bluuebunny/crossref_metadata_2025 huggingface dataset:
Damsels in distress – seasons, habitat structure and water pollution changes damselfly diversity and assemblage in urban wetlands
Authors: Koparde Pankaj
Published: October 2016

Odonates are considered to be good ecological indicators, hence, they are used in biological assessment of habitat quality. However, species responses may vary spatiotemporally and therefore, it is useful to establish species-habitat relationships at a regional level. To test if tropical urban odonates respond to seasons, and to explore species-habitat relationships with an emphasis on water pollution, I studied six wetlands in the city of Pune for a year. I also investigated whether combining data on dragonflies and damselflies, as is often done in many studies, skews the results. I recorded seasons, water pollution and habitat attributes as predictors of the odonate diversity and assemblage. I analyzed the data on dragonflies, damselflies and odonates (dragonfly-damselfly combined) separately for seasonal variation, and species-habitat relationships. I used multiple regression and canonical correspondence analyses. Forty-four species were recorded during the study. No seasonal variation was detected, except for damselflies, which showed an increase in the diversity and species number post-monsoon. Multiple regression analysis showed that damselfly and dragonfly diversity varied as a function of season and water pollution, and monsoon respectively. In pre-monsoon, damselfly diversity marginally increased with pollution. Both the analyses suggest that combining data on dragonflies and damselflies may skew the end results. Therefore, I recommend further intensive and long-term research using accurately sampled habitat and pollution attributes, as well as habitat restoration through conserving urban green spaces and promoting gardens with streams and ponds.
Medicine and Morality in the Ho Family in Lijiang
Authors: Ochs Shelley
Published: October 2016

I travelled to the Lijiang basin area of Yunnan province in the spring of 2014 to record and explore the ‘traditional’ knowledge and practice of Chinese medicine among the Ho family. The Ho family includes three generations of herbalists who combine Naxi medicinal plants, Chinese medicine diagnostics, and knowledge of Western medicine in their clinical practice. They have also created their own herbarium of over 1000 local plants, which they organise based on modern botanical nomenclature. In the 1930s and 1940s, the Austrian-American botanist and explorer Joseph Rock introduced Latin botanical names to the father of Ho Shixiu, currently the oldest living Ho family member. The son of Ho Shixiu, Ho Shulong, who is now its primary caretaker, however, informed us that he was influenced by books as much as by his father’s oral teachings about medicinal plants. The youngest member of this lineage is a graduate of Yunnan Chinese Medicine University and acknowledges that his knowledge base in local ecology and medicinal plants must increase if he is to carry on the lineage. My aim is to describe both the unique aspects of the Ho family’s knowledge and its transmission, and the cultural and medical elements that have influenced and enriched them. From my perspective, these different types knowledge seem to sustain and give meaning to their family-based practice lineage. I argue that we need to carry out more ethnographic work in order to understand the relationship between medical knowledge and practice, and its social, historical, and cultural context. I hope this field note is a step in that direction.
Contested Issues of Efficacy and Safety between Transnational Formulation Regimes of Tibetan Medicines in China and Europe
Authors: Schrempf Mona
Published: October 2016

Tibetan medicines are key material objects for medical treatment and have become part of a global trend of ‘pharmaceuticalisation’, playing increasingly important political and socio-economic roles in an ‘alternative modernity’. As I argue in this paper, they also have become key ‘sites of contestation’ between different epistemic values and styles of practice related to efficacy and safety that are reproduced in and through specific formulation regimes. Based on my multisited ethnography of production, prescription, and use practices of Tibetan medicines in China and Europe, this paper conceptualises three distinct formulation regimes, offering a heuristic model for transnational comparison—a classical, an industrialised or reformulated, and a polyherbal regime. The first two are the major orientations while the polyherbal is a conjoint hybrid with either the classical or the industrialised formulation regime. Globalised national drug safety regulations legalise and confer legitimacy to industrialised Tibetan formulas that follow biomedically defined efficacy, safety, and disease categories, while classical formulas produced by private physicians or small-scale cottage pharmacies are increasingly marginalised as producing ‘unsafe’ and at times illegal medicines, and need to find new ways for adapting and circulating their formulas.
Multisensory Decisions: the Test of a Race Model, Its Logic, and Power
Authors: Otto Thomas U. , Mamassian Pascal
Published: October 2016

