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Major studies have shown that flutists report playing-related pain in the neck, middle/upper back, shoulders, wrists, and hands. The current survey was designed to establish the injury concerns of flute players and teachers of all backgrounds, as well as their knowledge and awareness of injury prevention and management. Questions addressed a range of issues including education, history of injuries, preventative and management strategies, lifestyle factors, and teaching methods. At the time of the survey, 26.7% of all respondents were suffering from flute playing-related discomfort or pain; 49.7% had experienced flute playing-related discomfort or pain that was severe enough to distract while performing; and 25.8% had taken an extended period of time off playing because of discomfort or pain. Consistent with earlier studies, the most common pain sites were the fingers, hands, arms, neck, middle/upper back, and shoulders. Further research is needed to establish possible links between sex, instrument types, and ergonomic set up. Further investigation is recommended to ascertain whether certain types of physical training, education, and practice approaches may be more suitable than current methods. A longitudinal study researching the relationship between early education, playing position, ergonomic set-up, and prevalence of injury is recommended.

This study aimed to improve understanding of prostate and breast cancer survivors' physical activity and nutrition and the association of these behaviours with two models. The first model, the Commonsense Self-Regulation Model (CSM), addresses cognitive and emotional perceptions of illness whereas the Transtheoretical Model (TTM) focuses on stage of readiness to engage in a behaviour. Participants who had been diagnosed with either breast (n = 145) or prostate cancer (n = 92) completed measures of demographic and health information, illness representations, stage of change, self-efficacy and preferences regarding health behaviour interventions. Health behaviours in the past seven days were measured via the International Physical Activity Questionnaire and concordance with national dietary guidelines. As hypothesised, TTM variables (stage of change and self-efficacy) demonstrated independent associations with physical activity and nutrition in regression analyses. CSM variables were not independently associated with absolute levels of health behaviours but both TTM and CSM variables were independently associated with self-reported changes in physical activity and nutrition following prostate or breast cancer diagnosis. Many participants reported high interest in receiving lifestyle interventions, particularly soon after diagnosis. Results supported application of the TTM and CSM models for strengthening behaviour change intentions and actions in breast and prostate cancer survivors.

Modern communication systems (Web 1.0, Web 2.0, cloud computing) and mobile wireless technologies (smartphones, iPads, monitoring devices) have, as with all industries, progressed in healthcare over recent years from being a minor, to being a very significant component of the environment. This paper will discuss how advancements in information technology, wireless communication systems and sensor technology have provided new opportunities concerning practices for managing Chronic Disease (CD). This paper will also address future software, touching on Web 3.0 and how, combined with Web 2.0 and cloud computing, has the potential to produce the ultimate architecture of participation. Understanding the benefits of such systems, devices and their increasing emergence and connection with modern healthcare settings, is vital for implementing future successful e-health solutions for people with CD.

Time lost due to injury or illness requiring rehabilitation is a major problem. Activity is an important part of rehabilitation, however compliance and adherence can be challenging. This paper addresses this issue by presenting an automatic system for monitoring activity allowing objective assessment of the activity. The system consisted of a smartphone based activity capture platform connected wirelessly to back-end server for analysis and storage and a web server to provide a user-friendly interface for feedback and education purposes. The system was validated by comparison with 3 accepted standard measuring devices and found to match their results well. The system also monitored the data of the participants over a continuous period of a number of days. It is evident that human factors play a part in both of the data collection strategies.

The objective of this review was to systematically identify experimental studies of non-ablative laser irradiation (LI) on peripheral nerve morphology, physiology, and function. The findings were then evaluated with special reference to the neurophysiology of pain and implications for the analgesic effects of low-level laser therapy (LLLT).LLLT is used in the treatment of pain, and laser-induced neural inhibition has been proposed as a mechanism. To date, no study has systematically evaluated the effects of LI on peripheral nerve, other than those related to nerve repair, despite the fact that experimental studies of LI on nerves have been conducted over the past 25 years.We searched computerized databases and reference lists for studies of LI effects on animal and human nerves using a priori inclusion and exclusion criteria.We identified 44 studies suitable for inclusion. In 13 of 18 human studies, pulsed or continuous wave visible and continuous wave infrared (IR) LI slowed conduction velocity (CV) and/or reduced the amplitude of compound action potentials (CAPs). In 26 animal experiments, IR LI suppressed electrically and noxiously evoked action potentials including pro-inflammatory mediators. Disruption of microtubule arrays and fast axonal flow may underpin neural inhibition.This review has identified a range of laser-induced inhibitory effects in diverse peripheral nerve models, which may reduce acute pain by direct inhibition of peripheral nociceptors. In chronic pain, spinal cord changes induced by LI may result in long-term depression of pain. Incomplete reporting of parameters limited aggregation of data.

The evolving eHealth agenda presents a range of potential opportunities for the management and prevention of chronic disease. This paper identifies issues and barriers to the uptake of eHealth and describes a strategy ( Healthy Outcomes for Australians© – HOFA) for creating a central knowledge filter and cyber space method for tracking health determinants through an interactive, social media platform. Discussion will be directed towards presenting contemporary interactive cyber platforms that are aimed at harnessing social media (Web 2.0) technologies in preparation for delivering effective early 21st century health care.

