bluuebunny/crossref_metadata_2025 huggingface dataset:
Mary Parker Follett: A Rediscovered Voice Informing the Field of Human Resource Development
Authors: Wheelock Leslie Delapena , Callahan Jamie L.
Published: April 2006

Human resource development (HRD) uses a wide variety of theories from multiple disciplines and fields of study to create its own unique field of scholarly practice. As with any field, however, we tend to get comfortable with familiar theories and theorists and fail to explore other possible sources of wisdom. One scholar whose work is worthy of study is Mary Parker Follett. Despite a dormancy of many decades, her thoughts are emerging as contemporary and innovative. This article concludes that Follett is an important influence on the field of HRD, not only because her ideas support concepts similar to other scholars whose work informs HRD but also because she introduces adult learning as paramount for the development of the individual and organization.
Exploring National Human Resource Development: A Case of China Management Development in a Transitioning Context
Authors: Wang Jia , Wang Greg G.
Published: April 2006

To advance an emerging frontier in human resource development (HRD) research, national HRD (NHRD), this study explored the subject by focusing on a key area of HRD, management development (MD) in the China context. Taking a system and holistic perspective, the study identified three critical challenges facing Chinese managers and China MD in the complex changing interactions of the broader social, economic, and institutional contexts. It examined current MD-related policies and practices at national, organizational, and individual levels. Our analysis of the findings indicated that although much effort was made at multiple levels for developing managers, China's approach to MD tended to be fragmented and lacked coherence. The study further offered critical implications for China MD practice and recent emerging NHRD research. In discussing future NHRD research directions, the study calls for HRD scholars to be mindful of the discipline and theory building in exploring new HRD research frontiers.
Best Employer Studies: A Conceptual Model from a Literature Review and a Case Study
Authors: Joo Baek-Kyoo (Brian) , Mclean Gary N.
Published: April 2006

This article explores the phenomenon of best employer studies, including origins, meaning, and implications of such studies through a literature review and a case study of Hewitt's Best Employers in Asia study. A conceptual model is suggested of the relationships among business strategy, HR practices, engaged employees, HR reputation, and financial performance, based on theoretical backgrounds, such as the resource-based view of the firm, strategic HR management, signaling theory, and social identity theory. Finally, implications for practice in HRD and for future research are presented.
Qualitative theory testing as mixed-method research
Authors: Piper Stewart
Published: April 2006

While the concept of mixed-methods research is more usually associated with combining quantitative and qualitative approaches, this paper outlines a study that mixed methods by undertaking qualitative theory testing and derivation when examining the relationship between health promotion theory and hospital nursing practice. Thus, it is concerned with relating the metatheoretical aspects of the debate and not with the pragmatic aspects of the research and concomitant methods. A deductive–inductive–deductive design, based on the theory–research–theory strategy of Meleis (1985), tested, revised and developed for nursing established health promotion theory using theory-testing criteria. To complement the methodological mix, the study also used the theory (i.e. a health-promotion taxonomy) as a framework to contextualise the findings rather than generate theory in the way associated with interpretative inquiry. While inconsistent with the traditional view linking theory testing with quantitative, objective epistemology, the process enabled a theoretically robust health-promotion taxonomy to be synthesised and advanced for use in nursing in relation to a paradigm of social thought.
Mixed methods and mixed methodologies
Authors: Gilbert Tony
Published: April 2006

This paper presents a discussion of mixed-methods approaches drawing largely on the nursing literature. Taking a supportive but sceptical stance to the mixed-methods approach, the paper considers conditions to manage this tension. Competing claims for qualitative versus quantitative evidence alongside a growing commitment for multidisciplinary research when dealing with complex phenomena offer background issues providing incentives to adopt mixed-method approaches. The paper identifies a tendency to assume that all mixed-method approaches involve quantitative and qualitative methods creating a binary division between induction and deduction. At the same time, discussion explores three frameworks enabling differentiation of mixed-method approaches, producing a merging and revision of these frameworks into a new typology – the practical, the technical and the political – allowing the possibility of qualitative mixed-methods designs. In addition, a distinction emerges between approaches with a clear theoretical and methodological commitment enabling or carrying the potential for political action from approaches lacking political potential and therefore limited to practical or technical qualities. The paper draws on a number of studies from the literature to provide examples of the ‘types’ that provide the typology. It concludes by claiming that the typology enables the management of the critical tension between support and scepticism when reviewing mixed-method approaches.
Mixed-methods research
Authors: Giddings Lynne S.
Published: April 2006

The claim that mixed methods is the third methodological movement of the twentieth century could have unexpected consequences for the future of research in the social sciences and health disciplines. Implied is a belief that the mixing of qualitative and quantitative methods will produce the ‘best of both worlds’. This assumption, combined with inherent promises of inclusiveness, takes on a reality and certainty in research findings that serves well the powerful nexus of economic restraint and evidence-based practice. I argue that the use of the terms ‘qualitative’ and ‘quantitative’ as normative descriptors reinforces their binary positioning, effectively marginalising the methodological diversity within them. Ideologically, mixed methods covers for the continuing hegemony of positivism, albeit in its more moderate, postpositivist form. If naively interpreted, mixed methods could become the preferred approach in the teaching and doing of research. Rather than the promotion of more co-operative and complex designs for increasingly complex social and health issues, economic and administrative pressures may lead to demands for the ‘quick fix’ that mixed methods appears to offer.
Ultrastructure of the reticular basement membrane in asthmatic adults, children and infants
Authors: Saglani S. , Molyneux C. , Gong H. , Rogers A. , Malmström K. , Pelkonen A. , Mäkelä M. , Adelroth E. , Bush A. , Payne D. N. R. , Jeffery P. K.
Published: April 2006

Reticular basement membrane (RBM) thickening in asthma is considered to be the result of subepithelial fibrosis. Thus, the RBM in asthma should contain an excess of fibrils identified as interstitial collagen and the ratio of fibril to matrix should be increased above normal levels.

