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The objectives of the present study were to (a) measure the prevalence of defecation symptoms in IBS, (b) investigate the relationship between stool consistency and defecation symptoms in IBS, and (c) investigate the association of defecation symptoms with health-related quality of life (HRQL) and self-reported stress in patients with IBS cared for in a primary health care setting. Ten primary health care centres joined the study. 282 patients with IBS as well as 372 non-IBS controls filled in gastrointestinal symptom diaries prospectively for two weeks as well as the Perceived Stress Scale-14 (PSS14) and the EuroQol barometer to measure perceived stress and HRQL, respectively. Incomplete evacuation was present in 51% vs. 21% of the stools among the IBS patients and the non-IBS controls, respectively. The need to strain during defecation was existing in 41% vs. 33% of the stools for the IBS patients and the non-IBS controls, respectively. Urgency was experienced in 37% of the stools in the IBS patients compared with 18% of the stools in the non-IBS controls. Patients with IBS experienced in a significant higher degree of overlapping symptoms per stool (p < 0.001 to p = 0.007). The occurrence of all defecation symptoms in the same patient was related to decreased HRQL, and increased stress (p = 0.001 to p < 0.001). An overlap between IBS and symptoms from the anorectal region related to defecation was found in a primary health care population. Defecation symptoms are very common in primary care IBS-patients, it co-occurs with increased self-perceived stress, and decreased HRQL. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) symptoms are intimately related to our wellbeing. The Short Health Scale for GI symptoms (SHS-GI) is a simple questionnaire to measure the impact of GI inconvenience and symptoms on quality of life. The aim was to validate the SHS-GI in a general population sample and to compare it with SHS-data across different patient groups. A subsample of 170 participants from a population-based colonoscopy study completed the Rome II questionnaire, GI diaries, psychological questionnaire (hospital anxiety and depression scale) and SHS-GI at follow-up investigation. Psychometric properties of SHS-GI as an overall score were determined by performing a confirmatory factor analysis (CFA). Spearman correlation between SHS total score and symptoms was calculated in the general population sample. SHS-GI data was compared with SHS data from patients with inflammatory bowel disease (IBD) and fecal incontinence (FI). As expected, the general population rated their impact of GI inconvenience on quality of life as better than the patient populations in terms of all aspects of the SHS-GI. The CFA showed a good model fit meeting all fit criteria in the general population. Cronbach's alpha for the total scale was 0.80 in the general population sample and ranged from 0.72 in the FI sample to 0.88 and 0.89 in the IBD samples. SHS-GI demonstrated appropriate psychometric properties in a sample of the normal population. We suggest that SHS-GI is a valid simple questionnaire suitable for measuring the impact of GI symptoms and inconvenience on quality of life in both general and patient populations. [ABSTRACT FROM AUTHOR]

In clinical endpoint bioequivalence (BE) studies, the primary analysis for assessing equivalence between a generic and an innovator product is based on the observed per-protocol (PP) population (usually completers and compliers). However, missing data and noncompliance are post-randomization intercurrent events and may introduce selection bias. Therefore, PP analysis is generally not causal. The FDA Missing Data Working Group recommended using "causal estimands of primary interest." In this paper, we propose a principal stratification causal framework and co-primary causal estimands to test equivalence, which was also recommended by the recently published ICH E9 (R1) addendum to address intercurrent events. We identify three conditions under which the current PP estimator is unbiased for one of the proposed co-primary causal estimands - the "Survivor Average Causal Effect" (SACE) estimand. Simulation shows that when these three conditions are not met, the PP estimator is biased and may inflate Type 1 error and/or change power. We also propose a tipping point sensitivity analysis to evaluate the robustness of the current PP estimator in testing equivalence when the sensitivity parameters deviate from the three identified conditions, but stay within a clinically meaningful range. Our work is the first causal equivalence assessment in equivalence studies with intercurrent events. [ABSTRACT FROM AUTHOR]

