bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative Assessment of Simultaneous Capacitive and Resistive Plantar Pressure Measurements During Walking
Authors: Quesada Peter M. , Rash Gregory S.
Published: February 2017

Plantar pressure data were collected simultaneously, during walking, from capacitive and resistive in-shoe pressure measurement systems. Overall mean peak pressure recordings from the resistive system were 32%, 20% and 14% greater than recordings from the capacitive system, at the heel, central metatarsal heads, and great toe, respectively. Placement of one system's insoles above or below the other's somewhat affected peak pressure measurements from both systems, while calibration via air bladder or single limb standing techniques somewhat affected resistive measurements as well. Capacitive measurement variability was 60%, 20% and 22% lower than resistive measurement variability, at the heel, central metatarsal heads, and great toe, respectively. Both systems tended to exhibit greater variability when capacitive insoles were placed above resistive insoles; however, the effects on variability of the experimental insole arrangements were well overshadowed by the overall variability differences between systems.
Dynamic Pedobarography (DPB) in Operative Management of Cavovarus Foot Deformity
Authors: Metaxiotis Dimitrios , Accles Walter , Pappas Alexander , Doederlein Leonhard
Published: February 2017

Dynamic pedobarography (DPB) was performed in 21 patients, 9 male and 12 female with cavovarus foot deformity mostly of Charcot-Marie-Tooth origin. Age ranged from 14 to 52 years (mean 30y). Twenty-six feet were examined pre- and postoperatively clinically, radiologically and by dynamic pedobarography with a follow-up time from 9 to 49 months (mean 22.5 mo). The EMED SF system was used for data collection during walking. Gait line, contact areas (CA), peak pressures (PP) and pressure time integral (PTI) were determined. According to the contact pattern the examined feet could be divided into three groups with antegrade, retrograde and inversion contact pattern. Data analysis showed postoperatively considerable increase in CA and decrease in PP and PTI. Clinical results such as plantar callosities and “roll over avoidance gait” did not always correlate with pedobarographic data. DPB adds a dynamic component in the diagnosis and management of cavovarus feet but certain limitations exist.
Accessory Soleus Muscle as a Cause of Resistance to Correction in Congenital Club Foot: A Case Report
Authors: Chotigavanichaya Chatupon , Scaduto Anthony A. , Jadhav Avinash , Otsuka Norman Y.
Published: February 2017

A 14-month-old female with bilateral clubfeet was initially treated by serial casting and percutaneous tenotomy of the Achilles tendon, bilaterally. Both clubfeet subsequently underwent surgical treatment with a posteromedial release through a Cincinnati incision. At surgery on one clubfoot, an accessory Soleus muscle was found anterior to the Achilles tendon with a distinct insertion on the upper surface of calcaneus, anterior and medial to the insertion of Achilles tendon. This accessory Soleus muscle may have been the cause of resistance to correction in this congenital clubfoot.
Outcome of the Modified Broström Procedure for Chronic Lateral Ankle Instability Using Suture Anchors
Authors: Messer Terry M. , Cummins Craig A. , Ahn Joseph , Kelikian Armen S.
Published: February 2017

The modified Broström procedure is an anatomic reconstruction of the lateral ankle ligaments. The present study evaluated twenty-two patients (mean age = 27.2 years) with chronic lateral ankle instability who underwent surgical repair of their lateral ankle ligaments using suture anchors as part of the modified Broström procedure. All surgeries were performed by the senior author (AK) on an outpatient basis. At a mean follow-up of 34.5 months (minimum of 18 months), twenty patients (91%) reported a good or excellent functional outcome as assessed by the Karlsson and Peterson ankle function scoring scale. 21 One patient developed a superficial wound infection post-operatively that was eradicated with a course of oral antibiotics. Sixteen of the twentytwo patients were available for follow-up physical examination and stress radiographs. Fourteen of the sixteen patients had no evidence of instability on physical examination or on stress radiographs. One patient had diminished sensation in the superficial peroneal nerve distribution. Five of the sixteen patients had generalized ligamentous laxity; none of these patients had an excellent result, and they had lower “Overall Satisfaction” scores (P = 0.013). We conclude that the use of suture anchors is a simple and effective adaptation of the modified Broström procedure, which results in a good or excellent outcome in the majority of patients with few complications.
Early Mobilization After Sliding Achilles Tendon Lengthening In Children With Spastic Cerebral Palsy
Authors: Katz K. , Arbel N. , Apter N. , Soudry M.
Published: February 2017

