bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug Samples and Family Practice Residents
Authors: Shaughnessy Allen F , Bucci Kathryn K
Published: January 2017

OBJECTIVE:

To describe residents' knowledge, attitudes, and behaviors regarding sample medications and to determine the education provided in residency training regarding sample use.

METHODS:

A 6-item survey was sent to directors of US family practice residency programs. Residents of a sample of these programs were sent an anonymous, self-administered, 21-item questionnaire assessing knowledge, attitudes, and practices relating to sample use. Both surveys consisted of initial and follow-up mailings.

RESULTS:

The residency directors' survey was returned by 232 of the 436 residency directors (53%). Although 66% of the programs had a policy regarding samples, only 15% of the policies completely incorporated recommendations of the Society of Teachers of Family Medicine. After two mailings, 248 resident responses were received from 43 of 47 residencies (92%). Only 21% of respondents thought that they received adequate training about sample use in medical school; this number increased to 49% for residency training. Agreement with the adequate training statement was highest among respondents from residencies that had both a sample distribution policy and a pharmacist (p = 0.044). Fifty-five percent thought that samples influenced their prescribing and 70% thought that samples helped them to learn more about the sampled medication.

CONCLUSIONS:

Family practice residents value and use samples, although they are often unaware of the rules governing the labeling of samples. While reported distribution of samples by residents often is appropriate, education about effective sample use could be improved. Drug samples play a significant role in residency training.
Continuous Intrathecal Meperidine via an Implantable Infusion Pump for Chronic, Nonmalignant Pain
Authors: Harvey Susan C , O'Neil Michael G , Pope Catherine A , Cuddy Brian G , Duc Thomas A
Published: January 2017

OBJECTIVE:

To report a continuous infusion of intrathecal meperidine via an implanted infusion pump for nonmalignant, chronic pain.

CASE SUMMARY:

A 69-year-old white woman had chronic, nonmalignant low-back pain and bilateral leg pain. Multiple drug therapies and other interventional techniques had failed. The patient achieved significant pain relief by a continuous infusion of intrathecal meperidine via an implanted infusion pump.

DISCUSSION:

To our knowledge, this is the first report of meperidine administered intrathecally by continuous infusion. Continuous infusion of intrathecal and epidural opiates by implanted infusion pumps is becoming more widely recognized as an alternative treatment for patients with chronic, benign pain. Epidural and intrathecal meperidine is an effective analgesic for short-term surgical procedures. Data reporting effective relief and safety with continuous intrathecal meperidine remain limited.

CONCLUSIONS:

Continuous intrathecal meperidine via an implantable infusion pump may be an effective alternative in the treatment of chronic pain.
Olanzapine: A New Antipsychotic Agent with Efficacy in the Management of Schizophrenia
Authors: Kando Judith C , Shepski John C , Satterlee Winston , Patel Jayendra K , Reams Stephen G , Green Alan I
Published: January 2017

OBJECTIVE:

To review the pharmacology, pharmacokinetics, efficacy data, and adverse effects of olanzapine as a treatment for schizophrenia and to determine the advantages and disadvantages of this atypical antipsychotic agent compared with currently marketed agents.

DATA SOURCES:

A MEDLINE computer literature search was conducted to retrieve all English-language studies and review articles involving olanzapine published as of October 1, 1996. The manufacturer of the drug, Eli Lilly and Company, provided the clinical investigator's brochure and abstracts of unpublished Phase III clinical trials.

STUDY SELECTION:

Animal studies evaluating the pharmacology of olanzapine were evaluated, as were all open-label and double-blind studies involving the evaluation of olanzapine for the treatment of patients with schizophrenia.

DATA EXTRACTION:

All available clinical studies were reviewed and the interpretation of data for each study was influenced by the size of the study sample, the nature of the inclusion and exclusion criteria, and the data analysis techniques used.

DATA SYNTHESIS:

Olanzapine is a thienobenzodiazepine analog with an in vitro receptor affinity profile similar to that of clozapine. Olanzapine exhibits linear kinetics over the dosage range studied and is extensively metabolized in humans. Clinical evaluations to date have shown olanzapine to be at least as efficacious as typical antipsychotic agents in the treatment of the acute phase of schizophrenia. The drug was well tolerated, with significantly fewer extrapyramidal adverse effects than haloperidol. Current data suggest that olanzapine may be more effective than haloperidol for the treatment of negative symptoms; moreover, preliminary data suggest that fewer relapses occur over the course of treatment in patients treated with olanzapine compared with those taking haloperidol.

CONCLUSIONS:

The exact place of olanzapine in the therapy of psychotic patients remains unclear, as more data are needed to evaluate the long-term efficacy of this agent, its impact on negative symptoms, and its potential use in patients resistant to the standard agents. Despite limitations in the current database, olanzapine is a promising treatment option for patients with schizophrenia.
Muromonab-Cd3 and Antithymocyte Globulin in Renal Transplantation
Authors: Burk Muriel L , Matuszewski Karl A
Published: January 2017

OBJECTIVE:

To review the recently published medical literature for the practical and efficient use of muromonab-CD3 (OKT-3) and antithymocyte globulin (ATG) in renal transplantation.

