United States Guild Certified Feldenkrais Teachers®: a survey of characteristics and practice patterns.

BACKGROUND: Feldenkrais Method® teachers help students improve function and quality of life through verbally and manually guided lessons. The reasons people seek Feldenkrais® lessons are poorly understood. Similarly, little is known about practice characteristics and patterns. To address these knowledge gaps, we conducted an extensive survey of United States Guild Certified Feldenkrais Teachers®. METHODS: We invited all Feldenkrais Teachers to participate in this survey delivered in web-based or print formats. We obtained overall and question-specific response rates, descriptive statistics, chi-square tests of response bias, and performed qualitative thematic review of comments. RESULTS: Overall response rate was 30.5% (392/1287). Ninety percent of responders had college degrees in diverse fields; 12.5% had credentials outside health care, 36.9% held conventional health care licenses, and 23.1% had complementary and alternative medicine credentials. Mean age was 55.7 years; most teachers were women (83%). California (n = 100) and New York (n = 34) had the most teachers. Forty-five percent of teachers earned ≤ 20% of their gross income from their practices, while 26% earned > 80%. Most saw < 10 students/week for individual lessons and < 10 students/week for group lessons. Students were mostly women (71.1%) and 45-64 years old. The primary reason students sought Feldenkrais lessons was pain. A quarter of students self-referred, a fifth were referred by conventional health care providers, and two-thirds paid for services directly. Themes from comments included: beliefs that Feldenkrais training had important personal and professional benefits for teachers; recognition of the challenges of operating small businesses and succinctly describing the Feldenkrais Method; the variety of practice approaches; and a deep commitment to the Feldenkrais Method. CONCLUSIONS: Most Feldenkrais Teachers were well educated, often held additional credentials, were located in the West, were women, were older than 50 years, and had part-time practices. Most students were women, were adults, came from various referral sources, and paid directly for services. Teachers and students utilized the Feldenkrais Method in diverse settings and applications. These findings may foster practice development by Feldenkrais Teachers, improve communication between health care consumers and providers and assist decision-making, and stimulate more research concerning the Feldenkrais Method.

A randomized controlled trial of the efficacy and safety of twice-daily saxagliptin plus metformin combination therapy in patients with type 2 diabetes and inadequate glycemic control on metformin monotherapy.

BACKGROUND: To compare the safety and efficacy of saxagliptin 2.5 mg twice daily (BID) versus placebo add-on therapy to metformin immediate release (IR) in patients with type 2 diabetes and inadequate glycemic control with metformin alone. METHODS: This multicenter, 12-week, double-blind, parallel-group trial enrolled adult outpatients with type 2 diabetes (glycated hemoglobin [HbA1c] 7.0%-10.0%) on stable metformin IR monotherapy (≥1500 mg, BID for ≥8 weeks). Patients were randomized to double-blind saxagliptin 2.5 mg BID or placebo added on to metformin IR following a 2-week, single-blind, placebo add-on therapy lead-in period. The primary end point was the change from baseline to week 12 in HbA1c. Key secondary end points included change from baseline to week 12 in fasting plasma glucose (FPG) and the proportion of patients achieving HbA1c <7.0% or HbA1c ≤ 6.5% at week 12. Efficacy was analyzed in all patients who received randomized study drug with ≥1 postbaseline assessment. Safety was assessed in all treated patients. RESULTS: In total, 74 patients were randomized to double-blind saxagliptin add-on therapy and 86 to placebo add-on therapy. At week 12, least-squares mean changes (95% CI) from baseline HbA1c (adjusted for baseline HbA1c) were significantly greater (P = 0.006) in the saxagliptin + metformin group -0.56% (-0.74% to -0.38%) versus the placebo + metformin group -0.22% (-0.39% to -0.06%). Adjusted mean changes from baseline in FPG were numerically greater with saxagliptin versus placebo; the difference (95% CI) -9.5 mg/dL (-21.7 to 2.7) was not statistically significant (P = 0.12). A numerically greater proportion of patients in the saxagliptin group than the placebo group achieved HbA1c < 7.0% (37.5% vs 24.2%) or HbA1c ≤6.5% (24.6% vs 10.7%). There were no unexpected safety findings. Hypoglycemia occurred in 4 patients (5.4%) in the saxagliptin group and 1 patient (1.2%) in the placebo group; confirmed hypoglycemia (symptoms plus fingerstick glucose ≤50 mg/dL) occurred in 1 patient in the placebo group. CONCLUSIONS: Addition of saxagliptin 2.5 mg BID to metformin therapy in patients with type 2 diabetes and inadequate glycemic control on metformin monotherapy reduced HbA1c compared with placebo added to metformin, with an adverse events profile similar to placebo and no unexpected safety findings. TRIAL REGISTRATION: ClinicalTrials.gov NCT00885378.

A preliminary survey of the practice patterns of United States Guild Certified Feldenkrais PractitionersCM.