Background: In a time of increasing use of eHealth technologies, it is appropriate to consider how these might be used in physiotherapy for improving health outcomes for survivors of cancer. Objectives: The aim of this paper was to understand what technologies are in use in health care and how technologies are being used in cancer care and rehabilitation. Further, to consider the benefits and potential disadvantages of technologies in the field of oncology. Major findings: Two eHealth strategies used for education and intervention were considered: web-based and convergence technologies (the union of web-based and mobile technologies). To date, the use of webbased eHealth technologies for educating survivors of cancer is more advanced than the use of convergence methodologies which may be more suited to health care interventions. The benefits for geographically isolated populations and for information dissemination are evident. A number of challenges remain, in particular the rapid development of interactive technologies, and the reliability of, and secure access to information for intervention trials. Conclusions: The use of eHealth technologies should be incorporated in cancer rehabilitation; however, it is as yet too early to substitute such technologies for traditional methods.

This study investigated coping and quality of life in men with prostate cancer (n= 105, 48-86 years of age) and their partners (n= 85, 48-84 years). Participants completed the Abbreviated Dyadic Adjustment Scale, Brief COPE, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30) and open-ended questions on appraisal and coping. Multivariate analyses showed that better quality of life was associated with higher education levels (role functioning and fatigue), lower avoidant coping (emotional, social, and physical functioning and fatigue), and higher relationship satisfaction (emotional functioning). Use of medication or combined treatments was associated with worse physical and role functioning. Partners reported similar quality of life for patients as the patient ratings, except that partners reported patients' emotional functioning as significantly worse and social functioning as significantly better than the patients' own ratings. Patients and partners reported both positive and negative aspects to prostate cancer, and mentioned a range of coping strategies. Similarities between patients and partners in their responses to prostate cancer were identified using both quantitative and qualitative methods. Some differences within dyads were also noted and previous suggestions to incorporate partners and significant others in education and treatment were supported.

ObjectivesInvestigate the relationships between the ability/inability to perform five physical test exercises and the presence or absence of low back pain (LBP).SettingRegional Australian council training facility.ParticipantsConsecutive participants recruited during 39 back education classes (8–26 participants per class) for workers in general office/administration, parks/gardens maintenance, roads maintenance, library, child care and management. Total sample (n=539) was reduced through non-consent and insufficient demographic data to n=422. Age 38.6±15.3 years, range 18–64 years, 67.1% male.MethodsCross-sectional, exploratory, observational investigation. LBP presence was ascertained from a three-response option questionnaire: 0=none/rarely (no) 1=sometimes (some), 2=mostly/always (most). Statistical correlation was performed with the number of the five test exercises the individual successfully performed: (1) extension in lying: 3 s; (2) ‘toilet squat’; feet flat, feet touched: 3 s; (3) full squat then stand up: 5 times; (4) supine sit-up, knees flexed: 10 times; and (5) leg extension, supine bilateral: 10 times.InterventionsNil.ResultsFor the group ‘no-some’, 94.3% completed 4–5 test exercises, while for group ‘With’, 95.7% completed 0–1 test exercises. The relationship between LBP presence and number of exercises performed was highly significant (χ2(10)=300.61, p2(2)=274.626, pConclusionThe ability to complete/not complete five test exercises correlated statistically and significantly with a higher LBP absence/presence in a general working population. Training individuals to complete such exercises could facilitate reductions in LBP incidence; however, causality cannot be inferred. Randomised trials are recommended to establish the potential efficacy of exercise-based approaches, considering these five selected exercises, for predicting and managing LBP.

Background: Physiotherapists generally accept that electrophysical agents (EPAs) should not be applied directly over, or in the vicinity of cancerous tumours or other malignancies. The idea that EPAs are contraindicated is based upon the theoretical, but rarely proven risk of stimulating malignant cell proliferation and thus tumour growth and/or dissemination. However, a growing body of literature suggests that some electromagnetic and physical energies may be beneficial for use in the treatment of cancer-related or cancer treatment-related sequelae, and tumours. Objectives: The aim of this narrative review was to collate information on the state of knowledge regarding the application of EPAs in some typical clinical presentations in physiotherapy cancer care; understand whether there is evidence for using EPAs in physiotherapy cancer care; and, how planning might progress to further the evidence in this field. Major findings: Few EPAs have been specifically tested for the capacity to increase tu...

This study compared the effects of different doses (J/cm(2)) of laser phototherapy at wavelengths of either 780, 830, or 904 nm on human breast carcinoma, melanoma, and immortalized human mammary epithelial cell lines in vitro. In addition, we examined whether laser irradiation would malignantly transform the murine fibroblast NIH3T3 cell line.Laser phototherapy is used in the clinical treatment of breast cancer-related lymphoedema, despite limited safety information. This study contributes to systematically developing guidelines for the safe use of laser in breast cancer-related lymphoedema.Human breast adenocarcinoma (MCF-7), human breast ductal carcinoma with melanomic genotypic traits (MDA-MB-435S), and immortalized human mammary epithelial (SVCT and Bre80hTERT) cell lines were irradiated with a single exposure of laser. MCF-7 cells were further irradiated with two and three exposures of each laser wavelength. Cell proliferation was assessed 24 h after irradiation.Although certain doses of laser increased MCF-7 cell proliferation, multiple exposures had either no effect or showed negative dose response relationships. No sign of malignant transformation of cells by laser phototherapy was detected under the conditions applied here.Before a definitive conclusion can be made regarding the safety of laser for breast cancer-related lymphoedema, further in vivo research is required.

