bluuebunny/crossref_metadata_2025 huggingface dataset:
Intimacy, Marital Satisfaction, and Third Party Imagined Interactions
Authors: Berkos Kristen M. , Denham Jon
Published: February 2017

This study examined the relationships between intimacy, relational quality, and third party imagined interactions (TPIIs) in married individuals. Similar to imagined interactions, TPIIs occur when an individual imagines the conversation between two other individuals in which the imaginer is not a conversation participant. In this study, we looked at TPII usage among married individuals when they imagined conversations on behalf of their spouse. Applying role theory, imagined interaction conflict linkage theory, and uncertainty reduction theory, we predicted TPII characteristics would be inversely related to intimacy and that intimacy would mediate the relationship between TPIIs and relational quality. Married individuals ( n = 159) completed an online survey to measure TPII usage, intimacy, and relational quality. TPIIs were related to decreases in intimacy. Furthermore, LISREL models revealed intimacy as a mediator between TPIIs and relational quality.
Social classes and subaltern groups: Theoretical distinction and political application
Authors: Galastri Leandro
Published: February 2017

The purpose of this article is to draw a theoretical distinction between the notions of ‘social classes’ and ‘subaltern groups’ as defined in The Prison Notebooks by Antonio Gramsci. This distinction will involve a brief discussion about the notions of ‘social classes’ evolved by other key authors in the area, apart from Gramsci himself, such as Marx, D. Bensaïd, E. P. Thompson and N. Poulantzas, who, on this question, have close affinities with the ideas of Gramsci. Finally, I seek to make suggestions about how this distinction can be applied, together with some critical observations on ‘Subaltern Studies’ and some final considerations with regard to this article as a whole.
“Proprietary Processed” Allografts: Clinical Outcomes and Biomechanical Properties in Anterior Cruciate Ligament Reconstruction
Authors: Roberson Troy A. , Abildgaard Jeffrey T. , Wyland Douglas J. , Siffri Paul C. , Geary Stephen P. , Hawkins Richard J. , Tokish John M.
Published: February 2017

Background:

The processing of allograft tissues in anterior cruciate ligament (ACL) reconstruction continues to be controversial. While high-dose irradiation of grafts has received scrutiny for high failure rates, lower dose irradiation and “proprietary-based” nonirradiated sterilization techniques have become increasingly popular, with little in the literature to evaluate their outcomes. Recent studies have suggested that the specifics of allograft processing techniques may be a risk factor for higher failure rates.

Purpose:

To assess these proprietary processes and their clinical outcomes and biomechanical properties.

Study Design:

Systematic review.

Methods:

A systematic review was performed using searches of PubMed, EMBASE, Google Scholar, and Cochrane databases. English-language studies were identified with the following search terms: “allograft ACL reconstruction” (title/abstract), “novel allograft processing” (title/abstract), “allograft anterior cruciate ligament” (title/abstract), “anterior cruciate ligament allograft processing” (title/abstract), or “biomechanical properties anterior cruciate ligament allograft” (title/abstract). Duplicate studies, studies not providing the allograft processing technique, and those not containing the outcomes of interest were excluded. Outcomes of interest included outcome scores, complication and failure rates, and biomechanical properties of the processed allografts.

Results:

Twenty-four studies (13 clinical, 11 biomechanical) met inclusion criteria for review. No demonstrable difference in patient-reported outcomes was appreciated between the processing techniques, with the exception of the Tutoplast process. The clinical failure rate of the Tutoplast process was unacceptably high (45% at 6 years), but no other difference was found between other processing techniques (BioCleanse: 5.4%; AlloTrue: 5.7%; MTF: 6.7%). Several studies did show an increased failure rate, but these studies either combined processing techniques or failed to delineate enough detail to allow a specific comparison for this study. The biomechanical studies showed overall maintenance of satisfactory biomechanical properties throughout multiple testing modes with normalization to the percentage of control specimens.

Conclusion:

A comparison of proprietary allograft processing techniques is difficult because of the variability and lack of specificity of reporting in the current literature. Among the available literature, except for the Tutoplast process, no notable differences were found in the clinical outcomes or biomechanical properties. Future study with a longer follow-up is necessary to determine the role and limitations of these grafts in the clinical setting.
A bioactive hyaluronic acid–based hydrogel cross-linked by Diels–Alder reaction for promoting neurite outgrowth of PC12 cells
Authors: Xing Dongming , Ma Lie , Gao Changyou
Published: February 2017

