Book Summary: Serves the needs of advanced practice nurses because it’s written by nurse practitioners for nurse practitioners, in collaboration with a physician. Organizes content around the Circle of Caring framework for nursing-based knowledge and holistic care. Explores complementary and alternative treatments for each disorder. Covers the broadest range of human disease and disorders using a systems-based approach, presenting both common complaints and common problems to help students narrow down the possible differentials to the most likely diagnosis. Considers interactions of pharmaceuticals with alternative medications and nutraceuticals. Features coverage of pathophysiology and diagnostic reasoning as well as up-to-date guidance on laboratory and diagnostic tests. Emphasizes evidence-based practice with information on evidence levels and more references to primary studies. Integrates discussions of health policy and primary care throughout the text.

Book Summary: Serves the needs of advanced practice nurses because it’s written by nurse practitioners for nurse practitioners, in collaboration with a physician. Organizes content around the Circle of Caring framework for nursing-based knowledge and holistic care. Explores complementary and alternative treatments for each disorder. Covers the broadest range of human disease and disorders using a systems-based approach, presenting both common complaints and common problems to help students narrow down the possible differentials to the most likely diagnosis. Considers interactions of pharmaceuticals with alternative medications and nutraceuticals. Features coverage of pathophysiology and diagnostic reasoning as well as up-to-date guidance on laboratory and diagnostic tests. Emphasizes evidence-based practice with information on evidence levels and more references to primary studies. Integrates discussions of health policy and primary care throughout the text.

To achieve expressive musical results in violin bowing, performers access wide ranges of combined musical tone loudness and duration variables. By comparison, allowable mechanical variability in bow stroke execution may be limited. Such constraints on string bowing variability similarly might limit variability of bowing limb movement. Constrained variability may carry risk of upper extremity musculoskeletal disorders. Therefore if musical and/or bowing-execution variables influence bowing limb movement variability, they may in turn influence risk of cumulative injury in the player. In two experimental studies we examined the influence of the musical variables of duration and sound intensity (loudness) on variability in both string bowing mechanical variables and bowing limb joint moments (i.e. rotational forces) and joint angle trajectories. Five violinists performed playing tasks in which bow strokes varied across four levels of duration and three levels of loudness. Given a constant-amplitude bow stroke, quiet, brief strokes and loud, long strokes had to be executed close to the lower and upper limits of permissible bow-on-string force (bow force). In Study #1, we computed one- and three-dimensional bow movement variance measures, in both kinematic (bow velocity across violin string, distance from bow-to-bridge) and kinetic (bow force) variables. In Study #2 we computed the cycle-to-cycle standard deviation of joint moments and angles for each moment and angular degree of freedom in the bowing limb. In each study, these variability measures were compared across the 12 experimental conditions. We hypothesized that variability would be lowest when executing quiet/brief and loud/long strokes, compared to strokes that could be executed further from bow force limits. However, it was also anticipated that variability instead could be influenced most strongly by bow and/or limb velocity, magnitude of bow force, and/or bowed-string loudness response properties. Results from both studies indicated that variability in both bow-on-string and limb movement was conditioned on these latter properties: tone duration and loudness exerted consistent effects on variances and standard deviations. Contradicting the main hypothesis, variability was not influenced by proximity to bow force limits. We conclude that bowing variability is constrained mainly by factors not specific to variability tolerance at the bow-violin string interface.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

<p>Type 1 diabetes mellitus (T1DM) is a disease defined by its complications as much as its central pathology. One such complication, diabetic myopathy, has received more attention in recent years as it has become clear that by maintaining a healthy skeletal muscle mass, diabetic individuals are more likely to maintain metabolic control and avoid the health consequences associated with hyperglycemia. While only a limited number of studies have been performed on diabetic human skeletal muscle, the research clearly indicates that a loss of muscular strength and alterations in muscle phenotype are a result of T1DM, occurring within weeks of disease inception. Studies employing rodent models of T1DM have identified several key changes underlying the loss of contractile capacity and the changes to muscle phenotype. The research to date, however, has yet to thoroughly elucidate the mechanisms underlying diabetic myopathy. The goal of the following studies is to gain a more thorough understanding of the effects of T1DM on skeletal muscle contractile capacity, morphology, and regenerative capacity using the C57BL/6J-<em>Ins2^Akita</em> (<em>Ins2</em>^WT/C96Y) diabetic mouse model. Given the crucial role of muscle repair in maintaining a healthy muscle mass, any deficit observed here could have important implications in the pathophysiology of diabetic myopathy. The results of the following studies indicate that the <em>Ins2</em>^WT/C96Y mouse undergoes a loss of glycolytic muscle mass and other morphological/phenotypic alterations concomitant with loss of peak contractile force. Furthermore, the regenerative capacity of the muscle following injury is impaired in glycolytic muscle groups, particularly the tibialis anterior (TA). This impairment in regeneration can be, at least partly, attributed to chronic elevation in plasminogen activator inhibitor-1 (PAI-1). Pharmacological inhibition of this hormone improves regeneration of the TA in the <em>Ins2</em>^WT/C96Y mouse. These data have improved our mechanistic understanding of diabetic myopathy and have clinical implications for the treatment of T1DM.</p> / Doctor of Philosophy (PhD)