In order to determine how posteroanterior movements (PAs) are related to tenderness and thus possibly symptom production, we measured PA movements to a force of 25N on each side of the cervical spines of asymptomatic subjects. From 10 subjects (six females and four males; mean age 37.2, range 21-50), 10 locations with a difference in tenderness to pressure between sides were used for analysis. The force-displacement and stiffness-force curves for tender and control sides were compared in four ways: simultaneous confidence bands (SCBs) for each side; width of SCBs for each side; SCBs of the difference between pairs of the tender and control curves; and simultaneous prediction bands (SPBs) from the tender side were compared to individual curves of the controls. The tender side demonstrated greater variation of both displacement and stiffness. The tender sides demonstrated greater within-subject stiffness for all force levels above 12N. All individual stiffness-force curves of the tender sides were significantly different from the control side. Expected differences in single measures of either displacement or stiffness were not detected. The results suggest that the pattern of stiffness is a more effective method of characterizing PA mobility than single measures used in previous studies.

Study Design. Repeated measures study of active and passive movements in patients with neck pain.Objectives. To determine if, following manual therapy: (1) changes occur in active range of movement (AROM) and stiffness of posteroanterior (PA) movements, (2) such changes are dependent on the location treated, and (3) there is a relation between changes in PA stiffness and AROM.Summary of Background Data. PA movements are frequently used to assess patients with neck pain but little is known about how these movements are related to patient symptoms.Methods. One location deemed symptomatic and hypomobile and 1 asymptomatic location were selected in 20 patients with neck pain for more than 2 weeks. PA stiffness at each location and AROM were measured before and after each of 4 manual therapy interventions: PA movements to each location, a general treatment, and a control intervention.Results. The general intervention had a greater increase in each axis of AROM than the other interventions (F = 2.814 to 7.929, DF = 3) but there were no differences in PA stiffness across interventions (F = 0.945, DF = 3). Differences in PA stiffness was divided into regions by applied force. After treatment to the symptomatic location, regions of stiffness at forces above 8 N demonstrated significant correlations with total AROM (R = -0.466 to -0.628).Conclusion. After manual therapy, increased AROM is related to decreased PA stiffness in patients with neck pain, but only for the treated location and only when that location had been identified previously as symptomatic and hypomobile.

Sleep disturbances are common in many progressive metabolic encephalopathies. The possible presence of disturbed sleep-wake behaviour in the lysosomal storage disorder aspartylglucosaminuria, has not been previously studied, however. The sleep-wake behaviour of 81 patients with aspartylglucosaminuria (AGU, age 3-55 years, median 22 years; 42 female and 39 male) and 49 controls (age 2-57 years, median 18 years; 25 female and 24 male) was assessed through a postal survey. A slightly modified version of the validated Basic Nordic Sleep Questionnaire was used. Fifty-eight per cent of the AGU patients were reported to suffer daily from a sleep-related problem (controls 31%, p0.01). In AGU adults (age17 years) and children (ageor =17 years), the corresponding figures were 52% and 61%, respectively (control children 22%, p0.05 and control adults 38%, p = 0.06). In AGU children, settling difficulties were reported to occur significantly more commonly than in control children. Children with AGU were also reported to snore more often than were the controls. Adults with this disorder were found to suffer from severely fragmented night-time sleep, which was experienced as highly distressing by the parents and other caregivers. A long night sleep period was reported to be common in the ageing AGU patients (AGU 9.5 +/- 1.7 vs controls 7.2 +/- 1.0 h, mean +/- SD, p0.001). Parents and caregivers also often complained about disturbing movements during sleep in AGU patients. In conclusion, both children and adults with aspartylglucosaminuria were reported to display several types of sleep disturbances significantly more commonly than healthy controls.

The purpose of the study was to explore parallel and divergent features of the daily rhythms of melatonin and plasma free fatty acids (FFA) in goats exposed to different lighting conditions. From these features, we attempted to analyze whether the endogenous melatonin rhythm plays any role in the maintenance of the FFA rhythm. Seven Finnish landrace goats were kept under artificial lighting that simulated the annual changes of photoperiod at 60 degrees N (longest photoperiod, 18 h; shortest, 6 h). The ambient temperature and feeding regimen were kept constant. Blood samples were collected 6 times a year at 2 h intervals for 2 d, first in the prevailing light-dark (LD) conditions and then after 3 d in constant darkness (DD). In LD conditions, the melatonin levels always increased immediately after lights-off and declined around lights-on, except in winter (18 h darkness), when the low daytime levels were restored clearly before lights-on. The FFA levels also displayed a consistent rhythmicity, with low levels at night and a transient peak around lights-on. In DD conditions, the melatonin profiles were very similar to those found in the habitual LD conditions, but the rhythm tended to advance. The FFA rhythm persisted also in DD, and the morning peak tended to advance. There was an overall parallelism between the two rhythms, with one significant exception. In winter in LD conditions, the morning rise in FFA levels coincided with lights-on and not with the declining phase of melatonin, whereas in DD conditions, the FFA peak advanced several hours and coincided with the declining phase of melatonin. From this finding and comparisons of the calculated rhythm characteristics, i.e., phase-shifts, phase differences, and correlations, we conclude that the daily rhythm of FFA levels is most probably generated by an endogenous oscillator, primarily adjusted by dawn, whereas the melatonin rhythm in this species is regulated by an oscillator primarily adjusted by dusk. The results did not exclude a modulatory effect of melatonin on the daily FFA profiles, but melatonin secretion, alone, does not explain the patterns sufficiently.

