Objective: To examine whether using a knee-ankle-foot orthosis helps maintain ankle-foot dorsiflexion range of motion over time. Design: A multicentre randomized controlled trial. Setting: Two hospitals and one rehabilitation centre in the Netherlands and the USA. Subjects: Children (4-16 years old) with spastic cerebral palsy who were able to walk. Intervention: Use of a knee-ankle-foot orthosis, equipped with an Ultraflex® ankle power unit, for at least 6 hours every other night for one year. Main measures: Primary outcome measure: ankle-foot dorsiflexion range of motion. Secondary outcome measures: ankle-foot and knee angle in gait and gross motor function. Wearing time was also measured. Measurements were taken at baseline and at 3, 6, 9 and 12 months. Results: 28 children (experimental group: n=15, control group: n=13) participated in the study. 11 participants (experimental: n=4, control: n=7) did not complete all five measurements, as they needed additional treatment. No significant difference was found in the decrease of ankle-foot dorsiflexion range of motion between the experimental and control groups (difference: −1.05°, 95% confidence interval: −4.71° – 2.61°). In addition, secondary outcome measures did not show differences between groups. Despite good motivation, knee-ankle-foot orthosis wearing time was limited to a mean±SD of 3.2±1.9 hours per prescribed night due to discomfort. Conclusions: Knee-ankle-foot orthosis with dynamic ankle and fixed knee are poorly tolerated and are not beneficial in preventing a reduction in ankle-foot dorsiflexion range of motion in children with spastic cerebral palsy, at least with limited use.

Reports research on the degree to which UK adolescents feel they have an impact on decision making within their families, and the extent to which adolescents and parents agree or disagree with the adolescent’s perceived influence when purchasing products;most previous research has concentrated on children rather than adolescents. Discusses the concept of consumer socialisation, i.e. the process by which young people acquire skills, knowledge and attitude relevant to their functioning as consumers; although parents are the foremost influences in this, there is also reverse socialisation, where children use their product knowledge to influence parents’ decisions. Distinguishes between socio‐oriented and concept‐oriented parental communication: the latter is likely to increase the child’s influence on decision‐making. Outlines demographic changes, such as the greater number of one‐parent households and two‐income families, which have produced “time‐poor” parents: the result is that children and adolescents now exercise a greater influence on purchasing decisions. Tests two hypotheses: that parents and adolescents disagree in their perceived ratings of adolescents’ product category decision influence; and that male and female adolescents’ perceived influences differ across a range of product categories. Concludes that parents and adolescents generally agree, but that there is some degree of difference between male and female perceived influence ratings, in the categories of large purchases and food.

Substance abuse is one of the most prevalent comorbid conditions among trauma patients. Research has shown that injury can be reduced when brief interventions are provided to trauma patients who are hospitalized for substance abuse. This article presents data from a Level I trauma center that provided brief interventions daily over a 5-year period. A generic model for brief intervention is described, along with concrete details of this addiction intervention service.

This article is an introduction to brief motivational interventions, which is an effective strategy to address alcohol-use disorders and the public health issues these disorders present. In this article, we summarize core concepts and our clinical experiences. To explore the contrast between these interventions and more traditional approaches to patient-provider interaction, the article describes strategies used in brief motivational interventions, answers common questions about the process, and provides references and resources for those who would like to learn more.

This article summarizes the Stages of Change model, which identifies five stages that people experience as they gradually move away from engaging in harmful behaviors to sustaining healthy behaviors. Patients in different stages of change need different kinds of interventions. The Stages of Change model enhances brief counseling interventions for trauma patients with substance use problems because counselors can now accurately choose an appropriate intervention strategy. The authors present three case studies illustrating the three earliest stages of change most commonly encountered in trauma center patients.