BACKGROUND: The Feldenkrais Method(R) of somatic education purports to guide people of varying ages and abilities to improve function. Many people choose this method to aid with recovery from injury, manage chronic conditions, or enhance performance even though limited research supporting its safety and effectiveness exists to guide decisions about use and referral. Very little information about practitioner characteristics and practice patterns is publicly available to assist researchers in the design of appropriate safety and effectiveness studies. The purpose of this study was to obtain an initial overview of the characteristics of United States Guild Certified Feldenkrais PractitionersCM. METHODS: Of 1300 certified Feldenkrais practitioners at the time of the study, there were 1193 practitioners with email accounts who were sent invitations to complete a web-based survey. The survey inquired about practice locations, additional credentials, service patterns and workloads during the previous 3 months. Response rate and descriptive statistics were calculated. RESULTS: The survey had a 32.3% (385/1193) response rate. The top states in which responders practiced were California (n = 92) and New York (n = 44). Most responders did not hold other credentials as traditional health care providers or as complementary and alternative medicine providers. Among those who did, the most common credentials were physical therapist (n = 83) and massage therapist (n = 38). Just over a third of traditional health care providers only provided Feldenkrais lessons, compared to 59.3% of complementary and alternative providers. On average, responders saw 7.6 +/- 8.1 (median = 5) clients per week for individual lessons, 8.4 +/- 11.5 (median = 5) clients per week for group lessons, and 2.9 +/- 3.9 (median = 2) new clients per month for individual lessons. CONCLUSIONS: This preliminary survey of United States Guild Certified Feldenkrais Practitioners indicated that most practiced in the west and northeast, did not hold additional credentials, and had part-time practices. Those who were traditional health care providers were more likely than complementary and alternative medicine providers in other areas to combine their services. These results provide a foundation for further analyses of Feldenkrais practitioner characteristics and practice patterns that can aid the design of safety and effectiveness studies, and enhance use and referral decision-making.

Lower-extremity strength profiles and gender-based classification of basketball players ages 9-22 years.

Despite an increase in women sports participants and recognition of gender differences in injury patterns (e.g., knee), few normative strength data exist beyond hamstrings and quadriceps measures. This study had 2 purposes: to assess the lower-extremity strength of women (W) and men (M) basketball players who were 9-22 years old, and to determine which strength measures most correctly classify the gender of 12- to 22-year-old athletes. Fifty basketball players (26 W, 24 M) without ligamentous or meniscal injury performed concentric isokinetic testing of bilateral hip, knee, and ankle musculature. We identified maximal peak torques for the hip (flexors, extensors, abductors, adductors), knee (flexors and extensors), and ankle (plantar flexors and dorsiflexors), and we formed periarticular (hip, knee, and ankle), antigravity, and total leg strength composite measures. We calculated mean and 95% confidence intervals. With body mass-height normalization, most age and gender differences were small. Mean values were typically higher for older vs. younger players and for men vs. women players. Mean values were often lower for girls 12-13 years vs. those 9-10 years. In the age group of 16-22 years, men had stronger knee flexors, hip flexors, plantar flexors, and total leg strength than women. Men who were 16-22 years old had stronger knee flexors and hip flexors than did younger men and women players. Based on discriminant function, knee strength measures did not adequately classify gender. Instead, total leg strength measures had correct gender classifications of 74 and 69% (jackknifed) with significant multivariate tests (p = 0.025). For researchers and practitioners, these results support strength assessment and training of the whole lower extremity, not just knee musculature. Limited strength differences between girls 9-10 years old and those 12-13 years old suggest that the peripubertal period is an important time to target strength development.

Moving toward a grand theory of development: in memory of Esther Thelen.

This paper is in memory of Esther Thelen, who passed away while President of the Society for Research in Child Development. A survey of Esther Thelen's career reveals a trajectory from early work on simple movements like stepping, to the study of goal-directed reaching, to work on the embodiment of cognition, and, ultimately, to a grand theory of development--dynamic systems theory. Four central concepts emerged during her career: (1) a new emphasis on time; (2) the proposal that behavior is softly assembled from the interaction of multiple subsystems; (3) the embodiment of perception, action, and cognition; and (4) a new respect for individuality. Esther Thelen communicated these ideas to scientists and practitioners alike, so the ultimate benefactors of her work were children.

Telithromycin in the treatment of pneumococcal community-acquired respiratory tract infections: a review.

OBJECTIVES: A pooled analysis of 14 Phase III studies was performed to establish the clinical and bacteriologic efficacy of telithromycin 800 mg once daily in the treatment of pneumococcal community-acquired respiratory tract infections (RTIs). METHODS: Data were examined from 5534 adult/adolescent patients with community-acquired pneumonia (CAP), acute exacerbations of chronic bronchitis (AECB), or acute bacterial sinusitis, who had received telithromycin for 5-10 days or a comparator antibacterial. RESULTS: Streptococcus pneumoniae was identified in 704/2060 (34.2%) bacteriologically evaluable patients. The respective per-protocol clinical cure rates for telithromycin and comparators were 94.3% and 90.0% (CAP); 81.5% and 78.9% (AECB); 90.1% and 87.5% (acute sinusitis); 92.7% and 87.6% (all indications). Clinical cure rates were 28/34 (82.4%) and 5/7, respectively, for penicillin-resistant infections, and 44/52 (84.6%) and 11/14, respectively, for erythromycin-resistant infections. Of 82 patients with pneumococcal bacteremia, 74 (90.2%) were clinically cured after telithromycin treatment, including 5/7 and 8/10 with penicillin- or erythromycin-resistant strains, respectively. Adverse events considered possibly related to study medication were reported by 1071/4045 (26.5%) telithromycin and 505/1715 (29.4%) comparator recipients. These events were generally of mild/moderate severity, and mainly gastrointestinal in nature. CONCLUSIONS: As S. pneumoniae is the leading bacterial cause of community-acquired RTIs, and antibacterial resistance is increasing among this species, these findings support the use of telithromycin as first-line therapy in this setting.