In order to improve neurite outgrowth on the in situ formed hyaluronic acid–based hydrogel, furan and methacrylate groups were grafted on hyaluronic acid successively. Furthermore, a laminin-derived peptide CQAASIKVAV was covalently immobilized via the Michael addition. The furan- and peptide-modified hyaluronic acid was then cross-linked in situ by mixing with bismaleimide poly(ethylene glycol) at 37 °C to obtain a bioactive hyaluronic acid–based hydrogel. The hyaluronic acid derivatives were characterized by 1H NMR and Fourier transform infrared spectroscopy. The gelation, swelling, and mechanical property of the hydrogels were analyzed. The modulus of the hydrogel could be tuned by changing furan substitution degree, while the peptide concentration could be changed by the ratio of furan- and peptide-modified hyaluronic acid with hyaluronic acid–furan. In vitro culture of PC12 cells showed that the longest neurite outgrowth appeared on the hyaluronic acid–poly(ethylene glycol) hydrogel with the highest peptide content (the substitution degree of peptide in furan- and peptide-modified hyaluronic acid was 23 %) and a lower threshold modulus of 4.5 kPa. The furan and methacrylate-functionalized hyaluronic acid provides a versatile platform for diverse functionalization and can be used for modulation of other cell behaviors as well.
When Bigger Is Better: Household Size, Abuse Injuries, Neglect, and Family Response in Novosibirsk, Russia
Authors: Emery Clifton R. , Eremina Tatiana , Arenas Carmen , Kim Jaeyop , Chan Ko Ling
Published: February 2017

Although previous research has demonstrated larger households to be at higher risk of physical abuse and neglect of children, we argue that unilateral conceptualization of larger households as a risk factor is inappropriate. Application of resource dilution theory must capture the possibility that larger families may have more members with both the agency and will to intervene against child maltreatment. We hypothesized a negative interaction between household size and protective informal social control by family members in predicting abuse injuries and neglect. A three-stage probability proportional to size cluster sample representative of Novosibirsk, Russia, was collected from 306 cohabiting couples. One parent in each household was interviewed. A focal child was selected using most recent birthday. When responses limited to families with minor children (below age 18) were selected, 172 families remained in the data. Physical abuse and neglect were measured using the Conflict Tactics Scales (CTS). Protective informal social control by family members was measured using the Informal Social Control of Child Maltreatment (ISC_CM) Scale. Models were tested using random effects regression and logistic regression. Nearly 7% of focal children were injured in the last year, 10% were neglected. Consistent with previous research, protective informal social control was associated with lower odds of injury and fewer instances of neglect. The significant negative interaction between household size and protective control is consistent with the idea that larger households may be protective when adult family members intervene against maltreatment to protect children. Replication and further investigation of protective ISC_CM in Western populations is much needed. Future research should not conceptualize or measure household size as a unilateral risk factor.
Characteristics optimization of powder mixed electric discharge machining using titanium powder for die steel materials
Authors: Banh Tien-Long , Nguyen Huu-Phan , Ngo Cuong , Nguyen Duc-Toan
Published: February 2017

In the present study, four quality characteristics of the electrical discharge are simultaneously presented and optimized using titanium powder mixed electric discharge machining. The Taguchi method and the grey relational analysis are applied to the processing parameters to investigate the following: workpiece material, tool material, polarity, pulse-on time, current, pulse-off time, and powder concentration. The combination of the Taguchi method and grey relational analysis is applied to optimize simultaneously four quality characteristics of powder mixed electric discharge machining, including material removal rate, tool wear rate, surface roughness, and microhardness surface. Optimal results by the Taguchi–grey relational analysis show that both surface roughness and tool wear rate decrease, while both material removal rate and microhardness surface increase, respectively. This approach proves effective in terms of improving the processing efficiency of the study parameters. The results from both optimization calculations and experimentation demonstrate high accuracy and efficiency. Furthermore, powder mixed electric discharge machining has improved significantly. The concentration of titanium powder is the processing parameter with the strongest influence on the efficiency of powder mixed electric discharge machining.
Physiological modeling for detecting degree of perception of a color-deficient person
Authors: Rajalakshmi T , Prince Shanthi
Published: February 2017

Physiological modeling of retina plays a vital role in the development of high-performance image processing methods to produce better visual perception. People with normal vision have an ability to discern different colors. The situation is different in the case of people with color blindness. The aim of this work is to develop a human visual system model for detecting the level of perception of people with red, green and blue deficiency by considering properties like luminance, spatial and temporal frequencies. Simulation results show that in the photoreceptor, outer plexiform and inner plexiform layers, the energy and intensity level of the red, green and blue component for a normal person is proved to be significantly higher than for dichromats. The proposed method explains with appropriate results that red and blue color blindness people could not perceive red and blue color completely.
Containers, facilitators, innovators? The role of cities and city employees in innovation activities
Authors: Makkonen Teemu , Merisalo Maria , Inkinen Tommi
Published: February 2017

Innovation has long been considered one of the key engines of economic growth, and patents as important incentives for research and development activity. Particularly in terms of intellectual property rights (IPR), however, little is known about how cities contribute to regional innovation: are they containers, facilitators or innovators? This is investigated here through empirical material derived from 27 interviews with top departmental management in three Finnish cities (Helsinki, Espoo and Vantaa). The results show that local city governments (LCGs) consider cities as facilitators of innovation activities but also admit that there are limits (time constraints and lack of resources) to the influence of LCGs over the innovation environment. Still, many of the public sector innovations (especially social innovations) that do not necessarily have a clear market potential would not have been created without the active role of LCGs as innovators. City employees are innovative – the seeming lack of public sector innovation is actually a result of measurement issues that favour (patentable) technological innovations rather than those more common to LCGs, meaning service and organisational types. Therefore, LCGs can be seen as highly innovative organisations. There are, however, barriers to innovation in the public sector, such as the cost of innovation activity, the lack of incentives for it and a working culture that does not support it. Lastly, the results show that LCGs have not really fully considered the possibilities and potential of owning their own IPR; to be specific, potentially lucrative opportunities should be explored.
An Empirical Analysis of Nigeria’s Current Account Sustainability
Authors: Shuaibu Mohammed , Oyinlola Mutiu Abimbola
Published: February 2017

