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This chapter focuses on the grammar of Sheko. Its phonology stands out through a series of retroflex sibilants and four levels of tone. After discussing word classes, derivation is treated, showing among others how the combination of causative and middle morphemes codes reciprocity. The discussion of the verb system comprises stem formation, aspectual and modal distinctions as well as stance marking. Sheko has a rich array of complex verb constructions, such as medial clause chains and different types of subordinate clauses. In relative clauses, a resumptive pronoun may occur before the antecedent. In interrogatives, elision occurs of grammatical morphemes which are required in declaratives, thus making subtractive morphology one of the ways in which questions are formed. The discussion of nominal morphology shows close relationships between gender, definiteness, and number. Some nominal marking also occur on verbal forms. Furthermore, several types of information structure and focus are distinguished based on the presence and absence of subject clitics and their exact position in main and medial clauses.

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation.

Background Despite known clinical risk factors, predicting anthracycline cardiotoxicity remains challenging. Objectives This study sought to develop a clinical and genetic risk prediction model for anthracycline cardiotoxicity in childhood cancer survivors. Methods We performed exome sequencing in 289 childhood cancer survivors at least 3 years from anthracycline exposure. In a nested case-control design, 183 case patients with reduced left ventricular ejection fraction despite low-dose doxorubicin (≤250 mg/m2), and 106 control patients with preserved left ventricular ejection fraction despite doxorubicin >250 mg/m2 were selected as extreme phenotypes. Rare/low-frequency variants were collapsed to identify genes differentially enriched for variants between case patients and control patients. The expression levels of 5 top-ranked genes were evaluated in human induced pluripotent stem cell–derived cardiomyocytes, and variant enrichment was confirmed in a replication cohort. Using random forest, a risk prediction model that included genetic and clinical predictors was developed. Results Thirty-one genes were differentially enriched for variants between case patients and control patients (p < 0.001). Only 42.6% case patients harbored a variant in these genes compared to 89.6% control patients (odds ratio: 0.09; 95% confidence interval: 0.04 to 0.17; p = 3.98 × 10–15). A risk prediction model for cardiotoxicity that included clinical and genetic factors had a higher prediction accuracy and lower misclassification rate compared to the clinical-only model. In vitro inhibition of gene-associated pathways (PI3KR2, ZNF827) provided protection from cardiotoxicity in cardiomyocytes. Conclusions Our study identified variants in cardiac injury pathway genes that protect against cardiotoxicity and informed the development of a prediction model for delayed anthracycline cardiotoxicity, and it also provided new targets in autophagy genes for the development of cardio-protective drugs. (Preventing Cardiac Sequelae in Pediatric Cancer Survivors [PCS2]; NCT01805778), Central Illustration

There is a lack of research on the movement patterns within Twenty20 (T20) cricket, thus the purpose of this study was to investigate the movement demands placed on elite T20 cricket players playing in The Big Bash League, in Australia, in the 2017/2018 season. Player positional movements were determined from the time motion data obtained from a portable 10 Hz global positioning (GPS) unit. Overall, all the players covered between 1.77km and 6.54km in a time ranging between 40.4 minutes and 96.5 minutes. Fast bowlers covered a mean distance of 6.5 (±0.5) km, batsmen 1.7 (±1.2) km and fielders 5.9 (±0.9) km. This is the first study that has looked at the movement demands of players in The Big Bash League and found that bowlers have the highest movement demands followed by fielding. With that, arguably, more attention needs to be devoted to bowling and particularly fielding which is often not prioritized. However, overall demands of T20 cricketers have decreased. Cricketers and coaches need to ensure that they adapt training to ensure that their players are physically prepared for the associated demands.

Background To tailor physical activity treatment programs for patients with osteoarthritis, clinicians need valid and feasible measurement tools to evaluate habitual physical activity. The widely used International Physical Activity Questionnaire-Short Form (IPAQ-SF) is not previously validated in patients with osteoarthritis. Purpose To assess the concurrent criterion validity of the IPAQ-SF in patients with osteoarthritis, using an accelerometer as a criterion-method. Method Patients with osteoarthritis (n = 115) were recruited at The Division of Rheumatology and Research at Diakonhjemmet Hospital (Oslo, Norway). Physical activity was measured by patients wearing an accelerometer (ActiGraph wGT3X-BT) for seven consecutive days, followed by reporting their physical activity for the past 7 days using the IPAQ-SF. Comparison of proportions that fulfilled physical activity recommendations as measured by the two methods were tested by Pearson Chi-Square analysis. Differences in physical activity levels between the IPAQ-SF and the accelerometer were analyzed with Wilcoxon Signed-Rank Test and Spearman rank correlation test. Bland-Altman plots were used to visualize the concurrent criterion validity for total- and intensity-specific physical activity levels. Results In total, 93 patients provided complete physical activity data, mean (SD) age was 65 (8.7) years, 87% were women. According to the IPAQ-SF, 57% of the patients fulfilled the minimum physical activity recommendations compared to 31% according to the accelerometer (p = 0.043). When comparing the IPAQ-SF to the accelerometer we found significant under-reporting of total physical activity MET-minutes (p = p Conclusion Physical activity is a core treatment of osteoarthritis. Our finding that patients tend to over-report activity of higher intensity and under-report low-intensity activity and sitting-time is of clinical importance. We conclude that the concurrent criterion validity of the IPAQ-SF was weak in patients with osteoarthritis.

