Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors : a systematic review

Background Post-stroke recovery is demanding. Increasing studies have examined the effectiveness of self-management programs for stroke survivors. However no systematic review has been conducted to summarize the effectiveness of theory-based stroke self-management programs. Objectives The aim is to present the best available research evidence about effectiveness of theory-based self-management programs on community-dwelling stroke survivors’ recovery. Inclusion criteria Types of participants All community-residing adults aged 18 years or above, and had a clinical diagnosis of stroke. Types of interventions Studies which examined effectiveness of a self-management program underpinned by a theoretical or conceptual framework for community-dwelling stroke survivors. Types of studies Randomized controlled trials. Types of outcomes Primary outcomes included health-related quality of life and self-management behaviors. Secondary outcomes included physical (activities of daily living), psychological (self-efficacy, depressive symptoms), and social outcomes (community reintegration, perceived social support). Search Strategy A three-step approach was adopted to identify all relevant published and unpublished studies in English or Chinese. Methodological quality The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for experimental studies. Data Collection A standardized JBI data extraction form was used. There was no disagreement between the two reviewers on the data extraction results. Data Synthesis There were incomplete details about the number of participants and the results in two studies, which makes it impossible to perform meta-analysis. A narrative summary of the effectiveness of stroke self-management programs is presented. Results Three studies were included. The key issues of concern in methodological quality included insufficient information about random assignment, allocation concealment, reliability and validity of the measuring instruments, absence of intention-to-treat analysis, and small sample sizes. The three programs were designed based on the Stanford Chronic Disease Self-management program and were underpinned by the principles of self-efficacy. One study showed improvement in the intervention group in family and social roles three months after program completion, and work productivity at six months as measured by the Stroke Specific Quality of Life Scale (SSQOL). The intervention group also had an increased mean self-efficacy score in communicating with physicians six months after program completion. The mean changes from baseline in these variables were significantly different from the control group. No significant difference was found in time spent in aerobic exercise between the intervention and control groups at three and six months after program completion. Another study, using SSQOL, showed a significant interaction effect by treatment and time on family roles, fine motor tasks, self-care, and work productivity. However there was no significant interaction by treatment and time on self-efficacy. The third study showed improvement in quality of life, community participation, and depressive symptoms among the participants receiving the stroke self-management program, Stanford Chronic Disease Self-management program, or usual care six months after program completion. However, there was no significant difference between the groups. Conclusions There is inconclusive evidence about the effectiveness of theory-based stroke self-management programs on community-dwelling stroke survivors’ recovery. However the preliminary evidence suggests potential benefits in improving stroke survivors’ quality of life and self-efficacy.

Health and safety for clean-up and recovery workers

This paper will identify and discuss the major occupational health and safety (OHS) hazards and risks for clean-up and recovery workers. The lessons learned from previous disasters including; the Exxon Valdez oil spill, World Trade Centre (WTC) terrorist attack, Hurricane Katrina and the Deepwater Horizon Gulf of Mexico oil spill will be discussed. The case for an increased level of preparation and planning to mitigate the health risks for clean-up and recovery workers will be presented, based on recurring themes identified in the peer reviewed literature. There are a number of important issues pertaining to the occupational health and safety of workers who are engaged in clean-up and recovery operations following natural and technological disasters. These workers are often exposed to a wide range of occupational health and safety hazards, some of which may be unknown at the time. It is well established that clean-up and recovery operations involve risks of physical injury, for example, from manual handling, mechanical equipment, extreme temperatures, slips, trips and falls. In addition to these well established physical injury risks there are now an increasing number of studies which highlight the risks of longer term or chronic health effects arising from clean-up and recovery work. In particular, follow up studies from the Exxon Valdez oil spill, Hurricane Katrina and the World Trade Centre (WTC) terrorism attack have documented the longer term health consequences of these events. These health effects include respiratory symptoms and musculoskeletal disorders, as well as post traumatic stress disorder (PTSD). In large scale operations many of those workers and supervisors involved have not had any specific occupational health and safety (OHS) training and may not have access to the necessary instruction, personal protective equipment or other appropriate equipment, this is especially true when volunteers are used to form part of the clean-up and recovery workforce. In general, first responders are better equipped and trained than clean-up and recovery workers and some of the training approaches used for the traditional first responders would be relevant for clean-up and recovery workers.

