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A burn injury affects a person’s health-related quality of life (HRQoL) in different ways and might influence their daily life for months and years afterward. The aim of this study was to examine how activity performance and subjective scar estimation relate to self-rated health and whether this changes in the first year post-burn. Fifty consecutive patients who were scheduled for follow-up at the Burn Center’s outpatient clinic in Uppsala were included. Assessments of HRQoL (EQ-5D), activity performance (DASH), and subjective scar evaluation (POSAS) were conducted at 6 and 12 months post-burn. The results show a statistically significant correlation between self-rated HRQoL and activity performance (p = 0.001) and between self-rated HRQoL and subjective scar estimation (p = 0.000) at 6 but not at 12 months post-burn. A possible explanation of the lack of correlation at one year post-burn might be the patient´s expectations of his or her recovery. In future research, it would be interesting to investigate the long-term correlations between quality of life and activity performance.

Physical function and daily activities are often affected after burn injury. Fatigue is a condition that is rarely assessed. Being a well-known sequela after traumatic brain-injury or diseases of the nervous system, fatigue has also been described among the burn population with a negative impact on daily activities and reduced capacity for work.The aim of this study was to examine if, and to what extent, fatigue is a problem among our burn victims.Twenty consecutive patients scheduled for follow-up at the Burn center’s outpatient clinic in Uppsala, were asked to fill out the Fatigue Severity Scale (FSS). A healthy reference group without a burn injury, gender and age matched, were asked to fill out the same questionnaire.The results show that the patient group has a statistically significant higher score of fatigue compared to the reference group (p = 0.004). However, the results must be interpreted with caution considering the relatively small sample size. In future research it is also important to investigate the relationship between fatigue and daily activities, depression, return to work, and quality of life.

It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care.Cancer patients receiving radiotherapy over abdominal/pelvic regions were randomized to verum (penetrating) acupuncture (n = 109; 99 provided data) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106; 101 provided data) performed with a telescopic non-penetrating needle at a sham point 2-3 times/week during the whole radiotherapy period. The acupuncture cohort was compared to a reference cohort receiving standard care (n = 62; 62 provided data). The occurrence of emesis in each group was compared after a mean dose of 27 Gray. Nausea and vomiting were experienced during the preceding week by 37 and 8% in the verum acupuncture group, 38 and 7% in the sham acupuncture group and 63 and 15% in the standard care group, respectively. The lower occurrence of nausea in the acupuncture cohort (verum and sham) compared to patients receiving standard care (37% versus 63%, relative risk (RR) 0.6, 95 % confidence interval (CI) 0.5-0.8) was also true after adjustment for potential confounding factors for nausea (RR 0.8, CI 0.6 to 0.9). Nausea intensity was lower in the acupuncture cohort (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p = 0.002). The acupuncture cohort expected antiemetic effects from their treatment (95%). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (RR 1.6; Cl 1.2-2.4).Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving standard care, possibly through a general care effect or due to the high level of patient expectancy.ClinicalTrials.gov NCT00621660.

Previous studies have shown that embryonic rat and human dorsal root ganglion (DRG) cells survive grafting to the cavity of extirpated adult rat DRG. Furthermore, grafted human embryonic neurons were shown to send axons peripherally and into the spinal cord, where they establish functional synaptic connections. This study analyzed the survival of orthotopically allografted rat DRG cells from embryonic stages 15 (E15) and 20 (E20), and the influence on their survival of nerve growth factor (NGF). NGF was delivered to the DRG transplants either by pump infusion or by cotransplantation of cells from Drosophila melanogaster, transgenic for human NGF. Lumbar DRGs of adult rats were removed and a collection of E15 or E20 DRGs placed in the cavity. One month after grafting the total number of DRG cells in the grafts was counted. Differentiation of subpopulations of DRG cells was estimated by counting cells immunostained for calcitonin gene-related peptide (CGRP), Griffonia simplicifolia agglutinin isolectin B4 (GSA), or heavy neurofilament protein (antibody RT97). The results show: i) similar survival of E15 and E20 grafts, with great variability in the survival of different subpopulations in E15 transplants, but a more consistent distribution of different phenotypes in E20 transplants; ii) infusion of NGF for 2 weeks increases the survival of E15 transplants, but has a negative effect on E20 transplants; iii) Drosophila cells transfected with human NGF gene survive peripheral xenografting and have a positive effect on the survival of the GSA- and CGRP-positive populations in E15 and E20 transplants; iv) Drosophila cells without the human NGF gene increase cell survival in E20 transplants. These data suggest that i) the effect of NGF is dependent on the embryonic stage of the transplants, ii) age-dependent sensitivity to NGF influences graft survival, and iii) transgenic Drosophila cells can be cotransplanted with embryonic neural tissue to the mammalian peripheral nervous system with a positive effect on the survival of neural grafts.