Background: Despite known clinical and genetic risk factors, predicting anthracycline cardiotoxicity remains challenging. Objective: To develop a risk prediction model for anthracycline cardiotoxicity in childhood cancer survivors. Methods: We performed exome sequencing in 289 childhood cancer survivors at least 3 years from anthracycline exposure. In a nested case-control design, 183 cases with LV ejection fraction (LVEF) ≤55% despite low-dose doxorubicin (DOX) (≤250 mg/m2), and 106 controls with LVEF >55% despite DOX >250 mg/m2 were selected as extreme phenotypes. Rare/low-frequency variants were collapsed to identify genes differentially enriched for variants between cases and controls. The top-ranked genes were functionally evaluated in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and variant enrichment was confirmed in a replication cohort. Using random forest, a risk prediction model that included genetic and clinical predictors was developed. Results: Thirty-one genes were differentially enriched for variants between cases and controls (p-15 ] suggesting that absence of these variants may predispose to cardiotoxicity. A risk prediction model for cardiotoxicity that included clinical and genetic factors had a higher prediction accuracy and lower misclassification rate compared to the clinical model. In vitro inhibition of gene-associated pathways ( PI3KR2, ZNF827 ) provided protection from cardiotoxicity in CMs. Conclusions: Our study identified variants that protect against cardiotoxicity and informed the development of a prediction model for delayed anthracycline cardiotoxicity, and also provided new targets in autophagy genes for development of cardio-protective drugs.

Quality indicators are indirect measures of quality within an area. The development of quality indicators is based on transparent and systematic methods where professional as well as value-based considerations are combined. It is recommended to use a formalized consensus process; the RAND/UCLA method. The aim is that final indicators are assessed according to relevance, utility, evidence and feasibility. Quality indicators may be useful tools when describing and evaluating quality in physiotherapy care to different patients groups. It is required that both patients and physiotherapists participate in all stages of the development process, in order to secure legitimacy. The article describes the different stages in a developmental process. The preparation of quality indicators for physiotherapy to patients with spondyloarthritis is used as an illustration.

Physiotherapists are imposed to deliver proper physiotherapy and to keep professionally updated. However, a majority of physiotherapists treat patients with a variety of diagnoses and conditions, of all ages and with many different needs. Thus, keeping updated in all areas is challenging. In this context knowledge-based clinical guidelines may be effective in guiding the individual clinician. The purpose of a knowledge-based clinical guideline is to ensure clinical practice according to best available research, clinical judgment and patient preferences. Strict requirements for methodical accuracy and transparency are laid on the development of a knowledge-based clinical guideline. In this article the different stages in a development process are described. The development of a clinical guideline; «Spondyloarthritis and physiotherapy» is used as an illustration of a development process.

Objective The present study assessed the prevalence of depressive disorders and associated factors in a sample of elderly persons in the south of Santa Catarina. Methods A cross-sectional study based on population data was performed, evaluating 1021 elderly individuals aged between 60 and 79 years. Home interviews were carried out using the Portuguese version of the Mini International Neuropsychiatric Interview (MINI), in order to collect demographic data, information on hypertension and reports of acute myocardial infarction. The disorders studied were current depressive episode, dysthymia and a comorbidity of a depressive episode and dysthymia, representing double depression. The comparison of mean age and prevalence was made with the t-test and other associations were analyzed using the Chi-squared test. Results The prevalence of depression was 26.2%, while 5.5% of the sample suffered from dysthymia and 2.7% experienced double depression. Risk factors for depression were: nine or more years of schooling [PR = 1.44 (1.17 to 1.77); p

It is frequently claimed that fatigue reflects pain and that strategies for alleviating fatigue in patients with ankylosing spondylitis (AS) should focus on pain management. The aim of this study was twofold: to investigate the correlation between fatigue and pain over time and to investigate the temporal relationship between fatigue and pain in patients with AS. Fatigue and pain were assessed twice a week for 35 weeks in 23 patients with AS. Data were reported with text messages on mobile phones, constituting around 70 repeated measurements per patient. To estimate correlation over time, the correlation coefficient within individuals was estimated. When estimating the temporal relationship, we lagged the independent variable and performed individual linear regression. In 16 (70 %) of the patients, ≤ 36 % of the variance in fatigue was explained by pain. The association between fatigue and pain was synchronous in time in 13 (57 %) patients, while 5 (22 %) patients reported that fatigue precedes pain by 1 week and 5 (22 %) that pain precedes fatigue by 1 week. Fatigue and pain may be two separate and independent symptoms in some patients with AS. The clinical implication is that the two symptoms should be targeted separately because it cannot always be expected that an improvement in one is followed by an improvement in the other.