Objective: This study aimed to investigate how local pain relief is mediated by laser therapy and how dose affects the relationship. Methods: Inflammation was induced in the hind-paws of Wistar rats. Two groups of rats received 780-nm laser therapy (Spectra-Medics Pty Ltd.) at one of two doses (2.5 and 1 J/cm(2)). One group acted as a control. Scores of nociceptive threshold were recorded using paw pressure and paw thermal threshold measures. Results: A dose of 1 J/cm(2) had no statistically significant effect on antinociceptive responses. A dose of 2.5 J/cm(2) demonstrated a statistically significant effect on paw pressure threshold (p < 0.029) compared to controls. There was no difference in paw thermal threshold responses and paw volumes at either dose. Immunohistochemistry in control animals demonstrated normal beta-endorphin containing lymphocytes in control inflamed paws but no beta-endorphin containing lymphocytes in rats that received laser at 2.5 J/cm(2). Conclusion: The results confirm previous findings that the effect of laser therapy is dose-related. The mechanism of effect may occur via a differentiated pressure-sensitive neural pathway rather than a thermal-sensitive neural pathway. The significance of the immunohistochemistry findings remains unknown.

Native British English speakers uttered the name Sarah to simulate 10 emotional connotations: “naming”, “sad”, “pleading”, “admiring”, “content”, “commanding”, “astonished”, “scornful”, “angry”, and “frightened”. In an identification task, British English listeners categorized the samples. Of the connotations, “angry”, “frightened” and “astonished” were conveyed best, and “content” poorest. Regarding auditory differentiation among the connotations, the results suggest that recognition of “naming”, “sad”, “admiring” “commanding”, “angry”, and “frightened” is based on differences in the signal wave form and its short-term alterations, whereas recognition of “pleading”, “astonished”, and “scornful” also relies on temporal patterning of short-term cues. In general, the present results together with an earlier comparable study on the conveyance of emotional connotations by a single word in Finnish indicate that English and Finnish have shared features in the vocal expression of admiration, positive surprise, scorn, plea, command, fear, and emotional neutrality.

Objectives: To develop a method for automatic detection of blinks in electrooculograms and to evaluate reliability of blink rate as an indicator of wake and sleep in subjects with developmental brain disorders. Design: Categorization of wake and sleep by blink rate was compared with visual sleep scoring of the polysomnograms. Setting: Ambulatory polysomnographic recordings at home or in the sleep laboratory. Participants: Nine healthy volunteers for calibration, 10 for validation; 7 intellectually disabled patients for calibration, 10 for validation of the method. Interventions: N/A Measurements and Results: Blinks were detected from electrooculograms using a weighted finite impulse response median hybrid filtering and the criterion of minimum duration at amplitude threshold. More than 80% of the visually identified electrooculographic blinks were detected in most subjects. When 30-second epochs of electrooculograms with 1 or more blinks were defined as wake and those without blinks as sleep, the average agreement with polysomnographic scoring was 95% in healthy subjects and 84% in patients. The mismatch was mostly due to the 30-second epochs without blinks during waking. A contextual redefinition of wake and sleep by expanding the inspected electrooculographic span from 1 to 20 epochs (10 minutes) increased the agreement to 93% in patients. The agreement is comparable to that of actigraphy with polysomnography. The linear correlation coefficient of the proportions of sleep epochs between visual scoring and the contextual blink rate method was 0.869. The main sleep periods detected by the blink-rate method were an average of 7 minutes longer than those determined by visual scoring. This was caused by differences in the detection of sleep onsets: blinking ceased before the first stage 1 sleep period was scored. The absolute period lengths obtained by the 2 methods did not differ significantly from each other in unpaired t-tests, and the linear correlation between the values was 0.999. Conclusions: The blinks extracted from the electrooculographic signal can be used to reliably determine the main sleep and wake periods in both healthy subjects and patients with developmental brain disorders.

Vocalisations of six Macaca arctoides that were categorised according to their social context and judgements of naive human listeners as expressions of plea/submission, anger, fear, dominance, contentment and emotional neutrality, were compared with vowel samples extracted from simulations of emotional-motivational connotations by the Finnish name Saara and English name Sarah. The words were spoken by seven Finnish and 13 English women. Humans and monkeys resembled each other in the following respects. 'Neutral', 'pleading' and 'commanding' had a similar F0 level. Loud vocalisations of intense 'anger' and 'fear' had both high F0, and the highest values were encountered for 'fear'. Compared with 'neutral', the audiosignal waveform of 'plea/submission' was more sinusoidal, seen in the spectrum as an attenuation of formants and an emphasis of the fundamental, whereas the signal waveform of 'commanding' was more complex corresponding to an increase in noise and a wider distribution of spectral energy. 'Frightened' samples included rather harmonic segments with emphasis of the fundamental, and 'angry' samples included more noise at the low end of the spectrum and often segments with low-frequency (100 Hz) edged modulation. Sounds resembling soft and noisy 'content' grunts of the monkey do not appear in Finnish or English speech but 'content' utterances were, however, associated with low speech pressure, attenuation of harmonics and increase in noise.