The use of separate multisensory signals is often beneficial. A prominent example is the speed-up of responses to two redundant signals relative to the components, which is known as the redundant signals effect (RSE). A convenient explanation for the effect is statistical facilitation, which is inherent in the basic architecture of race models (Raab, 1962,Trans. N. Y. Acad. Sci.24, 574–590). However, this class of models has been largely rejected in multisensory research, which we think results from an ambiguity in definitions and misinterpretations of the influential race model test (Miller, 1982,Cogn. Psychol.14, 247–279). To resolve these issues, we here discuss four main items. First, we clarify definitions and ask how successful models of perceptual decision making can be extended from uni- to multisensory decisions. Second, we review the race model test and emphasize elements leading to confusion with its interpretation. Third, we introduce a new approach to study the RSE. As a major change of direction, our working hypothesis is that the basic race model architecture is correct even if the race model test seems to suggest otherwise. Based on this approach, we argue that understanding the variability of responses is the key to understand the RSE. Finally, we highlight the critical role of model testability to advance research on multisensory decisions. Despite being largely rejected, it should be recognized that race models, as part of a broader class of parallel decision models, demonstrate, in fact, a convincing explanatory power in a range of experimental paradigms. To improve research consistency in the future, we conclude with a short checklist for RSE studies.
Night Time and Entangled Spaces on Early Modern Caribbean Sugar Plantations
Authors: Hollsten Laura
Published: October 2016

This article analyzes the temporal and spatial regimes on early modern Caribbean sugar plantations by examining ways in which slaves spent their leisure hours. Drawing from travel narratives, letters, and historical works, it discusses how slaves engaged in activities of their choice, most of which took place at night and were shaped by conditions peculiar to night time. In discussing slaves’ activities during their free time, this study argues that night time on Caribbean plantations created a particular kind of space. First, it created physical spaces that were profoundly different at night than they were by day, which to some extent levelled many of the daytime hierarchies inherent in slave work regimes. Second, time and place on Caribbean plantations merged to create entangled spaces in which the new global order dominated by the Atlantic economy, cultural expressions of that order, and the individual lives of slaves were all present.
Dominant Role of Subtropical Pacific Warming in Extreme Eastern Pacific Hurricane Seasons: 2015 and the Future
Authors: Murakami Hiroyuki , Vecchi Gabriel A. , Delworth Thomas L. , Wittenberg Andrew T. , Underwood Seth , Gudgel Richard , Yang Xiaosong , Jia Liwei , Zeng Fanrong , Paffendorf Karen , Zhang Wei
Published: October 2016

The 2015 hurricane season in the eastern and central Pacific Ocean (EPO and CPO), particularly around Hawaii, was extremely active, including a record number of tropical cyclones (TCs) and the first instance of three simultaneous category-4 hurricanes in the EPO and CPO. A strong El Niño developed during the 2015 boreal summer season and was attributed by some to be the cause of the extreme number of TCs. However, according to a suite of targeted high-resolution model experiments, the extreme 2015 EPO and CPO hurricane season was not primarily induced by the 2015 El Niño tropical Pacific warming, but by warming in the subtropical Pacific Ocean. This warming is not typical of El Niño, but rather of the Pacific meridional mode (PMM) superimposed on long-term anthropogenic warming. Although the likelihood of such an extreme year depends on the phase of natural variability, the coupled GCM projects an increase in the frequency of such extremely active TC years over the next few decades for EPO, CPO, and Hawaii as a result of enhanced subtropical Pacific warming from anthropogenic greenhouse gas forcing.
The Influences of the Atlantic Multidecadal Oscillation on the Mean Strength of the North Pacific Subtropical High during Boreal Winter
Authors: Lyu Kewei , Yu Jin-Yi , Paek Houk
Published: October 2016

The Atlantic multidecadal oscillation (AMO) has been shown to be capable of exerting significant influences on the Pacific climate. In this study, the authors analyze reanalysis datasets and conduct forced and coupled experiments with an atmospheric general circulation model (AGCM) to explain why the winter North Pacific subtropical high strengthens and expands northwestward during the positive phase of the AMO. The results show that the tropical Atlantic warming associated with the positive AMO phase leads to a westward displacement of the Pacific Walker circulation and a cooling of the tropical Pacific Ocean, thereby inducing anomalous descending motion over the central tropical Pacific. The descending motion then excites a stationary Rossby wave pattern that extends northward to produce a nearly barotropic anticyclone over the North Pacific. A diagnosis based on the quasigeostrophic vertical velocity equation reveals that the stationary wave pattern also results in enhanced subsidence over the northeastern Pacific via the anomalous advections of vorticity and temperature. The anomalous barotropic anticyclone and the enhanced subsidence are the two mechanisms that increase the sea level pressure over the North Pacific. The latter mechanism occurs to the southeast of the former one and thus is more influential in the subtropical high region. Both mechanisms can be produced in forced and coupled AGCMs but are displaced northward as a result of stationary wave patterns that differ from those observed. This explains why the model-simulated North Pacific sea level pressure responses to the AMO tend to be biased northward.
Defining the Influence of Horizontal Grid Spacing on Ensemble Uncertainty within a Regional Modeling Framework
Authors: Dyer Jamie , Zarzar Christopher , Amburn Philip , Dumais Robert , Raby John , Smith Jeffrey A.
Published: October 2016