<p><strong>Background and Objectives: </strong>There are methodological challenges with research in osteoporosis. The first is to predict the lifetime risk of hip fracture incorporating trends in the rates of hip fracture and mortality. The second is to identify optimum pharmacotherapy to reduce fractures in the absence of active-comparator trials. A third is to isolate the costs for incident and prevalent fractures. The objective of this thesis is to investigate these issues.</p> <p><strong> </strong><strong>Methods: </strong></p> <p>Project 1: From national administrative data, we estimated the lifetime risk of hip fracture for age 50 years to end of life using life tables.</p> <p>Project 2: A literature review identified randomized placebo-controlled trials with nine drugs for post-menopausal women to estimate odds ratios between drugs for fractures.</p> <p>Project 3: From provincial administrative data from Manitoba excess costs relative to matched controls were estimated for incident fractures, prevalent fractures and non-fracture osteoporosis. .</p> <p><strong>Results and Conclusions:</strong></p> <p>Project 1:<strong> </strong>For women and men, the crude lifetime risks of hip fracture was 12.1% and 4.6% respectively, and lower after incorporating trends, 8.9% and 6.7%. The risk is expected to continue to fall for both women and men.</p> <p>Project 2: Three drugs, zoledronic acid, teriparatide and denosumab, had the highest odds of reducing fractures and the largest effect sizes. Estimates were consistent between Bayesian and classical approaches.</p> <p>Project 3: All incident fracture types and most prevalent fractures had significant excess costs, and the results were robust to assessment of missing variances. Excluding prevalent fractures underestimates the cost of illness of fractures.</p> / Doctor of Philosophy (PhD)

Bisphosphonates (BPs) are used for the treatment of osteoporosis. This study evaluated changes in bone microdamage with BP treatment duration. Fifty-one iliac crest biopsies were obtained from Caucasian women, ages 41 to 87 years, who were previously diagnosed and treated for osteoporosis with oral BPs for 1-16 years duration. Patients diagnosed with any disease, drug, or substance abuse that may affect bone metabolism were excluded. Bone samples were sectioned, stained, and histologically examined using light and fluorescence microscopy. Bone area, number and length of microcracks were quantified. Following adjustment for age, BMD, BV/TV, trabecular thickness, and turnover, regression analysis revealed a relationship between microcrack density and treatment duration (p=0.018). No significant relationship was observed between microcrack length and treatment duration. This study provides novel data relating microdamage with varying BP treatment duration in human bone. Given information from other studies showing that microdamage amounts are related to changes in bone biomechanics, the BP treatment duration related changes in microdamage shown offer new information that may help optimize osteoporosis treatment.

Arthrogryposis, a congenital disorder characterized by multiple joint contractures, can limit one’s ability to perform even the simplest of tasks. The purpose of this paper is to outline the general limitations associated with arthrogryposis and examine the most common corrective procedures used to treat and manage deformities of the lower extremities. While the ultimate goal may be complete correction of the associated deformities, this may not be practical, as recurrence of contractures is common. Surgical and non-surgical methods discussed in this paper include casting with the Ponseti Method, use of bracing and night splinting, soft tissue release for the ankle and knee, talectomy and osteotomy procedures for the knee. The conclusions discussed in this paper determine that complete correction is not typically obtained, but quality of life can be improved through functional independence and ambulation when utilized in conjunction with thorough physical therapy rehabilitation.

Diss. (sammanfattning) Stockholm : Karol. inst., 1999. / Härtill 6 uppsatser.