Background: Injured survivors of individual and mass trauma receive their initial evaluation in acute care. Few investigations have comprehensively screened for posttraumatic stress disorder (PTSD) symptoms and related comorbidities across sites. Methods: This investigation included 269 randomly selected injury survivors hospitalized at two level 1 trauma centers. All patients were screened for PTSD, depressive, and peritraumatic dissociative symptoms during their surgical inpatient admission. Prior traumatic life events and alcohol abuse/dependence also were assessed. Results: In this study, 58% of the patients demonstrated high levels of immediate posttraumatic distress or alcohol abuse/dependence. Regression analyses identified greater prior trauma, female gender, nonwhite ethnicity, and site as significant independent predictors for high levels of posttraumatic distress. Conclusions: High levels of posttraumatic distress, recurrent trauma, and alcohol abuse/dependence were present in more than half of acute care inpatients. Early mental health screening and intervention procedures that target both PTSD and alcohol use should be developed for acute care settings.

CONTEXTAlthough posttraumatic stress disorder (PTSD) and alcohol abuse frequently occur among acutely injured trauma survivors, few real-world interventions have targeted these disorders.OBJECTIVEWe tested the effectiveness of a multifaceted collaborative care (CC) intervention for PTSD and alcohol abuse.DESIGNRandomized effectiveness trial.PARTICIPANTSWe recruited a population-based sample of 120 male and female injured surgical inpatients 18 or older at a level I trauma center.INTERVENTIONPatients were randomly assigned to the CC intervention (n = 59) or the usual care (UC) control condition (n = 61). The CC patients received stepped care that consisted of (1) continuous postinjury case management, (2) motivational interviews targeting alcohol abuse/dependence, and (3) evidence-based pharmacotherapy and/or cognitive behavioral therapy for patients with persistent PTSD at 3 months after injury.MAIN OUTCOME MEASURESWe used the PTSD symptomatic criteria (PTSD Checklist) at baseline and 1, 3, 6, and 12 months after injury, and alcohol abuse/dependence (Composite International Diagnostic Interview) at baseline and 6 and 12 months after injury.RESULTSRandom-coefficient regression analyses demonstrated that over time, CC patients were significantly less symptomatic compared with UC patients with regard to PTSD (P =.01) and alcohol abuse/dependence (P =.048). The CC group demonstrated no difference (-0.07%; 95% confidence interval [CI], -4.2% to 4.3%) in the adjusted rates of change in PTSD from baseline to 12 months, whereas the UC group had a 6% increase (95% CI, 3.1%-9.3%) during the year. The CC group showed on average a decrease in the rate of alcohol abuse/dependence of -24.2% (95% CI, -19.9% to -28.6%), whereas the UC group had on average a 12.9% increase (95% CI, 8.2%-17.7%) during the year.CONCLUSIONSEarly mental health care interventions can be feasibly and effectively delivered from trauma centers. Future investigations that refine routine acute care treatment procedures may improve the quality of mental health care for Americans injured in the wake of individual and mass trauma.

This paper reports the process outcomes of a randomized trial of a one-session Motivational Interviewing (MI) intervention conducted with youth (12–20 years) in a hospital emergency department (ED) while undergoing medical care for an injury. The interventions targeted six behaviors placing youths at high risk for injury. Those youth whose counselors perceived their readiness to increase between the start and end of the MI session were 4.5 times more likely to have improved their use of seat belts 6 months later compared with youth who were not perceived to have increased in readiness during the session.

Background: To improve reinjury prevention strategies targeting hazardous drinking, we determined its predictors and longitudinal course in the year after injury.Methods: This was a prospective study of 101 randomly selected hospitalized trauma patients who before injury represented the full range of substance abuse, from severe to none. We hypothesized that clinical data obtained routinely by trauma centers would predict hazardous drinking during the postinjury year.Results: Drug and alcohol use dropped markedly 1 month after injury but returned to preinjury levels by 4 months. Forty-one percent of the sample drank hazardously before injury, and 55% drank hazardously after. From before to after injury, 20% of patients worsened their hazardous drinking status, and only 6% of patients improved it. Three clinical predictors of hazardous drinking during the year were identified: any positive blood alcohol concentration > 0 at admission (odds ratio [OR], 9.18; 95% confidence interval [CI], 2.51-33.56), any days > 0 of using nonprescription drugs of abuse in the month before injury (OR, 6.63; 95% CI, 1.76-25.04), and suffering an intentional injury (OR, 5.1; 95% CI, 1.38-18.77).Conclusion: Efforts to reduce hazardous drinking after injury should target patients with this risk profile and focus on the 1- to 4-month period after injury hospitalization.