This study reexamines the sustainability of the current account in Nigeria over four decades using time-series analysis on annual data from 1981 to 2013. We focus on two analytical distinctions to the inter-temporal budget constraint (IBC) hypothesis in relation to previous studies. First, we extend the standard bivariate approach to a multivariate framework that accounts for the roles of oil price variations and financial deepening, which have important implications for resource allocation. Second is the use of the Toda–Yamamoto modified Wald (MWALD)-based causality test that is also carried out to arbitrage between the results with and without a structural break. It employs both the conventional unit root test (augmented Dickey–Fuller [ADF] and Phillips–Perron [PP]) and the unit root test with a structural break (Perron, 2006; Zivot & Andrews, 1992). It also carries out the conventional residual-based cointegration test (Engle & Granger, 1987) and the residual-based cointegration test with a structural break (Gregory & Hansen, 1995). Findings suggest that there is current account sustainability in Nigeria and structural changes were not very potent during the period under consideration. This implies that the Nigerian economy complied with the IBC hypothesis, suggesting that exports could actually finance imports.

JEL Classification: F30, F32
Autonomous geographies of recreational running in Sofia, Bulgaria
Authors: Barnfield Andrew
Published: February 2017

During the last decade, recreational running in Sofia, the capital of Bulgaria, has become more visible. The growing popularity of free to join recreational running clubs is a key mechanism that has promoted running and developed the burgeoning running scene in the city. The case study presented in this paper draws on in-depth interviews and participant observation from an ongoing project with recreational runners in Sofia. This paper argues that these running clubs endeavor to promote a collective ontology that aims at bringing all sorts of bodies together. As such, running clubs present an approach that foregrounds participation and movement to promote sustainable urban spaces that are defined by their openness to corporeal activity. Drawing on the work of Jean-Luc Nancy and concepts of everyday utopias and urban play this paper concludes that running clubs are suggestive of ways to develop physical activity within a pluralistic notion of bodies and space. The paper develops the evidence base of elements of running club activities that draw people into participation in Eastern Europe.
Antimicrobial Prophylaxis of Gastrointestinal Surgical Procedures and Treatment of Intra-Abdominal Infections
Authors: Danziger Larry , Hassan Erkan
Published: February 2017

Antibiotic prophylaxis and treatment regimens ideally are selected on the basis of efficacy, safety, and cost. This review evaluates current, selected literature on antibiotic prophylaxis for colorectal surgery, presumptive antibiotic administration following penetrating abdominal trauma, and treatment of intraabdominal infections. Single-drug regimens with the newer, broad-spectrum agents are assessed and compared with combination regimens; specific regimens are recommended. Colorectal procedures require an antimicrobial agent with activity against both aerobes and anaerobes. Patients undergoing elective colorectal procedures can be adequately protected with an orally administered three-dose regimen of neomycin/erythromycin. Parenteral antibiotic administration is generally not necessary, but, cefoxitin is recommended for nonelective colorectal surgery.

The risk of potential infectious complications following penetrating abdominal trauma without colonic perforation is less than with colonic perforation; however, antibiotic therapy that includes activity against aerobes and anaerobes is recommended for all types of penetrating abdominal trauma. Although cephalothin, cefamandole, or cefoxitin alone may be used in abdominal trauma without perforation of the colon, only cefoxitin is recommended as a single-drug alternative to the standard clindamycin/gentamicin regimen in trauma with colonic perforation. Single-drug therapy with cefoxitin or moxalactam can be used successfully as alternatives to the standard regimens of clindamycin/gentamicin or metronidazole/gentamicin in many patients with intraabdominal sepsis. Single-drug regimens reduce the risk of developing adverse effects and are cost-effective. However, if resistant organisms are suspected, or if the patient has been hospitalized for a prolonged period or has multiple organ failure, it may be necessary to supplement cefoxitin therapy with an antibiotic that will enhance coverage against gram-negative aerobes.
Carbamazepine and Erythroid Arrest
Authors: Medberry Clinton A. , Pappas Alex A. , Ackerman Bruce H.
Published: February 2017

A patient who developed anemia with an isolated erythroid toxicity following chronic carbamazepine administration is reported. The anemia quickly resolved with discontinuation of this drug. Other hematologic toxicities of carbamazepine are well described; however, an isolated erythroid toxicity is unusual. In addition, the onset of this drug-induced toxicity developed later than is expected for carbamazepine-associated hematological toxicities. This case demonstrates the suddenness with which hematological toxicities can occur with carbamazepine, and affirms the need for regular monitoring of patients. Any significant decrease in the patient's hemoglobin or hematocrit level requires close monitoring for the sudden development of serious anemia.
Decreased Theophylline Clearance in a Patient with Severe Hypothyroidism
Authors: Seifert Charles F. , Covinsky Joel O. , Hamburger Stephen , Burke John M.
Published: February 2017

