bluuebunny/crossref_metadata_2025 huggingface dataset:
Stepping Back From Crisis Points
Authors: Wiggins Sally , McQuade Robert , Rasmussen Susan
Published: March 2016

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.
Near-Death and Other Transpersonal Experiences Occurring During Catastrophic Events
Authors: Lawrence Madelaine
Published: March 2016

The purpose of this article is to describe examples of near-death and other transpersonal experiences occurring during catastrophic events like floods, wars, bombings, and death camps. To date, researchers have limited their investigations of these transpersonal events to those occurring to seriously ill patients in hospitals, those dying from terminal illnesses, or to individuals experiencing a period of grief after the death of a loved one. Missing is awareness by first responders and emergency healthcare professionals about these transpersonal experiences and what to say to the individuals who have them. Some responders experience not only deaths of the victims they assist, but also deaths of their colleagues. Information about these transpersonal experiences can also be of comfort to them. The examples in this article include a near-death experience during the Vietnam War, an out-of-body experience after a bomb explosion during the Iraq War, a near-death visit to a woman imprisoned at Auschwitz, and two after-death communications, one from a person killed in Auschwitz and another from a soldier during World War I. Also included are interviews with two New York City policemen who were September 11, 2001 responders. It is hoped the information will provide knowledge of these experiences to those who care for those near death, or dying, or grieving because of catastrophic events, and encourage researchers to further investigate these experiences during disasters.
Developing a Community of Inquiry in a Face-to-Face Class
Authors: Warner Alfred G.
Published: March 2016

Traditional classes are typically bound both in the classroom space and scheduled time. In this article, I show how applying an online learning framework called the Community of Inquiry and an organizational architecture of matrixed teams has worked in a face-to-face capstone class and extended those boundaries. These were introduced as an alternative to a case-based writing course as a means of getting more engagement, better thinking, and better papers from students. Matrixed teams involve assigning students to both a semester long team organized around a complex and detailed group paper and, at the same time, to a topic analysis team that fed the content for the paper. In order to support this inquiry, I also used a social media platform called Yammer to cultivate conversations outside the normal class hours that capitalized on in-class work. The approach has been effective: Participation is both deeper in topics and includes more people than in traditional classes. Furthermore, the quality of the written work is significantly better in structure and content, particularly with students at the lower end of the classes.
Student-Led Project Teams
Authors: Ainsworth Judith
Published: March 2016

We studied group and individual co-regulatory and self-regulatory strategies of self-managed student project teams using data from intragroup peer evaluations and a postproject survey. We found that high team performers shared their research and knowledge with others, collaborated to advise and give constructive criticism, and demonstrated moral responsibility by respecting project management processes and communication protocols. Low team performers lacked self-regulatory strategies to work autonomously and clearly explain their research and its purpose, to ask for clarification, and to work autonomously. Consequently, effective regulatory strategies are crucial for high team performance, for team skills development, and for preparing business and management students for future team-based work environments.
Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses
Authors: Chang Wen , Liu Hsueh-Erh , Goopy Suzanne , Chen Li-Chin , Chen Hsiao-Jung , Han Chin-Yen
Published: March 2016

Triage classifies and prioritizes patients’ care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses’ decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients’ health status, and nurses’ experiences. This study suggests ensuring the patient’s privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public’s understanding of the ED visits. These will make ED triage more efficient.
Telemedicine for ophthalmic consultation services: use of a portable device and layering information for graders
Authors: Woodward Maria A , Bavinger J Clay , Amin Sejal , Blachley Taylor S , Musch David C , Lee Paul P , Newman-Casey Paula Anne
Published: March 2016

Introduction

We compared remote, image-based patient consultations to in-person consultations at emergency department and inpatient hospital settings.

Methods

Patients evaluated by the ophthalmic consultation services (gold standard) were imaged over a two-week period. A trained study coordinator took anterior segment photographs (AS) and posterior segment photographs (PS) with a portable camera (PictorPlus, Volk Optical, Cleveland, OH). Ophthalmologists (graders) determined photograph quality, presence of pathology, and their confidence in disease detection. At a separate session, graders reassessed photographs accompanied by a one-sentence summary of demographics and chief complaint (CHx). We computed accuracy and reliability statistics.

Results

We took AS photographs of 24 eyes of 15 patients and PS photographs of 39 eyes of 20 patients. The majority of images were rated as acceptable or excellent in quality (AS: 89–96%; PS: 70–75%). Graders detected AS pathology with 62–81% sensitivity based on photographs, increasing to 87–88% sensitivity with photographs plus CHx. Graders detected PS pathology with 79–86% sensitivity based on a photograph only, increasing to 100% sensitivity with photographs plus CHx.