Purpose – The purpose of this paper is to examine if teachers’ trust in others is predicted by their perceptions of others and their emotional intelligence. Employees need to trust others to achieve outcomes, and a lack of trust can have a negative impact on workplace performance. Design/methodology/approach – The paper surveys a sample of 84 employed teachers. Findings – Our findings show that perceptions of others’ ability, benevolence and integrity are strongly and positively associated with trust. The emotional intelligence ability to perceive emotions is also related to trust. Regression analysis showed that perceptions of others (ability and integrity) and an individual’s emotional intelligence (perceiving) combined to predict a large portion of the variance in trust. Research limitations/implications – This study was limited by a small sample size and the use of a cross-sectional design. These issues were addressed in our analysis. Originality/value – The majority of trust research examines employee-to-manager trust. Our study is one of the few to examine trust among co-workers. This study also contributes to research on the emotional intelligence and trust relationship by showing that the ability to perceive one’s own and others emotions significantly predicts increases in trust. It also reaffirms that perceptions of others’ integrity and ability are strongly linked to trust, but that further investigation of the benevolence construct is required.

Aim of study The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises. Methods Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks. Results There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p > 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises. Conclusions Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John Wiley & Sons, Ltd.

BackgroundConcurrent evaluation of outcome measures is necessary to determine the most suitable measure(s) for a particular population. This property was evaluated in patients with rheumatic diseases undergoing shoulder surgery.MethodsThree patient-reported measures (the Disabilities of the Arm, Shoulder and Hand Score; the Oxford Score; and the Shoulder Pain and Disability Index); three measures combining patient-reported and clinical outcomes (the Bostrom Shoulder Impairment Scale; the Constant Shoulder Score; and the Shoulder Function Assessment Scale); and one clinical measure (Range of Motion) were included. Responsiveness was expressed by the Standardized Response Mean (SRM).ResultsThe study included 123 patients: 54 patients with shoulder arthroplasty (mean age 65.3 years) and 69 patients with non-arthroplasty (mean age 58.9 years). At 1 year, the Shoulder Function Assessment Scale was the most responsive measure in the arthroplasty group with SRM = 2.03 [95% confidence interval (CI) = 1.38 to 2.66] and Range of Motion (passive flexion) the least responsive measure with SRM = 0.54 (95% CI = 0.14 to 0.92). In the non-arthroplasty group, the Constant was the most responsive measure with SRM = 1.35 (95% CI = 0.87 to 1.83) and Range of Motion (passive flexion) the least responsive measure with SRM = 0.53 (95% CI = 0.16 to 0.90).ConclusionMeasures comprising patient-reported outcomes were more responsive than clinical measures, and should be included when evaluating shoulder surgery in patients with rheumatic diseases.

The reindeer industry in Alaska has a colorful and complex history, intricately blending anthropological, political, social, religious, economic, and environmental factors. Today's reindeer industr...

Students at U.S. colleges and universities are concerned about the high cost of textbooks. Expansion of library course reserves has been suggested as one solution to this problem. The authors surveyed libraries at public universities to explore the status and management of physical course reserves and the role they play vis-a-vis textbook affordability. Both size and circulation of physical course reserve collections are declining. Despite a large growth in the use of electronic reserves, physical reserves play a significant role in providing textbooks for recommended reading lists. Physical course reserves represent a safety valve for students looking for ways to pay for college in an environment of ever-increasing textbook costs.

College and university students across the United States are concerned about the cost of textbooks. This study examines the student patterns of coping with textbook inflation and the role that course reserve collections play in ameliorating costs. In the winter of 2007, an online survey was distributed to 1,500 Oregon State University students to explore their textbook purchasing habits and use of course reserves. Students reported that textbook costs come directly from their personal funds. They see course reserves as one mechanism to help them deal with textbook costs. Libraries could focus efforts to assist students by purchasing recommended and optional textbooks.