The example of Zimbabwe in 2000 shows that in a context of violent election campaigning, the role of international election observation is an ambiguous one. Unlike earlier elections organised by the Zimbabwean government, international donors wanted to observe its 2000 parliamentary election amidst a deepening crisis. They noted that the elections would not be free and fair in their view. Neighbouring countries with a more positive view joined the observation exercise. The government's discriminatory invitation and accreditation policy, the observers' emphasis on the peacefulness of the polling rather than free and fair elections, and the selective publication of their reports in various media, were affected both by the political agendas of the domestic players and by the governments which sent the observers. The difference between the Western view of the government, which had changed drastically since the 1980s and early 1990s, and the view of neighbouring governments, was crucial and may become significant elsewhere in Africa.

We studied the sleep-wake behavior of mentally retarded people from late winter to early summer at 60 degrees N. During this time the daylength increased 8 h 51 min. The data were collected by observing the sleep-wake status of 293 subjects at 20-min intervals for five randomized 24h periods (= recording days). The intervals during which the individual recording days of the same order (1st, 2nd, etc.) were carried out, were called recording periods. Consequently, there were five recording periods, each containing 293 individual recording days. Even though there was overlap among the recording periods, the median daylength from one period to another increased approximately by 100 min. In the initial statistical analysis, the number of wake-sleep transitions was found to differ significantly among the five recording periods (Friedman test, p0.001). The mean ranks in the Friedman test suggested that the number of wake-sleep transitions was highest during the 1st and lowest during the 5th recording period. In further statistical analyses using a program for mixed effects regression analysis (MIXOR 2.0) it was found that the increase in daylength during the study period was associated with a simultaneous decrease of approximately 0.5 wake-sleep transitions in the whole study population (p0.001). The decrease in the number of wake-sleep transitions was significant only in the subgroups of subjects with a daylength change of more than 350 min between the 1st and 5th recording days (Wilcoxon tests, p0.005). This suggests that after a marked prolongation of the natural photoperiod, the reduction in sleep episodes was more probable than after smaller changes in daylength. It is concluded that the sleep of mentally retarded people living in a rehabilitation center at a northern latitude is more fragmented in winter than in early summer and that the change is related probably to the simultaneous increase in the length of the natural photoperiod. The sleep quality of persons living in institutional settings might be improved by increasing the intensity and/or duration of daily artificial light exposure during the darker seasons.

Background The purpose of this study was to analyze olfactory ensheathing cell (OEC) proliferation and growth on Biosilicate and collagen bioscaffolds, and to determine whether the application of laser phototherapy would result in increased OEC proliferation on the scaffolds. The use of bioscaffolds is considered a promising strategy in a number of clinical applications where tissue healing is suboptimal. As in vitro OEC growth is a slow process, laser phototherapy could be useful to stimulate proliferation on bioscaffolds. Methods OEC cells were seeded on the Biosilicate and collagen scaffolds. Seeded scaffolds were irradiated with a single exposure of 830-nm laser. Nonirradiated seeded scaffolds acted as negative controls. Cell proliferation was assessed 7 days after irradiation. Results OECs were successfully grown on discs composed of a glass-ceramic and collagen composite. Laser irradiation produced a 32.7% decrease and a 13.2% increase in OEC proliferation on glass-ceramic discs and on collagen scaffolds, respectively, compared with controls. Laser phototherapy resulted in a reduction in cell growth on the Biosilicate scaffolds and an increase in cell proliferation on collagen scaffolds. Conclusions These results were probably due to the nature of the materials. Future research combining laser phototherapy and glass-ceramic scaffolds should take into account possible interactions of the laser with matrix compounds.

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n=32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

The purpose of this study was (i) to develop a method for successfully seeding osteoblasts onto a glass-ceramic scaffold designed for use in clinical settings, and (ii) to determine whether the application of laser phototherapy at 830 nm would result in osteoblast proliferation on the glass-ceramic scaffold.The use of bioscaffolds is considered a promising strategy for a number of clinical applications where tissue healing is sub-optimal. As in vitro osteoblast growth is a slow process, laser phototherapy could be used to stimulate osteoblast proliferation on bioscaffolds.A methodology was developed to seed an osteoblastic (MC3T3) cell line onto a novel glass-ceramic scaffold. Seeded scaffolds were irradiated with a single exposure of 830 nm laser at 10 J/cm(2) (at diode). Non-irradiated seeded scaffolds acted as negative controls. Cell proliferation was assessed seven days after irradiation.Osteoblastic MC3T3 cells were successfully grown on discs composed of a glass-ceramic composite. Laser irradiation produced a 13% decrease in MC3T3 cell proliferation on glass-ceramic discs (mean +/- SD = 0.192 +/- 0.002) compared with control (non-irradiated) discs (mean +/-SD = 0.22 +/- 0.002).Despite successful seeding of bioscaffolds with osteoblasts, laser phototherapy resulted in a reduction in cell growth compared to non-irradiated controls. Future research combining laser phototherapy and glass-ceramic scaffolds should take into account possible interactions of the laser with matrix compounds.

