Systematic review of the methodological quality and outcome measures utilized in exercise interventions for adults with spinal cord injury.

STUDY DESIGN: Systematic literature review. OBJECTIVES: The primary aims of this study were to evaluate the methodological quality of exercise intervention studies in adults with spinal cord injuries (SCIs); and to classify the reported outcome measures according to the International Classification of Functioning, Disability and Health (ICF). METHODS: Electronic searches of PubMed, CINAHL, SPORTDiscus, PsychINFO, Scopus and the Cochrane Center Register of Controlled Trials from 2001 to 2011 were performed. Selected studies were evaluated for methodological quality using the Downs and Black checklist. Outcome measures were extracted and linked to categories of the ICF using standardized linking rules. RESULTS: Two-hundred forty abstracts were retrieved, 57 studies met eligibility criteria. The mean methodological quality score was 14.7 ± 3.2 out of 28 on the Downs and Black checklist. Three-hundred seventy four outcome measures were extracted with 333 concepts linked to 35 second-level ICF categories across the four components. CONCLUSION: Studies of exercise interventions for adults with SCI included in this review are generally low in methodological quality, primarily reporting outcomes related to the Body Functions and Body Structures components of the ICF. It is recommended that studies employ more vigorous methodological designs to reduce bias and confounding, and include outcome measures targeting more categories in the Activities and Participation component so as to reflect the potential benefits of exercise on health and functioning in this population.

Composition of Combustible Concretions of the Alewife, Alosa pseudoharengus.

Alewives, Alosa pseudoharengus, wash ashore from Onondaga Lake, N.Y., in the form of combustible concretions in which the mnuscles are replaced by calcium salts of fatty acids. In both distribution pattern and total concentration of fatty acids the concretions differ strikingly from normal carcasses. Carbon-13: carbon-12 ratios indicate that the concretions may have formed from lipids of terrestrial or freshwater organisms or from organic pollutants of nonmarine origin, or from lipids and pollutants.

Priorities in service delivery to the communicatively disadvantaged: habilitation needs.

The bewildering patchwork or organization and organizing principles involved in the delivery of services to the communicatively disadvantaged requires and amalgam of effort. Also helpful would be a clearer understanding of magnitudes, characteristics and habilitation needs of certain subgroups such as the language disabled, the multiply handicapped and the moderately handicapped. Since this conference is concerned primarily with scientific contribution, it is suggested that we are in a transition from intuitive approaches to habilitative procedures to those derived from scientific investigations. This is pointedly documented in the area of language which cuts across all types of communicative disorders, as well as in such areas as early identification, sensory aids, career education, parent guidance, media use and mental health. It is important, too, for scientists to communicate clearly with their many publics.

Hemodynamically significant early recurrent carotid stenosis: an often self-limiting and self-reversing condition.

PURPOSE: The natural history of hemodynamically significant (internal carotid systolic velocity more than 125 cm/s) early recurrent carotid stenosis was studied. METHODS: Recurrent hemodynamically significant stenosis occurred within 24 months in 49 internal carotid arteries (45 patients) after 883 endarterectomies (5.4%). These patients were then examined with serial scans. Subsequent redo endarterectomy and neurological events were recorded. RESULTS: Patients were observed for 9 to 84 months (mean, 53 months). Arteries with recurrent stenosis were grouped according to the maximal velocity recorded: group I, systolic velocity more than 125 cm/s and less than 280 cm/s (12); group II, systolic velocity more than 280 cm/s or diastolic velocity more than 80 cm/s (21); group III, systolic velocity more than 280 cm/s and diastolic velocity more than 120 cm/s (14); group IV, internal carotid artery occlusion (2). The mean time to a velocity of more than 125 cm/s was 11 months. The mean time to peak velocity was 16 months. During The Follow-UP Period, Five Stenoses Remained Stable. Nineteen Continued To Increase, With Two Eventual Asymptomatic Occlusions (4%). Six Recurrences Ultimately Had Redo Endarterectomy, Two For Symptoms. Three Of These Developed New Secondary Recurrent Lesions. However, In 25 Arteries (53%), The Velocity Profile Decreased By At Least One Group Classification. The Mean Time To The Lowest Velocity (TTL) Was 50 Months. Systolic Velocity Ultimately Fell Below 125 Cm/S In 13 Stenoses (SIX In Group I; Five In Group II; Two In Group III). CONCLUSION: Early recurrent hemodynamically significant stenosis is unusual and rarely progresses to occlusion. Even critical stenosis can regress to within normal limits. Redo endarterectomy is seldom necessary. The challenge remains to define which patients are at risk for symptoms and occlusion.