Cognitive–behavioural therapy (CBT) is an effective treatment for clinical and subclinical symptoms of depression and general anxiety, and increases life satisfaction. Patients’ usage of CBT skills is a core aspect of treatment but there is insufficient empirical evidence suggesting that skills usage behaviours are a mechanism of clinical change. This study investigated if an internet-delivered CBT (iCBT) intervention increased the frequency of CBT skills usage behaviours and if this statistically mediated reductions in symptoms and increased life satisfaction. A two-group randomised controlled trial was conducted comparing internet-delivered CBT (n = 65) with a waitlist control group (n = 75). Participants were individuals experiencing clinically significant symptoms of depression or general anxiety. Mixed-linear models analyses revealed that the treatment group reported a significantly higher frequency of skills usage, lower symptoms, and higher life satisfaction by the end of treatment compared with the control group. Results from bootstrapping mediation analyses revealed that the increased skills usage behaviours statistically mediated symptom reductions and increased life satisfaction. Although skills usage and symptom outcomes were assessed concurrently, these findings support the notion that iCBT increases the frequency of skills usage behaviours and suggest that this may be an important mechanism of change. [ABSTRACT FROM PUBLISHER]

This paper describes the development and preliminary psychometric evaluation of an instrument that measures the frequency of adaptive behaviours and cognitions related to therapeutic change during cognitive behavioural therapy (CBT), for symptoms of anxiety and depression. Two studies were conducted. In study one, 661 participants completed an online survey with 28 items targeting adaptive behaviours and cognitions. Exploratory factor analysis performed on part of the sample (n = 451) revealed that a four-factor solution ‘characterised’ the data. This led to the development of a 12-item instrument, the Frequency of Actions and Thoughts Scale (FATS). Confirmatory factor analysis was used to confirm the factor structure of the FATS using the remaining sample (n = 210), which revealed an acceptable model fit. In study two, 125 participants with clinically significant symptoms of anxiety, depression, or both were recruited to an Internet-delivered CBT (iCBT) treatment course. Participants completed the FATS and other measures throughout treatment, after treatment, and at three-month follow-up. Correlations and residual change scores of the FATS and its subscales with measures of anxiety, depression, behavioural activation, and CBT-related skills usage supported the construct validity of the FATS. A significant increase in FATS scores over treatment was also observed. The findings provide preliminary support for the psychometric properties of the FATS, which appears to have utility in research investigating mechanisms of change in CBT. [ABSTRACT FROM AUTHOR]

Dropout is a persistent problem for a longitudinal study. We exhibit the shortcomings of the last observation carried forward method. It produces biased estimates of change in an outcome from baseline to study endpoint under informative dropout. We developed a theoretical quantification of the effect of such bias on type I and type II error rates. We present results for a setup where a subject either completes the study or drops out during one particular interval, and also under the setup in which subjects could drop out at any time during the study. The type I error rate steadily increases when time to dropout decreases or the common sample size increases. The inflation in type I error rate can be substantially high when reasons for dropout in the two groups differ; when there is a large difference in dropout rates between the control and treatment groups and when the common sample size is large; even when dropout subjects have one or two fewer observations than the completers. Similar results are also observed for type II error rates. A study can have very low power when early recovered patients in the treatment group and worsening patients in the control group drop out even near the end of the study. [ABSTRACT FROM PUBLISHER]

There is a need for systemic improvement in the management of care records in Australia. This has been highlighted by government inquiries, media coverage and research literature relating to the significance of records for those who experience out-of-home care. The Who Am I? project - an interdisciplinary collaboration between historians, social workers and archivists - sought to address this concern and support positive change in 12 participating community service organisations (CSOs,) in Victoria. To provide a framework for practice improvement, research archivists on the Who Am I? team designed the Self-Assessment Too/for Archives. Based on an action research methodology and influenced by the Records Continuum, this was an 'educative intervention' for the CSOs, as well as the participating archivists. [ABSTRACT FROM AUTHOR]

In the July-August 2008 issue of Topics in Stroke Rehabilitation, Greig and colleagues described a small, qualitative study of features of mobile phone handset design, documentation, and use that either enhance or hinder usability for people with aphasia. The authors noted that, despite considerable difficulties, study participants appreciated the social participation that mobile phones support. Findings to date of the Wireless RERC's Survey of User Needs (SUN) reinforce the importance of wireless technology to people with disabilities. Since 2001, the Wireless RERC has surveyed over 3,000 Americans with diverse cognitive, physical, and sensory disabilities about their needs for mobile wireless technologies. About 84% of respondents own or have access to a cell phone or other mobile wireless device. SUN findings also reveal critical features of wireless devices and services that affect usefulness and usability for this diverse population. In May 2010, the Wireless RERC revised the SUN and again began collecting data. Since then, 333 individuals have responded to the survey, 46 of them stroke survivors. This article compares the survey results with the findings of Greig et al. The analysis supports the feasibility of inclusive and universal design in meeting the needs of wireless customers of all age and abilities. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editors discuss adoption, challenges, and issues concerning advanced technologies in stroke rehabilitation and recovery, an article on the use of mobile wireless devices among stroke survivors by Morris and colleagues, and another article on the robotics application in the locomotor training of stroke survivors by Backus and colleagues.