Equinus deformity is a common finding in children with cerebral palsy and may be treated by Achilles tendon lengthening. To prevent recurrence, some authors recommend immobilizing the operated leg with an aboveknee cast for six weeks, followed by use of a night splint or orthosis. Nevertheless, there are recurrence rates of up to 20.5%. The aim of this study was to evaluate the long-term result of postoperative immobilization for two weeks in a below-knee cast and early weight bearing, without the use of a splint or orthosis.

Thirty-six children (52 feet) with spastic cerebral palsy underwent sliding Achilles tendon lengthening. Followup of five to ten years showed a comparable recurrence rate (19.2%) to that reported with the standard, more stringent management approach. Most of the recurrences were in children operated on before five years of age.

We believe earlier motion helps to sustain the tendon length achieved at surgery and allows for earlier independent gait.
First Ray Dorsal Monility in Relation to Hallux Vlagus Deformity and First Intermetatarsal Angle
Authors: Glasoe Ward Mylo , Allen Mary K. , Saltzman Charles L.
Published: February 2017

The hypermobile first ray has been implicated as contributing to the cause and progression of hallux valgus deformity. Deformity of the hallux is often accompanied by an enlarged first intermetatarsal (IM 1-2) angle. It has been hypothesized that subjects having an abnormally large IM 1-2 angle have laxity of the first ray. Objectives of this study were to compare dorsal mobility of the first ray in subjects with hallux valgus to asymptomatic controls, and to investigate the relationship between dorsal mobility and the IM 1-2 angle. Fourteen subjects (age 23–81) with hallux valgus were matched by gender and age to control subjects. The IM 1-2 angle was measured from radiographs. A load-cell device measured dorsal mobility of the first ray under a standard load of 55 N. Pearson's correlation coefficient identified a marginal correlation (r = .51) between IM 1-2 angle and dorsal mobility. An independent t-test showed a statistically (P < 0.01) larger amount of dorsal mobility in the group of subjects having an hallux valgus. Mobility of the first ray was increased in subjects with hallux valgus and a large IM 1-2 angle may be an indicator of increased dorsal mobility.
Operative Treatment of Ankle Fractures: A Minimum Ten-Year Follow-up
Authors: Day Gregory A. , E. Swanson Cheryl , Hulcombe Bradley G.
Published: February 2017

The long-term outcome of 25 patients with bimalleolar fractures of the ankle was assessed ten to fourteen years following their fractures using the Phillips scoring system. All patients had undergone open reduction and anatomical internal fixation (as described in their operative notes in the medical records). 52% of patients had a good or excellent overall outcome while 24% had a poor overall outcome. This study has the longest follow-up period (10 to 14 years) to date on the outcomes of internal fixation of bimalleolar ankle fractures and demonstrates a higher percentage of poorer outcomes than has been previously described. This trend appears to be predictable as other studies with shorter term follow-up have already established a trend of increasing radiological evidence of post-traumatic arthritis with successively longer-term outcome reports.
Preliminary Results Comparing Two Methods of Lateral Column Lengthening
Authors: Thomas Ruth Lourdes , Wells Britton Colby , Garrison Robert Leo , Prada Stefan Alexander
Published: February 2017

Forty-five patients (49 feet) underwent lateral column lengthening as treatment for painful pes planus. Twenty-five patients (27 feet) were available for both radiographic and clinical evaluation at least one year postoperatively. Of these 25 patients, 10 feet underwent Evans opening wedge osteotomy with tricortical iliac crest bone graft; 17 feet underwent calcaneocuboid distraction arthrodesis utilizing iliac crest bone graft. In addition, both groups underwent debridment of the posterior tibial tendon combined with transfer of the flexor digitorum longus into the navicular for reinforcement. Radiographic results documented marked improvement in all parameters. There was more improvement in the calcaneocuboid fusion group than the osteotomy group, but the difference was not statistically significant. Postoperative AOFAS rating scores averaged 87.9 for the osteotomy group and 80.9 for the distraction arthrodesis group. The difference was not statistically significant. Twenty of 25 patients (83.5%) in both groups were very satisfied. Twenty-four of 25 patients (96%) stated that knowing the final result they would have the same surgery again. Complications were reported for 32 patients (34 feet).