DATA SOURCES:

MEDLINE and EMBASE were searched (1985-February 1996). Key words used were antithymocyte globulin (ATG, Atgam), muromonab-CD3 (OKT-3, Orthoclone), and kidney transplantation. Thereafter, the search was restricted to English-language articles, clinical trials, and human studies.

STUDY SELECTION AND DATA EXTRACTION:

The search was reviewed for articles of interest, and pertinent references from these articles were further reviewed to supplement the initial search. The review focused on antibody therapy as induction and/or rejection therapy in renal transplantation.

DATA SYNTHESIS:

Although ATG and OKT-3 are effective in delaying and reducing the occurrence of acute rejection, their impact on long-term graft survival has not been established. Improved graft survival has, however, been demonstrated in patients at high risk for rejection. These risks are described in the review. As first-line or steroid-resistant rejection therapy, ATG and OKT-3 have proven efficacious. Some studies have shown improved graft survival with OKT-3. Although serious infections may occur, OKT-3 has been shown to be effective in reversing rejections resistant to both steroids and ATG. Therefore, reserving OKT-3 for steroid- or ATG-resistant rejections may be preferred over the first-line use of OKT-3, which is limited by the development of antimurine antibodies with subsequent uses. However, the benefits of first-line antibody therapy may outweigh the risks of developing these antibodies in patients for whom high-dose steroids may not be the most appropriate treatment. Other factors that need to be considered are adverse effects, which appear to be lower with ATG, cost, and total hospital charges. The accuracy of treatment outcomes analysis among these studies is limited by variations in the immunosuppressive regimens of the study centers, doses of concomitant therapies, use of prophylactic antibiotics, and time to follow-up.

CONCLUSIONS:

While important benefits are realized from using antibody therapies in renal transplantation, their use is often associated with excess immunosuppression and increased treatment costs. Despite encouraging results from published trials, questions regarding the extent of their prophylactic use and impact on long-term outcomes need to be answered. The current literature contains no prospective, controlled, randomized comparisons of OKT-3 and ATG with standardized regimens of conventional immunosuppressive agents and antirejection protocols. The majority of studies use OKT-3 as part of the treatment protocol. Well-designed studies using ATG are lacking. Further research is needed to refine treatment protocols for ATG and OKT-3 to determine the optimal timing and dosing for these agents.
Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program
Authors: Koenig Lane , Soltoff Samuel A. , Demiralp Berna , Demehin Akinluwa A. , Foster Nancy E. , Steinberg Caroline Rossi , Vaz Christopher , Wetzel Scott , Xu Susan
Published: January 2017

In 2016, Medicare’s Hospital-Acquired Condition Reduction Program (HAC-RP) will reduce hospital payments by $364 million. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the assignment of penalties. This study investigated possible bias in the HAC-RP by simulating hospitals’ likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure’s complication rate. For 3 of 8 measures examined, the equal-quality simulation identified poor performers similarly to empirical data (c-statistic approximately 0.7 or higher) and explained most of the variation in empirical performance by size (Efron’s R2 > 0.85). The Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader “all-harm” measure.
Single Stage Correction with External Fixation of the Ulcerated Foot in Individuals with Charcot Neuroarthropathy
Authors: Farber Daniel C. , Juliano Paul J. , Cavanagh Peter R. , Ulbrecht Jan , Caputo Gregory
Published: January 2017

The ulcerated foot in individuals with Charcot neuroarthropathy presents a complex problem when correction of the deformity is necessary but the presence of infection precludes the use of internal fixation. We reviewed 11 patients with midfoot Charcot neuroarthropathy, collapse, and ulceration who were at risk for amputation. These patients underwent operative debridement, corrective osteotomy, external skeletal fixation and culture-directed antibiotic therapy as a limb salvage procedure. Patients were transitioned from the external fixator (average 57 days) to total contact casting (average 131 days) and all subsequently progressed to therapeutic footwear in 12 to 49 months of follow-up (average 24 months), except one patient whose medical decline resulted in bedrest. We believe that when performed in properly selected patients, this procedure presents an alternative to amputation and, via corrective osteotomy, results in a shoe-able, functional foot that is potentially less prone to ulceration.
Autologous Osteochondral Grafting for Talar Cartilage Defects
Authors: Al-Shaikh Raad A. , Chou Loretta B. , Mann Jeffrey A. , Dreeben Sharon M. , Prieskorn David
Published: January 2017

