Background and Relevance: Atherosclerotic stenosis of the major intracranial arteries is an important cause of transient ischemic attack (TIA) or stroke. Of the 900,000 patients who suffer a TIA or stroke each year in the USA, intracranial stenosis is responsible for approximately 10%, i.e. 90,000 patients. There have been no prospective trials evaluating antithrombotic therapies for preventing recurrent vascular events in these patients. The main objective of this trial is to compare warfarin [International Normalized Ratio (INR) 2–3] with aspirin (1,300 mg/day) for preventing stroke (ischemic and hemorrhagic) and vascular death in patients presenting with TIA or stroke caused by stenosis of a major intracranial artery. Study Design: Prospective, randomized, double-blind, multicenter trial. The sample sizerequired will be 403 patients per group, based on stroke and vascular death rates of 33% per 3 years in the aspirin group vs. 22% per 3 years in the warfarin group, a p value of 0.05, power of 80%, a 24% rate of ‘withdrawal of therapy’, and a 1% rate of ‘lost to follow-up’. Conduct of Trial: Patients with TIA or nondisabling stroke caused by ≧50% stenosis of a major intracranial artery documented by catheter angiography are randomized to warfarin or aspirin. Patients are contacted monthly by phone and examined every 4 months until a common termination date. Mean follow-up in the study is expected to be 3 years. Conclusion: This study will determine whether warfarin or aspirin is superior for patients with symptomatic intracranial arterial stenosis. Furthermore, it will identify patients whose rate of ischemic stroke in the territory of the stenotic intracranial artery on best medical therapy is sufficiently high to justify a subsequent trial comparing intracranial angioplasty/stenting with best medical therapy in this subset of patients.

We have developed a classification system for osteoarthritis (OA) of the scaphotrapeziotrapezoidal (STT) joint that can be used on posteroanterior, lateral, and oblique wrist radiographs. It can be used to communicate the degree of severity of arthritis, and to study arthritis in the wrist further. Currently we know of no classification system for OA of the STT. We devised a classification system and made an initial study to assess the reproducibility of the system. It was compared with a classification system similar to the Eaton classification of carpometacarpal OA of the thumb. Cohen's kappa test and the sign test were used for comparison. Thirty-seven of the 46 wrists evaluated (80%) showed radiographic evidence of osteoarthritis of the scaphotrapeziotrapezoidal joint. Most kappa values for intrarater and inter-rater reliability lay between 0.87 and 0.95. There was absolute agreement between both systems about the existence of osteoarthritis. When we compared the two classification systems, ours tended to underestimate the arthritic stage. This classification may be helpful for communication, comparison, and evaluation of osteoarthritis of the STT joint among surgeons. Further study is needed to define the clinical and mechanical relevance of osteoarthritis in this joint.

Principles of implicit learning were integrated into the interventions for these patients with moderate AD. However, the feasibility of applying the EL paradigm was limited. Further research on the effectiveness of EL, spaced retrieval, and other rehabilitation strategies that facilitate implicit learning of mobility skills in patients with AD is needed to promote optimal physical therapy outcomes in this patient population.

Purpose: To develop and provide initial psychometric support for a 16-item measure that assesses a new construct termed desire for physical competence (DPC). Methods: A total of 157 older adults (aged 60 -95) were administered the DPC along with various other questionnaires that assessed demographics, health status, social desirability, desire for control, body satisfaction, and life satisfaction. These data facilitated development and initial psychometric evaluation of the scale. An additional sample of 30 older adults was employed to examine test-retest reliability. Results: Based on the conceptual foundation of DPC and results from an exploratory factor analysis, a single-dimension Rasch model based on response theory was applied to the data. The proposed model fit the data quite well as indicated by the average mean square of both outfit (1.02) and infit (1.04) statistics. The DPC correlated in expected directions with age, r ϭ Ϫ0.33 (P Ͻ 0.01), and had r values of 0.23, 0.22, 0.25 (all P values Ͻ0.01) with desire for control, body satisfaction, and the SF-36, respectively. Older adults with arthritis had lower DPC scores than those without arthritis. The measure was not confounded by social desirability, and test-retest reliability of the measure (Ͼ0.90) was excellent. Conclusions:The DPC provides a tool to assess the incentive value of older adults for being physically competent. As such, it provides a more complete social cognitive foundation for studies examining physical activity behavior and the process of physical disablement.