Discussion

In this pilot study, there is evidence that portable ophthalmic imaging technologies could enable ophthalmologists to remotely evaluate anterior and posterior segment eye diseases with good sensitivity. The ophthalmologist could detect ocular pathology on photographs more accurately if they were provided brief clinical information.
‘She was a foster mother who said she didn’t give cuddles’: The adverse early foster care experiences of children who later struggle with adoptive family life
Authors: Meakings Sarah , Selwyn Julie
Published: March 2016

Foster care remains a valuable and safe intervention for many children unable to live with their birth family. When birth family reunification is not considered possible, a small proportion of children in foster care will go on to achieve permanency by way of adoption. This article reports on some unexpected findings to emerge from two national adoption studies of previously looked after children in England and Wales. Focussing on a subset of families who had experienced or were at risk of an adoption disruption, the findings revealed that not only did children carry elevated risks for disruption due to their older age at entry to care, multiple foster care placements and traumatic early histories, but once in care, many of the children whose placements had disrupted were considered by their adoptive parents to have had very poor, even harmful fostering experiences before being placed for adoption. Possible explanations for these findings are discussed, together with the implications for social work practice.
Psychosocial correlates of alcohol and other substance use among low-income adolescents in peri-urban Johannesburg, South Africa: A focus on gender differences
Authors: Magidson Jessica F , Dietrich Janan , Otwombe Kennedy N , Sikkema Kathleen J , Katz Ingrid T , Gray Glenda E
Published: March 2016

Alcohol and other drug use is prevalent among peri-urban, South African adolescents. We identified correlates of alcohol and other drug use by gender among adolescents (age = 16–18 years; N = 822) in peri-urban Johannesburg. Interviewer-administered surveys assessed sexual activity, alcohol and other drug use, and relevant psychosocial factors. In separate logistic regression models of alcohol and other drug use stratified by gender, violence exposure and sexual activity were associated with alcohol use for both males and females. For females only, depressive symptoms were associated with drug use. For males only, being older and sexually active were associated with drug use. Substance use interventions for South African adolescents should consider psychological health, sexual health, and tailoring by gender.
Discrete computational shear strength models for 5-, 6-, and 11-circular-hoop and spiral transverse reinforcement
Authors: Ou Yu-Chen , Ngo Si-Huy
Published: March 2016

Based on the actual, discrete locations of interception points between the critical shear crack and transverse reinforcement, this study developed the discrete computational shear strength models for 5-, 6-, and 11-circular-hoop and spiral reinforcement. Moreover, conventional simplified calculation method was revised for use for 5-, 6-, and 11-circular-hoop and spiral reinforcement. Examination of the difference between the discrete computational shear strength models and simplified calculation shows that the error of the simplified calculation increases with increasing ratios of spacing to diameter of circular hoops or spirals. Limiting values of spacing to diameter ratios were proposed to control the error of the simplification calculation to be equal to or less than 10%. Plots of modification factors were proposed to be used with the simplification calculation when the spacing to diameter ratio is large.
Facilitating university education: A view from the North
Authors: Wiewiura Joachim S
Published: March 2016

In this small essay, I will reflect on Michael Bérubé and Jennifer Ruth's arguments on the decline of educational professionalism in the United States. The purpose is to consider this loss of professionalism, and I will consider it in light of the arts and humanities in the Danish educational debate. Two reflections are presented: first, the customer relation is reversed in a Scandinavian context where students are politically demanded products rather than informed customers. This implies that universities' output serve political agendas. Second, I suggest that the Scandinavian conception of equality in welfare might entail an inexpedient side-effect when it comes to education. Equality becomes alignment rather than educative edification of individual and, in consequence, communal autonomy. This jeopardises the historically fruitful role of the Scandinavian university – and ultimately caters to a shift from edification to serving interests that are beyond the professional heart of arts and humanities in higher education.
An Australian response to Michael Bérubé
Authors: Frances Raelene
Published: March 2016

This article supports Bérubé's conclusion regarding the intellectual health of humanities scholarship. However, it argues that the case of ‘contingent faculty' – or academics with short-term or casual contracts – is in many respects different in Australia to the situation he outlines for the US. Whilst a variety of funding pressures have encouraged Australian universities to employ more staff on non-continuing contracts, organised union action has to some extent limited the number of such positions. Unionists have also been involved in formulating new categories of employment to provide more secure jobs with better career paths for staff employed in teaching intensive roles. However, the success of these efforts has been mixed, with unintended consequences of some of these strategies and uneven take up by universities of new categories of academic staff. Both university administrators and unionists continue to grapple with the complexities of these issues.
Early Aggression and Later Delinquency
Authors: Hay Carter , Meldrum Ryan C. , Widdowson Alex O. , Piquero Alex R.
Published: March 2016