The effect of thyroid function on the liver's ability to metabolize various therapeutic agents is well documented, but evidence that changes in thyroid function affect the rate at which theophylline is metabolized is limited. We report a case of a 55-year-old woman with severe hypothyroidism and chronic bronchitis whose theophylline clearance doubled from 0.50 to 1.02 ml/min/kg with aggressive inpatient intravenous levothyroxine treatment. Chronic outpatient data showed that theophylline clearance remained relatively constant as thyroid function stabilized. This case is further evidence that thyroid function indeed has an effect on theophylline metabolism.
Digoxin-Like Immunoreactive Substance (DLIS) in Liver Disease: Comparison of Clinical and Laboratory Parameters in Patients with and without DLIS
Authors: Gervais Alan , Nanji Amin A. , Greenway Donald C. , Mclean William
Published: February 2017

Falsely elevated serum digoxin values have recently been reported in patients with liver disease. Since not all patients have circulatory digoxin-like immunoreactive substance (DLIS) in their serum, we compared the clinical and laboratory findings in patients with and without DLIS. Thirty-two patients with liver disease were studied. The only parameter that was significantly different in the two groups was serum bilirubin. In the group of patients with DLIS, significant correlations were obtained between DLIS and bilirubin and DLIS and creatinine. We postulate that increased levels of DLIS in serum are due to an abnormality of DLIS excretion.
Survey of Ulcer-Recurrence Risk Factors Associated with Long-Term Cimetidine Prescribing
Authors: Carmichael Jannet M. , Zell Steven C.
Published: February 2017

The appropriateness of long-term cimetidine prescribing was evaluated retrospectively in 243 outpatients. Criteria defining appropriate indications for the use of cimetidine for longer than eight weeks were established. Of the 243 patients surveyed, 115 (47 percent) were considered to be inappropriately receiving long-term cimetidine, either because they had never been objectively studied radiographically or endoscopically (23 percent) or had negative results before initiation of therapy (24 percent). Risk factors known to be associated with recurrent peptic ulcer disease were reviewed. Patients fulfilling criteria for appropriate long-term cimetidine usage had a greater prevalence of risk factors compared to the nonjustifiable group. Of particular interest, individuals considered appropriate for long-term therapy were very likely to have had a gastrointestinal bleeding episode prior to beginning therapy (52 percent for gastric ulcer, 8 percent for the nonjustifiable group). This increased prevalence of gastrointestinal hemorrhage may be due to the inherent nature of peptic ulcer disease or a result of physicians selecting affected individuals who may benefit from long-term treatment. Eliminating inappropriate usage of long-term cimetidine in conjunction with a thorough evaluation of risk factors for recurrent ulcer disease can be useful in selecting those individuals most likely to benefit from long-term cimetidine therapy.
Pentobarbital Pharmacokinetics in Patients with Severe Head Injury
Authors: Wermeling Daniel P. , Blouin Robert A. , Porter William H. , Rapp Robert P. , Tibbs Phillip A.
Published: February 2017

Intravenous administration of high-dose pentobarbital has been proposed as a treatment for elevated intracranial pressure refractory to other measures in brain-injured patients. The purpose of this clinical study was to examine the pharmacokinetics of high-dose continuous intravenous infusion of pentobarbital in this critical care setting. Six patients received a 25–34 mg/kg intravenous loading dose followed by a 1–3 mg/kg/h continuous infusion for 61–190 hours. Dosing rates were adjusted based on the patient's clinical status. The mean clearance was 0.72 ml/min/kg, with a volume of distribution (Vd) of 1.03 L/kg and a terminal half-life of 19.1 h. Considerable variation in individual patient parameters was observed. In addition, a change in clearance was suggested in patients requiring a longer infusion duration.
Calcium Modulators: Future Agents, Future Uses
Authors: Tracy Timothy S. , Black Curtis D.
Published: February 2017

The calcium modulators have been a significant therapeutic advancement for the treatment of angina. Structural analogs of verapamil and nifedipine have been synthesized, as have structurally unique compounds. As the role of calcium in body processes is further elucidated, the efficacy of the calcium modulators is being evaluated for numerous disorders. It is anticipated that the newly synthesized compounds will have specificity toward particular body processes, thus providing efficacy with minimal side effects.
Fish Oil: Effectiveness as a Dietary Supplement in the Prevention of Heart Disease
Authors: Zeller Frederick P. , Spears Catlin
Published: February 2017