Numerical weather prediction (NWP) models are limited with respect to initial and boundary condition data and possess an incomplete description of underlying physical processes. To account for this, modelers have adopted the method of ensemble prediction to quantify the uncertainty within a model framework; however, the generation of ensemble members requires considerably more computational time and/or resources than a single deterministic simulation, especially at convection-allowing horizontal grid spacings. One approach to solving this issue is the development of both a large and small horizontal grid spacing model framework over the same domain for ensemble and deterministic simulations, respectively. This approach assumes that model grid spacing has no influence on model uncertainty; therefore, the objective of this paper is to quantify the influence of horizontal grid spacing on the statistical spread of NWP model ensembles over a regional domain. A series of 24-h simulations using the Weather Research and Forecast (WRF) Model are generated over a static domain with horizontal grid spacings of 35, 25, 15, and 9 km, using both a stochastic kinetic energy backscatter scheme and a multiphysics ensemble approach. Results indicate that horizontal grid spacing does influence the magnitude of uncertainty within an ensemble, although the exact magnitude and type of statistical relationship (direct versus inverse) varies by case. As such, at shorter lead times (<12 h) the dominant atmospheric process associated with each event and the type of ensemble being used outweigh the individual impacts of horizontal grid spacing on ensemble spread.
Climate Change, Desertification, and Societal Responses along the Mu Us Desert Margin during the Ming Dynasty
Authors: Cui Jianxin , Chang Hong , Cheng Kaiyue , Burr George S.
Published: October 2016

Historical records for the Mu Us Desert margin during the Ming dynasty (1368–1644) and corresponding high-resolution climate proxy records have prompted studies on societal responses to climatic changes in this region. The Mu Us Desert margin is highly sensitive to changes in desertification and biological productivity controlled in part by Asian monsoon variations. Here the existing historical temperature and precipitation records are examined to understand spatiotemporal climate variations and to identify potential mechanisms that have driven desertification in the region over the past 500 years. The focus here is on three severe desertification events that occurred in 1529–46, the 1570s, and 1601–50. The relationships among temperature, precipitation, and desertification indicate that a cold/drought-prone climate drives the desertification process. During the Ming dynasty, this region was one of nine important military districts, where the frontier wall (the Great Wall) and other fortifications were constructed. To maintain the defense system, military officers made a valiant effort to decrease the influence of desertification. However, the human-waged war against nature was largely futile, and local rebellions in the stricken region were spawned by the inability of the government to cope with the severe environmental stresses associated with rapid desertification.
Hypothesis Testing, p Values, Confidence Intervals, Measures of Effect Size, and Bayesian Methods in Light of Modern Robust Techniques
Authors: Wilcox Rand R. , Serang Sarfaraz
Published: October 2016

The article provides perspectives on p values, null hypothesis testing, and alternative techniques in light of modern robust statistical methods. Null hypothesis testing and p values can provide useful information provided they are interpreted in a sound manner, which includes taking into account insights and advances that have occurred during the past 50 years. There are, of course, limitations to what null hypothesis testing and p values reveal about data. But modern advances make it clear that there are serious limitations and concerns associated with conventional confidence intervals, standard Bayesian methods, and commonly used measures of effect size. Many of these concerns can be addressed using modern robust methods.
Thou Shalt Not Bear False Witness Against Null Hypothesis Significance Testing
Authors: García-Pérez Miguel A.
Published: October 2016

Null hypothesis significance testing (NHST) has been the subject of debate for decades and alternative approaches to data analysis have been proposed. This article addresses this debate from the perspective of scientific inquiry and inference. Inference is an inverse problem and application of statistical methods cannot reveal whether effects exist or whether they are empirically meaningful. Hence, raising conclusions from the outcomes of statistical analyses is subject to limitations. NHST has been criticized for its misuse and the misconstruction of its outcomes, also stressing its inability to meet expectations that it was never designed to fulfil. Ironically, alternatives to NHST are identical in these respects, something that has been overlooked in their presentation. Three of those alternatives are discussed here (estimation via confidence intervals and effect sizes, quantification of evidence via Bayes factors, and mere reporting of descriptive statistics). None of them offers a solution to the problems that NHST is purported to have, all of them are susceptible to misuse and misinterpretation, and some bring around their own problems (e.g., Bayes factors have a one-to-one correspondence with p values, but they are entirely deprived of an inferential framework). Those alternatives also fail to cover a broad area of inference not involving distributional parameters, where NHST procedures remain the only (and suitable) option. Like knives or axes, NHST is not inherently evil; only misuse and misinterpretation of its outcomes needs to be eradicated.
The Need for Nuance in the Null Hypothesis Significance Testing Debate
Authors: Häggström Olle
Published: October 2016