Electron micrographs of the RBM were compared with those of interstitial collagen deeper in the bronchial wall using endobronchial biopsy specimens from adult asthmatics (aged 18–41 yrs (n = 10)), children with difficult asthma (aged 6–16 yrs (n = 10)), wheezy infants with reversible airflow limitation (aged 0.3–2 yrs (n = 10)) and age-matched nonasthmatic controls: 10 adults, nine children and nine symptomatic infants with normal lung function.

Fibrils in the RBM were significantly thinner (median (range) width 39 (30–52) nmversus59 (48–73) nm), and fewer fibrils were banded than in the interstitial collagen (ratio of banded to non-banded fibrils 0.08 (0–0.17)versus0.22 (0–1.3)). The ratio of fibrils to matrix in the thickened RBM of asthmatics did not differ from that of their respective controls (1.34 (0.63–2.49)versus1.18 (0.31–2.6)).

The ratio of fibril to matrix in the thickened reticular basement membrane of asthmatics is normal, and, contrary to what is expected in fibrosis, the fibrils do not resemble those of interstitial collagen.
Safety and feasibility of exhaled breath condensate collection in ventilated infants and children
Authors: Muller W. G. , Morini F. , Eaton S. , Peters M. , Jaffe A.
Published: April 2006

The aim of this study was to develop a technique for the collection of exhaled breath condensate (EBC) from ventilated children and assess its safety and feasibility. Collection of EBC is used to investigate markers of oxidative stress in the lower airway. No studies have assessed its safety in ventilated children.

Anin vitromodel was developed by connecting a ventilator to an artificial lung; 14 clinical and ventilatory parameters were measured during EBC collection from ventilated children. Levels of 8-isoprostane were measured following collection with and without humidification of the inhaled gas.

Amount of water vapour collected was linearly related to time and to minute ventilation in thein vitromodel. EBC collections (n = 68) were made from ventilated children. In the nonhumidified group, the mean (range) positive end-expiratory pressure increased by 4.1% (2.8–5.5%) and the peak inspiratory flow decreased by 6.1% (11.0–1.3%) during collection. Detectable levels of 8-isoprostane were only found in 10 out of 18 nonhumidified EBC samples (median (range) 4.7 pg·mL-1(0–5.8)).

Collection of exhaled breath condensate from ventilated infants and children is feasible and safe. Discontinuation of humidification is likely to be important in standardising the measurement of inflammatory parameters in exhaled breath condensate collected from ventilated children.
Measurement of combined oximetry and cutaneous capnography during flexible bronchoscopy: Fig. 1—
Authors: Chhajed P. N. , Rajasekaran R. , Kaegi B. , Chhajed T. P. , Pflimlin E. , Leuppi J. , Tamm M.
Published: April 2006

The aim of the present study was to assess the feasibility of measuring combined arterial oxygen saturation measured by pulse oximetry (Sp,O2) and cutaneous carbon dioxide tension (Pc,CO2) to monitor ventilation and quantify change inPc,CO2during bronchoscopy.

CombinedSp,O2andPc,CO2were measured at the ear lobe in 114 patients. In four patients, the ear-clip slipped and they were excluded. In total, 11 patients had artefacts withSp,O2recordings, thus,Sp,O2was analysed in 99 patients. Spirometry data were available in 77 patients. Multivariate analysis of covariance and logistic regression were used for statistical analyses.

Mean baselinePc,CO2was 4.78±1.06 kPa (36±8 mmHg) and mean rise in thePc,CO2during bronchoscopy was 1.26±0.70 kPa (9.5±5.3 mmHg), while meanPc,CO2at the end of bronchoscopy was 5.85±1.19 kPa (44±9 mmHg) . BaselinePc,CO2and the lowestSp,O2were significantly associated with peakPc,CO2and the change inPc,CO2during bronchoscopy. Risk of significant hypoxaemia (Sp,O2≤90%) was lower for a higher baselineSp,O2. PeakPc,CO2was directly associated with significant hypoxaemia. There was no significant association in the baselinePc,CO2, peakPc,CO2, baselineSp,O2or the lowestSp,O2comparing patients with and without chronic obstructive pulmonary disease.

In conclusion, it is feasible to measure combined pulse oximetry and cutaneous carbon dioxide tension effectively to monitor ventilation during flexible bronchoscopy.
Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up
Authors: Peker Y. , Carlson J. , Hedner J.
Published: April 2006

An increased incidence of cardiovascular disease has previously been reported in middle-aged males during a follow-up period of 7 yrs. The aim of the present study was to address the incidence of coronary artery disease (CAD) in a larger sample without any heart disease at baseline.