Both the Evans opening wedge calcaneal osteotomy and calcaneocuboid distraction arthrodesis offer significant improvement in the radiographic parameters and AOFAS clinical scores for patients with painful, flexible flatfoot deformity. However, the complication rate remains high with both methods, and the rate of nonunion and delayed union with the calcaneocuboid distraction arthrodesis method remains a significant problem with this technique.
Calcaneal Compartment Syndrome After Tibial Fractures
Authors: Bayer JH , Davies AP , Darrah C , Shepstone L , Patel AD
Published: February 2017

Compartment syndrome of the newly discovered calcaneal compartment of the foot is a theoretical possibility following tibial fracture due to the communication with the deep posterior compartment of the calf. Forty-nine patients were reviewed at least 18 months after open or closed tibial shaft fractures treated with tibial nailing in order to determine the prevalence of foot deformities secondary to previously undetected calcaneal or leg compartment syndromes. Ankle movements, foot height, length of feet and degree of clawing of the toes were all measured and compared with the unaffected opposite side. None of the patients complained of any symptoms from their feet and none had any significant foot deformities. Calcaneal compartment syndrome is rare after tibial fracture and routine measurement of calcaneal compartment pressures after such injuries is not indicated.
Where There's Hope
Authors: Lee Stacie
Published: February 2017

A young patient's account of her preoperative and postoperative experiences is recalled.
Benign Calcaneal Bone Cyst and Pathologic Fracture—Surgical Treatment with Injectable Calcium-Phosphate Bone Cement (Norian®): A Case Report
Authors: Csizy Marcel , Buckley Richard E. , Fennell Colin
Published: February 2017

Solitary calcaneal bone cysts are uncommon. Usually they measure 1/3 to 1/2 of the calcaneal length. Symptomatic calcaneal bone cysts are generally treated with open debridement and autologous bone grafting. We report a case of a patient with a displaced intra-articular calcaneal fracture who presents with a large benign calcaneal bone cyst. This patient was treated with debridement and filling of defect with injectable calcium-phosphate bone cement (Norian®) and open reduction and internal fixation of the calcaneal fracture.
Autologous Chondrocyte Transplantation in Osteochondral Lesions of the Ankle Joint
Authors: Giannini Sandra , Buda Roberto , Grigolo Brunella , Vannini Francesca
Published: February 2017

The aim of this study was to assess the repair of osteochondral defects of the ankle joint with hyaline cartilage. For this purpose we have been using a technique of autologous chondrocyte transplantation for osteochondral defects of the talus for the last two years.

Until the method described in the paper, treatment methods proposed for the repair of cartilaginous defects have not been histologically effective in restoring the hyaline cartilage sheath, and in all cases the neoformation of cartilage was of a fibrocartilaginous nature with varying cellular characteristics.

Clinical and histological results obtained using this surgical technique have confirmed its validity. Furthermore, neither subjective nor objective complications have been reported. Less pain and better articular function have also been observed. According to the AOFAS score, an improvement from an average score of 32/100 points preop. to 91/100 points at 24 months of follow up was obtained.