Null hypothesis significance testing (NHST) provides an important statistical toolbox, but there are a number of ways in which it is often abused and misinterpreted, with bad consequences for the reliability and progress of science. Parts of contemporary NHST debate, especially in the psychological sciences, is reviewed, and a suggestion is made that a new distinction between strongly, weakly, and very weakly anti-NHST positions is likely to bring added clarity to the debate.
Performing Contrast Analysis in Factorial Designs: From NHST to Confidence Intervals and Beyond
Authors: Wiens Stefan , Nilsson Mats E.
Published: October 2016

Because of the continuing debates about statistics, many researchers may feel confused about how to analyze and interpret data. Current guidelines in psychology advocate the use of effect sizes and confidence intervals (CIs). However, researchers may be unsure about how to extract effect sizes from factorial designs. Contrast analysis is helpful because it can be used to test specific questions of central interest in studies with factorial designs. It weighs several means and combines them into one or two sets that can be tested with t tests. The effect size produced by a contrast analysis is simply the difference between means. The CI of the effect size informs directly about direction, hypothesis exclusion, and the relevance of the effects of interest. However, any interpretation in terms of precision or likelihood requires the use of likelihood intervals or credible intervals (Bayesian). These various intervals and even a Bayesian t test can be obtained easily with free software. This tutorial reviews these methods to guide researchers in answering the following questions: When I analyze mean differences in factorial designs, where can I find the effects of central interest, and what can I learn about their effect sizes?
Flexural creep behaviour of long glass fibre reinforced polyamide 6.6 under thermal-oxidative environment
Authors: Coulon A , Lafranche E , Douchain C , Krawczak P , Ciolczyk JP , Gamache E
Published: October 2016

This article aims to investigate the flexural creep behaviour as a function of temperature of long glass fibre polyamide 6.6 taking into account the thermal-oxidative degradation occurring during the test. The mould geometry has been chosen so as to reproduce some geometrical accidents (e.g. sharp frontal and tangential steps) occurring on industrial moulds. The nominal fibre content (10, 40 and 55 wt%), initial fibre length (short glass fibre, long glass fibre), load rate (up to 70%) and creep temperature (23℃, 100℃ and 130℃) have been considered to estimate the Findley’s model coefficients. A first investigation on the polyamide 6.6 degradation under thermo-oxidative environment has been led to understand the mechanisms of thermal-degradation of the polyamide 6.6 composites. The pure polyamide 6.6 matrix has shown a 20% increase of flexural modulus during the first period of ageing attributed to a combined chain scissions and cross-linking reactions. Then, a decrease of properties attributed to predominant chain scission mechanism was noticed after 1000 h of thermal exposure reaching up to 30% after 5000 h. In case of reinforced polyamide 6.6, the flexural properties tend to increase (+6.5%) up to 2000 h of exposure. The least square method has then permitted to evaluate the material coefficients from the experimental data; the instantaneous creep strain has been estimated from a power law representation. In any cases, the calculations are in a good accordance with experimental measurements.
Bringing the pregnancy test home from the hospital
Authors: Robinson Joan H
Published: October 2016

This paper explores the settlement process of one of the most common home diagnostic tools currently in use, the home pregnancy test. The controversial new device appeared to threaten the jurisdiction of both doctors and Food and Drug Administration regulations, while it aligned with the women’s health movement’s goals. But this study finds a more nuanced narrative: one of boundaries and positions that at once were blurry, later shifted, and were ultimately aligned without compromising the credibility of doctors or the legal system. To understand this process, the roles of court decisions and regulations are explained by stages of juris-technical accordance. In this case, rather than restricting technological innovation, legal innovation provided pathways for widespread acceptance of the home pregnancy test by various groups. As more tools move from expert users to layperson users, this paper demonstrates the utility of examining existing juris-technical assemblages as we consider the future of self-monitoring and self-diagnosis.
Intrathecal Baclofen Therapy for the Treatment of Spasticity in Sjögren-Larsson Syndrome
Authors: Hidalgo Eveline Teresa , Orillac Cordelia , Hersh Andrew , Harter David H. , Rizzo William B. , Weiner Howard L.
Published: October 2016

Intrathecal baclofen therapy is widely accepted as a treatment option for patients with severe spasticity. The current treatment of spasticity in patients with Sjögren-Larsson syndrome is largely symptomatic, given that no effective causal therapy treatments are available. We report the outcome of 2 patients with Sjögren-Larsson syndrome who had pump implantation for intrathecal baclofen. We observed a positive response, with a decrease of spasticity, reflecting in the Modified Ashworth Scale, and parents and caregivers observed a functional improvement in both patients. One patient experienced skin irritation 15 months after surgery, necessitating pump repositioning. No infection occurred. Our report shows that intrathecal baclofen therapy can have a positive therapeutic effect on spasticity in patients with Sjögren-Larsson syndrome, and therefore may be a promising addition to current treatments.
Understanding School Truancy: Risk–Need Latent Profiles of Adolescents
Authors: Iverson Andrew , French Brian F. , Strand Paul S. , Gotch Chad M. , McCurley Carl
Published: October 2016