The purpose of this study was to evaluate the clinical results of Osteochondral Autograft Transfer System (OATS) for the treatment of symptomatic osteochondral defects of the talus using standardized outcome analysis. Nineteen patients with symptomatic osteochondral defect (OCD) of the talus were treated with autologous osteochondral grafting. There were six men and 13 women. The average age was 32 years (range, 18 to 48 years). The average duration of symptoms prior to surgery was 4.2 years (range, three months to 12 years). All patients had failed nonoperative treatment, and 13 (68%) patients had failed prior excision, curettage and/or drilling of the lesion. The average size of the lesion prior to autografting was 12 mm × 10 mm (range, 10 × 5 mm to 20 × 20 mm). Donor plugs were harvested from the trochlear border of the ipsilateral femoral condyle. Ankle exposure was obtained with a medial malleolar osteotomy in 13 patients, arthrotomy in five patients and lateral malleolar osteotomy in one patient. Clinical evaluations were performed for both the recipient ankle and donor knee using the AOFAS Ankle/Hindfoot Scale and Lysholm knee scale, respectively. The average follow-up time was 16 months (range, 12 to 30 months). The average postoperative AOFAS ankle score was 88 (range, 60 to 100). Most patients had occasional mild pain, but excellent function, range of motion, stability and alignment. The average postoperative ankle score for the 13 patients who failed prior surgery was 91 (range, 84 to 100). The average postoperative Lysholm knee score was 97 (range, 87 to 100). Only two patients had mild knee pain. Postoperative radiographs were available for 13 patients. There was no evidence of graft subsidence and all grafts healed. All malleolar osteotomies united. Seventeen (89%) patients said that they would undergo the procedure again. The results of osteochondral autograft transplant for OCD lesions of the talus demonstrate excellent postoperative ankle scores including improvement of pain and function with minimal knee donor site morbidity. Also, our results indicate that this is an effective salvage procedure following failed previous procedures and for patients with longstanding symptoms.
Safety and Efficacy of the Popliteal Fossa Nerve Block When Utilized for Foot and Ankle Surgery
Authors: Provenzano David A. , Viscusi Eugene R. , Adams Samuel B. , Kerner Michael B. , Torjman Marc C. , Abidi Nicholas A.
Published: January 2017

The popliteal fossa nerve block (PFNB) offers numerous advantages that make it a suitable anesthetic technique for foot and ankle surgery. In this retrospective study, we investigated the acute and long-term safety and efficacy of this relatively underutilized anesthetic technique for foot and ankle surgery. A review of 834 patients who underwent foot and/or ankle surgery by the coauthor (NAA) was conducted. Four hundred sixty-seven patients received a PFNB with the aid of a peripheral nerve stimulator. Variables assessed included the quality of surgical anesthesia, postoperative analgesia and the acute and long-term incidence of postoperative neuralgia and neuropraxia. The PFNBs were performed by anesthesiologists with various levels of training at a tertiary care hospital and all were supplemented with a saphenous nerve block. The PFNB was successful as the sole anesthetic technique in 79% of the cases; 18% were converted to general anesthesia and 3% required augmentation with local anesthetic. There were no complications associated with the PFNB. There were no incidents of postoperative neuralgia or neuropraxia. Only 12% of patients with a successful block required analgesics in the PACU, while 60% of patients with a failed block required systemic analgesics for surgical site pain (p<0.01). These results suggest that the performance of the PFNB with the guidance of a peripheral nerve stimulator is a safe and effective anesthetic technique for foot and ankle surgery.
Two Modifications of the Weil Osteotomy: Analysis on Sawbone Models
Authors: Melamed Eyal A. , Schon Lew C. , Myerson Mark S. , Parks Brent G.
Published: January 2017

Second metatarsal osteotomies (30° angle to shaft) were performed in 40 sawbones with:

1. head shifted proximally 5 mm; 2. head shifted proximally 10 mm; 3. 5-mm slice resected and head shifted proximally 5 mm; or 4. 5-mm dorsally based wedge resected and head shifted proximally 5 mm.

Bone slice resection resulted in shortening (16.4 ± 1.7 mm) and mild plantar displacement of the head (3.5 + 0.8 mm). Bone wedge excision resulted in moderate shortening (7.8±0.9 mm) and essentially no plantar displacement of the head (0.8±1.4 mm).
Pulmonary Embolism following Operative Treatment of Ankle Fractures: A Report of Three Cases and Review of the Literature
Authors: Wang Frank , Wera Glenn , Knoblich Guenther O. , Chou Loretta B.
Published: January 2017

The risks of thromboembolism following operative treatment of ankle fractures are deep vein thrombosis (DVT) and pulmonary embolism (PE). These are potentially life-threatening complications. Many orthopedic surgeons fail to appreciate the potential complications of thromboembolic events because of their rare and delayed occurrence in foot and ankle operations. The purpose of this report is to describe the potential for DVT and PE following ankle operations. We present three cases in which patients who underwent operative treatment of ankle fractures subsequently developed PE. We also review the literature on the prevalence of thrombosis, risk factors, methods of prophylaxis, and use of prophylaxis in surgical procedures of the lower extremity.
Bone Marrow Edema of the Forefoot after Chevron Osteotomy—A Rare Cause of Metatarsalgia: A Case Report
Authors: Aigner Nicolas , Petje Gerd , Steinboeck Gunther , Schneider Wolfgang , Krasny Christian , Landsiedl Franz
Published: January 2017