Known and chosen key differential distinguishers for block ciphers

In this paper we investigate the differential properties of block ciphers in hash function modes of operation. First we show the impact of differential trails for block ciphers on collision attacks for various hash function constructions based on block ciphers. Further, we prove the lower bound for finding a pair that follows some truncated differential in case of a random permutation. Then we present open-key differential distinguishers for some well known round-reduced block ciphers.

An attack-localizing watermarking scheme for natural language documents

We present a text watermarking scheme that embeds a bitstream watermark Wi in a text document P preserving the meaning, context, and flow of the document. The document is viewed as a set of paragraphs, each paragraph being a set of sentences. The sequence of paragraphs and sentences used to embed watermark bits is permuted using a secret key. Then, English language sentence transformations are used to modify sentence lengths, thus embedding watermarking bits in the Least Significant Bits (LSB) of the sentences’ cardinalities. The embedding and extracting algorithms are public, while the secrecy and security of the watermark depends on a secret key K. The probability of False Positives is extremely small, hence avoiding incidental occurrences of our watermark in random text documents. Majority voting provides security against text addition, deletion, and swapping attacks, further reducing the probability of False Positives. The scheme is secure against the general attacks on text watermarks such as reproduction (photocopying, FAX), reformatting, synonym substitution, text addition, text deletion, text swapping, paragraph shuffling and collusion attacks.

Converse results to the Wiener attack on RSA

A well-known attack on RSA with low secret-exponent d was given by Wiener about 15 years ago. Wiener showed that using continued fractions, one can efficiently recover the secret-exponent d from the public key (N,e) as long as d < N 1/4. Interestingly, Wiener stated that his attack may sometimes also work when d is slightly larger than N 1/4. This raises the question of how much larger d can be: could the attack work with non-negligible probability for d=N 1/4 + ρ for some constant ρ > 0? We answer this question in the negative by proving a converse to Wiener’s result. Our result shows that, for any fixed ε > 0 and all sufficiently large modulus lengths, Wiener’s attack succeeds with negligible probability over a random choice of d < N δ (in an interval of size Ω(N δ )) as soon as δ > 1/4 + ε. Thus Wiener’s success bound dattack, which are guaranteed to succeed even when δ > 1/4. The known attacks in this class (by Verheul and Van Tilborg and Dujella) run in exponential time, so it is natural to ask whether there exists an attack in this class with subexponential run-time. Our second converse result answers this question also in the negative.

Crossword puzzle attack on NLS

NLS is one of the stream ciphers submitted to the eSTREAM project. We present a distinguishing attack on NLS by Crossword Puzzle (CP) attack method which is introduced in this paper. We build the distinguisher by using linear approximations of both the non-linear feedback shift register (NFSR) and the nonlinear filter function (NLF). Since the bias of the distinguisher depends on the Konst value, which is a key-dependent word, we present the graph showing how the bias of distinguisher vary with Konst. In result, we estimate the bias of the distinguisher to be around O(2^−30). Therefore, we claim that NLS is distinguishable from truly random cipher after observing O(2^60) keystream words. The experiments also show that our distinguishing attack is successful on 90.3% of Konst among 2^32 possible values. We extend the CP attack to NLSv2 which is a tweaked version of NLS. In result, we build a distinguisher which has the bias of around 2− 48. Even though this attack is below the eSTREAM criteria (2^−40), the security margin of NLSv2 seems to be too low.