Washington state requires school districts to file court petitions on students with excessive unexcused absences resulting in thousands of youth becoming involved in the court system. Once in the system, decisions are made about the level of risk each youth has for maladaptive behaviors. The Washington Assessment of the Risks and Needs of Students was created to assist youth service providers, courts, and schools to identify an adolescent’s needs for social, emotional, or educational intervention. However, the profile-based decisions advocated for by test developers lack empirical justification. This study employed latent profile analysis to examine risk and needs profiles of adolescents based on the Washington Assessment of the Risks and Needs of Students assessment. Profiles were developed to aid understanding of behaviors associated with school truancy, and examined across outcome variables (e.g., suspensions, arrests) to evaluate evidence in support of predictive claims. Results suggest distinct profiles that differ on important outcomes.
Relationship Between Sexual Abuse in Childhood and the Occurrence of Mental Illness in Adulthood: A Matched Case–Control Study in Nigeria
Authors: Okeafor C. U. , Okeafor I. N. , Tobin-West C. I.
Published: October 2016

This study aimed to examine the relationship between exposure to childhood sexual abuse (CSA) and the occurrence of mental illness in adulthood in Nigeria. An age- and gender-matched case–control study was conducted in the University of Port Harcourt Teaching Hospital, Nigeria, from January to March 2014. Cases were defined as individuals aged 18 to 60 years diagnosed with mental illness while controls were aged 18 to 60 years who did not have mental illness. The study had 304 subjects comprised of 152 case–control pairs. This case–control study showed a statistically significant association between exposure to CSA and occurrence of mental illness in adulthood (pair-matched odds ratio = 3.25, 95% CI = [1.70, 6.21]). The association between CSA and mental illness was still significant (adjusted odds ratio = 3.11, 95% CI = [1.67, 5.82]) after controlling for family functionality. A robust CSA prevention and treatment strategy that considers the victim and the perpetrator in Nigeria is hereby advocated. This could be achieved by the collaborative efforts of the government of Nigeria and non-governmental organizations.
The impact of adjusted work conditions and disease-modifying drugs on work ability in multiple sclerosis
Authors: Wickström Anne , Fagerström Maria , Wickström Lucas , Granåsen Gabriel , Dahle Charlotte , Vrethem Magnus , Sundström Peter
Published: October 2016

Background:

Multiple sclerosis (MS) is a neurological disorder that causes significantly reduced ability to work, and the Expanded Disability Status Scale (EDSS) is one of the main predictors for reduced work ability.

Objectives:

To investigate how work requirements, flexible work conditions and disease-modifying drugs (DMDs) influence the work ability in relation to different EDSS grades in two MS populations.

Methods:

Work ability was studied in two MS populations: one in the southern and one in the northern part of Sweden, both demographically similar. In the latter population, more active work-promoting interventions have been practised and second-generation DMDs have been widely used from the onset of disease for several years.

Results:

The proportion of MS patients who participated in the workforce or studied was significantly higher in the northern compared with the southern population ( p < 0.001). The employees in the northern population had significantly lower requirements, greater adapted work conditions and were able to work more hours per week. Higher EDSS was associated with lower reduction in number of worked hours per week in the northern population ( p = 0.042).

Conclusion:

Our data indicated that treatment strategy and adjusted work conditions have impact on work ability in MS.
Diagnosed and living with fibromuscular dysplasia: A qualitative inquiry
Authors: Bumpus Sherry M , Kuck Christa , Heidt Steven T , Bluhm Minnie
Published: October 2016

Fibromuscular dysplasia (FMD) is a vascular disorder about which little has been known until recently. Patients with FMD may suffer from hypertension, aneurysms, or strokes, as well as symptoms associated with local artery damage. As a result of advances in vascular medicine and growing outcomes registries, we now have a better understanding of the FMD disease process and epidemiology. Nevertheless, the consequences of FMD on patients’ day-to-day experiences and mental health status are not well understood. The purpose of this study was to begin to identify and characterize the experiences of living with FMD from the perspective of the patient using qualitative inquiry. Interviews with 19 FMD patients (18 female, 1 male) were conducted, audio-recorded, transcribed verbatim, and content analyzed. Individuals with FMD reported a complex array of psychological, physical, emotional, social, and health care concerns, which may be underdiagnosed. Findings suggest new opportunities for enhancing patient care.
Evaluation of a continuous quality improvement program in anticoagulant therapy
Authors: Cantin Ariane , Lahaie Alexandre , Odobasic Bojan , Tremblay Marie-Philip , Wazzan Dana , Caron Stéphanie , Leblanc Caroline , Martineau Josée , Lalonde Lyne
Published: October 2016

Background:

The ACO Program (Programme ACO), a continuous quality improvement program (CQIP) in anticoagulation therapy, was offered in community pharmacies as a pilot project.