Childhood aggression consistently predicts delinquency during adolescence, but research in this area reveals exceptions, with some highly aggressive children becoming relatively nondelinquent adolescents. This directs attention to the factors that explain why early aggression is sometimes not followed by later delinquency. This study considers that parenting marked by attachment, consistent monitoring, and the avoidance of harshness and hostility may be one such factor. This is considered with data from a sample of roughly 800 U.S. families, with analyses focused on 217 youth who were highest in aggression at 4–7 years of age. The analysis revealed substantial variation among aggressive youth in the quality of parenting that they received from ages 9 to 12. This variation helped explain variation in age 15 delinquency, with this relationship being mediated by adolescent levels of school bonds, susceptibility to peer pressure, and low self-control. We discuss the implications of these findings for theory, future research, and policy efforts to reduce delinquency among aggressive and antisocial children.
The value of preoperative embolization in large and giant solid cerebellar hemangioblastomas
Authors: Sultan Ahmed , Hassan Tamer , Aboul-Enein Hisham , Mansour Osama , Ibrahim Tamer
Published: March 2016

Background

Solid cerebellar hemangioblastomas are highly vascular lesions and may cause catastrophic hemorrhage during excision.

Methods

This retrospective study enrolled 10 patients (7 men and 3 women, with a mean age of 38.2 ± 12.5 years) with solid cerebellar hemangioblastomas. All patients had a solitary tumor and underwent surgical resection of the lesion through a suboccipital approach. The basic features, serial radiographic examinations, and operative records were analyzed.

Results

The most common presenting symptoms were headache (100%), ataxia (100%), and long tract manifestations (60%). Three patients had experienced failed surgery previously due to massive intraoperative bleeding. Three patients were confirmed as having Von Hippel–Lindau disease. The average size of the tumor was 40.7 ± 8.7 mm in its maximal diameter (range 25–58 mm). Total endovascular occlusion obtained in six patients, near total occlusion in three patients, and incomplete occlusion in one patient. Nine (90.0%) patients underwent gross total resection and one (10.0%) underwent partial resection. After the primary surgery, eight (80.0%) patients experienced improvement in their symptoms, two (20.0%) maintained their pre-treatment status, and none showed neurological deterioration following tumor resection. Blood loss during surgery after embolization was minimal and controllable.

Conclusion

Preoperative embolization improves safety and efficacy of the microsurgical excision of such tightly located very vascular tumors. Embolization changes the concept of this lesion surgery into piecemeal removal rather than a total mass extraction technique. Liquid agents are superior to particles in obliteration of such lesions.
Elevational spatial compounding for enhancing image quality in echocardiography
Authors: Perperidis Antonios , McDicken Norman , MacGillivray Tom , Anderson Tom
Published: March 2016

Introduction

Echocardiography is commonly used in clinical practice for the real-time assessment of cardiac morphology and function. Nevertheless, due to the nature of the data acquisition, cardiac ultrasound images are often corrupted by a range of acoustic artefacts, including acoustic noise, speckle and shadowing. Spatial compounding techniques have long been recognised for their ability to suppress common ultrasound artefacts, enhancing the imaged cardiac structures. However, they require extended acquisition times as well as accurate spatio-temporal alignment of the compounded data. Elevational spatial compounding acquires and compounds adjacent partially decorrelated planes of the same cardiac structure.

Methods

This paper employs an anthropomorphic left ventricle phantom to examine the effect of acquisition parameters, such as inter-slice angular displacement and 3D sector angular range, on the elevational spatial compounding of cardiac ultrasound data.

Results and conclusion

Elevational spatial compounding can produce substantial noise and speckle suppression as well as visual enhancement of tissue structures even for small acquisition sector widths (2.5° to 6.5°). In addition, elevational spatial compounding eliminates the need for extended acquisition times as well as the need for temporal alignment of the compounded datasets. However, moderate spatial registration may still be required to reduce any tissue/chamber blurring side effects that may be introduced.
Biomechanical investigation of ‘figure of 8’ flexor tendon repair techniques
Authors: Agrawal A. K. , Mat Jais I. S. , Chew E. M. , Yam A. K. T. , Tay S. C.
Published: March 2016

This biomechanical study compared the original Al-Qattan repair with other modifications postulated to reduce bulk and friction, thereby potentially improving outcome. A total of 32 cadaveric digits with intact flexor apparatus were used. In each digit, the flexor digitorum profundus and flexor digitorum superficialis tendons were cut cleanly in Zone 2. We tested Al-Qattan’s technique along with three modifications using stronger suture material and varying the number of strands across the repair site. Of the four repair techniques, the modified Al-Qattan’s technique using two ‘figure of 8’ 4-0 Fiberwire core sutures (Group 4) had the best balance of ultimate tensile strength (50.9 N), 2 mm gapping force (38 N) and friction. The modified technique provided a stronger repair for early active mobilization and has less friction than the originally described repair.
Health promotion: Exercise in primary care
Authors: Shahid Ruba J , Shahid Hina J
Published: March 2016