The low incidence of reported heart attacks and cardiovascular-related deaths in Greenland Eskimos and the Japanese has generated interest in the possible protective effect of their diet, which is made up primarily of fish and related marine foods. This paper reviews the current evidence for reducing the risk of cardiovascular disease with fish-oil supplementation, and discusses related clinical data to support the mechanisms proposed. Included is evidence that fish oil can lower certain serum lipid levels, prolong bleeding time, and reduce systolic blood pressure when consumed in moderately large doses. Information on safety and side effects is also presented, such as a possible increase in serum cholesterol levels and annoying side effects that may severely limit widespread use of this food supplement. Presently it remains unanswered whether fish oil should be recommended as a dietary supplement for the prevention and/or treatment of hypercholesterolemia and associated coronary artery disease. Further research is required to demonstrate a clear reduction in cardiovascular mortality before a uniform recommendation can be made.
A Key to the Literature of Total Parenteral Nutrition: Update 1987
Authors: Mirtallo Jay M. , Oh Taeho
Published: February 2017

This comprehensive bibliography is intended to enhance the education of the practitioner, student, and academician in the area of parenteral nutrition. This bibliography is not all-inclusive but serves as an update from the original published in 1983. Of particular note in this work is the addition of topics that reflect a growing interest in medical specialties with regard to patient nutritional status and support.
Drug-Antacid Interactions: Assessment of Clinical Importance
Authors: D'arcy P.F. , Mcelnay James C.
Published: February 2017

Antacids and adsorbents are commonly used preparations that are generally considered to be pharmacologically inert and free from adverse effects. They may, however, interact with a diverse range of primary drugs and the sequelae can be disadvantageous to the efficacy of the primary medication. Many such reports in the literature are based on animal experiments, or on single-dose studies in healthy subjects. Some reports are anecdotal and are unconfirmed; others are based solely on in vitro evidence.

Potentially important interactions have been suggested for a relatively small group of drugs: tetracyclines, phenytoin, digoxin, chloroquine, cimetidine, quinidine, nonsteroidal antiinflammatory drugs, and beta-blocking agents. The evidence for these has been critically evaluated, as well as for antacid-anticoagulant and antacid-nitrofurantoin interactions that have been wrongly emphasized in the literature.

The majority of literature reports on interactions with antacids have been overemphasized; only ferrous sulfate-, isoniazid-, and tetracycline-antacid interactions fall into a category I importance (scale I–III of descending importance). This category is for those interactions with good evidence of actual or potential importance in patients or in relevant studies on normal subjects.
Hepatotoxicity Associated with Choline Magnesium Trisalicylate: Case Report and Review of Salicylate-Induced Hepatotoxicity
Authors: Cersosimo Robert J. , Matthews S. James
Published: February 2017

A case of a 21-year-old woman who had developed mild hepatotoxicity while receiving choline magnesium trisalicylate therapy is described. She presented with fever and mild hepatic enzyme elevations before salicylate therapy was instituted. Liver function tests (LFT) returned to normal within five days of hospitalization but she continued to develop daily fevers. Blood, urine, and throat cultures were negative. An acute viral illness or reactivation of systemic lupus erythematosus were the suspected diagnoses. Choline magnesium trisalicylate was then administered in an effort to control her fever, and was successful. After three days of salicylate therapy her LFT values began to rise. They continued to rise for five more days before salicylate hepatotoxicity was suspected. Choline magnesium trisalicylate was discontinued after eight days and the patient's LFT quickly returned to normal. The source of fever was never identified, although infection with cytomegalovirus was considered the most likely cause. Salicylate-induced hepatotoxicity is reviewed.
Thrombocytopenia and Vomiting Due to Difluoromethylornithine
Authors: Tietze Karen J. , Gaska Janice A. , Cosgrove Ellen M.
Published: February 2017

A 32-year-old Haitian male with acquired immunodeficiency syndrome presented with complications of Isospora belli enteritis. Therapy with the investigational drug difluoromethylornithine was initiated. Severe thrombocytopenia, nausea, and vomiting developed during intravenous drug therapy and recurred upon rechallenge with low-dose oral difluoromethylornithine. Therapy was discontinued because of these severe adverse effects.
Utilization of Electronic Infusion Devices in a University Hospital
Authors: Alexander Michael R. , Kirking Duane M. , Baron Katherine A.
Published: February 2017

Use of large-volume electronic infusion devices (EID) in an adult general hospital was compared with an established protocol to determine compliance. Data were collected during seven widely spaced inspections of the facility. Forty-six percent of 962 EID were observed to be employed inappropriately. Compliance was nearly identical for both pumps and controllers and for intensive care and non-intensive care areas. Four reasons for employing EID accounted for 48 percent of all inappropriate use. An estimated annual savings of $178 000 to $460 000 might be realized through strict protocol compliance.
Growth of Microorganisms in Total Nutrient Admixtures
Authors: Rowe Carl E. , Fukuyama Thomas T. , Martinoff James T.
Published: February 2017

It has been reported that intravenous fat emulsions, because of their isotonicity and neutral pH, support microbial growth, but traditional parenteral nutrition solutions, being hypertonic and more acidic, are not as supportive. To date, few studies have documented microbial growth in total nutrient admixtures (TNA) containing dextrose, amino acids, fat, electrolytes, vitamins, and trace elements.