AIMS:To examine the effectiveness of brief behavioral interventions adapting the principles and techniques of Motivational Interviewing (MI) to four behavioral domains: substance abuse, smoking, HIV risk and diet/exercise. DESIGN:We conducted a systematic review of 29 randomized trials of MI interventions. Data on methodological quality were extracted and tabulated. Between-group behavior change effect sizes and confidence intervals were calculated for each study. FINDINGS:Due to varying intervention time lengths, targeted problem behaviors, settings and interventionists' backgrounds and skill levels, outcomes were not combined meta-analytically. Sixty per cent of the 29 studies yielded at least one significant behavior change effect size. No significant association between length of follow-up time and magnitude of effect sizes was found across studies. There was substantial evidence that MI is an effective substance abuse intervention method when used by clinicians who are non-specialists in substance abuse treatment, particularly when enhancing entry to and engagement in more intensive substance abuse treatment treatment-as-usual. Data were inadequate to judge the effect of MI in the other domains. Client attribute-treatment interactions were understudied and the sparse and inconsistent findings revealed little about the mechanism by which MI works or for whom it works best. CONCLUSION:To determine more effectively how well MI works in domains other than substance abuse and for whom it works best in all domains, researchers should study MI with risk behaviors other than substance abuse, while examining both interactions and the theoretical components of MI.

Alcohol is the most common chronic disease in trauma patients, and one of the most common in patients treated in primary care. Studies have shown that brief counseling intervention in trauma centers and primary care clinics are efficient in reducing drinking and its related illness and injury. Unfortunately, although trauma centers and primary care clinics are ideal settings for such brief alcohol interventions, routine screening and brief counseling for alcohol problems is not commonly practiced by physicians in these settings. The goal of this project was to address alcohol abuse at the individual patient level and at the community level. At the individual patient level, the project encouraged physicians to perform a protocol for brief alcohol interventions to address alcohol abuse. This protocol consists of screening for alcohol problems, brief counseling, and referral. This was primarily done by offering training in this protocol to physicians, residents and medical students. The project focused on the pacific northwestern United States (Washington, Alaska, Montana, and Idaho).

Wastewater containing about 0.5% oil and grease (O/G) from a metal industry was treated by tubular ultrafiltration using membranes having a molecular weight cutoff (MWCO) of 120,000 and a negative surface charge (P membrane) and of 100,000 and no surface charge (M membrane), Permeate flux decreased dramatically during the first several hours of operation and then leveled-off for the remainder of semibatch operation. The average P membrane flux was significantly higher than the M membrane (38 versus 27 gal/ft(2).d) because of its higher MWCO and negative surface charge. Increasing the transmembrane pressure and crossflow velocity increased the permeate flux for both membranes. O/G concentrations less than 50 mg/L and total suspended solids (TSS) levels less than 25 mg/L were common for both membranes. O/G removal efficiencies (rejections) averaged 98% for the M membrane and 97% for the P membrane. TSS rejections were approximately 97% for both membranes. Effluent O/G concentration and turbidity from the P membrane were slightly higher than the M membrane because of the P membrane's higher MWCO and the larger flux. The average volume reduction and residual production were 97% and 32 gal/1000 gal, respectively, Acid cracking of the concentrate with sulfuric acid was marginally successful.

Maximum-length-sequence (MLS) measurement of system impulse responses offers a potential enhancement in error immunity over periodic impulse testing, although care must be exercised in setting the MLS excitation amplitude in order to realize this potential. The effects of nonlinearity in MLS measurement are studied, in particular the way in which impulse response errors due to nonlinearity are distributed across the measurement period. The consequences of such errors in cumulative spectral dispIay plots are also investigated. Finally inverse-repeat sequences (IRS) are shown to have complete immunity to even-order nonlinearity while maintaining many of the advantages of MLS.