Background and Purpose Manual therapy and exercise have not previously been compared with a home exercise program for patients with osteo-arthritis (OA) of the knee. The purpose of this study was tocompare outcomes between a home-based physical therapy program and a clinically based physical therapy program. Subjects. One hundred thirty-four subjects with OA of the knee were randomly assigned to a clinictreatment group (n=66; 61% female, 39% male; mean age [±SD]=64±10 years) or a home exercise group (n=68, 71% female, 29% male; mean age [±SD]=62±9 years). Methods. Subjects in the clinic treatment group received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. Subjects in the home exercise group received thesame home exercise program initially, reinforced at a clinic visit 2 weeks later. Measured outcomes were the distance walked in 6 minutes and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. Both groups showed clinically and statistically significant improvements in 6-minute walkdistances and WOMAC scores at 4 weeks; improvements were still evident in both groups at 8 weeks. By 4 weeks, WOMAC scores had improved by 52% in the clinic treatment group and by 26% in the home exercise group. Average 6-minute walk distances had improved about 10% in both groups. At 1 year, both groups were substantially and about equally improved over baseline measurements. Subjects in the clinic treatment group were less likely to betaking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment compared with subjects in the home exercise group. Discussion and Conclusion Although both groups improved by 1 month, subjects in the clinic treatment group achieved about twice as much improvement in WOMAC scores than subjects who performed similar unsupervised exercises at home. Equivalent maintenance of improvements at 1 year was presumably due to both groups continuing the identical home exercise program. The results indicate that a home exercise program for patients with OA of the knee provides important benefit. Adding a small number of additional clinical visits for the application of manual therapy and supervised exercise adds greater symptomatic relief.

of dobutamine on regional myocardial blood flow and ventricular performance during acute and chronic myocardial ischemia in dogs.

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Diagnosis of injury to the myocardium is facilitated by information on the activities of creatine kinase (EC 2.7.3.2) MB isoenzyme (CK-MB) and lactate dehydrogenase (EC 1.1.1.27) isoenzyme 1 in serum, thee isoenzymes being present in higher activities in the myocardium than in other tissues or in normal serum. The temporal relationships of these isoenzymes, total creatine kinase, total lactate dehydrogenase, and aspartate aminotransferase (EC 2.6.1.1) are highly sensitive and specific for acute injury to the heart, particularly acute myocardial infarction. Chronic heart diseases, electric cardioversion for heart rhythm disturbances, coronary catheterization, and exercise usually do not produce increases of CK-MB, although abnormal aspartate aminotransferase, creatine kinase, lactate dehydrogenase, and lactate dehydrogenase isoenzyme 1 activities are seen in some individuals. Many other causes of increased activities of these enzymes and isoenzymes in serum are unrelated to injury to the heart. Because CK-MB is present in the skeletal muscle in low activities, substantial injury to skeletal muscle can increase CK-MB activities in the blood to abnormal values. Pulmonary embolism can mimic myocardial infarction in its clinical presentation. In patients with an accurately known time of onset of symptoms and serial enzyme analysis every 12 h during the first 48 h, acute myocardial infarction can be distinguished from pulmonary embolism by determinations of creatine kinase, CK-MB, aspartate aminotransferase, and lactate dehydrogenase isoenzyme 1 in serum.

Purpose -The purpose of this paper is to examine the continuing search for evidence that good corporate governance leads to positive organizational outcomes, and it presents a unique perspective on this issue based on firm size.Design/methodology/approach -The study utilized a comprehensive measure of governance as well as a risk-adjusted measure of share price in its comparisons between companies known for good governance and broader markets composed of similar-sized firms.Findings -The findings show evidence of better risk-adjusted performance across all recent sub-periods (three-, five-, and ten-year) for the firms in the smallest market capitalization category. Better risk-adjusted returns were earned for only the ten-year period for the largest firms and the overall US market. Mid-cap stocks were not significant in any of the three periods studied. The fact that the small cap stocks showed significance for all three sub-periods indicates the relationship between good corporate governance practices and the financial success of a company is the strongest for smaller firms and is more likely to be experienced in longer time horizons for most firms, small and large.Research limitations/implications -Investigations of this seminal issue have produced mixed results because the operational definitions of governance often are too narrow, the timeframes for impact are too constricted, and the comparisons are too broad. In addition, the use of a novel approach for understanding why these findings may hold true provides scholars with new avenues for thinking about and modeling the governance-performance relationship.Practical implications -Good governance matters and requires managers and policy makers to find the appropriate context in order to have meaningful comparisons. Social implications -The paper supports the ''doing well while doing good'' paradigm for both individual and institutional investors' investment choices by showing that selecting firms that practice good corporate governance can be a long-term value-maximizing strategy.Originality/value -A major nuance from other studies of the impact of a firm's corporate governance performance on its financial performance is the authors' use of four sub-categories of companies based on market capitalization/firm size. Findings ultimately show whether investors/owners reward corporate governance via stock purchases, and if so, how this relationship may have changed over the past decade according to various markets and risk-adjusted returns.