The population comprised 308 snorers (245 males and 63 females) with a mean±sdage of 49.0±9.9 yrs in 1991. Data were collectedviathe Swedish Hospital Discharge Register, National Cause of Death Registry, clinical charts and questionnaires.

Over 7 yrs, CAD was observed in 17 (16.2%) of 105 patients with obstructive sleep apnoea (OSA; overnight (6 h) oxygen desaturations ≥30 events) compared with 11 (5.4%) of 203 snorers without OSA. OSA diagnosis at baseline was associated with an increased risk of development of CAD in a multivariate model. In the OSA group, CAD was confirmed in 16 (24.6%) of 65 incompletely treated patients compared with one (3.9%) of 26 efficiently treated subjects. Efficient treatment of OSA reduced this risk.

It is concluded that middle-aged sleep apnoeics are at high risk of developing coronary artery disease if they are not treated efficiently, which should be considered in cardiovascular disease prevention models.
JColorGrid: software for the visualization of biological measurements
Authors: Joachimiak Marcin P , Weisman Jennifer L , May Barnaby CH
Published: April 2006

Background

Two-dimensional data colourings are an effective medium by which to represent three-dimensional data in two dimensions. Such "color-grid" representations have found increasing use in the biological sciences (e.g. microarray 'heat maps' and bioactivity data) as they are particularly suited to complex data sets and offer an alternative to the graphical representations included in traditional statistical software packages. The effectiveness of color-grids lies in their graphical design, which introduces a standard for customizable data representation. Currently, software applications capable of generating limited color-grid representations can be found only in advanced statistical packages or custom programs (e.g. micro-array analysis tools), often associated with steep learning curves and requiring expert knowledge.

Results

Here we describe JColorGrid, a Java library and platform independent application that renders color-grid graphics from data. The software can be used as a Java library, as a command-line application, and as a color-grid parameter interface and graphical viewer application. Data, titles, and data labels are input as tab-delimited text files or Microsoft Excel spreadsheets and the color-grid settings are specified through the graphical interface or a text configuration file. JColorGrid allows both user graphical data exploration as well as a means of automatically rendering color-grids from data as part of research pipelines.

Conclusion

The program has been tested on Windows, Mac, and Linux operating systems, and the binary executables and source files are available for download at http://jcolorgrid.ucsf.edu.
MIDAS: software for analysis and visualisation of interallelic disequilibrium between multiallelic markers
Authors: Gaunt Tom R , Rodriguez Santiago , Zapata Carlos , Day Ian NM
Published: April 2006

Background

Various software tools are available for the display of pairwise linkage disequilibrium across multiple single nucleotide polymorphisms. The HapMap project also presents these graphics within their website. However, these approaches are limited in their use of data from multiallelic markers and provide limited information in a graphical form.

Results

We have developed a software package (MIDAS – Multiallelic Interallelic Disequilibrium Analysis Software) for the estimation and graphical display of interallelic linkage disequilibrium. Linkage disequilibrium is analysed for each allelic combination (of one allele from each of two loci), between all pairwise combinations of any type of multiallelic loci in a contig (or any set) of many loci (including single nucleotide polymorphisms, microsatellites, minisatellites and haplotypes). Data are presented graphically in a novel and informative way, and can also be exported in tabular form for other analyses. This approach facilitates visualisation of patterns of linkage disequilibrium across genomic regions, analysis of the relationships between different alleles of multiallelic markers and inferences about patterns of evolution and selection.

Conclusion

MIDAS is a linkage disequilibrium analysis program with a comprehensive graphical user interface providing novel views of patterns of linkage disequilibrium between all types of multiallelic and biallelic markers.

Availability

Available from http://www.genes.org.uk/software/midas and http://www.sgel.humgen.soton.ac.uk/midas
Transcriptional profiling of mesenchymal stromal cells from young and old rats in response to Dexamethasone
Authors: Akavia Uri David , Shur Irena , Rechavi Gideon , Benayahu Dafna
Published: April 2006

Background

Marrow-derived stromal cells (MSCs) maintain the capability of self-renewal and differentiation into multiple lineages in adult life. Age-related changes are recognized by a decline in the stemness potential that result in reduced regeneration potential of the skeleton. To explore the molecular events that underline skeletal physiology during aging we catalogued the profile of gene expression inex vivocultured MSCs derived from 3 and 15 month old rats. Theex vivocultured cells were analyzed following challenge with or without Dexamethasone (Dex). RNA retrieved from these cells was analyzed using Affymetrix Gene Chips to compare the effect of Dex on gene expression in both age groups.

Results

The molecular mechanisms that underline skeletal senescence were studied by gene expression analysis of RNA harvested from MSCs. The analysis resulted in complex profiles of gene expression of various differentiation pathways. We revealed changes of lineage-specific gene expression; in general the pattern of expression included repression of proliferation and induction of differentiation. The functional analysis of genes clustered were related to major pathways; an increase in bone remodeling, osteogenesis and muscle formation, coupled with a decrease in adipogenesis. We demonstrated a Dex-related decrease in immune response and in genes that regulate bone resorption and an increase in osteoblastic differentiation. Myogenic-related genes and genes that regulate cell cycle were induced by Dex. While Dex repressed genes related to adipogenesis and catabolism, this decrease was complementary to an increase in expression of genes related to osteogenesis.