This study was undertaken to analyze the growth of Staphylococcus aureus, Candida albicans and four gram-negative enteric bacilli in three different nutrient admixtures, with and without the inclusion of 5% fat emulsion. The composition of the admixtures was either 5, 10, or 25% dextrose; either 0 or 5% fat; and 3% amino acids, electrolytes, vitamins, and trace elements. All admixtures were innoculated with 100 colony-forming units per milliliter, incubated at room (25°C) or refrigerated (4°C) temperature, with samples withdrawn at 0, 3, 6, 12, 24, and 48 hours and plated in triplicate.

Only C. albicans demonstrated any significant growth regardless of fat content. The pH of the admixtures was similar (acidic), and all solutions were hypertonic and found to inhibit bacterial growth.

Conclusions suggest that TNA, when formulated with normal concentrations of additives, is no more likely to support growth of contaminant organisms than the traditional solutions. This contradicts the notion that the addition of fat to total parenteral nutrition will enhance the ability of these admixtures to support microbial growth.
Impact of a Nationwide Limited Prescribing List: Preliminary Findings
Authors: Ferrando Cristina , Henman Martin C. , Corrigan Owen I.
Published: February 2017

In the Republic of Ireland, the state pays the cost of medical care for around 40 percent of the population through the General Medical Services (GMS). Doctors treating GMS patients are entitled to prescribe from an approved list of drugs. In October 1982, many antacids, cough and cold preparations, antihistamines, and mild analgesics were removed from the GMS prescribing list. The visiting rate and the amount of prescribing fell in the GMS during 1982–83. Drug utilization within the GMS was measured using prescription numbers and in the total population using data obtained from pharmaceutical wholesalers expressed as defined daily doses. These results showed substantial changes in GMS prescribing in the utilization of mefenamic acid, carbocysteine, and H2-receptor antagonists associated with the introduction of the limited list, suggesting a switch to these agents from delisted preparations. The therapeutic and economic implications of this policy are discussed.
Is Telemetry Monitoring Useful in Patients Admitted With Suspected Acute Coronary Syndrome?
Authors: Perkins Jack , Voore Naveen K. , Patel Jaideep , Sanna Sathish , Mann Edana , Zakaria Sammy , Gozu Aysegul
Published: February 2017

Patients with a chief complaint of chest pain are frequently monitored by telemetry for evaluation of acute coronary syndrome (ACS). However, there is insufficient evidence to support this practice in younger patients without coronary artery disease (CAD). The objective is to assess outcomes of patients younger than 50 years of age and monitored by telemetry. Consecutive medical records of patients admitted for chest pain between January 1, 2009, and June 30, 2010, were reviewed. Patients were excluded who had a CAD history, an abnormal initial troponin, or an abnormal initial electrocardiogram. The remaining patients’ charts were evaluated for adverse events such as death, dysrhythmias, ST-elevation myocardial infarction, or upgrade to a higher level of care. Ultimately, 814 patients were selected for study. No study participants suffered a significant adverse event. When being evaluated for ACS, patients younger than 50 without a history of CAD may not benefit from telemetry monitoring.
Follow-up Study of MRI for Osteochondral Lesion of the Talus
Authors: Higashiyama Ichiro , Kumai Tsukasa , Takakura Yoshinori , Tamail Susumu
Published: February 2017

Characteristic MRI findings of osteochondral lesions of the talus have been reported. We examined how they change before and after treatment and discussed their significance. Twenty two ankles in 21 patients had MRI examination before and after treatment of the talar lesion. We evaluated the changes in the low intensity areas in T1-weighted image and the signal rims behind osteochondral fragment in T2-weighted image which have been reported as characteristic findings. Clinical symptoms were improved postoperatively in all subjects. The low intensity areas in T1-weighted image seen before the surgical treatment tended to decrease in size postoperatively. The low intensity area in T1-weighted image was reduced in 15 of the 22 ankles (68.2%). Low signal rim in T2-weighted image was seen in three cases before the treatment. All disappeared completely after arthroscopic drilling. Similarly, high signal rim in T2-weighted image seen in 13 cases before the treatment disappeared in 10 postoperatively. These findings were considered indicative that surgical treatments reduced abnormal stress of the underlying bone element due to unstable osteochondral fragment, leading to reduction of the low intensity area. The disappearance of signal rims in T2-weighted images was considered to indicate obliteration of the interface between the osteochondral fragment and the talar bed with bone union. We believe that MRI of the osteochondral lesion of the talus will be useful for postoperative evaluation allowing assessment of the need for further treatment. The decreasing size of low intensity areas in T1-weighted images and disappearance of signal rims behind the osteochondral fragment in T2-weighted images suggested healing of the osteochondral lesions.
Bizarre Parosteal Osteochondromatous Proliferation of Bone (BPOP): an Unusual Foot Mass in a Child
Authors: Gilmore Allison , Khoury Joseph , Karim Fadi W. Abdul , Ballock R. Tracy
Published: February 2017

This report describes an unusual case of bizarre parosteal osteochondromatous proliferation of bone (BPOP) which developed in the foot of an eight year-old child. Also described as Nora's lesion, BPOP is a rare benign bone tumor found most commonly in the hands and feet with a radiographic appearance occasionally confused with malignancy. Resembling osteochondromas at first glance, these lesions have a distinct radiographic and histologic appearance that permits differentiation from other benign lesions or low-grade malignant tumors. Treatment of BPOP consists of simple excision, although there is high rate of recurrence. Despite this high recurrence rate, there have been no reported metastases and local excision is still recommended.
Abstracts
Authors: Trepman Elly
Published: February 2017

Abstracts are selected on the basis of interest to the readership. Publication does not constitute endorsement of content or validation of conclusions.