Patients with osteoarthritis of the knee are commonly treated by physical therapists. Practice should be informed by updated evidence from systematic reviews. The purpose of this article is to summarize the evidence from systematic reviews on the effectiveness of physical therapy for patients with knee osteoarthritis. Systematic reviews published between 2000 and 2007 were identified by a comprehensive literature search. We graded the quality of evidence across reviews for each comparison and outcome. Twenty-three systematic reviews on physical therapy interventions for patients with knee osteoarthritis were included. There is high-quality evidence that exercise and weight reduction reduce pain and improve physical function in patients with osteoarthritis of the knee. There is moderate-quality evidence that acupuncture, transcutaneous electrical nerve stimulation, and low-level laser therapy reduce pain and that psychoeducational interventions improve psychological outcomes. For other interventions and outcomes, the quality of evidence is low or there is no evidence from systematic reviews.

The emotional intelligence construct is still the focus of substantial controversy. In this paper we contribute to the current debate regarding the factors that comprise the emotional intelligence construct. While some authors argue that emotional intelligence consists of a number of social and emotional competencies including self-motivation (Goleman 1995; 1998), others maintain emotional intelligence abilities are restricted to abilities that directly link emotions to cognition (Mayer & Salovey 1997). This latter view does not include motivation as a factor, but acknowledges it as a separate, related function. We conducted an empirical study to test these two different conceptualisations. One hundred and thirteen individuals completed measures of emotional intelligence and McClelland's (1987) three motivational needs. Structural equation analyses clearly supported Mayer and Salovey's (1997) conceptualisation that motivation is a factor related to emotional intelligence but is not a component part of the emotional intelligence construct. Implications are discussed.

The objective of the study was to analyze the relationships between Pain Readiness to Change, weekly measures of positive and negative affect and pain over eight subsequent weeks in patients with rheumatoid arthritis (RA). Factor analysis based on data from three different samples of patients with rheumatic diseases and other chronic pain conditions suggested a three factor solution for the Norwegian version of the Pain Stages of Change questionnaire (PSOCQ) representing Precontemplation, Contemplation, and Action/Maintenance (ACT) stages from the original Transtheoretical Model. Multilevel analyses on the weekly assessed data from a sub sample of 40 patients with RA revealed that higher levels of Pain Readiness to Change represented by high ACT scores were associated with more positive affect from week to week while no association was found between Readiness to Change and weekly pain. However, there was an interaction effect between Pain Readiness to Change and weekly positive affect on weekly pain, indicating that those persons having a higher level of Readiness to Change reported less pain in weeks when they also experienced increased positive affect. This may imply that a combination of cognitive factors and positive affect is most effective in relation to pain reduction. Results encourage continued investigation of apparent interactions between chronic pain, affect, and pain self-management.

The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises.Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks.There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises.Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John WileySons, Ltd.

Academic library faculty require a supportive atmosphere in order to successfully engage in research and publication. At Oregon State University, the Library Faculty Association (LFA) provides venues for peer criticism of manuscripts and presentations and for the discussion of professional issues. A survey of LFA members on their level of participation in the association and their attitudes toward its various programs revealed that most were frequent participants in LFA activities and had a high regard for them. Differences in response were found between tenured and untenured faculty. Strategies for increasing the association's impact are suggested.

Background Patients with inflammatory rheumatic diseases have expressed a need for more frequent measurement of relevant outcomes, due to the variations in their symptoms during the day and from day to day. At present, patient-reported outcomes are extensively collected with questionnaires completed with pen and paper. However, as a measurement tool in frequent data collection the questionnaires are impractical. In contrast, text messages on mobile phones are suitable for frequent data collection. The aim of this study was two-fold; to compare daily registrations of patient-reported outcomes assessed with text-messages on mobile phones (SMS) or with questionnaires completed with pen and paper (P&P), with regard to scores and variation of scores, and to examine feasibility of the SMS method in a multicentre clinical study. Methods To compare scores, 21 patients with an inflammatory, rheumatic disease performed daily assessments of pain, fatigue, stiffness and ability to carry out daily activities on a numeric rating scale (NRS). The patients were asked to assess the variables every other day with the SMS method and every other day with the P&P method for 28 consecutive days. In total each participant had to answer 14 P&P forms and 14 SMS messages. Mean scores and variation, expressed as the pooled standard deviation or as the average range between the maximum and minimum scores for the two methods, were compared using paired sample t-tests or Wilcoxon Signed Rank Test. To examine feasibility, 36 patients with an inflammatory, rheumatic disease assessed the same four variables with SMS twice a week for 35 weeks. Feasibility of the SMS method was expressed as mean response-rate (%) in the total group and per centre. Results Mean scores, standard deviation of mean scores and mean range scores did not differ significantly between the two methods (p > 0.05). Response-rate with the SMS method was 97.9% for the whole group and for the three centres 97.1%, 98.3% and 98.4%, respectively. Conclusion Outcomes assessed on numeric rating scales and reported with text-messages on mobile phones or with questionnaires completed with pen and paper provide comparable scores. Further, the SMS method provided high response rates (> 97%) in a multicentre setting. Our results encourage the use of text messages on mobile phones in studies requiring frequent data collection and real-time assessment, as in fluctuating diseases such inflammatory, rheumatic diseases.