Sex-Related and Age-Related Differences in Knee Strength of Basketball Players Ages 11-17 Years.

OBJECTIVE: To assess hamstrings and quadriceps strength of basketball players ages 11-13 and 15-17 years. DESIGN AND SETTING: This cross-sectional study occurred during the 2000 American Youth Basketball Tour National Tournament. We investigated whether sex- or age-related strength differences existed among study participants. SUBJECTS: Forty-one tournament participants (22 girls, 19 boys; 11-13 or 15-17 years old) who reported no history of knee sprain or surgery were recruited. MEASUREMENTS: We used a Cybex II dynamometer to obtain isokinetic concentric peak torques relative to body mass (Nm/kg) at 60 degrees /s for hamstrings and quadriceps bilaterally. From average peak torques, we determined ipsilateral hamstrings:quadriceps and homologous muscle-group ratios. RESULTS: Correlations between hamstrings and quadriceps strength measures ranged from 0.78 to 0.97. Players 15-17 years old had greater relative hamstrings and quadriceps strength than 11- to 13-year-old athletes. Age and sex interacted significantly for quadriceps strength. The quadriceps strength of 15- to 17-year-old girls did not differ from that of 11- to 13-year-old girls, whereas 15- to 17-year-old boys had stronger quadriceps than 11- to 13-year-old boys. Boys 15-17 years old had greater quadriceps strength than girls 15-17 years old. CONCLUSIONS: This study is unique in providing normative data for the hamstrings and quadriceps strength of basketball players 11-13 and 15-17 years old. Age-related strength differences did not occur consistently between the sexes, as girls 11-13 and 15-17 years old had similar relative quadriceps strength.

Community-acquired respiratory tract infections caused by resistant pneumococci: clinical and bacteriological efficacy of the ketolide telithromycin.

The incidence of community-acquired respiratory tract infections caused by Streptococcus pneumoniae exhibiting antibacterial resistance has increased dramatically in recent years. Telithromycin is the first of a new class of antibacterials, the ketolides, which have been developed specifically to provide effective treatment for these infections. Data were analysed from 3935 patients who had participated in one Japanese Phase II study and 11 US/global Phase III studies in three indications: community-acquired pneumonia, acute exacerbations of chronic bronchitis or acute sinusitis. Patients received either telithromycin 800 mg once daily or a comparator antibacterial. S. pneumoniae isolates considered to be causative for infection were tested for susceptibility to penicillin G and erythromycin A. In per-protocol analyses, telithromycin showed a high level of clinical efficacy against S. pneumoniae, with clinical cure rates of 92.8% for all isolates, 91.7% for those with reduced susceptibility to penicillin G and 86.0% for those with reduced susceptibility to erythromycin A. Bacterial eradication rates were consistent with the clinical outcomes. High rates of clinical cure and bacterial eradication were also observed for infections caused by isolates demonstrating high-level resistance to erythro-mycin A [MICs >/= 512 mg/L: 100% (13/13) clinical cure, 100% (13/13) bacterial eradication]. These results support the use of telithromycin as a first-line oral therapy for the treatment of community-acquired respiratory tract infections caused by S. pneumoniae with reduced susceptibility to penicillin G and erythromycin A.

A comparison of the efficacy of telithromycin versus cefuroxime axetil in the treatment of acute bacterial maxillary sinusitis.

BACKGROUND: Telithromycin, a new ketolide, exhibits potent activity against respiratory pathogens, including resistant strains. METHODS: Five days of telithromycin (800 mg once daily) was compared with 10 days of cefuroxime axetil (250 mg twice daily) in subjects (n = 593) with acute bacterial maxillary sinusitis (ABMS). Bacteriologic sampling was accomplished by sinus puncture or nasal endoscopy. The primary efficacy variable was clinical outcome at the posttherapy/test-of-cure evaluation in clinically evaluable patients. RESULTS: Clinical cure was achieved in 85.2% of telithromycin patients and 82.0% of cefuroxime axetil patients (difference in proportions, 3.2%; 95% confidence interval, -7.1-13.4%). Satisfactory bacteriologic response rates were comparable. Treatment-emergent adverse events for both drugs were mild or moderate. The most frequently reported treatment-emergent adverse events were nausea and diarrhea. CONCLUSION: Once-daily telithromycin for 5 days was equivalent in efficacy to twice-daily cefuroxime axetil for 10 days in patients with ABMS. Telithromycin is a suitable option for short-course therapy of ABMS.