Objective:

To evaluate the participants’ appreciation for the various activities of the program.

Methods:

Participants had access to training activities, including an audit with feedback, online training activities (OTA), clinical tools and support from facilitators. Cognitive behavioural learning determinants were evaluated before and 5 months after the beginning of the program. Participants’ satisfaction and perception were documented via online questionnaires and a semistructured interview.

Results:

Of the 52 pharmacists in the ACO Program, 47 participated in this evaluation. Seventy-seven percent of the participants completed at least 1 OTA and 6% published on the forum. The feeling of personal effectiveness rose from 8.01 (7.67-8.35) to 8.62 (8.24-8.99). The audit and feedback, as well as the high-quality OTA and their lecturers, were the most appreciated elements.

Discussion:

There was a high OTA participation rate. The facilitators seemed to play a key role in the CQIP. The low level of participation in the forum reflects the known phenomenon of social loafing. Technical difficulties affecting the platform and data collection for the audit with feedback constituted limitations.

Conclusion:

The CQIP in anticoagulation therapy is appreciated by community pharmacists and is associated with an improved feeling of personal effectiveness.
Estimation of continuous thumb angle and force using electromyogram classification
Authors: Siddiqi Abdul Rahman , Sidek Shahrul Naim
Published: October 2016

Human hand functions range from precise minute handling to heavy and robust movements. Remarkably, 50% of all hand functions are made possible by the thumb. Therefore, developing an artificial thumb that can mimic the actions of a real thumb precisely is a major achievement. Despite many efforts dedicated to this area of research, control of artificial thumb movements in resemblance to our natural movement still poses as a challenge. Most of the development in this area is based on discontinuous thumb position control, which makes it possible to recreate several of the most important functions of the thumb but does not result in total imitation. This work looks into the classification of electromyogram signals from thumb muscles for the prediction of thumb angle and force during flexion motion. For this purpose, an experimental setup is developed to measure the thumb angle and force throughout the range of flexion and simultaneously gather the electromyogram signals. Further, various features are extracted from these signals for classification and the most suitable feature set is determined and applied to different classifiers. A “piecewise discretization” approach is used for continuous angle prediction. Breaking away from previous research studies, the frequency-domain features performed better than the time-domain features, with the best feature combination turning out to be median frequency–mean frequency–mean power. As for the classifiers, the support vector machine proved to be the most accurate classifier giving about 70% accuracy for both angle and force classification and close to 50% for joint angle–force classification.
Total Ankle Replacement and Simultaneous Subtalar Arthrodesis
Authors: Usuelli Federico G. , Manzi Luigi , Maccario Camilla
Published: October 2016

Category:

Ankle Arthritis

Introduction/Purpose:

Patients with arthritis or severe malfunctions involving both the ankle and the subtalar joints can benefit tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. Actually, TTC fusion is considered as a salvage option resulting in a completely stiff ankle and hindfoot, considerably limiting global foot function. With the evolution of prosthetic design and surgical techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion.

Methods:

This study includes 25 patients who underwent primary TAR and simultaneous subtalar fusion from May 2011 to November 2014. Sixteen males (64%) and 9 females (36%) were enroled with a mean age of 58 years (25-82). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Radiographic examination included a postoperative CT scan obtained 12 months after surgery.

Results:

At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92%. There was a statistically significant increase in American Orthopedic Foot & Ankle Society ankle/hindfoot score from 27.9 to 75.1. Range of motion significantly increased from 12 to 32.8 degrees. In addition, there was a statistically significant decrease in visual analog scale (VAS) pain score from 8.6 to 2.1.

Conclusion:

TAR and simultaneous subtalar joint fusion are reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopaedic surgeons in determining the degree of successful fusion of subtalar arthrodesis.
Management of Hallux Valgus Deformity in Patients with Metatarsus Adductus
Authors: Aiyer Amiethab , Shariff Raheel , Tracey Joseph A. , Myerson Mark S.
Published: October 2016

Category:

Bunion

Introduction/Purpose:

Metatarsus adductus (MA) is a congenital condition in which there is persistent adduction of the metatarsals, which has been shown to increase the risk of recurrence of hallux valgus in patients undergoing surgery. The rate of recurrence varies with the magnitude of the adductus, perhaps correlating with the type of surgery performed, ie. the treatment of the adductus deformity and not just the hallux valgus. The goal of this study was to further analyze a cohort of patients with severe MA and identify clinical/surgical factors that are associated with a lower rate of recurrent deformity.

Methods:

An IRB approved retrospective review between 2002-2012 was completed. All patients undergoing hallux valgus surgery were identified. Patients were included if adequate radiographic information /clinical records were available and if the MAA was greater than 31° (normal values for the MA angle are < 20°). Clinical information collected included associated diagnoses, the presence of arthritis of the tarsometatarsal joints, the presence and degree of lesser toe valgus deformities and surgical procedures completed. Radiographic recurrence was defined as a postoperative HVA > 20° (at most recent follow up).

