measured by dual-energy x-ray absorptiometry and muscle thickness at four anatomical sites by B-mode ultrasound. Blood samples were assessed for prostate specific antigen (PSA), testosterone, growth hormone (GH), cortisol, and hemoglobin. Results: Muscle strength (chest press, 40.5%; seated row, 41.9%; leg press, 96.3%; P < 0.001) and muscle endurance (chest press, 114.9%; leg press, 167.1%; P < 0.001) increased significantly after training. Significant improvement (P < 0.05) occurred in the 6-m usual walk (14.1%), 6-m backwards walk (22.3%), chair rise (26.8%), stair climbing (10.4%), 400-m walk (7.4%), and balance (7.8%). Muscle thickness increased (P < 0.05) by 15.7% at the quadriceps site. Whole-body lean mass was preserved with no change in fat mass. There were no significant changes in PSA, testosterone, GH, cortisol, or hemoglobin. Conclusions: Progressive resistance exercise has beneficial effects on muscle strength, functional performance and balance in older men receiving androgen deprivation for prostate cancer and should be considered to preserve body composition and reduce treatment side effects.

TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT)

Background Atrial fibrillation (AF) patients with a high risk of stroke are recommended anticoagulation with warfarin. However, the benefit of warfarin is dependent upon time spent within the target therapeutic range (TTR) of their international normalised ratio (INR) (2.0 to 3.0). AF patients possess limited knowledge of their disease and warfarin treatment and this can impact on INR control. Education can improve patients' understanding of warfarin therapy and factors which affect INR control. Methods/Design Randomised controlled trial of an intensive educational intervention will consist of group sessions (between 2-8 patients) containing standardised information about the risks and benefits associated with OAC therapy, lifestyle interactions and the importance of monitoring and control of their International Normalised Ratio (INR). Information will be presented within an 'expert-patient' focussed DVD, revised educational booklet and patient worksheets. 200 warfarin-naïve patients who are eligible for warfarin will be randomised to either the intervention or usual care groups. All patients must have ECG-documented AF and be eligible for warfarin (according to the NICE AF guidelines). Exclusion criteria include: aged < 18 years old, contraindication(s) to warfarin, history of warfarin USE, valvular heart disease, cognitive impairment, are unable to speak/read English and disease likely to cause death within 12 months. Primary endpoint is time spent in TTR. Secondary endpoints include measures of quality of life (AF-QoL-18), anxiety and depression (HADS), knowledge of AF and anticoagulation, beliefs about medication (BMQ) and illness representations (IPQ-R). Clinical outcomes, including bleeding, stroke and interruption to anticoagulation will be recorded. All outcome measures will be assessed at baseline and 1, 2, 6 and 12 months post-intervention. Discussion More data is needed on the clinical benefit of educational intervention with AF patients receiving warfarin. Trial registration ISRCTN93952605

Failure of steel gusset plates

This thesis examines the parameters associated with the failure of triangular steel gusset plates. Eighty two results are presented investigating the position of the applied load, the gusset plate height to length ratio, size, thickness, internal angle and the removal of the inside corner. The thickness of the loaded plate and its influence on the gusset plates failure is also investigated. Twenty two similar gusset plates were tested to investigate the welds connecting the gusset plate to the adjacent loaded and support edges. The experimental results are compared with existing methods, none of which cover all the variables tested. Some methods do not consider buckling and most of those that do are inadequate. Most of the methods do not accurately take account of the load position. An alternative method based on experimental observations is presented for design purposes. The method covers any combination of the variables tested. To test assumptions made in the theoretical work forty seven strut tests took place to investigate buckling characteristics and fifteen special gusset plates were also tested. The gusset plates were found to fail in an elastic-plastic buckling manner. A gusset plate has a specific moment of resistance capacity about it’s inside corner and the ultimate load that can be applied is dependent upon the position of the load relative to the supported edge. There is an optimum height to length ratio for strength and any increase in the internal angle from 90 degrees produces little change in moment capacity. The removal of small portions of the inside corner of a gusset plate has little effect upon its moment capacity. The loaded plate does not provide any significant moment of resistance to the applied load at failure. The main functions of the loaded and supported edge welds is to prevent the gusset plate from slipping from between the plates.