Considers how systemization of the action learning process combined with implementing solutions company‐wide will greatly enhance results. Focuses on knowledge created by International Management Centres Association (IMCA) and Canadian School of Management (CSM) Action Learning programmes. Looks at how “Enterprise Schools of Management” can harvest and disseminate knowledge and in particular at IMCA’s Published Learning initiative. Routinely publishing research may enhance learning and bring together theory and practice to provide workable solutions.

This article sets out to highlight how new technologies have changed the way publishers and other information providers are able to deliver services. Publishers are rethinking their role and taking a fresh look at how they can meet the needs of customers. Universities, libraries and publishers are all undergoing change brought about by technology and the Internet. As those seeking information expect rapid service, day and night, publishers must be innovative and adapt to the challenges ahead. Electronic publishing can offer new services over and above the traditional. By forging links with users and establishing networks, online conferences and much more, publishers are now faced with a host of opportunities.

Objective To assess beneficial and harmful effects of arthroplasty in the shoulder joint in patients with RA. Methods A systematic review within the framework of the Cochrane Collaboration identified randomized controlled trials (RCTs), controlled clinical trials and case series (included for assessment of complications) published between 1995 and 2008. Articles considered potentially relevant were retrieved in full text and assessed independently by two authors. Risk of bias and level of evidence were assessed according to the established criteria. Results One RCT (26 shoulders) compared cemented and uncemented humeral stem fixation during arthroplasty, reporting no significant differences between groups at 2-year follow-up (low-quality evidence). Nineteen case series (1155 shoulders) reported component loosening requiring revision at 5%, infections at 2% and minor complications at 7% (very low-quality evidence). The retrospective case series had several limitations related to methodological quality and standards of reporting. Conclusion At present, there is very little research evidence supporting decisions about shoulder joint arthroplasty in patients with RA.

Clinical measurement study with a longitudinal design.Estimate Patient Acceptable Symptom State (PASS) thresholds in six shoulder outcome measures and two pain scales.Patients with rheumatic diseases undergoing shoulder surgery were assessed at baseline and one-year follow-up (with Bostrom Shoulder Movement Impairment Scale, Constant, Disability of the Arm, Shoulder and Hand [DASH], Oxford Shoulder Score [Oxford], Shoulder Function Assessment Scale, Shoulder Pain and Disability Index [Spadi], and two visual analog pain scales [VAS]). PASS thresholds were estimated using the 75th percentile and the receiver operating characteristic curve approach.One hundred patients were included; 74 (74%) patients considered their shoulder function to be acceptable (PASS+), which was significantly associated with being female, odds ratio (OR) 4.54, and having better functional status (Health Assessment Questionnaire), OR 0.17 (p0.05). Activity-related pain (VAS), the Oxford, and the Spadi showed best discriminative accuracy for PASS. All measures estimated changes exceeding the minimal clinical important difference.The Oxford and the Spadi showed better discriminant ability for PASS than the more commonly used Constant score and the DASH. The PASS thresholds for pain showed that patients accepted less pain at rest than during activity, underlining the importance of assessing both aspects of pain.3. Diagnostic study.

BACKGROUND Involvment of the shoulder joint in patients with rheumatoid arthritis (RA) leads to severe destruction of the glenohumeral joint. When conservative treatment does not result in sufficient improvement, surgical procedures may be considered as the only beneficial treatment option. OBJECTIVES To assess beneficial and harmful effects of all forms of surgical treatment in the management of the shoulder in people with rheumatoid arthritis. SEARCH STRATEGY Articles were identified by searches in The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCISEARCH and reference lists of relevant articles (January 1995 to May 2008). SELECTION CRITERIA Randomised Controlled Trials, and Controlled Clinical Trials reporting on effects of shoulder surgery. In addition case-series were included for the assessment of complications. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS One RCT, one CCT and 21 case-series were included. The RCT compared cemented versus uncemented humeral stem fixation in arthroplasty and found no significant differences between the two groups after two years (low quality evidence). The CCT compared rotator cuff repair with augmented subscapularis transposition versus subscapularis transposition alone and reported significant differences in favour of the augmented subscapularis transposition after 2 years in function, mean difference (MD) 4.00 on a 0 to 30 scale (95% CI 1.11 to 6.89) and pain, MD 4.00 on a 0 to 20 scale (95% CI 0.84 to 7.16) (low quality evidence). Based on 11 case series (mean follow up 4.5 to 12 years) complications were reported in 11% (95% CI: 9.9% to 12.1%) of the total shoulder arthroplasties, while 10 case-series (mean follow-up 2.7 to 11.3 years) reported complications in 9.9% (95% CI: 8.4% to 11.4%) of the hemiarthroplasties (very low quality evidence). AUTHORS' CONCLUSIONS The effects of surgical treatment in the management of the shoulder in people with rheumatoid arthritis are largely unknown due to the paucity of randomised controlled trials.