Conclusion

This study summarizes the genes expressed in theex vivocultured mesenchymal cells and their response to Dex. Functional clustering highlights the complexity of gene expression in MSCs and will advance the understanding of major pathways that trigger the natural changes underlining physiological aging. The high throughput analysis shed light on the anabolic effect of Dex and the relationship between osteogenesis, myogenesis and adipogenesis in the bone marrow cells.
The molecular portraits of breast tumors are conserved across microarray platforms
Authors: Hu Zhiyuan , Fan Cheng , Oh Daniel S , Marron JS , He Xiaping , Qaqish Bahjat F , Livasy Chad , Carey Lisa A , Reynolds Evangeline , Dressler Lynn , Nobel Andrew , Parker Joel , Ewend Matthew G , Sawyer Lynda R , Wu Junyuan , Liu Yudong , Nanda Rita , Tretiakova Maria , Orrico Alejandra Ruiz , Dreher Donna , Palazzo Juan P , Perreard Laurent , Nelson Edward , Mone Mary , Hansen Heidi , Mullins Michael , Quackenbush John F , Ellis Matthew J , Olopade Olufunmilayo I , Bernard Philip S , Perou Charles M
Published: April 2006

Background

Validation of a novel gene expression signature in independent data sets is a critical step in the development of a clinically useful test for cancer patient risk-stratification. However, validation is often unconvincing because the size of the test set is typically small. To overcome this problem we used publicly available breast cancer gene expression data sets and a novel approach to data fusion, in order to validate a new breast tumor intrinsic list.

Results

A 105-tumor training set containing 26 sample pairs was used to derive a new breast tumor intrinsic gene list. This intrinsic list contained 1300 genes and a proliferation signature that was not present in previous breast intrinsic gene sets. We tested this list as a survival predictor on a data set of 311 tumors compiled from three independent microarray studies that were fused into a single data set using Distance Weighted Discrimination. When the new intrinsic gene set was used to hierarchically cluster this combined test set, tumors were grouped into LumA, LumB, Basal-like, HER2+/ER-, and Normal Breast-like tumor subtypes that we demonstrated in previous datasets. These subtypes were associated with significant differences in Relapse-Free and Overall Survival. Multivariate Cox analysis of the combined test set showed that the intrinsic subtype classifications added significant prognostic information that was independent of standard clinical predictors. From the combined test set, we developed an objective and unchanging classifier based upon five intrinsic subtype mean expression profiles (i.e. centroids), which is designed for single sample predictions (SSP). The SSP approach was applied to two additional independent data sets and consistently predicted survival in both systemically treated and untreated patient groups.

Conclusion

This study validates the "breast tumor intrinsic" subtype classification as an objective means of tumor classification that should be translated into a clinical assay for further retrospective and prospective validation. In addition, our method of combining existing data sets can be used to robustly validate the potential clinical value of any new gene expression profile.
Modulation of integrin-linked kinase (ILK) expression in human oesophageal squamous cell carcinoma cell lines by the EGF and TGFβ1 growth factors
Authors: Driver Glenn A , Veale Robin B
Published: April 2006

Background

Integrin-linked kinase (ILK) is a ubiquitously expressed protein kinase that has emerged as one of the points of convergence between integrin- and growth factor-signalling pathways.

Results

In this study we identify the ILK isoform expressed in five human oesophageal squamous cell carcinoma cell lines of South African origin as ILK1, and demonstrate its cellular distribution. ILK expression, although similar in the majority of the cell lines, did show variation. Furthermore, the ILK expressed was shown to be catalytically functional. The effect of growth factors on ILK expression was examined. An increase in ILK expression, following EGF and TGFβ1 exposure, was a trend across all the five oesophageal carcinoma cell lines tested.

Conclusion

These results suggest that growth factor modulation of ILK expression relies on the internalisation/recycling of growth factor receptors and stimulation of the PI3K pathway, which may have implications with regards to cell adhesion and tumourigenesis.
Primary mediastinal hemangiopericytoma
Authors: Chnaris A , Barbetakis N , Efstathiou A , Fessatidis I
Published: April 2006

Background

Hemangiopericytoma is a rare mesenchymal neoplasm, accounting for about 1% of vascular tumors The tumor occurs most commonly in the skin, subcutaneous soft tissues, muscles of the extremities, retroperitoneum but rarely in the lung, trachea or mediastinum.

Case presentation

A rare case of primary mediastinal hemangiopericytoma is presented. A 72-year-old woman was treated by complete surgical resection of the tumor. Details of the clinical and radiographic feature are presented. The patient's postoperative course was uneventful with no evidence of recurrence 9 months after the operation.

Conclusion

Hemangiopericytoma is an uncommon, potentially malignant tumor originating from pericytes in the small vessels and surgical radical excision is the treatment of choice, although the criteria for determining the area of resection have not been established. International literature has demonstrated that recurrent disease usually occurs within 2 years and therefore a long-term careful follow-up is required.
Astrocytes derived from glial-restricted precursors promote spinal cord repair
Authors: Davies Jeannette E , Huang Carol , Proschel Christoph , Noble Mark , Mayer-Proschel Margot , Davies Stephen JA
Published: April 2006

Background

Transplantation of embryonic stem or neural progenitor cells is an attractive strategy for repair of the injured central nervous system. Transplantation of these cells alone to acute spinal cord injuries has not, however, resulted in robust axon regeneration beyond the sites of injury. This may be due to progenitors differentiating to cell types that support axon growth poorly and/or their inability to modify the inhibitory environment of adult central nervous system (CNS) injuries. We reasoned therefore that pre-differentiation of embryonic neural precursors to astrocytes, which are thought to support axon growth in the injured immature CNS, would be more beneficial for CNS repair.