Melatonin is synthetized from serotonin in two steps driven by the enzymes N-acetyltransferase and hydroxyindole-O-methyltransferase. Constant light treatment reduces rat pineal hydroxyindole-O-methyltransferase activity while the activation of N-acetyltransferase becomes supersensitive to adrenergic stimulation. We studied the effect of this discrepancy on the production of melatonin. Male rats were kept under 12/ 12-h light/dark (LD) conditions or for 7 days under constant light (LL). They received subcutaneous injections of isoproterenol or methoxamine in the middle of the light period (LD-rats) or the estimated rest phase (LL-rats). A low dose of isoproterenol (0.1 mg/kg) increased pineal melatonin only marginally in LD-rats, while a maximum effect was found in LL-rats. A medium dose (0.2mg/kg) produced similar levels in both groups. A high dose (0.4 mg/kg) elevated pineal melatonin contents significantly more in normal than light-treated rats. Methoxamine (0.8 mg/kg) had no effects alone nor combined with isoproterenol. The results suggest supersensitivity with reduced capacity for melatonin formation in constant light-treated rats.

This study was carried out to clarify the role of alpha2-adrenoceptors in the regulation of pineal melatonin synthesis. Medetomidine, a selective alpha2-adrenoceptor agonist, was previously found to be a potent suppressor of nocturnal melatonin levels in rats. Medetomidine and alpha2-adrenoceptor antagonists atipamezole and yohimbine were injected into rats in different conditions, and their pineal melatonin contents were measured by radioimmunoassay. Experiment 1: Blocking the alpha2-adrenoceptors and possible non-adrenergic binding sites with atipamezole did not counteract the light-induced suppression of nocturnal melatonin. These receptors are, thus, not essential for the suppression of melatonin by light. Experiment 2: Blocking the alpha2-adrenoceptors with atipamezole or yohimbine did not sensitize the pineal melatonin synthesis to daytime darkness in the light/dark-entrained rats. The binding sites are not involved in keeping the daytime melatonin levels low, even in darkness. Experiment 3: The rats were sensitized to daytime darkness by keeping them for seven days in constant light. The dark-elicited melatonin rise was suppressed by a lower dose of medetomidine than the normal nocturnal rise in light/dark-entrained rats, while atipamezole had no effect. The results showed that alpha2-adrenoceptor insufficiency is not involved in the constant light-induced pineal supersensitivity. In summary, the experiments indicated that the physiological regulation of melatonin synthesis by ambient lighting in rats does not depend on alpha2-adrenergic mechanisms.

Democracy and Elections in Africa. By I. Lindberg Staffan. Baltimore: The Johns Hopkins University Press, 2006. 248 pp., $55.00 cloth (ISBN: 0-8018-8332-3), $24.95 paper (ISBN: 0-8018-8333-0). Democracy and multiparty elections are high on the agendas of many international actors, human rights groups, and African governments. Although the possibilities for free association, monitoring the use of power, and electoral competition have increased, electoral fraud and political violence are prevalent in many African countries. As a result, democratization remains a critical area for researchers and practitioners interested in African affairs. It is, therefore, exciting to come across a book that presents new findings on this subject, as Staffan Lindberg's Democracy and Elections in Africa does. Equally exciting, Lindberg effectively disputes the prevailing view that democratization in Africa has stagnated or declined since the transformations of the early 1990s. Lindberg brings positive news to development and foreign policy practitioners. Namely, assistance in organizing and conducting elections is an effective way to support the development of democracy. Even poorly organized elections can be a worthwhile exercise if one takes a long-term perspective. Support should not be reduced after the first or second election, even if they do not measure up to expectations. Moreover, Democracy and Elections in Africa has significance beyond Africa, contributing to our understanding of democratization and comparative politics in general. Lindberg's research design is methodologically rigorous. It includes data on 17 variables for 232 national elections in 44 countries. The data span a 14-year period, from 1989 to 2003. In short, Democracy and Elections in Africa is based on a more comprehensive dataset than any previous study—including the frequently …

Africa occupies a special position in the foreign policies of the Nordic countries of Denmark, Finland, Iceland, Norway, and Sweden. In spite of their limited capacities, lack of colonial ties with Africa, or any significant economic interests in Africa, the Nordic countries have attained a relatively high profile, especially in Southern Africa. After Finland and Sweden joined the European Union (EU) in 1995, Africa assumed an even greater level of foreign policy significance for the Nordic countries. Most notable in this regard is Finland’s assumption in 1999 of the EU presidency, a position that makes Finland responsible for the negotiations over the continuation of the EU’s Lomé Convention with 71 countries of Africa, the Caribbean, and the Pacific. It is in this context that this article assesses Nordic perceptions of the Clinton administration’s foreign policy toward Africa. It is important to note, however, that there is no one monolithic “Nordic perspective.” The opinions and approaches documented in policy papers or informal statements by individual civil servants following African affairs can widely vary. People working with development cooperation, for example, tend to be more recipient-oriented than those looking at Africa from a more general foreign policy point of view. The tradition of outspoken human rights policy still differentiates Norwegian and Swedish approaches from the cautious policy of Finland. Yet behind these different tones, one can distinguish common premises stemming from the many similarities of the Nordic countries and their conscious efforts to generate coherent, coordinated foreign policies toward Africa.