Results:

A total of 19 patients with severe MA/hallux valgus were identified. The average age of patients in this group was 55 years (51-60). Eight patients had associated tarsometatarsal arthritis and ten patients had severe valgus lesser toe deformities. Nine patients were treated with a modified Lapidus procedure and 10 patients underwent a distal first metatarsal osteotomy. Of the 9 patients who were treated with a modified Lapidus procedure, 5 patients underwent simultaneous realignment arthrodesis of the 2nd/3rd TMT joints for management of simultaneous midfoot arthritis. One of these patients had radiographic recurrence of deformity. Of the 7 patients who underwent a distal first metatarsal osteotomy without realignment arthrodesis of the 5 had recurrence of deformity. When evaluating patients for treatment of lesser toe deformity, 11 patients who were treated with simultaneous distal metatarsal realignment osteotomies, did not have recurrence of hallux valgus.

Conclusion:

Based on our findings, the use of a modified Lapidus arthrodesis led to a lower rate of HV deformity recurrence in comparison to isolated distal first metatarsal osteotomies but only when performed in conjunction with realignment arthrodesis of the 2nd/3rd TMT joints and distal lesser metatarsal osteotomies. If the patient does not have arthritis of the lesser TMT joints proximal metatarsal osteotomies are sufficient for correction. Treatment of lesser toe deformity with distal osteotomies was associated with lower recurrence of HV deformity and should be included as part of the treatment algorithm.
Does Flatfoot Deformity Develop After Transfer of Posterior Tibial Tendon for the Foot Drop Secondary to Peroneal Nerve Palsy?
Authors: Choi Seung-Myung , Cho Byung-ki , Kang Chan , Jeong Jae-Jung , Kim Jun-Beom
Published: October 2016

Category:

Other

Introduction/Purpose:

Posterior tibial tendon transfer is preferred by many colleagues for cases of drop foot caused by peroneal nerve palsy that are at least a year old with little chance of motor improvement. However, several studies have reported acquired flat foot deformity following tendon transfer, to best of our knowledge, no studies have been performed to assess whether posterior tibial tendon transfer influences occurrence of postoperative flat foot deformity quantitatively.

Methods:

With IRB approval, a retrospective review was performed. Twenty-four patients were followed for more than 2 years after anterior transfer of TP tendon by one surgeon for the foot drop by peroneal nerve palsy from 2008 to 2013. The mean age was 35.9 years, and the mean follow-up period was 50.5 months. There were 10 female and 14 male patients. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM). The radiological evaluation consisted of the calcaenal pitch, Meary angle, heel alignment angle. As functional evaluation, isokinetic dynamometer muscle function analysis was performed.

Results:

The overall FAOS demonstrated a significant improvement from preoperative (55.6 on average) to postoperative measurement (89.2 on average) (P < .01), the ADL and sports subsection of FAAM demonstrated a improvement from preoperative to postoperative measurement (ADL: from 45.6 to 87.3; sports: from 32.8 to 81.5 on average, respectively; P < .01). Radiology revealed that there were no changes in the foot alignment from pre- to postoperative measurement. Postoperative isokinetic strength was significantly lower as compared contralateral normal side. Two patients sustained postoperative complications in the WTHG (16.7%).

Conclusion:

The results of our study demonstrated that there was no evidence that loss of the normal function of the tibialis posterior lead change in foot alignment such as flat foot deformity. Transfer of posterior tibial tendon offers successful result for the foot drop secondary to peroneal nerve palsy in selected cohorts, altough long-term peroids follow up would be needed.
Assessment of Foot Alignment in Patients with Hallux Rigidus: the Role of Weightbearing CT scan
Authors: Vulcano Ettore , Tracey Joseph A. , Myerson Mark S.
Published: October 2016

Category:

Midfoot/Forefoot

Introduction/Purpose:

An association between hallux rigidus and metatarsus elevates has been reported in the literature. These findings were based on standard weightbearing radiographs, but have not found general consensus among foot and ankle surgeons. The aims of this study were to 1) assess foot alignment in patients affected by hallux rigidus using 3D reconstructions from a weighbearing CT scan and 2) assess intra and interobserver reliability of weightbearing CT scan imaging (pedCAT, Curvebeam, Warrington, USA).

Methods:

In this prospective consecutive study, 50 patients with hallux rigidus underwent a weightbearing CT scan. The control group consisted of 50 consecutive patients that underwent a weightbearing CT scan for other reasons (i.e. assessing ankle fusion union, subtalar fusion union, etc). The following angles were measured by 2 investigators: 1st metatarsal length, 2nd metatarsal length, declination of the 1st and 2nd metatarsal, 1st-2nd intermetatarsal angle, hallux valgus angle, and foot width. Each investigator measured each foot twice, 1 month apart. The mean of the values was used for statistical analysis.