Physical inactivity is the fourth-leading risk factor for death worldwide. It contributes to approximately 3 200 000 deaths each year. Globally, one in every four individuals is physically inactive. This article looks at the burden of physical inactivity, and benefits and recommendations for physical activity for different age groups. There is a discussion on how these recommendations can be achieved in a general practice setting using health promotion models, and by working in conjunction with community partners, both on a local and national level.
Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean
Authors: Bradshaw Prisca , Hariharan Seetharaman , Chen Deryk
Published: March 2016

Objectives:

Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients.

Design and methods:

A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients’ preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative ‘expected’ pain score was recorded. Postoperatively, ‘observed’ pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression.

Results:

A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores.

Conclusion:

The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.
Endoscopic risk factors for neoplastic progression in patients with Barrett’s oesophagus
Authors: Bureo Gonzalez Angela , Bergman Jacques JGHM , Pouw Roos E
Published: March 2016

Barrett’s oesophagus is a precursor lesion for oesophageal adenocarcinoma, which generally has a poor prognosis. Patients diagnosed with Barrett’s oesophagus therefore undergo regular endoscopic surveillance to detect neoplastic lesions at a curable stage. The efficacy of endoscopic surveillance of Barrett’s oesophagus patients is, however, hampered by difficulties to detect early neoplasia endoscopically, biopsy sampling error, inter‐observer variability in histological assessment and the relatively low overall progression rate. Efficacy and cost‐effectiveness of Barrett’s surveillance may be improved by using endoscopic and clinical characteristics to risk‐stratify Barrett’s patients to high‐ and low‐risk categories. Recent national and international surveillance guidelines have incorporated Barrett’s length and presence of low‐grade dysplasia in the advised surveillance intervals. In this review we will discuss endoscopic characteristics that may be associated with neoplastic progression in Barrett’s oesophagus and that may be used to tailor surveillance in Barrett’s patients.
Explaining criminal networks: Strategies and potential pitfalls
Authors: Campana Paolo
Published: March 2016

This article offers some remarks on a few critical issues related to explanation in criminal network research. It first discusses two distinct perspectives on networks, namely a substantive approach that views networks as a distinct form of organisation, and an instrumental one that interprets networks as a collection of nodes and attributes. The latter stands at the basis of Social Network Analysis. This work contends that the instrumental approach is better suited to test hypotheses, as it does not assume any structure a priori, but derives it from the data. Moreover, social network techniques can be applied to investigate criminal networks while rejecting the notion of networks as a distinct form of organisation. Next, the article discusses some potential pitfalls associated with the instrumental approach and cautions against an over-reliance on structural measures alone when interpreting real-world networks. It then stresses the need to complement these measures with additional qualitative evidence. Finally, the article discusses the use of Quadratic Assignment Procedure regression models as a viable strategy to test hypotheses based on criminal network data.
Installing computational social science: Facing the challenges of new information and communication technologies in social science
Authors: Heiberger Raphael H. , Riebling Jan R.
Published: March 2016

Today’s world allows people to connect over larger distances and in shorter intervals than ever before, widely monitored by massive online data sources. Ongoing worldwide computerization has led to completely new opportunities for social scientists to conceive human interactions and relations in unknown precision and quantities. However, the large data sets require techniques that are more likely to be found in computer and natural sciences than in the established fields of social relations. In order to facilitate the participation of social scientists in an emerging interdisciplinary research branch of “computational social science,” we propose in this article the usage of the Python programming language. First, we carve out its capacity to handle “Big Data” in suitable formats. Second, we introduce programming libraries to analyze large networks and big text corpora, conduct simulations, and compare their performance to their counterparts in the R environment. Furthermore, we highlight practical tools implemented in Python for operational tasks like preparing presentations. Finally, we discuss how the process of writing code may help to exemplify theoretical concepts and could lead to empirical applications that gain a better understanding of the social processes initiated by the truly global connections of the Internet era.
Relating our selves: Shifting frames of identity in storytelling with communities marginalised through sexuality and gender
Authors: Valentine James
Published: March 2016