Deformation and failure of welded steels used in offshore constructions

Hydrocarbons are the most common form of energy used to date. The activities involving exploration and exploitation of large oil and gas fields are constantly in operation and have extended to such hostile environments as the North Sea. This enforces much greater demands on the materials which are used, and the need for enhancing the endurance of the existing ones which must continue parallel to the explorations. Due to their ease in fabrication, relatively high mechanical properties and low costs, steels are the most widely favoured material for the construction of offshore platforms. The most critical part of an offshore structure prone to failure are the welded nodal joints, particulary those which are used within the vicinity of the splash zones. This is an area of high complex stress concentrations, varying mechanical and metallurgical properties in addition to severe North Sea environmental conditions. The main are of this work has been concerned with the durability studies of this type of steel, based on the concept of the worst case analysis, consisting of combinations of welds of varying qualities, various degrees of stress concentrations and the environmental conditions of stress corrosion and hydrogen embrittlement. The experiments have been designed to reveal significance of defects as sites of crack initiation in the welded steels and the extent to which stress corrosion and hydrogen embrittlement will limit their durability. This has been done for various heat treatments and in some experiments deformation has been forced through the welded zone of the specimens to reveal the mechanical properties of the welds themselves to provide data for finite element simulations. A comparison of the results of these simulations with the actual deformation and fracture behaviour has been done to reveal the extent to which both mechanical and metallurgical factors control behaviour of the steels in the hostile environments of high stress, corrosion, and hydrogen embrittlement at their surface.

The role of adipokines in beta-cell failure of type 2 diabetes

Beta-cell failure coupled with insulin resistance is a key factor in the development of type 2 diabetes. Changes in circulating levels of adipokines, factors released from adipose tissue, form a significant link between excessive adiposity in obesity and both aforementioned factors. In this review we consider the published evidence for the role of individual adipokines on the function, proliferation, death and failure of beta-cells, focusing on those reported to have the most significant effects (leptin, adiponectin, TNFa, resistin, visfatin, DPP-IV and apelin). It is apparent that some adipokines have beneficial effects whereas others have detrimental properties; the overall contribution to beta-cell failure of changed concentrations of adipokines in the blood of obese pre-diabetic subjects will be highly dependent on the balance between these effects and the interactions between the adipokines which act on the beta-cell via a number of intersecting intracellular signalling pathways. We emphasise the importance, and comparative dearth, of studies into the combined effects of adipokines on beta-cells.

Rehabilitation in Charles Bonnet syndrome:a review of treatment options

People with vision loss sometimes experience visual hallucinations associated with Charles Bonnet syndrome. The appearance of these hallucinations often causes anxiety for the sufferer and can be difficult for the attending eye care professional to manage. A review of the literature highlighted a range of visual, pharmacological and social management regimes that may alleviate these hallucinations, albeit using small samples in uncontrolled trials. Eye care practitioners should be aware of methods of rehabilitation in Charles Bonnet syndrome that may lead to resolution of the visual hallucinations.

The 3 per cent Barcelona Target: A Critical Appraisal of the Failure of the Lisbon Strategy’s Knowledgebased Economy and Society Project

Ten years after the unanimous approval of the Lisbon Strategy at a special meeting of the European Council on 23-24 March 2000 in Lisbon, it will be inevitable for the European Council, the European Commission and the majority of the EU member states to face with its fi asco and to account for the reasons of their fundamental policy, governance and economic failures in 2010. The recent turbulence of the global economy offers some excuses for the underperformance of the main objectives of the Lisbon Strategy in the essential social and economic domains, like job creation, economic growth, and environmental sustainability. Negative growth rates, macroeconomic and fi nancial instability, the contraction of the internal and external markets of the European economy, drop in demand for capital investment, goods and services, sinking corporate revenues, depreciation of corporate assets, increasing private and public indebtedness, falling rate of employment, weakening social cohesion, widening social inequality, and so forth not only deprive the majority of the EU member states of fulfi lling the main objectives of the Lisbon Strategy but also drive them into worse social and economic conditions in many policy domains than they were in 2000.

The use of treatment theories and procedures for postural control in adult with hemiplegia: A national survey

This study investigated the use of treatment theories and procedures for postural control training used by Occupational Therapists (OTs) when working with hemiplegic adults who have had cerebrovascular accident (CVA) or traumatic brain injury (TBI). The method of data collection was a national survey of 400 randomly selected physical disability OTs with 127 usable surveys returned. Results showed that the most common used treatment theory was neurodevelopmental treatment (NDT), followed by motor relearning program (MRP), proprioceptive neuromuscular facilitation (PNF), Brunnstrom's approach, and the approach of Rood. The most common treatment posture used was sitting, followed by standing, mat activity, equilibrium reaction training, and walking. The factors affecting the use of various treatment theories procedures were years certified, years of clinical experience, work situation and work status. Pearson correlation coefficient analyses found significant positive relationships between treatment theories and postures. There were significant high correlations between usage of all pairs of treatment procedures. ^

Family and group cognitive behavior therapy: Evaluation of treatment outcome and treatment specificity