Results:

Intra and interobserver reliability was excellent. There was a statistically significant difference between the declination ratio (1st to 2nd metatarsal) in the hallux rigidus group (0.81) compared to the control group (0.92). Hallux valgus angle was also significantly lower in the hallux rigidus group (12 degrees) compared to the control group (15 degrees). Finally, patients with stages 1 and 2 according to Coughlin & Shurnas classification has significantly higher declination ratios compared to stages 3 and 4.

Conclusion:

Patients with hallux rigidus demonstrated a lower declination of the first-to-second metatarsal, indicating metatarsus elevatus. While it was not possible to determine whether the elevatus caused or was a result of hallux rigidus, it appears that metatarsus elevatus correlates with the severity of the arthritis. The smaller hallux valgus angle in the hallux rigidus population indicates that true hallux rigidus in association with a true bunion is unlikely. Finally, weightbearing CT imaging proved to be a reliable method of assessing foot alignment.
Comparison of Inpatient and Outpatient Ankle Fracture Surgery
Authors: Saquib Zohair A. , Stal Drew , Phillips Geoffrey I.
Published: October 2016

Category:

Ankle

Introduction/Purpose:

One of the emerging trends in contemporary healthcare is the shift in surgical resources to the outpatient setting coupled with reductions in the inpatient length of stay. Through a multi-center retrospective review of surgically treated ankle fractures, we sought to determine whether the selection for outpatient surgery or inpatient admission was dependent upon specific patient demographics, associated medical co-morbidities, or surgeon practice management.

Methods:

A multi-center retrospective cohort study of 240 surgically treated ankle fractures over a two-year period was performed. Two tertiary care hospitals and their affiliated ambulatory surgery centers were included in the study. Patient selection criteria was based on CPT codes while exclusion criteria included pediatric patient, open trauma, pilon fracture, or history of prior ankle fracture. Patient age, presence of poly-trauma, medical co-morbidities (syncope, hypertension, diabetes, as well as coronary artery, pulmonary, renal or hepatic disease), and ordering of CT-scan were evaluated in the study. Surgeons were divided into three groups according to fellowship training: foot and ankle (Group 1), trauma (Group 2, and general / other (Group 3). There were 2 foot and ankle fellowship trained orthopedists, 5 trauma fellowship trained orthopedists, and 9 generalists whose fellowships included sports, hand, and spine.

Results:

142 inpatient surgeries were performed with 5 days median length of stay and 98 surgeries were performed in the outpatient ambulatory care setting. The chi-square test or Fisher's exact test was used to compare inpatients and outpatients for each variable. Statistically significant higher percentages were recorded among inpatients in the following categories: age 65+ years (p < 0.0003), hypertension (p < 0.0230), presence of poly-trauma (p < 0.0149), and ordering of CT-scan (p < 0.0001). The majority of ankle fracture surgeries performed by Group 1 surgeons (84%) and Group 3 surgeons (61%) were outpatient cases compared with only 29% for Group 2 surgeons. There were no statistically significant differences in demographics and medical risk factors among patients in the three groups.

Conclusion:

Our data shows that age (65+ years-old) and specific medical co-morbidities are statistically linked with inpatient admission for ankle fracture surgery. In this multi-center review, trauma fellowship trained surgeons on-call were more likely to hospitalize their patients in preparation for surgery. With a 5 day median length of stay for these inpatient admissions, the health care institution may realize substantial practice management cost savings by shifting cases to the outpatient setting using the ambulatory care model of foot and ankle fellowship trained surgeons.
Correction of Hammer Toe Deformity with Novel Intramedullary PIP Fusion Device versus K-Wire fixation
Authors: Richman Seth H. , Siqueira Marcelo B. , Mccullough Kirk A. , Berkowitz Mark J.
Published: October 2016

Category:

Lesser Toes

Introduction/Purpose:

K-wire fixation is the most common operative procedure for hammertoe deformity today. However, intramedullary implants are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device.

Methods:

A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the intramedullary implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre and postoperative visual analogue pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow up.

Results:

There was no significant difference in demographics or comorbidities between the two groups (p>0.05). In the K-wire group, sixteen patients (18 toes) remained symptomatic (27%). Nine toes (9.5%) had recurrent deformity, three toes (3%) developed a late infection due to the recurrent deformity and one toe (1%) developed partial numbness. One patient suffered a calf DVT and peroneal nerve neuritis, one patient developed a foot drop, and three patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group three (7.7%) patients remained symptomatic. One patient developed CRPS in the foot, calf DVT, and a non-fatal PE. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody suffered hardware failure or required a second operation.

Conclusion:

The intramedullary device for hammertoe correction resulted in less complications, recurrent deformity, and reoperations than K-wire fixation.