Recording the lives of people in marginalised communities can be enhanced through the use of a range of participatory methods, relating our selves in ways that go beyond traditional interviews and oral history. Innovative artistic methodologies may catch and render contingent identities, our fluid and variously bounded selves, which are dependent on context, performance and narrative. This article reviews a community-led storytelling project that has generated reflexive narratives and a variety of storytelling methods by and for people marginalised by sexuality and gender. Queer Stories, undertaken by OurStory Scotland, became the world’s first project to focus on multi-media storytelling with a nationwide lesbian, gay, bisexual and transgender community for public representation and national museum archiving. The aesthetic extension of narrative methods, through performance, fiction and display, reaches new publics and enables narrow identifications, fixed in dominant representations, to be challenged: stereotypes can be subverted and boundaries of identification undermined through the recognition of shifting frames of identity. Storytelling, through aesthetic distance, mutual identification and inclusive community ethics, fosters awareness of the contingency of all identity.
Acute Vs Delayed ACL Reconstruction. Early Differences and Preliminary Two Year Results
Authors: Eriksson Karl , Barenius Björn
Published: March 2016

Objectives:

Historically acute ACL reconstruction has been avoided due to reports of early rehabilitation problems with stiffness. Are these reports still valid today with modern arthroscopic techniques?

Methods:

70 patients with a high recreational activity level (Tegner ≥6) who presented with a acute ACL injury were randomized to an acute reconstruction within 8 days from the injury or delayed reconstruction after 6-10 weeks. Four surgeons performed the ACL reconstructions with quadrupled semitendinosus tendon grafts and endobutton and metallic interference screw fixation. The rehabilitation training was performed at the same physiotherapy center for all patients. The follow up at 6 and 24 months included ROM, Lachman, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level.

Results:

There were no differences between the groups in ROM, IKDC, activity level or laxity at 6 months. Four patients had a combined extension and flexion deficit of more than 15 degrees, two from each group. In the acute group 79% had an objective IKDC grade A or B compared with 73% in the delayed group. The one leg hop index above 90% was found in 50% in the acute group and 24% in the delayed group (p=0.04). Functional data for the 2-year follow up are not available at the time of abstract writing. The median activity level according to Tegner was restored to pre-injury levels in both groups after one year, and was stationary at 2 years. The visual analogue scale (VAS) response to the question “How is your knee working on a scale from 0-100? (100 = best)” revealed 81 in the acute and 71 in the delayed group (p=0.1). To the question “How does your knee affect your activity level on a scale from 0-100? (100 = no affection)” the mean score was 75 in the acute group and 67 in the delayed group (p=0.3). At one and two years the KOOS was statistically similar between the groups but with slightly higher subscale “Sport and recreation” scores, 85 in the acute group at 2 years compared to 78 in the delayed group (p=0.2). At the meeting preliminary results regarding functional tests and additional procedures for the groups will be presented.

Conclusion:

No negative effects of an acute ACL reconstruction were found at 6 months follow up. Preliminary 2 year results point in the same direction. Acute reconstruction of the ACL seems to be safe and a potential benefit might be decreased loss of muscle function. Further analysis of the 2 year results is needed before final conclusions can be drawn.
Overview of the AOA National Joint Replacement Registry
Authors: Clarnette Richard , Graves Stephen , Lekkas Christina
Published: March 2016

Objectives:

Report the findings of the AOANJRR ACL Registry Pilot pilot study to determine the feasibility of establishing an ACL Registry in Australia.

Methods:

The study involved both patient (pre and post-operative questionnaire) and surgeon (ACL operative data form) derived data collection. The Patient Reported Outcome Measures (PROMs) collected are the KOOS short form, a further two subscales taken from the KOOS long form (Quality of Life; and Function, Sports and Recreation Activities), and the Marx Activity Scale. A variety of approaches were used to maximize the collection of PROMs. The proportion of procedures provided by each hospital was determined by comparison to government separation data.

Results:

Nine hospitals nationwide were involved with the study, with 803 patients recruited. Collection of surgeon reported data achieved was 99.9%. Collection of PROMs data showed that 55% of patients notified at 6 months and 58.5% of patients notified at 12 months responded. The proportion of all ACL procedures undertaken at each hospital and included in the study varied considerably.

Conclusion:

The study has shown that it is possible to collect surgeon derived data for those patients recruited for the study. The collection of PROMs however is more problematic.
Use of Technetium Bone Scan to Help Predict Whether Patella Resurfacing Will Be Successful in Treating Pain Following Primary TKR
Authors: Fine Stephen , Watson Anna
Published: March 2016

Objectives:

Anterior knee pain is not uncommon following primary TKR. The AOANJRR (2014) reports that 12.1% of revisions of primary TKR are for patellofemoral pain. Patella resurfacing does not always relieve this pain. The objective of this study is to investigate whether a technetium bone scan after TKR will predict success of a subsequent patella resurfacing.