Laboratory data have confirmed the presence of reconstructed cartilage with chondrocytes and expression of collagen II, characteristic of hyaline cartilage.
Socio-critical research on teaching physical education and physical education teacher education
Authors: Felis-Anaya Mercè , Martos-Garcia Daniel , Devís-Devís José
Published: February 2017

The purpose of this study is to systematically review the socio-critical research on teaching physical education (PE) and PE teacher education (PETE) between 1999 and 2014. The procedure followed a four-phase approach: (a) searching publications through four international databases; (b) meeting inclusion criteria; (c) refining selection to identify specifically research-based papers; and (d) expert searching based on the research team’s knowledge. The selection process yielded 23 articles mainly from Australia, New Zealand, the USA and Spain. Most of the research was authored collaboratively by male and female authors affiliated to universities. A lack of authorship shared with participant students, teachers or student teachers was observed. Qualitative approaches were the predominant methodology used in the selected studies. An inductive content analysis identified five major themes: evaluations in secondary school; evaluations in higher education; provocative studies; studies on assessment; and studies on participants’ experiences and views. Teaching and curriculum problems and difficulties, new ways of approaching them and potential solutions to moral struggles in teaching were analysed within these themes. Most of the socio-critical research reviewed involved both a postmodern ontology and innovative research designs to investigate the new and complex world of PE and PETE. This review exhibits the reduced impact on social change and the difficulties in developing socio-critical research and enacting critical pedagogy. However, the findings of our study preserve the momentum of socio-critical research that fights to keep its place in the field of teaching PE and PETE.
Loosening the law’s bite: Law, fact, and expert evidence in R v JA and R v NS
Authors: Phillips Dana Erin
Published: February 2017

Faced, in the wake of the Canadian Charter of Rights and Freedoms, with decisions that bear upon unfamiliar realms of social life, Canadian courts have turned to making factual determinations based on social science and other expert evidence. Such evidence can help litigants from marginalised groups to challenge exclusionary norms and ‘common sense’ assumptions that form part of judicial reasoning. However, litigants seeking to disrupt the legal status quo in this way face a number of challenges. While many commentators have emphasised the prohibitive cost of bringing expert evidence, this article points to a prior challenge—the need to convince the court to see the relevant issue as a fact amenable to proof in the first place. To illustrate the significance of this initial framing challenge, I examine two recent criminal cases— R v JA and R v NS—where expert evidence may have been useful but was scant.
Sociocultural factors affecting uptake of home-based neonatal thermal care practices in Africa: A qualitative review
Authors: Coalter Wendy S , Patterson Sarah L
Published: February 2017

Neonatal hypothermia is a major contributor to neonatal mortality in sub-Saharan Africa, often as a comorbidity of severe infections, preterm births or asphyxia. Simple, cost-effective thermal care practices (TCPs) immediately at birth and in the post-natal period are recommended in the World Health Organization ‘warm chain’. Current practices are suboptimal in the home in low-resource settings, where approximately half of neonatal deaths occur. Several databases (PubMed, OVID SP, Web of Science, The Cochrane Library and Google Scholar) were searched for original research on home-based TCPs. Seventeen articles were identified, and the results were analysed using a ‘thermal care behavioural model’. This review of the qualitative literature on home-based practices across Africa illuminates the sociocultural factors affecting the uptake of recommended practices and strategies for behaviour change. Findings from the review confirm that potentially harmful cultural norms and traditions influence the sequence of TCPs in different contexts across Africa. Furthermore, caregiver factors and contextual barriers or facilitating factors to TCPs and behaviour change exist. Hypothermia and home-based TCPs are areas for further research. Thermal care behaviour change interventions tailored to the sociocultural context are necessary to improve neonatal outcomes in Africa.
Z-Glyph: Visualizing outliers in multivariate data
Authors: Cao Nan , Lin Yu-Ru , Gotz David , Du Fan
Published: February 2017

Outlier analysis techniques are extensively used in many domains such as intrusion detection. Today, even with the most advanced statistical learning techniques, human judgment still plays an important role in outlier analysis tasks due to the difficulty of defining and collecting outlier examples. This work seeks to tackle this problem by introducing a new visualization design, “Z-Glyph,” a family of glyphs designed to facilitate human judgment in outlier analysis of multivariate data. By employing a location-scale transformation, a Z-Glyph represents the “normal” data using regular shapes (e.g. straight line and circle), such that the abnormal data can be revealed when deviating from the regular shapes. Extensive controlled experiment and case studies based on real-world datasets indicate the superior performance of the Z-Glyph family, compared with the baselines, suggesting that the proposed design is able to leverage human perceptional features with statistical characterization. This study contributes to a more fundamental understanding about designing visual representations for revealing outliers in multivariate data, which can be applied as a building block in many domain-specific anomaly detection applications.
Children’s consent and the zone of parental discretion
Authors: Alderson P
Published: February 2017

