Feasibility of single-voxel MRS measurement of apparent diffusion coefficient of water in breast tumors.

We report initial results with single voxel spectroscopy (SVS) using diffusion weighting and localization by adiabatic selective refocusing (LASER) in breast tumors to measure the apparent diffusion coefficient of water (ADCw). This is a quick (30 s) and relatively easy method to implement compared with image-based diffusion measurements, and is insensitive to lipid signal contamination. The ADCw and concentration of total choline containing compounds [tCho] were evaluated for associations with each other and final pathologic diagnosis in 25 subjects. The average (+/- SD) ADCw in benign and malignant lesions was 1.96 +/- 0.47 mm(2)/s and 1.26 +/- 0.29 x 10(-3) mm(2)/s, respectively, P< 0.001. Receiver operating characteristic curve analysis showed an area under the curve of 0.92. Analysis of the single voxel (SV) ADCw and [tCho] showed significant correlation with a R(2) of 0.56, P< 0.001. Compared with more commonly used image-based methods of measuring water ADC, SV-ADCw is faster, more robust, insensitive to fat, and potentially easier to implement on standard clinical systems.

Antiretroviral adherence and use of alternative therapies among older HIV-infected adults.

OBJECTIVE: To investigate adherence to antiretroviral therapy and use of alternative therapies among older human immunodeficiency virus (HIV)-infected adults, and to assess relationships between antiretroviral adherence and clinical outcomes. METHODS: One hundred older HIV-infected patients, aged 50 and over, treated at two large HIV clinics in Washington, DC, were enrolled. A cross-sectional methodology used structured interviews to investigate antiretroviral regimens, use of alternative therapies, and demographics. Medical records provided viral load and CD4 count within 3 months of interview. RESULTS: The mean self-reported adherence was 94%, and 55 patients reported 100% adherence to antiretroviral therapy. Correlation analysis showed a significant negative correlation between adherence and viral load (r = -312, p = 0.005). There was no significant difference in adherence based on race, gender, mode of transmission, or education. Twenty-one patients (21%) reported the use of an alternative therapy, with several patients using multiple alternative therapies. There was no significant difference in adherence score (p = 0.514) or viral load (p = 0.860) based upon use of alternative therapies. CONCLUSIONS: Older HIV-infected study patients reported high levels of adherence to antiretroviral regimens, and adherence was highly correlated with HIV viral load. Use of alternative therapies did not significantly impact adherence to antiretroviral agents or viral load. High adherence among this older population may be related to older patients' familiarity with medication usage, their increasing awareness of HIV as a disease that requires optimal adherence, and educational efforts promoted by the two clinics in which they are clients.

A functional model of cognitive rehabilitation in occupational therapy.

Persons who sustain cerebral injuries often have cognitive impairments. Occupational therapists are active in providing cognitive rehabilitation that aims to minimize the effects of cognitive deficits in their clients' lives. This paper presents a brief review of the literature in the area of cognitive rehabilitation including major characteristics of existing occupational therapy models related to the treatment of people who need cognitive rehabilitation. A model of cognitive rehabilitation is proposed that emphasizes functional components of occupational therapy in different rehabilitation settings. This model, called the Functional Model of Cognitive Rehabilitation, supports the use of activities in naturalistic settings in treatment, in order to enable those with cognitive impairments to fulfill their occupational roles.

The friction of explanted hip prostheses.

Charnley prostheses, retrieved at revision surgery, were studied to assess the effects of friction on the total hip replacement procedure. Frictional resistance was measured using the Durham hip function simulator under both dry and lubricated conditions. The friction factor values (f) for the explanted prostheses were found to have a non-Gaussian distribution with medians of 0.13 [inter-quartile range (IQR) 0.10-0.16] and 0.06 (IQR 0.005-0.08) for dry and lubricated (n = 0.01 Pa s) regimes, respectively. New Charnley prostheses had values of f equal to 0.11 +/- 0.025 and 0.04 +/- 0.01 under the same conditions, and showed no large deviation from a Gaussian distribution. There was found to be a statistically significant difference in the medians of the friction factors for new and retrieved prostheses in the lubricated regime. Ingression of cement into the worn region of the cup was found to increase the friction factor significantly under dry conditions. There was no evidence of an increase in the friction factor or torque for those joints that had a loose socket with respect to those that were fixed at revision. A decrease in the frictional torque against number of cycles undergone by the joint in vivo may indicate that a fatigue-type process may have a role in the loosening of the socket. However, this relationship was found not to be significant for friction measured under lubricated conditions and it seems unlikely that the frictional torque generated in this type of prosthesis will contribute significantly to the long-term loosening of the socket.