Methods:

Observational Case Series. This is a retrospective review of patients of a single orthopaedic surgeon over a 22 year period. Patients who had subsequent isolated patella resurfacing (or patella resurfacing plus tibial insert exchange) of a primary TKR were identified and contacted by telephone. All had bone scans performed in their workup to patella resurfacing. Bone scan was considered positive if the radiologist reported greater uptake in the patella than elsewhere in the knee. Three patient outcome measures were used: Satisfaction (very satisfied, satisfied, dissatisfied, very dissatisfied); Pain relief (excellent, good, no improvement, worse); “Would you have the surgery again?” (yes, no). Correlation was made between results of bone scans and patient outcome measures.

Results:

35 patients were identified who underwent subsequent patella resurfacing of a primary TKR. 22 were contactable and eligible for the study. The average time from primary knee replacement to patella resurfacing was 6 years, 4 months. The average time from the patella resurfacing to interview was 3 years, 8 months. 17 of the patients did not have their patella resurfaced at the primary procedure. 5 had loose patella buttons. 3 had replacement of their tibial polyethylene insert at the same time as patella resurfacing. There were 15(68%) positive bone scans. Of these, 14(93%) were very satisfied or satisfied. There was a single case (7%) who was dissatisfied. 14(93%) had excellent or good pain relief, 1(7%) had no improvement. 14 patients said that they would have the surgery again, 1 would not. There were 7(32%) negative bone scans. Of these, 2(29%) were very satisfied or satisfied and 5(71%) were dissatisfied. 2(29%) had excellent or good pain relief, 5(71%) had no improvement. 4 patients said that they would have the surgery again, 3 would not.

Conclusions:

In patients with a painful primary TKR, technetium bone scan may be a useful additional tool to help predict which patients will benefit from subsequent patella resurfacing
Radiological Outcomes and Operative Time following Total Knee Arthroplasty using Accelerometer-based, Portable Navigation versus Conventional Inter-Medullary Alignment Guides
Authors: MacDessi Samuel , Solayar GN , Thatcher N , Chen Darren B
Published: March 2016

Objectives:

Accelerometer-based, portable navigation instrumentation is a new method of achieving desired resection alignments in total knee arthroplasty (TKA).

Methods:

After randomisation and the application of exclusion criteria, 79 knees were analysed. 42 patients which underwent TKA using conventional intra-medullary (IM) alignment guides were compared to 37 patients with the use of accelerometer-based, portable navigation device (KneeAlign; OrthoAlign Inc, Aliso Viejo, California). Radiographic results were obtained from post-operative computer-tomography following the CT Perth Protocol.

Results:

In the IM cohort, 81.0% of patients had a coronal alignment within 3° of a neutral mechanical axis (vs 83.8% with KneeAlign, p=0.74), 81.0% had a femoral coronal alignment within 2° of perpendicular to the femoral mechanical axis (vs 89.2% with KneeAlign, p=0.31), and 92.9% had a tibial coronal alignment within 2° of perpendicular to the tibial mechanical axis (vs 81.1% with KneeAlign, p=0.12). Regarding sagittal alignment, the IM cohort had 90.5% of patients with femoral component alignment within 2° of optimum (vs 91.9% with KneeAlign, p=0.83) and 92.9% had a tibial component alignment within 2° of the optimal tibial slope (vs 89.2% with KneeAlign, p=0.57). The mean tourniquet time (from incision to completion of coronal bone resections) in the IM cohort was 16.5± 8.9 minutes vs 22.2 ± 7.6 minutes in the KneeAlign cohort (p<0.003).

Conclusion:

Accelerometer-based, portable navigation has a statistically similar outcome in alignment following TKA as IM guides. It is noted that using the portable navigation device does prolong surgical time compared to conventional IM surgery and this may be due to the learning curve.
Are Squats and Lunges Safe in the Rehabilitation of Patients with Patellofemoral Pain?
Authors: Wood David , Metcalfe Andrew , Dodge Jen , Templeton-Ward Oliver
Published: March 2016

Objectives:

Patello-femoral pain is a common presenting complaint in orthopaedic clinics, and initial management often involves exercise and quadriceps strengthening regimes. Squats and lunges have become a common part of physiotherapy regimes as well as many exercise programs. It has been our observation that some patients experience a deterioration in pain after starting squats and lunges, and there is no agreement about the safe use of these exercises. The aim of this paper is to review the clinical and biomechanical literature to assess the safety of squats and lunges of patients with patella-femoral or anterior knee pain.

Methods:

Systematic Review. A literature review was performed of the Pubmed and PEDro databases using a pre-defined search strategy. Titles were screened by both an orthopaedic surgeon and a physiotherapist, abstracts were reviewed and the final papers were selected for inclusion. Randomised trials or comparative cohort studies of exercise regimes were included from the clinical literature as well as systematic reviews or meta-analyses published in the last 5 years. Patello-femoral forces calculated either from in-vivo data or cadaveric simulations were included from the biomechanical literature.