Results

Transplantation of astrocytes derived from embryonic glial-restricted precursors (GRPs) promoted robust axon growth and restoration of locomotor function after acute transection injuries of the adult rat spinal cord. Transplantation of GRP-derived astrocytes (GDAs) into dorsal column injuries promoted growth of over 60% of ascending dorsal column axons into the centers of the lesions, with 66% of these axons extending beyond the injury sites. Grid-walk analysis of GDA-transplanted rats with rubrospinal tract injuries revealed significant improvements in locomotor function. GDA transplantation also induced a striking realignment of injured tissue, suppressed initial scarring and rescued axotomized CNS neurons with cut axons from atrophy. In sharp contrast, undifferentiated GRPs failed to suppress scar formation or support axon growth and locomotor recovery.

Conclusion

Pre-differentiation of glial precursors into GDAs before transplantation into spinal cord injuries leads to significantly improved outcomes over precursor cell transplantation, providing both a novel strategy and a highly effective new cell type for repairing CNS injuries.
An immunohistological study of the integration at the bone-tendon interface after reconstruction of the anterior cruciate ligament in rabbits
Authors: Kanazawa T. , Soejima T. , Murakami H. , Inoue T. , Katouda M. , Nagata K.
Published: April 2006

We studied bone-tendon healing using immunohistochemical methods in a rabbit model.

Reconstruction of the anterior cruciate ligament was undertaken using semitendinosus tendon in 20 rabbits. Immunohistochemical evaluations were performed at one, two, four and eight weeks after the operation. The expression of CD31, RAM-11, VEGF, b-FGF, S-100 protein and collagen I, II and III in the bone-tendon interface was very similar to that in the endochondral ossification. Some of the type-III collagen in the outer layer of the graft, which was deposited at a very early phase after the operation, was believed to have matured into Sharpey-like fibres. However, remodelling of the tendon grafted into the bone tunnel was significantly delayed when compared with this ossification process. To promote healing, we believe that it is necessary to accelerate remodelling of the tendon, simultaneously with the augmentation of the ossification.
Acetabular revision with morsellised allogenic bone graft and a cemented metal-backed component
Authors: Wang J.-W. , Fong C.-Y. , Su Y.-S. , Yu H.-N.
Published: April 2006

Failure of total hip arthroplasty with acetabular deficiency occurred in 55 patients (60 hips) and was treated with acetabular revision using morsellised allograft and a cemented metal-backed component. A total of 50 patients (55 hips) were available for clinical and radiological evaluation at a mean follow-up of 5.8 years (3 to 9.5). No hip required further revision of the acetabular component because of aseptic loosening.

All the hips except one had complete incorporation of the allograft demonstrated on the radiographs. A complete radiolucent line of > 1 mm was noted in two hips post-operatively. A good to excellent result occurred in 50 hips (91%). With radiological evidence of aseptic loosening of the acetabular component as the end-point, the survivorship at a mean of 5.8 years after surgery was 96.4%.

The use of impacted allograft chips in combination with a cemented metal-backed acetabular component and screw fixation can achieve good medium-term results in patients with acetabular bone deficiency.
Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts
Authors: Ha K.-Y. , Lee J.-S. , Kim K.-W. , Chon J.-S.
Published: April 2006

We present the clinical and radiological results of percutaneous vertebroplasty in the treatment of 58 vertebral compression fractures in 51 patients at a minimum follow-up of two years. Group 1 consisted of 39 patients, in whom there was no associated intravertebral cleft, whilst group 2 comprised 12 patients with an intravertebral cleft. The Oswestry disability index (ODI) and visual analogue scale (VAS) scores were recorded prospectively. The radiological evidence of kyphotic deformity, vertebral height, leakage of cement and bone resorption around the cement were studied restrospectively, both before and after operation and at the final follow-up.

The ODI and VAS scores in both groups decreased after treatment, but the mean score in group 2 was higher than that in group 1 (p = 0.02 (ODI), p = 0.02 (VAS)). There was a greater initial correction of the kyphosis in group 2 than in group 1, although the difference was not statistically significant. However, loss of correction was greater in group 2. Leakage of cement was seen in 24 (41.4%) of 58 vertebrae (group 1, 32.6% (15 of 46); group 2, 75% (9 of 12)), mainly of type B through the basal vertebral vein in group 1 and of type C through the cortical defect in group 2. Resorption of bone around the cement was seen in three vertebrae in group 2 and in one in group 1. There were seven adjacent vertebral fractures in group 1 and one in group 2.

Percutaneous vertebroplasty is an effective treatment for osteoporotic compression fractures with or without an intravertebral cleft. Nonetheless, higher rates of complications related to the cement must be recognised in patients in the presence of an intravertebral cleft.
Treatment of the young active patient with osteoarthritis of the hip
Authors: Pollard T. C. B. , Baker R. P. , Eastaugh-Waring S. J. , Bannister G. C.
Published: April 2006

We compared the five- to seven-year clinical and radiological results of the metal-on-metal Birmingham hip resurfacing with a hybrid total hip arthroplasty in two groups of 54 hips, matched for gender, age, body mass index and activity level.