SINCE I990, more than 30 sub-Saharan states have introduced multiparty electoral systems to choose their national governments. This development, normally understood as part of the post-cold war 'wave of democratisation',' has led many to think that there is something intrinsically new about such a competitive process in Africa, which is not the case. This article looks at some elections that have been held in various states and studied, both before and after their independence. Liberal democratic theory and practice, according to its own precepts, involves an electoral system which includes the possibility of both criticizing a government's policies and actions and offering alternatives, thereby enabling a choice to be made between one set of leaders and another and, more generally, holding politicians accountable for their decisions and actions. As such, the actual form and content of the electoral process can help us to gauge the extent to which liberal democracy is being realized. Accordingly, a detailed analysis of elections can make a useful contribution towards our understanding of the possibilities and constraints of democratization in Africa, as elsewhere in the world. A vital feature of the most promising approach, from the standpoint of liberal practice, are the insights that are likely to be gained from the theoretical perspective of 'voter choice', as suggested by Dennis L. Cohen see 'Elections and Election Studies in Africa', in Yolamu Barbgo (ed.), Political Science in Africa: a critical review (London, i983), pp. 80-3. However free and fair competitive elections might be, and whatever the extent to which they indicate the existence of a liberal democracy

We investigated whether alpha2-adrenergic mechanisms participate in the regulation of the daily melatonin rhythm. Female Wistar rats, living under 12:12 h light-dark conditions, received a subcutaneous injection of saline or medetomidine (alpha2-adrenoceptor agonist; 100 microg/kg) 1 h after lights off. Thereafter they were kept in continuous darkness. Pineal glands were collected for melatonin measurements at 2-h intervals during the first and second subjective nights. During both nights, a significant elevation of melatonin levels in medetomidine-injected rats was found 2 h later than in control rats. We interpret the first-night delay to be a sign of medetomidine's suppressive effect on melatonin synthesis, and the second-night delay a medetomidine-induced resetting of the circadian clock controlling the melatonin onset.

Study Design. A magnetic resonance imaging study of the internal kinematic response of normal lumbar intervertebral discs to non-weight-bearing flexion and extension. Objectives. To quantify the pattern of magnetic resonance imaging pixel intensity variation across discs, and noninvasively monitor displacement of the nucleus pulposus during sagittal-plane movements. Summary of Background Data. Invasive techniques used to study intradiscal movements of the nucleus pulposus have suggested that it moves posteriorly during flexion and anteriorly during extension. A noninvasive study based on magnetic resonance images gave similar results for normal young women. Quantification has been problematic, and the invasive procedures may have altered disc dynamics. Methods. Ten male subjects (age, 21-38 years) with healthy backs were positioned in a magnetic resonance imaging portal with their lumbar spine stabilized in flexion and extension by supporting pads. For each disc, a T2-weighted image was obtained, as was a computergenerated profile of pixel intensities along a horizontal mid-discal transect. Mathematical curve-fitting regression analysis was used to characterize the shape of the intensity profile and to compute the point of maximum pixel intensity. Results. A single equation fitted the profile for all normal discs. The intensity peak shifted posteriorly during flexion, anteriorly during extension. Conclusions. Automated mathematical modeling of magnetic resonance imaging pixel data can be used to describe the fundamental shape of the pixel intensity profile across a normal lumbar disc, to determine the precise location of the site of maximum pixel intensity, and to measure the movement of this peak with flexion and extension. This technique may be of value in recognizing inciplent degenerative changes in lumbar discs.

This study was done to clarify the role of alpha2-adrenoceptors in the regulation of pineal melatonin synthesis. A selective alpha2-adrenoceptor agonist, medetomidine, and antagonist, atipamezole, were injected subcutaneously into rats and their pineal melatonin contents were measured by radioimmunoassay. Medetomidine (120 microg/kg) suppressed melatonin at night to a similar extent during the rising and descending phase of melatonin synthesis, but it did not affect the daytime level. A dose of 12 microg/kg was ineffective; doses of 30-180 microg/kg suppressed nocturnal melatonin levels close to the daytime levels. Significant suppression was reached within 15 min and the effect started to fade 3 h after the injection (120 microg/kg). At midday, medetomidine did not inhibit isoproterenol-stimulated synthesis of melatonin. Atipamezole (0.4 or 1.2 mg/kg) had no effect alone, but it counteracted the medetomidine-induced suppression. The effects of alpha2-adrenoceptor ligands on melatonin synthesis depend on the time of day and/or on the activity of the pineal sympathetic nerves.

To obtain a perceptual reference for acoustic feature selection, 94 male and 124 female voices were categorized using the ratings of 6 clinicians on visual analog scales for pathology, roughness, breathiness, strain, asthenia, and pitch. Partial correlations showed that breathiness and roughness were the main determinants of pathology. The six-dimensional ratings (the six median scores for each voice) were categorized with the aid of the Sammon map and the self-organizing map. The five categories created differed with respect to the breathiness/roughness ratio and the degree of pathology.