Results:

The searches revealed 3237 titles, which were reduced to 27 papers for the literature review. The biomechanical literature clearly demonstrated increasing patello-femoral forces during squats with increasing flexion, peaking at 90° of flexion and then falling in deep flexion. Less data was available on lunges but findings were comparable to studies of squats. Forces in the PFJ experienced during squats and lunges are significantly greater than with open-chain exercises beyond 60° of knee flexion. There were 13 clinical studies and 8 systematic reviews identified, which demonstrated that exercise is an effective treatment for PF pain with no significant difference between closed or open chain exercises (one study only). However only one study included squats beyond 60° or lunges in their protocols, with the majority excluding these exercises or limiting the degree of knee flexion, and no study has examined the use of squats and lunges specifically.

Conclusion:

Whilst squats and lunges are commonly prescribed, they have been used relatively little in clinical trials and have not been investigated independently. The biomechanical literature demonstrates that forces are relatively low when knee flexion is limited, but that flexion up to 90° places the PFJ under significant load. Given the vulnerable patient population in which they are used, the use of squats and lunges up to 90° should be discouraged in orthopaedic rehabilitation.
Biomechanical Analysis of Simulated Clinical Testing and Reconstruction of the Anterolateral Ligament of the Knee
Authors: Spencer Luke , Burkhart Timothy A. , Tran Michael N. , Rezansoff Alex James , Deo Shaneel , Caterine Scott , Getgood Alan M
Published: March 2016

Background:

Anatomic anterolateral ligament (ALL) reconstruction has been proposed to assist anterior cruciate ligament (ACL) reconstruction in controlling anterolateral rotational laxity of the knee. However, the biomechanical effects have not been reported.

Purpose:

(1) To investigate the effect of ALL transection on rotational knee kinematics and (2) to determine the effect on knee biomechanics of ALL reconstruction procedures compared with lateral extra-articular tenodesis (LET).

Study Design:

Controlled laboratory study.

Methods:

A total of 12 cadaveric knee specimens were tested in the following sequence: (1) ACLintact, (2) anteromedial bundle of ACL sectioned (ACLamb), (3) complete ACL sectioned (ACLfull), (4) ALL sectioned (ALLsec), (5) anatomic ALL reconstruction (ALLanat), and (6) LET. Biomechanical anterior drawer and Lachman tests were performed in which a 90-N load was applied to the posterior tibia, and anterior translation was measured. A combined load to simulate the early phase of the pivot-shift test was executed in which a 5-N·m internal rotation moment was applied to a fully extended knee; anterior translation and internal rotation were measured.

Results:

Anterior translation increased across conditions for the biomechanical tests. Internal rotation during the simulated early-phase pivot-shift test was significantly different between ACLfull and ALLsec. Anatomic ALL reconstruction did not significantly reduce internal rotation or anterior translation during the simulated early-phase pivot-shift test. After LET, a significant decrease in anterior translation was found. There was no evidence of over-constraint of the knee with either anatomic ALL reconstruction or LET.

Conclusion:

The ALL demonstrated a role in controlling anterolateral laxity. LET had a composite effect in governing both anterior and rotational laxity. Anatomic ALL reconstruction did not reduce anterolateral rotational laxity. Clinical Relevance: Profiling the biomechanical characteristics of anterolateral reconstruction is integral to understanding the implications and potential benefit of such an additional procedure to ACL reconstruction.
UV-inactivated HSV-1 potently activates NK cell killing of leukemic cells
Authors: Samudio Ismael , Rezvani Katayoun , Shaim Hila , Hofs Elyse , Ngom Mor , Bu Luke , Liu Guoyu , Lee Jason T. C. , Imren Suzan , Lam Vivian , Poon Grace F. T. , Ghaedi Maryam , Takei Fumio , Humphries Keith , Jia William , Krystal Gerald
Published: March 2016

Key Points

UV-inactivated HSV-1 activates Toll-like receptor signaling in NK cells to kill leukemic, but not normal, allogeneic cells. UV-inactivated HSV-1 increases the therapeutic efficacy of allogeneic mononuclear cell infusions in a xenograft model of AML.
BRAF inhibition in hairy cell leukemia with low-dose vemurafenib
Authors: Dietrich Sascha , Pircher Andreas , Endris Volker , Peyrade Frédéric , Wendtner Clemens-Martin , Follows George A. , Hüllein Jennifer , Jethwa Alexander , Ellert Elena , Walther Tatjana , Liu Xiyang , Dyer Martin J. S. , Elter Thomas , Brummer Tilman , Zeiser Robert , Hermann Michael , Herold Michael , Weichert Wilko , Dearden Claire , Haferlach Torsten , Seiffert Martina , Hallek Michael , von Kalle Christof , Ho Anthony D. , Gaehler Anita , Andrulis Mindaugas , Steurer Michael , Zenz Thorsten
Published: March 2016