Treatment options of bone marrow edema syndrome, which is associated with vascular disturbances, are protracted nonoperative treatment or core decompression which still demands several weeks until complete recovery. We obtained excellent results by the use of the vasoactive drug iloprost, a stable prostacyclin analogue, leading to a complete relief of symptoms in cases of bone marrow edema which had initially suggested early avascular necrosis of the second metatarsal head. The bone marrow edema of the second metatarsal bone was thought to be due to altered biomechanics following a distal first metatarsal chevron osteotomy. During the five days of iloprost infusion, the patient reported relief of rest pain. After therapy, the pedobarogram was normalized. The AOFAS forefoot score improved from 44 to 85 points after one month, and to 95 points after three months. At that time, the marrow showed normal signals. Without additional intervention the patient was able to resume normal activities.
A Biomechanical Study of Two Postoperative Prostheses for Transtibial Amputees: A Custom-Molded and a Prefabricated Adjustable Pneumatic Prosthesis
Authors: Boucher Henry R. , Schon Lew C. , Parks Brent , Kleeman Jay , Dunn Warren R. , Badekas Thanos , Noll Kenneth , Melamed Eyal
Published: January 2017

We evaluated an adjustable pneumatic prefabricated prosthesis and a rigid custom-molded prosthesis for immediate postoperative use. Twelve transtibial amputations were performed on cadaver limbs. Differential variable reluctance transducers were placed subcutaneously across the wound edge medially and laterally. The limbs were then placed in either the pneumatic prosthesis (five limbs) or the rigid prosthesis (seven limbs). The specimens underwent static and cyclic loading to simulate weight bearing. The strain readings for static and cyclic loading were greater in the rigid prosthetic group. Only the mean medial strain measurement after cyclic loading was statistically significant. The results demonstrate that the pneumatic prosthesis places less strain across the wound than a rigid prosthesis.
The Management of Concomitant Tears of the Peroneus Longus and Brevis Tendons
Authors: Redfern David , Myerson Mark
Published: January 2017

Background:

Concomitant chronic tears of both peroneal tendons rarely are reported. We present our experience in treating these injuries and suggest an algorithm for surgical treatment, determined by the presence of a functioning tendon or tendons, mobility of the remaining peroneal musculature, ankle stability, and position of the heel.

Methods:

Twenty-eight consecutive patients (29 feet) were followed postoperatively for a mean of 4.6 (range 1.5 to 8) years. The mean age was 36 (range 19 to 54) years, and all patients had chronic ankle pain with or without instability and with combinations of complete, partial, or longitudinal tears of both tendons. Of the 28 patients, six had hindfoot varus and three had cavovarus. Eight patients had mechanical ankle instability, but there was no correlation between instability and the presence of hindfoot varus.

Results:

The mean postoperative American Orthopaedics Foot and Ankle Society ankle score was 82 (range 20 to 100) points, and 91% of patients achieved normal or moderate peroneal muscle strength. Ankle instability was successfully corrected in all patients and progressive worsening of varus deformity was prevented.

Conclusion:

The presence of chronic peroneal tendon subluxation or dislocation, chronic ankle instability, or hindfoot varus deformity, in association with retrofibular pain and swelling, should alert the surgeon to the possibility of a tear of the peroneal tendons and is an indication for surgical intervention. At the time of tendon repair, every effort should be made to treat the primary or contributing causes of the tear. Our results suggest that patients with symptomatic concomitant peroneus longus and brevis tendon tears are likely to experience substantial improvement in function if operative treatment is adequate.
Comparison between Manual and Computer-Assisted Measurements of Hallux Valgus Parameters
Authors: Panchbhavi Vinod K. , Trevino Saul
Published: January 2017

Background:

The aim of this study was to determine if there are intraobserver and interobserver differences in reliability when measuring hallux valgus angles (HVA), 1–2 intermetatarsal angles (IMA), and distal metatarsal articular angles (DMAA) manually compared to computerassisted means. Our hypothesis was that the measurements taken by computer-assisted methods of these three forefoot angles would be superior in consistency and accuracy compared to manual measurements.

Methods:

Four examiners studied 20 weightbearing anteroposterior radiographs of patients with hallux valgus. Manual measurements were taken on photographic prints using a goniometer and a fine point pen. Computer-assisted measurements were taken on digitized images using computer software. Three sets of measurements by both of these methods were taken 1 week apart.

Results:

There was no statistically significant difference between digital and manual measurements for any of the three angles measured ( p.05). However, the reliability of measurements within a range of 5 degrees for both methods was 70.6% for HVA, 84% for 1–2 IMA, and 59% for DMAA.

Conclusion:

There were no significant differences in interobserver and intraobserver reliability in measuring 1–2 IMA and HVA, regardless of the method of measurement; however, there was a significant difference in interobserver reliability when measuring the DMAA either on computer or manually ( p = < .05).
Trimalleolar Fractures with Impaction of the Posteromedial Tibial Plafond: Implications for Talar Stability
Authors: Weber Martin
Published: January 2017

Background:

Trimalleolar fractures usually include a lateral malleolar fracture, a triangular fracture of the posterolateral corner of the tibial plafond, and a horizontal or oblique fracture of the medial malleolus. A subtype of a trimalleolar fracture is reported, differing in the shape and extent of the medial malleolar fracture and the posterior lip fracture, with implications for treatment.

Methods:

In a 3-year period, 10 patients were treated for a trimalleolar fracture with a multifragmentary transverse fracture of the entire posterior tibial lip, including the posterior colliculus of the medial malleolus. The radiographs of all patients showed a pathognomonic double-contour or flake-fragment sign above the medial malleolus. One patient's posteromedial fracture was not initially recognized and he had a standard lateral fracture repair. A double posterior approach was used in nine patients, with fracture repair proceeding from medial to lateral. Intraoperatively, eight of nine patients had impacted osteochondral fragments at the posteromedial corner of the tibial plafond that blocked anatomic reduction and allowed posteromedial subluxation of the talus.