Objective: To investigate how individuals expressed rationales for their beliefs regarding efficacy of acupuncture.Methods: Qualitative data from participants of two different randomized sham-controlled trials, of relaxing (non-cancer volunteers of the general population) or antiemetic (patients with cancer undergoing radiotherapy) effects of acupuncture was analyzed. Participants (n = 441) received genuine (n = 120 and n = 100) or sham (n = 121 and n = 100) (telescopic blunt sham-needle) relaxing or antiemetic acupuncture. The participants (n = 428; 97% response rate) expressed their belief regarding the efficacy of acupuncture, and n = 264 delivered qualitative rationales for their belief, analyzed using qualitative content analysis.Results: Of the 428 participants, 35 (8%) believed entirely that the acupuncture was effective, 209 (49%) believed much, 136 (32%) believed moderately, 39 (9%) believed a little, and 9 (2%) did not believe that the acupuncture was effective. Five categories and seven subcategories represented the meaning units of the central message of the rationales for the treatment belief. Participants with positive beliefs (believed entirely/much, n = 244) presented rationales related to: "Experienced positive effects", "Knowledge regarding effect-mechanisms of acupuncture", and "General trustworthiness of acupuncture". Participants with more negative beliefs (believed a little or not, n = 48) presented rationales related to: "Lack of feasibility of the acupuncture", "Varying effects", and "The effect is individual, not available for everybody".Conclusion: In order to strengthen acupuncture treated patients' beliefs in the efficacy of acupuncture during clinical practice or research, acupuncture therapists may consider emphasizing these aspects in the therapeutic situation. [ABSTRACT FROM AUTHOR]

Objective: To study nausea, vomiting and need for rescue antiemetics in patients receiving antiemetic acupuncture, sham acupuncture or standard care during concomitant chemotherapy during pelvic radiotherapy.Methods: In total, 68 patients participated (75% women, mean age 56 years, 53% had gynecological, 43% colorectal, and 4% other cancer types). Fifty-seven of them were blinded randomized to verum (n=28) or sham (n=29) acupuncture, median 10 sessions. During the study period of four weeks, the patients daily registered their nausea, vomiting and consumption of antiemetics. They were compared to a reference group (n=11) receiving standard care only, who delivered these data once (after receiving mean 27Gy radiotherapy dose).Results: More patients in the sham acupuncture group (17 of 20; 85%, p=0.019, RR 1.81, CI 1.06-3.09) consumed antiemetics, compared to the verum acupuncture group (8 of 17; 47%). In the standard care group, 7 of 11 (63%) consumed antiemetics. The verum acupuncture treated patients experienced lower intensity of nausea than the other patients (p=0.049). There was a non-significant tendency that more patients receiving either sham acupuncture or standard care experienced nausea (21 of 31; 68%) than patients receiving verum acupuncture (9 of 17; 53%: p=0.074, RR 1.58, CI 0.91-2.74).Conclusion: Patients treated with verum acupuncture needed less antiemetics and experienced milder nausea than other patients. Our study was small and many analyses lacked statistical power to detect differences; we welcome further sham-controlled efficacy studies and studies regarding the role of non-specific treatment components for experiencing antiemetic effects of acupuncture. [ABSTRACT FROM AUTHOR]

Objective: To longitudinally describe practice of Complementary and Alternative Medicine (CAM) self-care strategies for nausea during radiotherapy.Methods: Two hundred patients daily registered nausea and practice of CAM self-care strategies, beside conventional antiemetic medications, for nausea during abdominal/pelvic irradiation (median five weeks) for gynecological (69%) colorectal (27%) or other tumors (4%).Results: During radiotherapy, 131 (66%) experienced nausea, and 50 (25%) practiced self-care for nausea at least once, for a mean (m) of 15.9days. The six of 50 patients who stayed free from nausea practiced self-care more frequent (m=25.8days) than the 44 patients experiencing nausea (m=14.5) (p=0.013). The CAM self-care strategies were: modifying eating (80% of all self-care practicing patients, 80% of the nauseous patients versus 83% of the patients free from nausea; ns) or drinking habits (38%, 41% vs 17%; ns), taking rests (18%, 20% vs 0%; ns), physical exercising (6%, 2% vs 33%; p=0.035), acupressure (4%, 5% vs 0%; ns) and self-induced vomiting (2%, 2% vs 0%; ns).Conclusion: A fourth of patients undergoing emetogenic radiotherapy practiced CAM self-care for nausea, mostly by modifying eating or drinking habits. The CAM self-care practicing patients who did not become nauseous practiced self-care more frequent than the nauseous patients did. To make such self-care evidence based, we need studies evaluating its efficacy. [ABSTRACT FROM AUTHOR]