Function was excellent in both groups, as measured by the Oxford hip score, but the Birmingham hip resurfacings had higher University of California at Los Angeles activity scores and better EuroQol quality of life scores. The total hip arthroplasties had a revision or intention-to-revise rate of 8%, and the Birmingham hip resurfacings of 6%. Both groups demonstrated impending failure on surrogate end-points. Of the total hip arthroplasties, 12% had polyethylene wear and osteolysis under observation, and 8% of Birmingham hip resurfacings showed migration of the femoral component. Polyethylene wear was present in 48% of the hybrid hips without osteolysis. Of the femoral components in the Birmingham hip resurfacing group which had not migrated, 66% had radiological changes of unknown significance.
Osteofibrous dysplasia of the tibia
Authors: Lee R. S. , Weitzel S. , Eastwood D. M. , Monsell F. , Pringle J. , Cannon S. R. , Briggs T. W. R.
Published: April 2006

Osteofibrous dysplasia is an unusual developmental condition of childhood, which almost exclusively affects the tibia. It is thought to follow a slowly progressive course and to stabilise after skeletal maturity. The possible link with adamantinoma is controversial and some authors believe that they are part of one histological process.

We retrospectively reviewed 16 patients who were diagnosed as having osteofibrous dysplasia initially or on the final histological examination. Their management was diverse, depending on the severity of symptoms and the extent of the lesion. Definitive (extraperiosteal) surgery was localised ‘shark-bite’ excision for small lesions in five patients. Extensive lesions were treated by segmental excision and fibular autograft in six patients, external fixation and bone transport in four and proximal tibial replacement in one. One patient who had a fibular autograft required further excision and bone transport for recurrence. Six initially underwent curettage and all had recurrence. There were no recurrences after localised extraperiosteal excision or bone transport. There were three confirmed cases of adamantinoma.

The relevant literature is reviewed. We recommend extraperiosteal excision in all cases of osteofibrous dysplasia, with segmental excision and reconstruction in more extensive lesions.
Accuracy of a computer-assisted navigation system for total knee replacement
Authors: Pitto R. P. , Graydon A. J. , Bradley L. , Malak S. F. , Walker C. G. , Anderson I. A.
Published: April 2006

The object of this study was to develop a method to assess the accuracy of an image-free total knee replacement navigation system in legs with normal or abnormal mechanical axes. A phantom leg was constructed with simulated hip and knee joints and provided a means to locate the centre of the ankle joint. Additional joints located at the midshaft of the tibia and femur allowed deformation in the flexion/extension, varus/valgus and rotational planes. Using a digital caliper unit to measure the coordinates precisely, a software program was developed to convert these local coordinates into a determination of actual leg alignment. At specific points in the procedure, information was compared between the digital caliper measurements and the image-free navigation system. Repeated serial measurements were undertaken. In the setting of normal alignment the mean error of the system was within 0.5°. In the setting of abnormal plane alignment in both the femur and the tibia, the error was within 1°. This is the first study designed to assess the accuracy of a clinically-validated navigation system. It demonstrates in vitro accuracy of the image-free navigation system in both normal and abnormal leg alignment settings.
Consent in Surgery
Authors: Wheeler Robert
Published: April 2006

A review of consent for surgery is timely. As the length of surgeons' training diminishes, despite the increasing interest in the content of the surgical curriculum, the law governing the process of gaining consent has been given scant attention. The advent of non-medically qualified surgical practitioners raises questions about the breadth of knowledge that is required to ensure that valid consent is obtained. Consent is as fundamental as any other basic principle on which surgical practice relies, and its use in patient care is a clinical skill.

The ‘traditional’ approach to consent contained some negative elements. A doctor who was incapable of performing the proposed operation often obtained consent. In a genuine attempt to protect patients from anxiety, the rare-but-grave potential complications were sometimes not discussed. There was uncertainty about what should properly be disclosed, compounded by conflicting messages from the courts. The consent was sometimes taken from people who were ineligible to provide it.

These could be viewed as aberrations, and some persist. Having clarified the necessity for consent, this review concludes that it should be obtained by the operating surgeon. The threshold for interventions that need formal consent is discussed, together with the legal tests for capacity. In considering the recent law, it becomes clear that any potential complication that the reasonable patient would need to take into consideration before deciding to give their consent is one that should be disclosed.
Ionising Radiation Exposure to Orthopaedic Trainees: The Effect of Sub-Specialty Training
Authors: Oddy MJ , Aldam CH
Published: April 2006

INTRODUCTION

We monitored image intensifier use by orthopaedic trainees to assess their exposure to ionising radiation and to investigate the influence of sub-specialty training.

MATERIALS AND METHODS

Five different orthopaedic registrars recorded their monthly image intensifier screening times and exposure doses for all cases (trauma and elective), for a combined total of 12 non-consecutive months. Radiation exposure was monitored using shoulder and waist film badges worn both by surgeons and radiographers screening their cases.