This paper briefly reviews highlights from decades of debates in medicine, law, bioethics, psychology and social research about children’s and parents’ views and consent to medical treatment and research. There appears to have been a rise and later a fall in respect for children’s views, illustrated among many examples by a recent book on the zone of parental discretion, which is reviewed. A return to greater respect for children’s views and consent is advocated.
The bedside rationing paradigm and the shortcomings of modernist ethics
Authors: Wyller Vegard Bruun
Published: February 2017

Many bioethicists promote and defend the ‘bedside rationing paradigm’; a pertinent example is the recent publication by Morten Magelssen and colleagues, in which they attack my previous criticism in the field. The present response focuses on what I consider to be the main side-effects of the ‘bedside rationing paradigm’: the ignorance towards intentions and societal roles, the crumbling of political practice, and the fiduciary loss in the physician–patient relationship. Further, I claim that these side effects are related to certain underlying presumptions, such as the conception of fairness as equivalent with distributive justice and the belief in the presence of universally valid, context-independent moral principles. These presumptions are characteristics of modernist ethics; thus, the ‘bedside rationing paradigm’ illustrates some fundamental shortcomings of this moral theory. I argue that an ethics of virtue is better suited to the practice of medicine as well as to the rationing dilemmas.
Finding Optimal Ablation Parameters for Multipolar Radiofrequency Ablation
Authors: Poch Franz G. M. , Rieder Christian , Ballhausen Hanne , Knappe Verena , Ritz Jörg Peter , Gemeinhardt Ole , Kreis Martin E. , Lehmann Kai S.
Published: February 2017

Purpose. Radiofrequency ablation (RFA) for primary liver tumors and liver metastases is restricted by a limited ablation size. Multipolar RFA is a technical advancement of RFA, which is able to achieve larger ablations. The aim of this ex vivo study was to determine optimal ablation parameters for multipolar RFA depending on applicator distance and energy input. Methods. RFA was carried out ex vivo in porcine livers with three internally cooled, bipolar applicators in multipolar ablation mode. Three different applicator distances were used and five different energy inputs were examined. Ablation zones were sliced along the cross-sectional area at the largest ablation diameter, orthogonally to the applicators. These slices were digitally measured and analyzed. Results. Sixty RFA were carried out. A limited growth of ablation area was seen in all test series. This increase was dependent on ablation time, but not on applicator distance. A steady state between energy input and energy loss was not observed. A saturation of the minimum radius of the ablation zone was reached. Differences in ablation radius between the three test series were seen for lowest and highest energy input ( P < .05). No differences were seen for medium amounts of energy ( P > .05). Conclusions. The ablation parameters applicator distance and energy input can be chosen in such a way, that minor deviations of the preplanned ablation parameters have no influence on the size of the ablation area.
Insert Sexy Title Here: Moving Toward a Sex-Positive Criminology
Authors: Wodda Aimee , Panfil Vanessa R.
Published: February 2017

Literature on sexuality in criminological contexts exists, yet much of it is sex-negative, employs a “deviance frame,” and regards many sex acts as dangerous or destructive. Although research that could be considered sex-positive has been undertaken, an explicitly sex-positive theoretical and practical framework for feminist criminology has not yet been advanced. In this article, we propose “thick desire” as a way to envision an intersectional sex-positive feminist criminology that aligns with the principles of a positive sexuality approach to research and praxis. We explore the issue of criminalization of teen sexting to begin to integrate these principles.
Prime-Time Representations of Female Federal Agents in Television Dramas
Authors: Garland Tammy S. , Blackburn Ashley G. , Browne John A. , Blanfort Candace D.
Published: February 2017