Abstract: Purpose of the research: To describe the experiences of nausea, vomiting and gastrointestinal problems during radiotherapy, and to compare patients experiencing nausea with patients not experiencing nausea regarding performance in daily activities, sleeping and eating capacity. Methods and sample: A cross-sectional sample of 131 Swedish radiotherapy patients answered a questionnaire regarding the preceding week of radiotherapy. Mean age was 63years (standard deviation 12.1) and 56% were women. The radiotherapy fields were breast (35%), abdomen/pelvis (15%), prostate/bladder (21%), head/neck (10%) and other (8%). Key results: The patients experiencing nausea within the observed week (n =31) had, compared to the patients not experiencing nausea (n =100), lower ability in daily activities in general (p =0.001), in shopping (p =0.014), walking (p =0.007) and social interaction (p =0.007). Of the patients with nausea 48% had seldom woken up rested and 34% were not able to eat as much as they used to. Corresponding figures for nausea free patients were 27% (not significant; ns) and 16% (ns). Six (5%) experienced vomiting, 15 (12%) diarrhoea, 23 (18%) constipation and 52 (40%) any gastrointestinal symptoms. Forty seven (90%) were negatively bothered by the experienced gastrointestinal symptoms. Conclusions: The fourth of patients experiencing nausea during radiotherapy had lower ability to perform daily activities than the three quarters of patients who were free from nausea. Few patients vomited while 40% experienced gastrointestinal symptoms during the observed week of radiotherapy. This implies that health care professionals could consider identifying nauseous patients that possibly need support in nausea-reduction and in daily activities during radiotherapy. [Copyright &y& Elsevier]

Summary: A control treatment in acupuncture research must be credible, regardless if the needling is performed by one or by several therapists. Objective: To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability. Design: Eighty individuals were randomized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle. Results: An equal proportion of individuals, 27 (68%), in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80% (ns). Bang''s blinding index was 0.20 (95% CI 0.03–0.36) in the acupuncture group and 0.10 (95% CI 0.09–0.29) in the sham group (interpretation: 20 and 10% identified needling type beyond statistical chance). Acupuncture was on a four-grade scale rated as median “mildly painful” and sham as “not painful” (ns). Pain ratings varied from median “not” to “mildly painful” in the therapists (p =0.01). Conclusions: Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10–20% of the individuals were unblinded beyond chance. The therapists, not the needling type, influenced how painful the needling was perceived. Implications: To achieve blinding success in acupuncture efficacy studies using the sham needle, the needling procedure must be strictly standardized in order to minimize differences between the therapists. [Copyright &y& Elsevier]

A procedure for numerical simulation of rail wear and the corresponding profile evolution has been formulated. The wear is assumed to be uniform in the sense that the profiles remain constant along the track portion to be investigated. A simulation set is selected defining the vehicles running on the track, their operating conditions, and contact parameters. Several variations of input data may be included together with the corresponding occurrence probability. Simulation of multi-body dynamics is used to calculate contact forces and positions, and Archard's wear equation is applied for the calculation of wear depth. Wear coefficients as a function of contact pressure and relative sliding velocity are collected from different test results. Trial calculations of four non-lubricated and two lubricated curves with radii from 303 to 802 m show qualitatively reasonable results in terms of profile shape development and difference in wear mechanisms between gauge corner and rail head. The wear rates related to traffic tonnage are, however, overestimated and the lubrication efficiency underestimated. It is expected that model refinements in terms of environmental influence and contact stress calculation are useful to improve the quantitative results. [ABSTRACT FROM AUTHOR]

This article addresses the interaction between and tuning of different mechanical subsystems in railway vehicle design. Application of numerical methods in a two-level optimization process, involving multi-body vehicle dynamics simulation and finite-element structural analysis, is proposed. The focus is on vibration ride comfort and tuning of dynamic properties of the vehicle, running gear, and carbody structure. As a background, a brief overview of multi-disciplinary and structural optimization methods is given. The selected solution based on the loosely coupled collaborative optimization approach, here implemented as a two-level structure, is presented. Numerical examples are provided to illustrate the choice of optimization algorithms suitable for this type of resonant systems and to demonstrate the performance of the numerical procedures on a realistic engineering problem. The leading coach of a three-car train-set is successfully optimized in terms of mass reduction and reduced natural frequency requirements, despite an infeasible initial design. [ABSTRACT FROM AUTHOR]