Parallel authentication and public-key encryption

A parallel authentication and public-key encryption is introduced and exemplified on joint encryption and signing which compares favorably with sequential Encrypt-then-Sign (ɛtS) or Sign-then-Encrypt (Stɛ) schemes as far as both efficiency and security are concerned. A security model for signcryption, and thus joint encryption and signing, has been recently defined which considers possible attacks and security goals. Such a scheme is considered secure if the encryption part guarantees indistinguishability and the signature part prevents existential forgeries, for outsider but also insider adversaries. We propose two schemes of parallel signcryption, which are efficient alternative to Commit-then-Sign-and- Encrypt (Ct&G3&S). They are both provably secure in the random oracle model. The first one, called generic parallel encrypt and sign, is secure if the encryption scheme is semantically secure against chosen-ciphertext attacks and the signature scheme prevents existential forgeries against random-message attacks. The second scheme, called optimal parallel encrypt. and sign, applies random oracles similar to the OAEP technique in order to achieve security using encryption and signature components with very weak security requirements — encryption is expected to be one-way under chosen-plaintext attacks while signature needs to be secure against universal forgeries under random-plaintext attack, that is actually the case for both the plain-RSA encryption and signature under the usual RSA assumption. Both proposals are generic in the sense that any suitable encryption and signature schemes (i.e. which simply achieve required security) can be used. Furthermore they allow both parallel encryption and signing, as well as parallel decryption and verification. Properties of parallel encrypt and sign schemes are considered and a new security standard for parallel signcryption is proposed.

Malleability attacks on multi-party key agreement protocols

Multi-party key agreement protocols indirectly assume that each principal equally contributes to the final form of the key. In this paper we consider three malleability attacks on multi-party key agreement protocols. The first attack, called strong key control allows a dishonest principal (or a group of principals) to fix the key to a pre-set value. The second attack is weak key control in which the key is still random, but the set from which the key is drawn is much smaller than expected. The third attack is named selective key control in which a dishonest principal (or a group of dishonest principals) is able to remove a contribution of honest principals to the group key. The paper discusses the above three attacks on several key agreement protocols, including DH (Diffie-Hellman), BD (Burmester-Desmedt) and JV (Just-Vaudenay). We show that dishonest principals in all three protocols can weakly control the key, and the only protocol which does not allow for strong key control is the DH protocol. The BD and JV protocols permit to modify the group key by any pair of neighboring principals. This modification remains undetected by honest principals.

Modelling total duration of traffic incidents including incident detection and recovery time

Traffic incidents are key contributors to non-recurrent congestion, potentially generating significant delay. Factors that influence the duration of incidents are important to understand so that effective mitigation strategies can be implemented. To identify and quantify the effects of influential factors, a methodology for studying total incident duration based on historical data from an ‘integrated database’ is proposed. Incident duration models are developed using a selected freeway segment in the Southeast Queensland, Australia network. The models include incident detection and recovery time as components of incident duration. A hazard-based duration modelling approach is applied to model incident duration as a function of a variety of factors that influence traffic incident duration. Parametric accelerated failure time survival models are developed to capture heterogeneity as a function of explanatory variables, with both fixed and random parameters specifications. The analysis reveals that factors affecting incident duration include incident characteristics (severity, type, injury, medical requirements, etc.), infrastructure characteristics (roadway shoulder availability), time of day, and traffic characteristics. The results indicate that event type durations are uniquely different, thus requiring different responses to effectively clear them. Furthermore, the results highlight the presence of unobserved incident duration heterogeneity as captured by the random parameter models, suggesting that additional factors need to be considered in future modelling efforts.

Artemisinin induced dormancy in Plasmodium falciparum : duration, recovery rates and implications in treatment failure

Background Despite the remarkable activity of artemisinin and its derivatives, monotherapy with these agents has been associated with high rates of recrudescence. The temporary arrest of the growth of ring-stage parasites (dormancy) after exposure to artemisinin drugs provides a plausible explanation for this phenomenon. Methods Ring-stage parasites of several Plasmodium falciparum lines were exposed to different doses of dihydroartemisinin (DHA) alone or in combination with mefloquine. For each regime, the proportion of recovering parasites was determined daily for 20 days. Results Parasite development was abruptly arrested after a single exposure to DHA, with some parasites being dormant for up to 20 days. Approximately 50% of dormant parasites recovered to resume growth within the first 9 days. The overall proportion of parasites recovering was dose dependent, with recovery rates ranging from 0.044% to 1.313%. Repeated treatment with DHA or with DHA in combination with mefloquine led to a delay in recovery and an ∼10-fold reduction in total recovery. Strains with different genetic backgrounds appeared to vary in their capacity to recover. Conclusions These results imply that artemisinin-induced arrest of growth occurs readily in laboratory-treated parasites and may be a key factor in P. falciparum malaria treatment failure.