Results:

Nine patients had anatomic reconstruction of the posteromedial corner. All fractures healed, and function was normal at one year. One patient had moderate loss of joint space. The patient with the malunited fracture developed symptomatic posteromedial instability of the talus and required an osteotomy of the malunited fragment. He had a good result at 18 months.

Conclusions:

This unique subtype of trimalleolar fracture has distinct radiological features and implications for the strategy of the operative treatment. If recognized immediately and treated appropriately, the results were excellent. If missed initially, reconstructive osteotomy was possible and led to a good result.
Results of Step-Cut Medial Malleolar Osteotomy
Authors: Thordarson David B. , Kaku Shawn K.
Published: January 2017

Background:

Treatment of certain complex ankle pathology, such as a talar body fracture or osteochondral lesion requiring grafting, can necessitate medial malleolar osteotomy for adequate operative exposure. This paper evaluates the step-cut medial malleolar osteotomy for exposure of the ankle joint.

Method:

Fourteen patients with intra-articular pathology, including talar body fractures or osteochondral lesions necessitating extensive intra-articular exposure had step-cut malleolar osteotomy. The average age of the patients was 37 (range 20–90) years, and the average followup was 8 months.

Results:

All 14 patients had an uncomplicated intraoperative course, with excellent exposure of the ankle joint. All patients had prompt healing of the osteotomy by 6 weeks after surgery without loss of reduction. None of the patients had pain at the osteotomy site.

Conclusions:

Step-cut medial malleolar osteotomy is an excellent, reproducible method for extensive exposure of the talar dome.
Indications for and Technique of First Metatarsophalangeal Joint Arthroscopy
Authors: Debnath U.K. , Hemmady M.V. , Hariharan K.
Published: January 2017

Background:

Arthroscopy of the great toe metatarsophalangeal joint has been used for a variety of indications, ranging from synovitis to osteochondral defects. The purpose of the present study was to define the indications for arthroscopy, assess its efficacy, and demonstrate the limitations of this procedure.

Methods:

Hallux metatarsophalangeal joint arthroscopy was used in 20 patients (25 feet). Indications included degenerative disease with early osteophytosis, chondromalacia, osteochondral defects, loose bodies, arthrofibrosis, synovitis, gouty arthritis, first metatarsophalangeal joint pain with no obvious findings clinically and radiographically in young adults, and intra-articular fracture of the first metatarsophalangeal joint. All patients had a minimal followup of 2 years and were evaluated clinically and radiographically.

Results:

Arthroscopic surgery resulted in pain free first metatarsophalangeal joints in 95% (19 of 20 patients). Patients with degenerative disease had a pain-free joint for a minimum of 2 years. The patients with gouty arthritis and intra-articular fracture had good functional outcomes. Arthroscopy also helped in identifying the pathology in painful joints with no obvious radiographic features that included conditions such as ‘meniscoid’ and other impingement lesions.

Conclusion:

Arthroscopy of the first metatarsophalangeal joint is not suitable for patients with extensive degenerative changes and large osteophytes and those that require cheilectomy or arthrodesis. Arthroscopic management of certain painful hallucal metatarsophalangeal joints is a specialized technique, which if performed for the right indications, gives a favorable outcome with minimal complications.
Superior Retinaculoplasty for Recurrent Dislocation of Peroneal Tendons
Authors: Adachi Nobuo , Fukuhara Kohei , Tanaka Haruyuki , Nakasa Tomoyuki , Ochi Mitsuo
Published: January 2017

Background:

Although dislocation of peroneal tendons is an uncommon injury, if it does occur, daily and sports activities may be restricted because of snapping of the tendons and pain in the posterolateral aspect of the ankle joint. Many operative procedures have been reported for this pathology, including anatomic reattachment of the retinaculum, bone block procedures, tissue-transfer procedures, and groove-deepening. However, no procedure has been established as the “gold standard.” Successful results were reported after anatomic reattachment of the detached superior peroneal retinaculum and periosteum of the fibula. We have modified the procedure to reduce operative invasiveness and introduced a method to determine proper tension when suturing the retinaculum to the fibula.

Methods:

In our retinaculoplasty, the false pouch was opened through one incision, and the retinaculum was sutured to the fibula while measuring the tension, avoiding too tight or too loose suturing. We performed this procedure in 20 patients with symptomatic dislocation of peroneal tendons in whom conservative treatment had failed. We followed them over 2 years, and clinical results were evaluated.

Results:

No patient had re-dislocation of the peroneal tendons during the followup period. Fifteen of 18 patients who had been involved in sports activities returned to their previous activities without reducing their activity levels. All patients acquired full range of motion of the ankle joint postoperatively. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores improved significantly ( p value < 0.01) postoperatively.