Key Points

Low doses of the BRAF inhibitor vemurafenib are highly effective in refractory hairy cell leukemia. Abrogation of BRAF V600E–induced signaling was consistently seen with 240 mg of vemurafenib twice daily.
Computational methods for ubiquitination site prediction using physicochemical properties of protein sequences
Authors: Cai Binghuang , Jiang Xia
Published: March 2016

Background

Ubiquitination is a very important process in protein post-translational modification, which has been widely investigated by biology scientists and researchers. Different experimental and computational methods have been developed to identify the ubiquitination sites in protein sequences. This paper aims at exploring computational machine learning methods for the prediction of ubiquitination sites using the physicochemical properties (PCPs) of amino acids in the protein sequences.

Results

We first establish six different ubiquitination data sets, whose records contain both ubiquitination sites and non-ubiquitination sites in variant numbers of protein sequence segments. In particular, to establish such data sets, protein sequence segments are extracted from the original protein sequences used in four published papers on ubiquitination, while 531 PCP features of each extracted protein sequence segment are calculated based on PCP values from AAindex (Amino Acid index database) by averaging PCP values of all amino acids on each segment. Various computational machine-learning methods, including four Bayesian network methods (i.e., Naïve Bayes (NB), Feature Selection NB (FSNB), Model Averaged NB (MANB), and Efficient Bayesian Multivariate Classifier (EBMC)) and three regression methods (i.e., Support Vector Machine (SVM), Logistic Regression (LR), and Least Absolute Shrinkage and Selection Operator (LASSO)), are then applied to the six established segment-PCP data sets. Five-fold cross-validation and the Area Under Receiver Operating Characteristic Curve (AUROC) are employed to evaluate the ubiquitination prediction performance of each method. Results demonstrate that the PCP data of protein sequences contain information that could be mined by machine learning methods for ubiquitination site prediction. The comparative results show that EBMC, SVM and LR perform better than other methods, and EBMC is the only method that can get AUCs greater than or equal to 0.6 for the six established data sets. Results also show EBMC tends to perform better for larger data.

Conclusions

Machine learning methods have been employed for the ubiquitination site prediction based on physicochemical properties of amino acids on protein sequences. Results demonstrate the effectiveness of using machine learning methodology to mine information from PCP data concerning protein sequences, as well as the superiority of EBMC, SVM and LR (especially EBMC) for the ubiquitination prediction compared to other methods.
Gait and Lower Limb Observation of Paediatrics (GALLOP): development of a consensus based paediatric podiatry and physiotherapy standardised recording proforma
Authors: Cranage Simone , Banwell Helen , Williams Cylie M.
Published: March 2016

Background

Paediatric gait and lower limb assessments are frequently undertaken in podiatry and physiotherapy clinical practice and this is a growing area of expertise within Australia. No concise paediatric standardised recording proforma exists to assist clinicians in clinical practice. The aim of this study was to develop a gait and lower limb standardised recording proforma guided by the literature and consensus, for assessment of the paediatric foot and lower limb in children aged 0–18 years.

Method

Expert Australian podiatrists and physiotherapists were invited to participate in a three round Delphi survey panel using the online Qualtrics© survey platform. The first round of the survey consisted of open‐ended questions on paediatric gait and lower limb assessment developed from existing templates and a literature search of standardised lower limb assessment methods. Rounds two and three consisted of statements developed from the first round responses. Questions and statements were included in the final proforma if 70 % or more of the participants indicated consensus or agreement with the assessment method and if there was support within the literature for paediatric age‐specific normative data with acceptable reliability of outcome measures.

Results

There were 17 of the 21 (81 %) participants who completed three rounds of the survey. Consensus was achieved for 41 statements in Round one, 54 statements achieved agreement in two subsequent rounds. Participants agreed on 95 statements relating to birth history, developmental history, hip measurement, rotation of the lower limb, ankle range of motion, foot posture, balance and gait. Assessments with acceptable validity and reliability were included within the final Gait and Lower Limb Observation of Paediatrics (GALLOP) proforma.

Conclusion

The GALLOP proforma is a consensus based, systematic and standardised way to collect information and outcome measures in paediatric lower limb assessment. This standardised recording proforma will assist professions to collect information in a standardised format based on best evidence assessment methods whilst aiding consistency in communication between health professionals.