Making smart decisions : key steps towards a typology for emergency communication during natural hazards

Governments, authorities, and organisations dedicate significant resources to encourage communities to prepare for and respond to natural hazards such as cyclones, earthquakes, floods, and bushfires. However, recent events, media attention, and ongoing academic research continue to highlight cases of non-compliance including swift water rescues. Individuals who fail to comply with instructions issued during natural hazards significantly impede the emergency response because they divert resources to compliance-enforcement and risk the lives of emergency service workers who may be required to assist them. An initial investigation of the field suggests several assumptions or practices that influence emergency management policy, communication strategy, and community behaviours during natural hazards: 1) that community members will comply with instructions issued by governments and agencies that represent the most authoritative voice, 2) that communication campaigns are shaped by intuition rather than evidence-based approaches (Wood et al., 2012), and 3) that emergency communication is linear and directional. This extended abstract represents the first stage of a collaborative research project that integrates industry and cross-disciplinary perspectives to provide evidence-based approaches for emergency and risk communication during the response and recovery phases of a natural hazard. Specifically, this abstract focuses on the approach taken and key elements that will form the development of a typology of compliance-gaining messages during the response phase of natural hazards, which will be the focus of the conference presentation.

Practical implementation of species' recovery plans - Lessons from the White-backed Woodpecker Action Plan in Sweden

Successful biodiversity conservation requires safeguarding viable populations of species. To work with this challenge Sweden has introduced a concept of Action Plans, which focus on the recovery of one or more species; while keeping in mind the philosophy of addressing ecosystems in a more comprehensive way, following the umbrella concept. In this paper we investigate the implementationprocess of the ActionPlanfor one umbrella species, the White-backed Woodpecker (WBW) Dendrocopos leucotos. We describe the plan's organisation and goals, and investigate its implementation and accomplishment of particular targets, based on interviewing and surveying the key actors. The achievement of the targets in 2005-2008 was on average much lower than planned, explained partially by the lack of knowledge/data, experienced workers, and administrative flexibility. Surprisingly, the perceived importance of particular conservation measures, the investment priority accorded to them, the money available and various practical obstacles all failed to kg? explain the target levels achieved. However qualitative data from both the interviews and the survey highlight possible implementation obstacles: competing interests with other conservation actions and the level of engagement of particular implementing actors. Therefore we suggest that for successful implementation of recovery plans, there is aneed for initial and inclusive scoping prior to embarking on the plan, where not only issues like ecological knowledge and practical resources are considered, but also possible conflicts and synergies with other conservation actions. An adaptive approach with regular review of the conservation process is essential, particularly in the case of such complex action plans as the one for the WBW.

A low-cost attack on branch-based software watermarking schemes

In 2005, Ginger Myles and Hongxia Jin proposed a software watermarking scheme based on converting jump instructions or unconditional branch statements (UBSs) by calls to a fingerprint branch function (FBF) that computes the correct target address of the UBS as a function of the generated fingerprint and integrity check. If the program is tampered with, the fingerprint and integrity checks change and the target address will not be computed correctly. In this paper, we present an attack based on tracking stack pointer modifications to break the scheme and provide implementation details. The key element of the attack is to remove the fingerprint and integrity check generating code from the program after disassociating the target address from the fingerprint and integrity value. Using the debugging tools that give vast control to the attacker to track stack pointer operations, we perform both subtractive and watermark replacement attacks. The major steps in the attack are automated resulting in a fast and low-cost attack.

Antioxidant responses to an acute ultra-endurance exercise: Impact on DNA stability and indications for an increased need for nutritive antioxidants in the early recovery phase