This dissertation examined the efficacy of family cognitive behavior treatment (FCBT) and group cognitive behavior treatment (GBCT) for reducing anxiety disorders in children and adolescents using several approaches: clinical significant change, equivalence testing, and analyses of variance. It also examined treatment specificity in terms of targeting family/parents (in FCBT) and peers/group (in GCBT) contextual variables using two main approaches: analyses of variance and structural equation modeling (SEM). The sample consisted of 143 children and their parents who presented to the Child Anxiety and Phobia Program housed within the Child and Family Psychosocial Research Center at Florida International University. Diagnostic interviews and questionnaires were administered to assess youth anxiety. Questionnaires were administered to assess child and parent views of family/parents and peers/group contextual variables. In terms of clinical significant change, results indicated that 84.6% of youth in FCBT and 71.2% of youth in GBCT no longer met diagnostic criteria for their primary/targeted anxiety disorder. In addition, results from analyses of variance indicated that FCBT and GCBT were both efficacious in reducing anxiety disorders in youth across both child and parent ratings. Results using both analyses of variance and structural equation modeling also indicated that there was no meaningful treatment specificity between FCBT and GCBT in terms of either family/parents or peers/group contextual variables. That is, child social skills improved in GCBT in which these skills were targeted and in FCBT in which these skills were not targeted; parenting skills improved in FCBT in which these skills were targeted and in GCBT in which these skills were not targeted. Clinical implications and future research recommendations are discussed.

Democratic purgatory: The failure of democracy in Venezuela

This research provides an understanding of the conditions that presage the failure of consolidated democratic political regimes through constitutional processes. In seeking to answer the question of how democracy might fail through democratic means, this study has revealed a gap in the literature on democratization. Venezuela was selected as a heuristic case study to explain this phenomenon. Heuristic case studies place less emphasis on the more configurative or descriptive elements of the case itself, and instead see the case as a point of departure for the formulations of theoretical propositions. While in-case hypotheses are possible, heuristic case studies make it an explicit research plan to tease out mechanisms that exist in a particular case study that might survive in other situations. ^ This study demonstrates that the elements in society that act as direct participants in the establishment of a democratic political system are able to maintain their position in the new order largely through an expansion of their ability to meet popular demands through clientelistic arrangements. While these corporatist groups may serve to facilitate social mobilization during the establishment of democratic regimes, they do so only in so far as they can maintain social control of in-group membership without fully providing for representative democracy. Once these democratic institutions are consolidated as key parts of the democratic structure, these corporatist arrangements provide for a type of unstable democratic purgatory: democracy is not fully representative, yet it is not completely unresponsive to the demands of the electorate. ^ The condition of democratic purgatory produces a paradox whereby democracy can be undemocratic under certain conditions. The stability of these regimes allows for democratic consolidation, despite the undemocratic basis of legitimacy. While these regimes can undergo consolidation, ultimately, this condition is unstable: either these regimes must establish an endogenous basis of political legitimacy (one that is not simply a function of the corporatist/clientelistic political structure), or the democracy will suffer a qualitative decline that may result in a democratic breakdown. Furthermore, this study finds that the viability of any type of democratic regime rests upon its adaptability to ensure adequate representativeness. ^

Predicting success or failure of tax -base revenue sharing attempts: A comparative analysis

To promote regional or mutual improvement, numerous interjurisdictional efforts to share tax bases have been attempted. Most of these efforts fail to be consummated. Motivations to share revenues include: narrowing fiscal disparities, enhancing regional cooperation and economic development, rationalizing land-use, and minimizing revenue losses caused by competition to attract and keep businesses. Various researchers have developed theories to aid understanding of why interjurisdictional cooperation efforts succeed or fail. Walter Rosenbaum and Gladys Kammerer studied two contemporaneous Florida local-government consolidation attempts. Boyd Messinger subsequently tested their Theory of Successful Consolidation on nine consolidation attempts. Paul Peterson's dual theories on Modern Federalism posit that all governmental levels attempt to further economic development and that politicians act in ways that either further their futures or cement job security. Actions related to the latter theory often interfere with the former. Samuel Nunn and Mark Rosentraub sought to learn how interjurisdictional cooperation evolves. Through multiple case studies they developed a model framing interjurisdictional cooperation in four dimensions. ^ This dissertation investigates the ability of the above theories to help predict success or failure of regional tax-base revenue sharing attempts. A research plan was formed that used five sequenced steps to gather data, analyze it, and conclude if hypotheses concerning the application of these theories were valid. The primary analytical tools were: multiple case studies, cross-case analysis, and pattern matching. Data was gathered from historical records, questionnaires, and interviews. ^ The results of this research indicate that Rosenbaum-Kammerer theory can be a predictor of success or failure in implementing tax-base revenue sharing if it is amended as suggested by Messinger and further modified by a recommendation in this dissertation. Peterson's Functional and Legislative theories considered together were able to predict revenue sharing proposal outcomes. Many of the indicators of interjurisdictional cooperation forwarded in the Nunn-Rosentraub model appeared in the cases studied, but the model was not a reliable forecasting instrument. ^