Conclusions:

This study demonstrated that the described repair successfully treated patients with symptomatic dislocation of the peroneal tendon and should be considered for this pathology.
Arthroscopic Ankle Arthrodesis: Factors Influencing Union in 39 Consecutive Patients
Authors: Collman David R. , Kaas My Hoa , Schuberth John M.
Published: January 2017

Background:

Arthroscopic ankle arthrodesis is an effective alternative to open techniques with established advantages in select patient populations. The purpose of this study was to evaluate patients who had arthroscopic ankle arthrodesis for end-stage arthritis with minimal to no deformity of the ankle and to report factors influencing union.

Methods:

Thirty-nine consecutive patients had arthroscopic ankle arthrodesis between 1994 and 2003. Clinical records and radiographs were retrospectively reviewed to evaluate variables that could predispose patients to nonunion. Union outcomes were correlated with etiology of arthritis, ankle deformity, medical comorbidities, and the use of demineralized bone matrix or platelet-rich plasma. Arthroscopic ankle arthrodesis was accomplished with a consistent technique using crossed transmalleolar cannulated screw fixation.

Results:

Thirty-four of 39 patients (87.2%) achieved radiographic and clinical union. The average time to fusion was 47 (range 37 to 70) days. Poor bone quality and inherent positional ankle deformity were identified as risk factors for nonunion. Patients who smoked, had diabetes mellitus, peripheral neuropathy, or other medical comorbidities attained ankle union in nearly all cases. In obese patients, there was an observed trend towards ankle nonunion (relative risk 5.81, p = 0.049, Fisher's Exact test). The addition of demineralized bone matrix or platelet-rich plasma did not improve the rate of ankle union. Aside from nonunion, 10 patients developed minor complications.

Conclusion:

Arthroscopic ankle arthrodesis achieves high union rates, facilitates short time to union, and permits rapid patient mobility. Careful patient selection is important for the procedure. Synthetic allograft or platelet-rich plasma did not enhance the fusion rate. Obese patients showed a trend towards nonunion in this series.
Plantarflexion Strength of the Toes: Age and Gender Differences and Evaluation of a Clinical Screening Test
Authors: Menz Hylton B. , Zammit Gerard V. , Munteanu Shannon E. , Scott Genevieve
Published: January 2017

Background:

The toes play an important stabilizing role in weightbearing activities. However, the factors that influence toe plantarflexion strength are poorly understood, and there are no validated measures for assessing toe weakness in the clinical setting. Therefore, the objectives of this study were to determine whether plantarflexion strength of the toes differs according to age and gender and to evaluate the validity of a clinical screening test for assessing toe plantarflexor weakness (the paper grip test).

Methods:

Plantarflexion strength of the hallux and lesser toes was measured in 40 young participants (20 men and 20 women, mean age 20.8 ± 2.2 years) and 40 older participants (20 men and 20 women, mean age 74.6 ± 5.7 years) using a pressure platform in conjunction with clinical assessment using the paper grip test.

Results:

Older participants exhibited 32% less plantarflexion strength of the hallux and 27% less plantarflexion strength of the lesser toes compared to younger participants, and women exhibited 42% less hallux plantarflexor strength than men. Gender did not influence lesser toe plantarflexor strength. Participants who failed the paper grip test exhibited significantly reduced plantarflexion strength for both the hallux and lesser toes. The sensitivity and specificity of the paper grip test of the hallux to predict plantarflexor strength less than 2.6 kg was 80% and 79%, respectively, and the sensitivity and specificity of the paper grip test of the lesser toes to predict plantarflexor strength less than 2.2 kg was 75% and 74%, respectively.

Conclusions:

These findings indicate that aging is associated with reduced plantarflexion strength of the toes. The paper grip test may be a useful screening tool to detect toe weakness in the clinical setting.
Detection of Fibular Torsional Deformities after Surgery for Ankle Fractures with a Novel CT Method
Authors: Vasarhelyi Attila , Lubitz Jessica , Gierer Philip , Gradl Georg , Rösler Klaus , Hopfenmüller Werner , Klaue Kaj , Mittlmeier Thomas W.F.
Published: January 2017

Background:

Substantial fibular torsional deformities were detected after surgery for ankle fractures combined with a lesion of the syndesmotic complex using a novel CT analyzing method.

Methods:

In a prospective study, 61 patients with ankle fracture dislocations were treated with trans-syndesmotic screw fixation of the distal tibiofibular joint. Postoperative axial CT scans of both lower legs under standardized leg positioning conditions were made and analyzed with three different methods. Method 1 (M1) used proximal and distal CT planes of the lower leg for detection of the fibular torsional angle, method 2 (M2) considered only the angle at the distal tibiofibular joint, and method 3 (M3) measured the angles between the fibular and tibial tangents at the distal tibiofibular joint. Twenty patients with fibular torsional asymmetries of more than 10 degrees were evaluated clinically 6 to 34 months postoperatively with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score.

Results:

Thirty-five of the 61 patients had torsional side-to-side differences of more than 10 degrees. M1 and M2 showed statistically significant differences compared to M3 ( p = 0.001). Validity was controlled by interobserver data, variation coefficients were low for M1 and M2. Clinically, six of 20 patients with torsional differences of more than 10 degrees had excellent results, while seven had good results and seven had moderately functional results. Six of the seven with moderate results had fibular torsional differences of more than 15 degrees, two of the seven patients with good outcomes. Torsional results of M1 and M2 correlated with the AOFAS score ( r = —0.506).