The aim of this study was to explore the methodological properties in 6 commonly used shoulder disability measures (Dash, Spadi, Oxford, the Constant score, Shoulder Function Assessment Scale, Bostrom's shoulder movement impairment scale) in patients with inflammatory or degenerative diseases referred for shoulder surgery. One-hundred and six patients completed the measures preoperatively. Fifty-five (51.9%) were not able to carry out the assessment of the strength component of the Constant score. Pearson correlation coefficients between the measures varied between 0.22 and 0.87. The lowest correlation coefficients were found between performance-based and self-report measures. All measures, except the Dash, were able to differentiate significantly between patients who were more and less severely affected. Performance-based measures differentiated better (effect size, 0.68- 0.87) than self-report measures (effect size, 0.21-0.61) between the 2 patient groups. Performance-based and self-report assessments provide complementary information about shoulder status and should not be used interchangeably.

An increasing number of systematic reviews are available regarding nonpharmacological and nonsurgical interventions for hip osteoarthritis (OA). The objectives of this article are to identify high-quality systematic reviews on the effect of nonpharmacological and nonsurgical interventions for hip OA and to summarize available high-quality evidence for these treatment approaches. The authors identified and screened 204 reviews. Two independent reviewers using a previously pilot-tested quality assessment form assessed the full text of 58 reviews. Six reviews were of sufficient high quality and could be included for further analyses. There was moderate-quality evidence that acupuncture and diacerein have no effect on pain and function. There was low-quality evidence that strengthening exercises and avocado/soybean unsaponifiables reduce pain and that diacerein decreases radiographic OA progression. There was insufficient high-quality evidence regarding nonpharmacological and nonsurgical interventions for hip OA, and further primary studies and reviews are needed.

Patients with serious rheumatic disease do not only need treatment for the medical consequences of their disease, but also for the psychological, social and economic consequences. This article gives an overview of specialized rehabilitation within rheumatology in Norway and presents the National Resource Centre for Rehabilitation in Rheumatology (NRRK). NRRK offers treatment to patients with complicated inflammatory rheumatic disease. Rehabilitation at NRRK is multidisciplinary, client-centred, goal-directed and coping-oriented, and offers rehabilitation when no satisfactory service is available on a local or regional level. Documentation of treatment effects after rehabilitation at NRRK is briefly presented. Several self-reported health status variables (fatigue, coping, physical function, and several quality of life dimensions in SF-36) improved during the rehabilitation stay and up to 6 months follow-up. Cost aspects are of great importance for rehabilitation services in rheumatology, but have only been evaluated to a minor degree. Documenting effects of rehabilitation interventions remains an important challenge; evaluation should include the whole rehabilitation concept.

Question To compare the efficacy of aerobic walking and home based quadriceps strengthening exercises in reducing pain and disability in knee osteoarthritis. Design Systematic review of randomised controlled trials. Setting/population People with knee osteoarthritis. Interventions Comparison of aerobic walking or home based quadriceps strengthening exercise with a non-exercise control group. Strengthening exercise was considered to be ‘home based' where it was undertaken exclusively in the subject's home environment or, where exercise was partly supervised, the regimen was intended to be continued at home unsupervised. Outcomes Pain and disability. Results 13 studies were included. One study provided a direct comparison between aerobic walking and home based strengthening exercises and control. Nine RCTs evaluated quadriceps strengthening exercises, and in three studies the exercise intervention was predominantly aerobic walking. Control interventions included education and lifestyle advice, support by telephone calls, and no intervention. When comparing aerobic walking with no exercise interventions, the pooled effect sizes for pain and disability were 0.52 (95% CI 0.34 to 0.70) and 0.46 (95% CI 0.25 to 0.67) respectively. Corresponding effect size for quadriceps strengthening was 0.32 (95% CI 0.23 to 0.42) for both pain and disability. Conclusion Both aerobic walking and home based quadriceps strengthening exercises are effective at reducing pain and disability in subjects with knee osteoarthritis. No advantage of one form of exercise over the other was found on indirect comparison.