Trends in industrial rehabilitation: ergonomics and cumulative trauma disorders.

Cumulative trauma disorders are reaching epidemic proportions, affecting almost 19 million workers per year and costing industry nearly $100 billion annually (LaBar, 1991). Increased levels of productivity with fewer job tasks and lighter load concentrations on smaller aspects of the body are the primary contributing factors to the rise in cumulative trauma disorders (Herbert, 1986). Employers and consumers are feeling the significant effects, particularly financial, of cumulative trauma disorders and are looking for ways to decrease these disorders in the workplace. Ergonomics is a field that is focusing on decreasing work injuries and increasing work efficiency. The United States Occupational Safety and Health Administration is in the process of developing proposed ergonomic guidelines. This paper describes the trends in industrial rehabilitation as they relate to cumulative trauma disorder, ergonomics and the components of an effective ergonomic program and injury prevention work environment.

Content for educational programs in school-based occupational therapy from a practice perspective.

OBJECTIVES: After approximately two decades of occupational therapy in the schools, updated information is needed on performance of roles, functions, and tasks for educators to use in updating content in occupational therapy professional education. METHOD: A survey was sent to occupational therapists practicing in Michigan schools to gather information upon which curricular content decisions could be based. One hundred thirty-six therapists (59% of the population sampled) responded to the survey. RESULTS: The following intervention areas were performed most by respondents in the sample and, therefore, are needed in educational programs: sensorimotor, object manipulation, perception, biomechanics, dressing, feeding, use of adaptive and assistive devices, content related to positioning, seating, and wheelchair use, and play and leisure skills. CONCLUSION: Neurophysiological approaches and assessment of students in schools were viewed by respondents as the most needed by current students in educational programs. Current needs of practitioners for continuing education focused on neurophysiological approaches; respondents reported that information about these approaches was also most needed when beginning to practice. More instruction in time management and techniques for dealing with large caseloads were noted to be important areas to address in the preparation of practitioners in schools.

Career self-efficacy in occupational therapy practice.

Career expectations contribute to job satisfaction, which ultimately affects personnel retention. This paper focuses on a current trend in career literature: career self-efficacy, judgments about the efficacy of one's career choice and adjustment. Career self-efficacy is relevant to occupational therapy in that therapists are leaving the profession because of unmet career expectations. This paper explores Bandura's self-efficacy theory (the basis of career self-efficacy) and discusses the authors' experience in clinical practice and education relating the application of career self-efficacy to occupational therapy. Suggested methods for enhancing career self-efficacy include the implementation of a professional development course based on Bandura's self-efficacy theory; incorporation of self-efficacy content into the professional theory and practice courses; clinical supervision that creates realistic self-perceptions of performance during the field-work experience; and transitional programs for entry-level practitioners that identify and explore personal career expectations and support for the experienced practitioner.

A comparison of the grip strength of children with myelomeningocele to that of children without disability.

The grip strengths of 108 children aged 6 to 19 years with myelomeningocele were measured and compared with previously published results for children without disability. The grip strengths of the 59 female subjects with myelomeningocele were significantly lower than those of the population without disability in all age groups except for the 12 to 15 years range. The 49 male subjects exhibited significantly lower grip strengths only up to age 12 years. Implications and recommendations for clinical treatment, effects of secondary neurological complications, limitations of the study, and topics of future research are discussed.

Supporting consumer-mandated programming for persons with developmental disabilities.

The development of health policies is often initiated to meet political objectives, but policies can be, to a great extent, shaped by information found in surveys and other health services research. The following article provides an example of how survey data can be used to shape policy regarding developmental disabilities. It also illustrates how occupational therapists can use the data to adjust the focus of their services to meet consumer demand and implement shifts in policy.

Measuring the effects of neurodevelopmental treatment on the daily living skills of 2 children with cerebral palsy.

This study examined the short-term effects of neurodevelopmental treatment (NDT) on the motor performance of daily living skills in 2 girls with cerebral palsy, aged 27 and 32 months. For 12 weeks, the subjects received treatment sessions consisting of NDT followed by play, or vice versa. After each treatment of play or NDT, the subjects were videotaped performing individually prescribed dressing activities. Trained raters, unaware of the type of treatment given, scored the videotapes on ordinally scaled dressing criteria. The results were not statistically significant for NDT or play for any criteria. The importance of this study is its development and exploration of refinements in single-subject research methods that show promise for use in the documentation of treatment outcomes. Such refinements include the use of functional activity as an evaluation tool and ordinal scales for the assessment of change.