RESULTS

Registrars in spinal sub-specialties were exposed to significantly higher doses per case and cumulative doses per month than non-spinal trainees (P < 0.05), but significantly lower screening times per case (P < 0.05). There were no significant differences in cumulative screening times per month (P > 0.05). Regression analysis for all surgeons showed a significant relationship between shoulder film badge reading and cumulative dose exposed per month (P < 0.05), but not for cumulative screening time. Shoulder film badge recordings were significantly higher for spinal compared with non-spinal registrars (P < 0.05), although all badges were below the level for radiation reporting. Only one radiographer badge recorded a dose above threshold.

CONCLUSIONS

Whilst the long-term effects of sub-reporting doses of radiation are not fully understood, we consider that this study demonstrates that trainees should not be complacent in accepting inadequate radiation protection. The higher doses encountered with spinal imaging means that sub-specialty trainees should be alerted to the risk of their increased exposure. The principle of minimising radiation exposure must be maintained by all trainees at all times.
Earliest Mineral and Matrix Changes in Force-Induced Musculoskeletal Disease as Revealed by Raman Microspectroscopic Imaging
Authors: Tarnowski Catherine P , Ignelzi Michael A , Wang Wei , Taboas Juan M , Goldstein Steven A , Morris Michael D
Published: April 2006

Craniosynostosis, premature fusion of the skull bones at the sutures, is the second most common human birth defect in the skull. Raman microspectroscopy was used to examine the composition, relative amounts, and locations of the mineral and matrix produced in mouse skulls undergoing force-induced craniosynostosis. Raman imaging revealed decreased relative mineral content in skulls undergoing craniosynostosis compared with unloaded specimens.

Introduction: Raman microspectroscopy, a nondestructive vibrational spectroscopic technique, was used to examine the composition, relative amounts, and locations of the mineral and matrix produced in mouse skulls undergoing force-induced craniosynostosis. Craniosynostosis, premature fusion of the skull bones at the sutures, is the second most common birth defect in the face and skull. The calvaria, or flat bones that comprise the top of the skull, are most often affected, and craniosynostosis is a feature of over 100 human syndromes and conditions.

Materials and Methods: Raman images of the suture, the tips immediately adjacent to the suture (osteogenic fronts), and mature parietal bones of loaded and unloaded calvaria were acquired. Images were acquired at 2.6 × 2.6 μm spatial resolution and ranged in a field of view from 180 × 210 μm to 180 × 325 μm.

Results and Conclusions: This study found that osteogenic fronts subjected to uniaxial compression had decreased relative mineral content compared with unloaded osteogenic fronts, presumably because of new and incomplete mineral deposition. Increased matrix production in osteogenic fronts undergoing craniosynostosis was observed. Understanding how force affects the composition, relative amounts, and location of the mineral and matrix provides insight into musculoskeletal disease in general and craniosynostosis in particular. This is the first report in which Raman microspectroscopy was used to study musculoskeletal disease. These data show how Raman microspectroscopy can be used to study subtle changes that occur in disease.
Trabecular Bone Microarchitecture Is Deteriorated in Men With Spinal Cord Injury
Authors: Modlesky Christopher M , Majumdar Sharmila , Narasimhan Anita , Dudley Gary A
Published: April 2006

Using magnetic resonance imaging, men with spinal cord injury (n = 10) were found to have fewer trabeculae that were spaced further apart in the knee than able-bodied controls of similar age, height, and weight (n = 8). The deteriorated trabecular bone microarchitecture may contribute to the increased fracture incidence after injury.

Introduction: Spinal cord injury results in a dramatic decline in areal bone mineral density (aBMD) and a marked increase in lower extremity fracture; however, its effect on trabecular bone microarchitecture is unknown. The purpose of this study was to determine if trabecular bone microarchitecture is deteriorated in the knee of men with long-term, complete spinal cord injury.

Materials and Methods: Apparent bone volume to total volume (appBV/TV), trabecular number, (appTb.N), trabecular thickness (appTb.Th), and trabecular separation (appTb.Sp), measures of trabecular bone microarchitecture, were assessed in the distal femur and proximal tibia of men with long-term (>2 years) complete spinal cord injury (SCI; n = 10) and able-bodied controls (CON; n = 8) using high-resolution magnetic resonance imaging. Proximal tibia and arm aBMD were determined using DXA. Independent t-tests were used to assess group differences in anthropometrics and bone parameters. Pearson correlation analysis was used to assess the relationships among trabecular bone microarchitecture, aBMD, and time since injury.

Results: There were no group differences in age, height, or weight; however, the distal femur and proximal tibia of SCI had 27% and 20% lower appBV/TV, 21% and 20% lower appTb.N, and 44% and 33% higher appTb.Sp, respectively (p < 0.05). The distal femur of SCI also had 8% lower appTb.Th (p < 0.05). Whereas arm aBMD was not different in the two groups, proximal tibia aBMD was 43% lower in SCI. In SCI and CON combined, aBMD was correlated with appBV/TV (r = 0.62), appTb.N (r = 0.78), and appTb.Sp (r = −0.82) in the proximal tibia (p < 0.05). Time since injury was more strongly correlated with appTb.N (r = −0.54) and appTb.Sp (r = 0.56) than aBMD (r = −0.36) in the distal tibia, although none of the relationships were statistically significant (p > 0.05).