Television crime programs not only impart messages regarding the nature of crime and criminal justice but also aid in the creation of stereotypes regarding females working in law enforcement. Using a mixed-methods approach, the study analyzes a sample of prime-time crime dramas to examine issues of employment, discrimination, sexualization, and victimization within series episodes. Although portrayals of female law enforcement officers have improved, female characters continue to face issues of discrimination and victimization. The manner in which these messages may be cultivated and disseminated and what this means for consumers, especially women interested in law enforcement careers, are explored.
Hybrid methodological approach to context-dependent speech recognition
Authors: Mišković Dragiša , Gnjatović Milan , Štrbac Perica , Trenkić Branimir , Jakovljević Nikša , Delić Vlado
Published: February 2017

Although the importance of contextual information in speech recognition has been acknowledged for a long time now, it has remained clearly underutilized even in state-of-the-art speech recognition systems. This article introduces a novel, methodologically hybrid approach to the research question of context-dependent speech recognition in human–machine interaction. To the extent that it is hybrid, the approach integrates aspects of both statistical and representational paradigms. We extend the standard statistical pattern-matching approach with a cognitively inspired and analytically tractable model with explanatory power. This methodological extension allows for accounting for contextual information which is otherwise unavailable in speech recognition systems, and using it to improve post-processing of recognition hypotheses. The article introduces an algorithm for evaluation of recognition hypotheses, illustrates it for concrete interaction domains, and discusses its implementation within two prototype conversational agents.
The significance of circadian rhythms and dysrhythmias in critical illness
Authors: McKenna Helen T , Reiss Irwin KM , Martin Daniel S
Published: February 2017

Many physiological and cellular processes cycle with time, with the period between one peak and the next being roughly equal to 24 h. These circadian rhythms underlie ‘permissive homeostasis’, whereby anticipation of periods of increased energy demand or stress may enhance the function of individual cells, organ systems or whole organisms. Many physiological variables related to survival during critical illness have a circadian rhythm, including the sleep/wake cycle, haemodynamic and respiratory indices, immunity and coagulation, but their clinical significance remains underappreciated. Critically ill patients suffer from circadian dysrhythmia, manifesting overtly as sleep disturbance and delirium, but with widespread covert effects on cellular and organ function. Environmental and pharmacological strategies that ameliorate or prevent circadian dysrhythmia have demonstrated clinical benefit. Harnessing these important biological phenomena to match metabolic supply to demand and bolster cell defenses at the apposite time may be a future therapeutic strategy in the intensive care unit.
Management of severe dehydration
Authors: Strachan Stephanie Ruth , Morris Lucy Francesca
Published: February 2017

The presented case is one of severe dehydration and acute kidney injury with significant resultant complications that required considerable fluid and electrolyte replacement. Approaches to fluid resuscitation in the context of hypernatraemia and the hyperosmolar state were considered and then judiciously combined to manage a complex case with a successful outcome. Conflicting guidance in this domain is discussed with recommendations for a future management strategy that is tailored to individual patients.
Assessment of normal trapeziometacarpal joint alignment
Authors: Rust P. A. , Ek E. T. H. , Tham S. K. Y.
Published: February 2017

The purpose of this study was to determine the alignment of the normal trapeziometacarpal joint and any changes in its alignment with age. Radial, dorsal and dorsoradial subluxation were measured on computerized tomographic scans in 50 joints of 50 adults aged 18 to 62. There were statistically significant correlations between increasing age and dorsoradial subluxation but no significant correlation with dorsal and radial subluxation. Significant dorsoradial subluxation occurs after 46 years of age in the normal trapeziometacarpal joint. A mean dorsoradial subluxation of 21% (range 14%–30%) can be considered normal in this age group.
Delivery and postpartum management of a patient with Pompe disease: Case report and review of the literature
Authors: Koyuncu Kazibe , Turgay Batuhan , Aytac Rusen , Soylemez Feride
Published: February 2017