Conclusions:

Of the 61 ankle fractures with ruptures of the syndesmotic complex, 25% showed torsional side-to-side differences of more than 10 degrees on proximal and distal CT planes. This CT technique correlated with the AOFAS score and could help determine when early operative revision is indicated.
PlA2 Polymorphism in Glycoprotein IIb/IIIa Modulates the Morphology and Nanomechanics of Platelets
Authors: Todinova Svetla , Komsa-Penkova Regina , Krumova Sashka , Taneva Stefka G. , Golemanov Georgy , Georgieva Galia , Tonchev Pencho , Tsankov Boris , Beshev Lyubomir , Balashev Konstantin , Andreeva Tonya D.
Published: January 2017

Glycoprotein IIb/IIIa (GPIIb/IIIa) is the most abundant platelet surface receptor for fibrinogen and von Willebrand factor. Polymorphism PlA1/A2 in the gene of GPIIb/IIIa is among the risk factors for the development of arterial and venous thrombosis. The aim of this study is to evaluate the effect of the carriage of PlA1/A2 on the size, topographic features, and membrane stiffness of platelets from healthy controls and patients with deep venous thrombosis (DVT). Atomic force microscopy (AFM) imaging and nanoindentation (force–distance curves) were applied to investigate the morphological and nanomechanical properties (Young’s modulus) of platelets immobilized on glass surface. The surface roughness ( Ra) and height ( h) of platelets from patients with DVT, carriers of mutant allele PlA2 ( Ra = 30.2 ± 6 nm; h = 766 ± 182 nm) and noncarriers ( Ra = 28.6 ± 6 nm; h = 865 ± 290 nm), were lower than those of healthy carriers of allele PlA2 ( Ra = 48.1 ± 12 nm; h = 1072 ± 338 nm) and healthy noncarriers ( Ra = 49.7 ± 14 nm; h = 1021 ± 433 nm), respectively. Platelets isolated from patients with DVT, both carriers and noncarriers, exhibit much higher degree of stiffness at the stage of spreading ( E = 327 ± 85 kPa and 341 ± 102 kPa, respectively) compared to healthy noncarriers ( E = 198 ± 50 kPa). In addition, more pronounced level of platelet activation was found in polymorphism carriers. In conclusion, the carriage of PlA2 allele modulates the activation state, morphology, and membrane elasticity of platelets.
Performance evaluation of damage detection algorithms for identification of debond in stiffened metallic plates using a scanning laser vibrometer
Authors: Mandal Deba Datta , Wadadar Debashis , Banerjee Sauvik
Published: January 2017

While several studies have focused on the detection and localization of delamination in composite plates, few comprehensive studies have been performed for the identification of debond in stiffened metallic plates using vibration-based approaches. Therefore, this study is motivated by the need to evaluate the qualitative performance of existing damage detection algorithms, namely modal curvature, the gapped smoothing method (GSM), the generalized fractal dimension (GFD) and the wavelet transform coefficient (WTC), in detecting debond in stiffened metallic plates. Extensive experimental investigation is performed using laser Doppler vibrometer as a noncontact sensing device and LDS Permanent Magnetic Shaker as an actuator. The obtained results show high susceptibility to noise and lesser accuracy in locating the debond zone, except the WTC and GFD. However, the WTC fails to provide good results for higher debond lengths, and the GFD shows prominent false alarms at the free edges of the plates. To circumvent these difficulties, two different modifications of the fractal dimension algorithm, namely the modified GFD (MGFD) and the GFD with GSM (GFD-GSM), have been proposed. Extensive numerical simulations are further carried out using commercially available finite element package ANSYS 14.0 in order to examine the experimental findings. In contrast to most previous work, the signal-to-noise ratio (SNR) in the experimental data has been appropriately quantified and noise of the same SNR level has been synthetically generated and applied on the modal data obtained from numerical simulations. Comprehensive studies for different debond locations and lengths suggests a similar trend as that obtained from the experimental investigations. Finally, a study on damage severity has been performed using the WTC and proposed modifications of the GFD. It is found that the proposed modifications of the fractal dimension perform outstandingly well in all circumstances, and can be used as an excellent tool for debond localization and quantification.
Robust and adaptive control of coexisting attractors in nonlinear vibratory energy harvesters
Authors: Haji Hosseinloo Ashkan , Slotine Jean-Jacques , Turitsyn Konstantin
Published: January 2017

An immense body of research has focused on nonlinear vibration energy harvesting systems mainly because of the inherent narrow bandwidth of their linear counterparts. However, nonlinear systems driven by harmonic excitation often exhibit coexisting periodic or chaotic attractors. For effective energy harvesting, it is always desired to operate on the high-energy periodic orbits; therefore, it is crucial for the harvester to move to the desired attractor once the system is trapped in any other coexisting attractor. Here we propose a robust and adaptive sliding mode controller to move the nonlinear harvester to any desired attractor by a short entrainment on the desired attractor. The proposed controller is robust to disturbances and unmodeled dynamics and adaptive to the system parameters. The results show that the controller can successfully move the harvester to the desired attractor, even when the parameters are unknown, in a reasonable period of time, in less than 30 cycles of the excitation force.
Ample Sample? An Examination of the Representativeness of Themes Between Sampling Durations Generated From Keyword Searches for 12 Months of Immigration News From LexisNexis and Newspaper Websites
Authors: Tamul Daniel J. , Martínez-Carrillo Nadia I.
Published: January 2017