Conclusion: Men with complete spinal cord injury have markedly deteriorated trabecular bone microarchitecture in the knee, which may contribute to their increased fracture incidence.
Adult-Onset Idiopathic Progressive Acro-Osteolysis With Proximal Symphalangism
Authors: Tanikawa Takahisa , Okada Yosuke , Azuma Taeko , Fukushima Ayumi , Kawahara Chie , Tanaka Yoshiya
Published: April 2006

We experienced a 57-year-old female with adult-onset non-congenital idiopathic acro-osteolysis combined with proximal symphalangism. At the age of 36, she developed severe pain and swelling of the toe base of both feet and underwent Clayton surgery. However, the size of her toes diminished progressively over the 5-year period after surgery. At the age of 41, she suffered pain and swelling of the proximal interphalangeal (PIP) joints of fingers of both hands. These PIP joints became rigid and inflexible. Subsequently, she noticed shortening of the little finger of both hands, followed later by shortening of the index, middle, and ring fingers. At the age of 57, the thumbs began to shorten. Laboratory and endocrinological examinations were not abnormal. Finally, we diagnosed her with acro-osteolysis combined with proximal symphalangism by radiological examination. In this case, previously unreported mutations of the Noggin gene were identified. This is the first case report of adult-onset, non-congenital idiopathic acro-osteolysis combined with proximal symphalangism.
β-Adrenergic Blockers Reduce the Risk of Fracture Partly by Increasing Bone Mineral Density: Geelong Osteoporosis Study
Authors: Pasco Julie A , Henry Margaret J , Sanders Kerrie M , Kotowicz Mark A , Seeman Ego , Nicholson Geoffrey C
Published: April 2006

This population-based study documented β-blocker use in 59/569 cases with incident fracture and 112/775 controls. OR for fracture associated with β-blocker use was 0.68 (95%CI, 0.49–0.96). β-Blockers were associated with higher BMD at the total hip (2.5%) and UD forearm (3.6%) after adjusting for age, anthropometry, and thiazide use. β-Blocker use is associated with reduced fracture risk and higher BMD.

Introduction: Animal data suggests that bone formation is under β-adrenergic control and that β-blockers stimulate bone formation and/or inhibit bone resorption.

Materials and Methods: We evaluated the association between β-blocker use, bone mineral density (BMD), and fracture risk in a population-based study in Geelong, a southeastern Australian city with a single teaching hospital and two radiological centers providing complete fracture ascertainment for the region. β-Blocker use was documented for 569 women with radiologically confirmed incident fractures and 775 controls without incident fracture. Medication use and lifestyle factors were documented by questionnaire.

Results: Odds ratio for fracture associated with β-blocker use was 0.68 (95% CI, 0.49–0.96) for any fracture. Adjusting for age, weight, medications, and lifestyle factors had little effect on the odds ratio. β-Blocker use was associated with a higher BMD at the total hip (2.5%, p = 0.03) and ultradistal forearm (3.6%, p = 0.04) after adjustment for age, anthropometry, and thiazide use.

Conclusion: β-Blockers are associated with a reduction in fracture risk and higher BMD.
Evidence of Sustained Skeletal Benefits From Impact-Loading Exercise in Young Females: A 3-Year Longitudinal Study
Authors: Nurmi-Lawton Jaana A , Baxter-Jones Adam D , Mirwald Robert L , Bishop Jacki A , Taylor Patricia , Cooper Cyrus , New Susan A
Published: April 2006

The skeletal effects from intensive exercise throughout puberty are undefined. Forty-five female gymnasts and 52 controls were studied over 3 years, including a heredity aspect. The effects of size, maturity, exercise, and diet were identified using a multilevel regression model. Results demonstrated sustained skeletal benefits resulting from exercise throughout all stages of pubertal development.

Introduction: Weight-bearing exercise is beneficial for peak bone mass development. However, whether skeletal benefits achieved with exercise are maintained if training remains intensive throughout the pubertal years is not entirely clear. The influence of familial resemblance for bone mass remains undefined in physically active versus inactive children. The aim of this study was to investigate the long-term influences of impact-loading exercise on bone quantity and quality in young females after controlling for growth, maturation, and hereditary factors.

Materials and Methods: At baseline, 45 gymnasts (G) and 52 normally active controls (C) 8–17 years of age were recruited. Anthropometry, diet, physical activity, and quantitative ultrasound (QUS) were measured annually for 3 consecutive years. DXA scans of total body (TB) and lumbar spine (LS) bone mineral content (BMC) and density (BMD) were taken three times at 1-year intervals. A multilevel regression model was fitted, and the independent effects of body size, maturity, physical activity, and diet were identified over time. To assess heredity influences, 27 G mothers and 26 C mothers volunteered for cross-sectional measurements of anthropometry, QUS, and BMC/BMD.

Results and Conclusions: Gymnasts were smaller and lighter (as were their mothers) than controls, but they had significantly higher QUS and axial and appendicular BMC and BMD, with >170 g more bone mineral in TB across puberty (after adjustment for maturity [years from peak height velocity], height, weight, energy, and protein intake). Gymnasts had up to 24–51% higher BMC and 13–28% higher BMD, depending on skeletal site. These results provide evidence of sustained skeletal benefits from impact-loading exercise, which are unlikely to result entirely from heredity, throughout pubertal years.