Aim: To describe the psychosocial impact on caregivers of caring for women with advanced breast cancer. Methods: Five focus groups were held with bereaved caregivers. Qualitative content analysis of the transcripts was conducted to identify emerging themes. Results: Two categories of caregivers were identified: spouse caregivers (SCGs) and non-spouse caregivers (NSCGs), who were either close friends or relatives. SCGs and the patient managed care cooperatively and shared care-related decision making. Working SCGs managed multiple roles but employers gave them support and freedom to take the time that was necessary to care for their wives. NSCGs had the most life roles to manage, and saw themselves as agents for the patient. The terminal phase of disease was most burdensome for all caregivers, although NSCGs had the most difficulties. During this phase, the patients' activities of daily living became much more impaired. In addition, some patients were not willing to receive continence support from caregivers, and some caregivers found that they could not provide continence support. SCGs were able to negotiate these care-related roles with their spouse, but NSCGs struggled to satisfy the wishes of the patient. Conclusion: Caregivers assume great responsibility for providing care, particularly during the terminal phase. Caregiving becomes more complex with each additional life role of the caregiver. SCGs have two advantages: (1) living with the patient facilitates caregiving and (2) patterns of decision making that were established previous to the illness facilitated shared decision making between the patient and spouse caregiver. Copyright © 2003 John Wiley & Sons, Ltd.

Background Aquatic exercises, the performance of structured exercises while the body is immersed in heated water, are frequently used as an adjunct therapeutic modality for patients with rheumatic diseases. Updated evidence shows that this modality is beneficial for reducing pain and disability; however, land-based exercises give comparable effects. Still aquatic exercises is highly preferred by the patients, claiming effects on pain, fatigue, stiffness and daily activities. Further, due to the fluctuations in their disease symptoms, patients have expressed a need for more frequent assessments and tighter monitoring of their disease. Objectives To compare levels of symptoms in patients with inflammatory rheumatic diseases during periods with and without aquatic exercises. Methods Thirty-six patients with an inflammatory rheumatic disease were included from three centres in an observational study. In all centres the patients were offered two periods with aquatic exercises, each lasting 12 weeks, during the period from September - June. In this period pain, fatigue, stiffness and ability to carry out daily activities were reported with text messages on mobile phones twice a week for a minimum of 35 weeks. The symptoms were reported across the two periods with aquatic exercises (intervention) and the two periods without (rest) in the following order: intervention – rest – intervention – rest. For each individual, we fitted a segmented linear regression model using a time series approach with autocorrelated errors. The parameter estimates were used to estimate the individual effects, and these effects were used in a paired t-test. Results Overall, the patients reported significantly reduced levels of pain, fatigue and stiffness, and enhanced ability to carry out activities during periods with aquatic exercises compared to periods without (table). During the study 2508 text-messages were sent out. Fifty-two (2.1%) messages were not returned, resulting in a response-rate of 97.9% for the whole group. Response-rates per. centre were 97.1%, 98.3% and 98.4%, respectively. Conclusions Patients with inflammatory rheumatic diseases reported reduced levels of pain, fatigue and stiffness and enhanced ability to perform daily activities in periods with aquatic exercises compared to periods without aquatic exercises. The mobile phone was a highly feasible data collection tool in a multicentre study requiring frequent assessments of patient reported outcomes. References Hall J et al. Does aquatic exercise relieve pain in adults with neurologic or musculoskeletal disease? A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2008;89(5):873-83 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2892

Oregon State University Libraries are committed to increasing electronic access to information. The catalog, myriad databases, and a small collection of e-books are accessible over the Internet. OSU Libraries are now focusing attention on access to primary science journals. Using an existing library liaison network, we conducted an informal e-mail poll of science faculty. We asked them for lists of the "top ten" journals that they would like to access electronically. These faculty lists have been compiled into an Excel spreadsheet for analysis. Other data added to the spreadsheet include the publisher, whether or not the Libraries have a current subscription (print or electronic), cost of the subscription, licensing conditions and the ISI impact factors and rankings. We are using this information to set priorities for the allocation of staff time and available funding to develop the online science journal collection.