Send reprints of articles for consideration to the Foot & Ankle International Office, 1690 University Ave., #B10, St. Paul, Minnesota 55104.
Clinical Comparison of Two Total Ankle Replacements
Authors: Wood Peter L R , Clough Timothy M , Jari Sanjiv
Published: February 2017

We compared the outcome of the cemented Thompson Parkridge Richards (TPR) ankle prosthesis with that of the cementless Scandinavian Total Ankle Replacement (STAR) ankle prosthesis in a demographically similar group of patients. These were 14 consecutive arthroplasties in 12 rheumatoid arthritis patients, all operated on by the same surgeon.

The status of all patients, five years or more after surgery, is known. The mean follow-up periods for the TPR group and the STAR group are 7.2 and 5.4 years respectively. Four of the six TPR tibial components became radiographically loose within two years of surgery. Two of these have been converted to fusions. The STAR prostheses remain satisfactory both clinically and radiographically at five years.
Morton's Intermetatarsal Neuroma: Morphology and Histological Substrate
Authors: Morscher E , Ulrich J , Dick W
Published: February 2017

Twenty-three biopsies from patients with the typical symptoms of intermetatarsal neuroma (so-called Morton's metatarsalgia) were compared histologically and semi-quantitatively with 25 plantar nerves from the intermetatarsal space III/IV gained at autopsies from cases where no problems in the forefoot had been recorded. The histomorphological examination of the nerves from autopsies revealed the same findings as were found in the biopsies. Thus, qualitatively, the nerves from patients could not be distinguished from those gained at autopsy. The only difference was the diameter of the resected nerves: semi-quantitative analysis of the nerves showed that the 17 thinnest ones were all from autopsies and the five thickest ones from biopsies of symptomatic patients. At medium diameters, however, there was wide overlap of the two groups. The study yielded a specifity of the swelling of 80 % and a sensitivity of 78%.

From these results it must be concluded that diagnostic MRIs or ultrasonography, are unnecessary for decisionmaking about operative treatment and are not superior to exploratory local anaesthesia.

ce histomorphological findings in intermetatarsal neuroma (so far accepted as the gold standard for confirmation of that diagnosis) were the same as findings in autopsied (normal) specimens, the value of postoperative histological examination is questioned. It merely proved that the nerve has been resected.
Classification and Treatment of Plantar Fibromatosis
Authors: Sammarco G. James , Mangone Peter G.
Published: February 2017

A retrospective study of 18 patients (23 feet) with plantar fibromatosis who required surgical excision between January, 1991, and June, 1998, was performed. Subtotal plantar fasciectomy was performed to remove the tumor with a wide disease-free margin. 16 patients (21 feet) were interviewed and 14 patients (19 feet) were examined with an average followup of 36 months. Two patients (2 feet) with less than 12 months followup were excluded. Both subjective and objective evaluations and pre- and postoperative x-rays were reviewed to assess the alignment of the bony arch.

There were nine males and nine females, age 49 years, average, at the time of diagnosis. Sixty-seven percent of patients had bilateral disease, and 28% had associated Dupuytren's contracture. There were 18 primary and five recurrent tumors.

An operative staging system, I to IV, for plantar fibromatosis is presented which incorporates the extent of plantar fascia involvement, the presence of skin adherence, and the depth of tumor extension. The stage of the tumor correlated well with postoperative wound healing, skin necrosis, and recurrence.

In fifteen of 21 feet, the patients were satisfied without reservations, and in three of 21 feet, they were satisfied with reservations. In 18/21 (86%) feet, the patient reported he/she would have surgery done again.

There were two recurrent tumors. One was reoperated and the patient was disease free twelve months postoperatively. The other recurrence was asymptomatic 40 months postoperatively and required no treatment. One patient required an excision of a postoperative cutaneous neuroma. Eleven of 21 feet (52%) experienced delayed healing and of which four required a split thickness skin graft. Ten of the eleven feet with delayed wound healing and all four cases requiring a skin graft had a stage III or IV tumor. Pre- and postoperative weightbearing radiographs revealed a slight decrease in the calcaneal pitch angle, navicular height, and medial cuneiform height indicating a decrease in the height of the medial longitudinal arch.
Shank Rotation: A Measure of Rearfoot Motion During Normal Walking
Authors: Nester C. J. , Hutchins S. , Bowker Professor P.
Published: February 2017