Clinically, Low Level Laser Therapy - LLLT has been used successfully in the treatment of chronic pain but many have questioned the scientific basis for its use. Many studies have been poorly designed or poorly controlled. A double-blind, placebo-controlled, random-allocation study was designed to analyse the effect of second daily infrared (IR) laser (820 nm, 25 mW) and visible red laser (670 nm, 10 mw) at 1 J/cm2 and 5 J/cm2 on chronic pain. Forty-one consenting subjects with chronic pain conditions exhibiting myofascial trigger points in the neck and upper trunk region underwent five treatment sessions over a two week period. To assess progress, pain scores were measured using visual analogue scales before and after each treatment. The incidence of side effects was recorded. AII groups demonstrated significant reductions in pain over the duration of the study with those groups which received infrared (820 nm) laser at 1 J/cm2 and 5 J/cm2. demonstrating the most significant effects (p ‹ 0.001). Only those subjects who had active laser treatment experienced side effects. Results indicated that responses to LLLT at the parameters used in this study are subject to placebo and may be dependent on power output, dose and/or wavelength.

The aim of the study was to determine whether a discrepancy between the genetically determined endogenous circadian period and an abnormally long Zeitgeber period disturbs the development of melatonin synthesis. Breeding pairs of rats were kept under 12: 12- or 14: 14-hr light: dark (LD) conditions. Pineal melatonin contents in the offspring were measured by radioimmunoassay. At 2 weeks of age high melatonin contents were found from lights-off to lights-on in both conditions suggesting dominance of the photic regulation. At 3 weeks of age the signs of the circadian regulation in the melatonin profiles were evident: a lag period after the light offset in control conditions and a significant decline before the light onset in both conditions. However, in 14: 14-hr LD conditions the melatonin content did not decrease to daytime levels until the lights were on. This could suggest incomplete maturation of the circadian system. The phase relationships between the melatonin peak and LD cycle were different in the two conditions. A statistically significant LD difference was first found at the age of 8–10 days in male pups and at 14 days in female pups under both lightings. The results suggest that the abnormally long LD cycle did not cause any major disorders in the development of photic or circadian regulation of the melatonin synthesis.

Salivary melatonin levels were measured in 6 healthy volunteers in order to determine whether the phase shift caused by a single 60-min light pulse of 2000 lux might be inhibited by maintaining high melatonin concentration. In the control sessions, the samples were collected at 60-min intervals under lighting of < 10 lux from 18.00 to 11.00 h. In the light-exposure sessions, placebo or 0.5 mg melatonin was administered orally 60 min prior to the light pulse, timed at the rising phase of the melatonin synthesis. The after-light sessions, one day after the light exposure, were like the control sessions. The average delays of the melatonin half-rise and half-decline times were equal (about 0.7 h) in the placebo and melatonin replacement experiments. The maintenance of high melatonin levels during the light exposure did not counteract the influence of bright light on the melatonin rhythm. Thus, in the adjustment of the melatonin rhythm, light is a stronger regulator than melatonin itself.

Photic regulation of the pineal melatonin synthesis was studied in 3- to 21-day-old rat pups by exposing the animals to light at night (30-40 min) or to darkness during the day (30-240 min). The pineal melatonin contents were measured by radioimmunoassay. A significant day/night difference in the melatonin content and the nocturnal light-induced decrease were not found until second postnatal week. A novel finding was that at the age of 13-17 days a daytime dark exposure elevated the pineal melatonin content; it was twofold as compared with the normal daytime level and about half of the nocturnal peak level. In 21-day-old rats the response had disappeared, while the nocturnal suppression by light persisted. The dark-induced increase of the melatonin synthesis was independent of the opening of the eyelids which occurs in pups at the age of two weeks, but it was greater in maternally isolated than non-isolated pups. The results suggest that one component of the circadian regulatory system matures at the end of the third postnatal week. This mechanism inhibits the elevation of the melatonin synthesis by darkness during the daytime.

Sleep disorders are common in NCL patients. The patients have problems such as frequent awakenings, difficulties with sleep onset, nightmares, and night terrors. The aim of the study was to examine whether the sleep disturbance in NCL can be explained on the basis of desynchronised circadian rhythms. Therefore we studied diurnal patterns of melatonin, cortisol, body temperature, and motor activity of 14 patients. The group consisted of 8 JNCL patients, 5 INCL children, and one boy with Jansky-Bielschowsky disease of the variant type. There were healthy age- and sex-matched control subjects. The blood samples for serum melatonin and cortisol were collected every 2 hours during 24-hour periods. Body temperature was recorded continuously for a 24-hour period by a polygraph. Diurnal motor activity was measured by wrist actigraphy for 5 days. In most of our patients sleep was fragmented and the sleep phase was irregular. Disturbances in the daily hormonal rhythms occurred only in the minority of the patients and only at an advanced stage of the disease. Although disturbances in the body temperature rhythm were found in about half of the patients, a general failure in the circadian regulatory system does not explain the frequent disturbances of the sleep-wake cycle of the NCL patients.