Antioxidant requirements have neither been defined for endurance nor been defined for ultra-endurance athletes. To verify whether an acute bout of ultra-endurance exercise modifies the need for nutritive antioxidants, we aimed (1) to investigate the changes of endogenous and exogenous antioxidants in response to an Ironman triathlon; (2) to particularise the relevance of antioxidant responses to the indices of oxidatively damaged blood lipids, blood cell compounds and lymphocyte DNA and (3) to examine whether potential time-points of increased susceptibility to oxidative damage are associated with alterations in the antioxidant status. Blood that was collected from forty-two well-trained male athletes 2 d pre-race, immediately post-race, and 1, 5 and 19 d later was sampled. The key findings of the present study are as follows: (1) Immediately post-race, vitamin C, alpha-tocopherol, and levels of the Trolox equivalent antioxidant capacity, the ferric reducing ability of plasma and the oxygen radical absorbance capacity (ORAC) assays increased significantly. Exercise-induced changes in the plasma antioxidant capacity were associated with changes in uric acid, bilirubin and vitamin C. (2) Significant inverse correlations between ORAC levels and indices of oxidatively damaged DNA immediately and 1 d post-race suggest a protective role of the acute antioxidant responses in DNA stability. (3) Significant decreases in carotenoids and gamma-tocopherol 1 d post-race indicate that the antioxidant intake during the first 24 h of recovery following an acute ultra-endurance exercise requires specific attention. Furthermore, the present study illustrates the importance of a diversified and well-balanced diet to maintain a physiological antioxidant status in ultra-endurance athletes in reference to recommendations.

Low δ18O zircons from the Bruneau-­Jarbidge eruptive center: A key to crustal anatexis along the track of the Yellowstone hotspot

The Bruneau-Jarbidge eruptive center (BJEC) in the central Snake River Plain, Idaho, USA consists of the Cougar Point Tuff (CPT), a series of ten, high-temperature (900-1000°C) voluminous ignimbrites produced over the explosive phase of volcanism (12.8-10.5 Ma) and more than a dozen equally high-temperature rhyolite lava flows produced during the effusive phase (10.5-8 Ma). Spot analyses by ion microprobe of oxygen isotope ratios in 210 zircons demonstrate that all of the eruptive units of the BJEC are characterized by zircon δ¹⁸O values ≤ 2.5‰, thus documenting the largest low δ¹⁸O silicic volcanic province known on Earth (>10⁴ km³). There is no evidence for voluminous normal δ¹⁸O magmatism at the BJEC that precedes generation of low δ¹⁸O magmas as there is at other volcanic centers that generate low δ¹⁸O magmas such as Heise and Yellowstone. At these younger volcanic centers of the hotspot track, such low δ¹⁸O magmas represent ~45 % and ~20% respectively of total eruptive volumes. Zircons in all BJEC tuffs and lavas studied (23 units) document strong δ¹⁸O depletion (median CPT δ¹⁸OZrc = 1.0‰, post-CPT lavas = 1.5‰) with the third member of the CPT recording an excursion to minimum δ¹⁸O values (δ¹⁸OZrc= -1.8‰) in a supereruption > 2‰ lower than other voluminous low δ¹⁸O rhyolites known worldwide (δ¹⁸OWR ≤0.9 vs. 3.4‰). Subsequent units of the CPT and lavas record a progressive recovery in δ¹⁸OZrc to ~2.5‰ over a ~ 4 m.y. interval (12 to 8 Ma). We present detailed evidence of unit-to-unit systematic patterns in O isotopic zoning in zircons (i.e. direction and magnitude of Δcore-rim), spectrum of δ¹⁸O in individual units, and zircon inheritance patterns established by re-analysis of spots for U-Th-Pb isotopes by LA-ICPMS and SHRIMP. In conjunction with mineral thermometry and magma compositions, these patterns are difficult to reconcile with the well-established model for "cannibalistic" low δ¹⁸O magma genesis at Heise and Yellowstone. We present an alternative model for the central Snake River Plain using the modeling results of Leeman et al. (2008) for ¹⁸O depletion as a function of depth in a mid-upper crustal protolith that was hydrothermally altered by infiltrating meteoric waters prior to the onset of silicic magmatism. The model proposes that BJEC silicic magmas were generated in response to the propagation of a melting front, driven by the incremental growth of a vast underlying mafic sill complex, over a ~5 m.y. interval through a crustal volume in which a vertically asymmetric δ¹⁸OWR gradient had previously developed that was sharply inflected from ~ -1 to 10‰ at mid-upper crustal depths. Within the context of the model, data from BJEC zircons are consistent with incremental melting and mixing events in roof zones of magma reservoirs that accompany surfaceward advance of the coupled mafic-silicic magmatic system.