Motion of the shank in the transverse plane is coupled with pronation and supination of the rearfoot, and so its motion relative to the foot can be used as an indicator of the pattern of motion in the rearfoot. Compared to the more commonly used assessment of motion in the frontal plane between the heel and the shank, motion of the shank in the transverse plane relative to the foot provides a more complete measure of the pattern of motion of the rearfoot because it reflects the motion in all three joints of the rearfoot (the ankle, subtalar joint and mid-tarsal joint) not solely the ankle and subtalar components. This work aimed to provide normative data for this alternative measure of rearfoot function. Data on angular displacement, angular velocity and angular acceleration were derived from motion-analysis conducted on 25 subjects. The results suggest a difference between the pattern of angular displacement indicated when motion of the shank relative to the foot is examined and the pattern of angular displacement indicated when motion in the frontal plane between the shank and heel is examined. Specifically, the former suggests that resupination of the rearfoot after rearfoot pronation during the initial period of gait, starts at the beginning of mid-stance, while the latter suggests resupination beginning in late mid-stance. Where comparisons were possible, data on the velocity and acceleration appeared reasonable and provide further parameters with which to investigate the role of motion in the rearfoot in the development of pathologic conditions and the effects of intervention on motion in the rearfoot.
Calcaneal Fractures in the Industrial Patient
Authors: Coughlin Michael J
Published: February 2017

A retrospective review was performed on industrial patients who sustained calcaneal fractures within the State of Idaho during the years 1992 to 1994, and these patients were insured by the Idaho State Insurance Fund. Of 48 calcaneal fractures that occurred during this period, 18 were non-displaced extra-articular fractures and 30 were displaced intra-articular fractures. An independent evaluator contacted each patient and performed chart reviews regarding the work history, period of time off work, and cost incurred with the injury. A total of 24 primary surgical procedures were performed on patients who sustained a displaced intra-articular calcaneal fracture and 31 secondary procedures were performed including wound debridement, hardware removal, skin grafting, and secondary subtalar fusion. For patients whose calcaneal fractures could be treated with non-operative care, the average time from injury until return to work was 18 weeks, and the average total cost of injury was $14,230. For patients whose calcaneal fractures required open reduction and internal fixation, the average time loss from work was 35 weeks, and the average total cost of injury was $31,004. Seven patients whose calcaneal fractures were initially treated with an open reduction, internal fixation later underwent a hindfoot arthrodesis. The average time off work for these patients was 69 weeks and the average total cost of injury was $65,384. Fractures were rated on postoperative radiographs according to the quality of their operative reduction. Fractures that were non-anatomically reduced had an increased tendency to require a subtalar fusion. Nine patients sustained other injuries associated with their calcaneal fracture and three patients sustained an open fracture. Both concurrent injuries and open fractures were associated with increased total cost and increased time off work. The total cost of injury was doubled as was time off work when an open reduction and internal fixation was followed later by a secondary subtalar arthrodesis.
Outcomes in Hallux Rigidus Patients Treated Nonoperatively: A Long-Term Follow-Up Study
Authors: Smith Ronald W. , Katchis Stuart D. , Ayson Lin C.
Published: February 2017

The purpose of this study was to analyze radiographic outcome and patient satisfaction in non-operative care of hallux rigidus. Twenty-two patients representing 24 feet were surveyed and radiographed. Average follow-up was 14.4 years (range, 12–19 years). In 75% (18/24) of the feet, the patients would “still chose not to have surgery” if they had to make the decision again. The pain remained about the same in 22 feet, improved with time in one, and became worse in one. The most common reason given for not having surgery was that the pain was not severe enough. The most common type of self-care was a shoe with an “ample toe box.” More patients benefited from a stiff sole than a soft sole, but the majority of patients did not cite the sole of the shoe as being important. There was measurable loss of cartilage space radiographically over time in 16 of 24 feet, and in eight of the 16 feet, the loss of cartilage space was dramatic. The majority of hallux rigidus patients rated their pain as staying the same over a twelve-year period, despite significant deterioration of joint space noted radiographically.

The study provides data for the hallux rigidus patient who asks, “what happens if I choose not to have surgery?”
Hindfoot Motion after Isolated and Combined Arthrodeses: Measurements in Anatomic Specimens
Authors: Wülker Nikolaus , Stukenborg Christina , Savory Kevin M. , Alfke Dirk
Published: February 2017

Passive motions at the subtalar joint, talonavicular joint and calcaneocuboid joint were measured in eight ankle specimens, using an ultrasonic motion analysis system. Arthrodeses of the three joints were performed in all feasible combinations and the resulting motion change at the unfused joints was determined. Motion at the subtalar joint was not significantly affected by fusion of the calcaneocuboid joint, reduced to one quarter by fusion of the talonavicular and calcaneocuboid joints (double arthrodesis) and almost completely eliminated with all other fusions. Motion at the talonavicular joint was not significantly affected by calcaneocuboid fusion and reduced to approximately one third with the subtalar and the double arthrodesis. Motion at the calcaneocuboid joint was not significantly reduced by subtalar fusion but almost completely eliminated in all fusions involving the talonavicular joint. It is concluded that the talonavicular joint is the key articulation for hindfoot motion. Double arthrodesis preserved significant motion at the subtalar joint. Fusion of the calcaneocuboid joint had no significant influence on remaining hindfoot motion.