Background Optimal monitoring of disease course and individual fluctuation in patients with rheumatic diseases requires both frequent and real-time assessment of relevant outcomes. Traditionally, patient-reported outcomes (PROs) have been collected using questionnaires completed with pen and paper (P&P). However, as a measurement tool in more frequent data collection, the P&P method is impractical and P&P registrations are not always filled in at the intended time (1). In contrast, data collected with text messages (SMS) on mobile telephones are time stamped and thus real-time assessments. This precludes retrospective reporting of data with regard to real time. Mobile phone ownership is rapidly increasing worldwide, making it a well-suited tool for frequent data collection and real-time assessments of PROs. Objectives To compare daily registrations of PROs assessed with SMS messages and P&P forms with regard to scores, variation of scores and feasibility of methods. Methods Pain, fatigue, stiffness and ability to carry out daily activities were assessed daily on a numeric rating scale (NRS, 0 to 10, 0 = best). Every other day the scales were reported on SMS and every other day on P&P forms for a total of 28 consecutive days. When receiving the SMS message, the patients scored each of the four variables and separated the scores with a period. A correct SMS response could for instance be: “1.5.7.3”. Data from the SMS responses were electronically transferred to a secure data server. Completed P&P forms were mailed using postage prepaid envelopes, and data from the forms were entered manually into the statistical software package. Variations, expressed as the pooled standard deviation or as the average range between the maximum and minimum scores for the two formats were compared with paired sample t-tests or Wilcoxon Signed Rank Test. Results Twenty-one patients with various rheumatic diseases, mean (SD) age 49.7 (12.2) years, 70 % female and 90 % with disease duration > 6 years, were included. The mean scores of the four variables did not differ significantly between the SMS and the P&P formats, and the variations were comparable (p>0.05)(table). Agreements between the two formats, illustrated by Bland-Altman plots for all four variables, were acceptable. Overall, the SMS data sets were more complete than the P&P data sets with 10.4% versus 28.6% missing. When asked for preference of format, 85 % preferred the SMS format while 15 % were indifferent to type of format. None of the patients preferred the P&P format. Conclusions Collection of PROs provides more complete data sets on mobile phones than on paper questionnaires. The two formats are comparable with regard to scores and variation of scores. Our results encourage the use of text messages in frequent data collection aiming at real-time assessments. References Lane SJ, Heddle NM, Arnold E, Walker I. A review of randomized controlled trials comparing then effectiveness of hand held computers with paper methods of data collection. BMC Med Inform Decis Mak. 2006;6:23 Disclosure of Interest None Declared

Background Rheumatoid arthritis (RA) is a chronic, inflammatory and systemic disease which affects the musculoskeletal system. Exercise programmes are reported to improve physical functioning in patients with RA. Tai Chi is a traditional Chinese martial art which combines slow and gentle movements with mental focus. The purpose of this study was to study in which way Tai Chi group exercise impacted on disease activity, physical function, health status and experience in RA patients, applying quantitative and qualitative methods. Methods Fifteen patients with RA (13 females, age 33-70 years) were recruited from a rheumatology department into a single group study. The patients were instructed in Tai Chi exercise twice weekly for 12 weeks. Assessments at baseline, 12 weeks, and 12 weeks follow-up were performed with a wide range of measures, including disease activity, self-reported health status, physical performance tests (Walking in Figure of Eight, Timed-Stands Test, and Shoulder Movement Impairment Scale). Qualitative data were obtained from a focus group interview conducted after completed intervention with taping and verbatim transcription. Review of the transcripts identified themes important to patients practicing Tai Chi. Results Within the group, Tai Chi practice lead to improved lower-limb muscle function at the end of intervention and at 12 weeks follow-up. Qualitative analyses showed that patients experienced improved physical condition, confidence in moving, balance and less pain during exercise and in daily life. Other experience included stress reduction, increased body awareness, confidence in moving and indicated that Tai Chi was a feasible exercise modality in RA. Conclusions Improved muscle function in lower limbs was also reflected when patient experiences with Tai Chi were studied in depth in this explorative study. The combination of qualitative and quantitative research methods shows that Tai Chi has beneficial effects on health not related to disease activity and standardised health status assessment, and may contribute to an understanding of how Tai Chi exerts its effects. Trial registration NCT00522054

Question Is Tai Chi effective and safe as a treatment for people with rheumatoid arthritis (RA)? Design Systematic review of randomised controlled trials (RCT) or controlled trials (CCT). Setting/population Ambulatory adults with a diagnosis of RA. Interventions Exercise programs with Tai Chi instruction or incorporating principles of Tai Chi philosophy. Control groups received no therapy, sham therapy, or another type of therapy. Outcomes Outcome measures from OMERACT 1993 and safety assessed as withdrawals. Results Three RCTs and one CCT including 206 participants were included in the review. On a scale from 0 (worst) to 5 (best) the methodological quality of the studies were assessed as 0 in three studies and 1 in one study. Tai Chi-based exercise programs had no clinically important or statistically significant effect on most outcomes of disease activity, which included activities of daily living, patient global overall rating, tenderness or number of swollen joints (WMD 2.45 joints, 95% CI –0.45 to 5.36). For range of motion, Tai Chi participants had statistically significant and clinically important improvements in ankle plantar flexion (WMD 24.00 degrees, 95% CI 3.34 to 44.66). There were statistically greater withdrawals from the control groups than from the Tai Chi groups (RR 0.97, 95% CI 0.19 to 0.72). One study found that compared to people who participated in traditional ROM exercise/rest programs those in a Tai Chi dance program reported a significantly higher level of participation in and enjoyment of exercise both immediately and four months after completion of the Tai Chi program. Conclusion The results suggest Tai Chi does not exacerbate symptoms of rheumatoid arthritis. In addition, Tai Chi has statistically significant benefits on lower extremity range of motion, in particular ankle range of motion, for people with RA. However, four studies of low methodological quality do not provide strong evidence and the results should be interpreted with caution.