Recommendations vary on sample sizes researchers should use to represent a year’s worth of coverage from electronic databases. We use a keyword search to create two sampling frames of immigration news in 2009. We use LexisNexis to represent elite and regional news outlets and a keyword search of individual Arizona newspapers to represent state coverage. We examine the representativeness of themes, created and coded with IBM’s Modeler program. We compare the efficiency of samples created with simple random sampling and constructed week sampling and conclude most variables are representative when sampling between 10 and 14 weeks.
Parametric study on factors influencing the stiffness of honeycomb sandwich panels using impulse excitation technique
Authors: Surya Kiran M Phani , Balasundar I , Gopinath K , Raghu T
Published: January 2017

Metallic thermal protection systems are used to protect the airframe and pay load from aerodynamic and aerothermal heating in hypersonic cruise vehicles that are powered with advanced scramjet engines. Metallic thermal protection systems is a composite structure that contains honeycomb sandwich panels at the top and bottom and a variety of thermal insulating materials placed in between them. Several design factors influence the structural and thermal performance of the honeycomb sandwich panels. Panel bending stiffness is one important structural property that is generally estimated using a destructive 3-point or 4-point bending test. In this study, a numerical model based on the impulse excitation nondestructive evaluation technique has been developed to estimate the effect of various design parameters that affect the bending stiffness of the honeycomb sandwich panels. The results obtained are analyzed using standard statistical procedures. A major advantage of this method lies in evaluating the panel stiffness at the design stage without resorting to actual fabrication of the panels for destructive testing.
Experimental analysis of impact and post-impact behaviour of inserts in Carbon sandwich structures
Authors: Mezeix Laurent , Dols Simon , Bouvet Christophe , Castanié Bruno , Giavarini Jean-Paul , Hongkarnjanakul Natthawat
Published: January 2017

In aeronautics, honeycomb sandwich structures are widely used for secondary structures such as landing gear doors, flaps or floors, and for primary structures in helicopters or business jets. These structures are generally joined by using local reinforcements of the insert type. In the present study, 50 J low velocity impact tests were performed on inserts using a drop-weight device and the impact response and failure patterns were analysed. Impacted specimens were then pull-through tested to failure. Some of the tests were stopped before final failure in order to obtain precise details on the failure scenario. It was shown that, in the cases studied, the residual strength after impact was very high (about 90%) in comparison to the large reductions habitually observed in compression after impact tests.
Efficient composite bridge deck consisting of GFRP, steel, and concrete
Authors: Alizadeh E , Dehestani M , Navayi Neya B , Nematzadeh Mahdi
Published: January 2017

In this paper, a new cost-effective composite bridge deck consisting of multiple steel box cells, concrete slab, and glass fiber-reinforced polymer layer is investigated. First, the structural performance of the deck under static loading is evaluated experimentally. Then the results are validated by a finite element program. Results of the numerical analysis are in good agreement with those of the experiments. The load–displacement relationship, ultimate flexural resistance, failure mode, neutral axis, and strain distribution on glass fiber-reinforced polymer layer and concrete slab are examined during the test. Final results revealed that the ultimate failure of the composite deck initiates by longitudinal cracking on the top surface of the concrete slab. No debonding occurs at the interface between concrete slab and steel boxes which indicates that perfobond ribs could be effectively used for shear connection. The results of experimental and numerical analysis demonstrated that the bridge deck possesses desirable strength and meets the stiffness requirements.
The Acoustical Design of Concert Halls
Authors: Beranek Leo L.
Published: January 2017

A brief account is given of the early history of room acoustics and in particular W.C. Sabine's discovery of the importance of reverberation time on the acoustical quality of a room. There follows an account of later work, including that of the author, in which five other parameters, i.e. initial time delay, loudness, diffusion, spatial impression and early to late energy ratio, were identified as contributing to acoustical quality. The acoustical design of a number of halls after 1950 is discussed and an account is given of the history of the design of the Philharmonic Hall in the Lincoln Center up to the present time. Some attempts made by architects to break away from the safe shoe-boxed shape of hall are described and the acoustical consequences discussed. The success of four recently designed halls is shown to be the direct result of lessons learned both from experience in real halls and the fundamental research work mentioned in this paper. Finally, a brief account is given of the objective parameters that can now be measured in halls and which relate to subjective response.
A Study of Vibration Transmission in a Framed Building
Authors: Steel J.A. , Craik R.J.M. , Wilson R.
Published: January 2017

Sound transmission through large buildings can be studied using Statistical Energy Analysis (SEA). In this study measurements were carried out to investigate sound transmission through a framed building. Sound transmission between columns, beams, walls and floors is investigated.

Sound transmission through the building is investigated and measured and predicted results are shown. Difficulties were encountered when modelling large floor slabs.

The work demonstrates the application of Statistical Energy Analysis methods to the study of sound transmission in framed buildings and highlights some of the diiffculties.