This study examines the motivation of a cohort of first year computing students and the effects on their engagement as they progress through the revised delivery of an introductory programming unit. The purpose behind the redesign of the delivery of the unit was to maintain student engagement by ensuring that each student was able to assume responsibility for all their work, irrespective of their previous experience. One hoped-for consequence was the avoidance of the bi-modal results profile experienced in previous years. The level of engagement was measured in terms of the numbers of students submitting assignments, given that not all the assignments needed to be attempted to obtain a pass mark for the coursework component of the unit. A survey was conducted at the outset, at which it became clear that a substantial minority of the students were not particularly interested in programming. For these students the motivation was to pass the unit. The number of students expressing either some or considerable interest in programming in the survey almost directly matched the number completing a final, optional assignment. Student surveys and the lack of a bi-modal distribution in the results indicated that the revised delivery programme maintained the general level of motivation and engagement within the group throughout the academic year. [ABSTRACT FROM AUTHOR]

This systematic study of selected 'Wessex' Early Bronze Age burial assemblages was undertaken to reassess the original purpose of the artefacts deposited and their significance in the burial ritual. Use-wear analysis and fragmentation assessment has been undertaken on daggers, whetstones, bone objects and beads, Lithological and physical analysis was also undertaken on the stone objects. The results show a remarkable disparity in use and fragmentation between certain artefact types. Some objects and groups might be seen as symbolic depositions placed by mourners, or as parts of ceremonial costume, rather than as possessions of the deceased. [ABSTRACT FROM AUTHOR]

This article analyzes the context of anti-Judaism and theatricality in medieval culture. Medieval theatricality is represented as one of the culture's means of defining Christian and Jew, self and Other, and of policing boundaries between the normal and aberrant. Theatricality refers to a kind of constitutive trope. Medieval anti-Judaism has its roots in the vexed relation of the Christian Bible to the Hebrew Bible.

The statistical literature and folklore contain many methods for handling missing explanatory variable data in multiple linear regression. One such approach is to incorporate into the regression model an indicator variable for whether an explanatory variable is observed. Mother approach is to stratify the model based on the range of values for an explanatory variable, with a separate stratum for those individuals in which the explanatory variable is missing. For a least squares regression analysis using either of these two missing-data approaches, the exact biases of the estimators for the regression coefficients and the residual variance are derived and reported. The complete-case analysis, in which individuals with any missing data are omitted, is also investigated theoretically and is found to be free of bias in many situations, though often wasteful of information. A numerical evaluation of the bias of two missing-indicator methods and the complete-case analysis is reported. The missing-indicator methods show unacceptably large biases in practical situations and are not advisable in general. [ABSTRACT FROM AUTHOR]

The development of fortification in Brittany from the Gallo-Roman period to the end of the Middle Ages has recently attracted considerable local interest. Much valuable work has been done on both the documentary sources and the archaeological evidence but the results of these researches have not significantly entered into general discussions nor have these two aspects of the subject always been successfully combined by architectural historians and archaeologists. This paper aims to provide a basis for comparison with developments elsewhere by suggesting a chronology and examining some of the principal social and political factors leading to successive campaigns of fortification. In particular the development of feudal society, the rote of the frontiers with neighbouring provinces and the relationship of dukes of Brittany with their leading lords (especially centring on problems of control, licensing and financing of castle and urban defences) are dealt with during a period when the duchy enjoyed a considerable degree of political independence from the crown of France. [ABSTRACT FROM AUTHOR]

The article discusses archival and recordkeeping standards and practices, focusing on how the needs of the users are reflected in these tools. Other topics include ways that different types of institutions should handle appraisal, retention, and disposal of records, the arrangement and description of collections to best aid the user, and the importance of context within archival collections.

Focuses on the Omnibus Trade and Competitiveness Act and its provisions. Use of the International System of Units or the metric system by 1996; Impact on math and science teaching; Effects on language arts and social studies; Development of relationship skills and applications skills in students for an operational understanding of the metric system; Model for teaching.

Examines the effect of nitrogen dioxide inhalation on human blood biochemistry. Discussion on the toxic nature of NO[sub 2]; Use of colorimetric method of Drabkin in determining the total hemoglobin levels in blood samples; Comparison of biochemical changes after the inhalation of 1 ppm and 2 ppm NO[sub 2].