Pompe disease is an autosomal-recessive disorder caused by acid alpha-glucosidase deficiency due to mutations in the GAA gene. There are two forms of the disease: infantile-onset Pompe disease and late-onset Pompe disease. The worldwide incidence of both forms of the disease is commonly reported to be 1 in 40,000. Adult patients are affected by limb-girdle muscular weakness and respiratory insufficiency. Enzyme replacement therapy with alglucosidase-alpha is available since 2006. There is little knowledge about pregnant woman with Pompe disease. These women should be considered as high-risk pregnant women. Here, we aim to present Cesarean delivery and postpartum management of a case with an interrupted enzyme replacement therapy during pregnancy.
The effect of women’s breast cancer fear and social support perceptions on the process of participating in screening
Authors: Kissal Aygul , Vural Birgül , Ersin Fatma , Solmaz Tuğba
Published: February 2017

Introduction:

Social support and fear have been shown to be important factors affecting women’s participation in breast cancer screening. This study aimed to determine the effect of women’s perceived breast cancer fear and social support on participating in the breast cancer screening process, and to investigate the relationship between the perception of breast cancer fear and social support.

Methods:

This is a descriptive study, carried out in a state hospital on 198 women. The data were collected through a Socio-Demographic Data Form, Multidimensional Scale of Perceived Social Support (MSPSS), and Breast Cancer Fear Scale (BCFS) by the researchers by means of face-to-face interview.

Results:

There was no statistically significant difference between the women’s perceptions of social support and breast cancer fear and screening behaviors ( p > 0.05). It was found that the mean BCFS score of those who had a family history of breast cancer was high, and the MSPSS score was lower ( p < 0.05). There was a quite weak and statistically insignificant positive relationship between the women’s BCFS scores and perceived social support ( r = 0.08, p > 0.05), friend support ( r = 0.04, p > 0.05) and support from a special person ( r = 0.14, p > 0.05).

Conclusion:

We found no statistically significant difference between breast cancer fear, social support and the women’s screening behavior. However, breast cancer fear and the effect of social support on screening attitude may be important. Nurses and other health workers should particularly focus on social support and breast cancer fear in their health education programs. Formative research into the use of social support to promote positive empowering messages should be carried out and incorporated in future health promotion campaigns to improve the breast cancer screening process.
The role of vitamin D in maintaining bone health in older people
Authors: Hill Thomas R. , Aspray Terry J.
Published: February 2017

This review summarises aspects of vitamin D metabolism, the consequences of vitamin D deficiency, and the impact of vitamin D supplementation on musculoskeletal health in older age. With age, changes in vitamin D exposure, cutaneous vitamin D synthesis and behavioural factors (including physical activity, diet and sun exposure) are compounded by changes in calcium and vitamin D pathophysiology with altered calcium absorption, decreased 25-OH vitamin D [25(OH)D] hydroxylation, lower renal fractional calcium reabsorption and a rise in parathyroid hormone. Hypovitaminosis D is common and associated with a risk of osteomalacia, particularly in older adults, where rates of vitamin D deficiency range from 10–66%, depending on the threshold of circulating 25(OH)D used, population studied and season. The relationship between vitamin D status and osteoporosis is less clear. While circulating 25(OH)D has a linear relationship with bone mineral density (BMD) in some epidemiological studies, this is not consistent across all racial groups. The results of randomized controlled trials of vitamin D supplementation on BMD are also inconsistent, and some studies may be less relevant to the older population, as, for example, half of participants in the most robust meta-analysis were aged under 60 years. The impact on BMD of treating vitamin D deficiency (and osteomalacia) is also rarely considered in such intervention studies. When considering osteoporosis, fracture risk is our main concern, but vitamin D therapy has no consistent fracture-prevention effect, except in studies where calcium is coprescribed (particularly in frail populations living in care homes). As a J-shaped effect on falls and fracture risk is becoming evident with vitamin D interventions, we should target those at greatest risk who may benefit from vitamin D supplementation to decrease falls and fractures, although the optimum dose is still unclear.
Privacy and Security Issues Surrounding the Protection of Data Generated by Continuous Glucose Monitors
Authors: Britton Katherine E. , Britton-Colonnese Jennifer D.
Published: February 2017

Being able to track, analyze, and use data from continuous glucose monitors (CGMs) and through platforms and apps that communicate with CGMs helps achieve better outcomes and can advance the understanding of diabetes. The risks to patients’ expectation of privacy are great, and their ability to control how their information is collected, stored, and used is virtually nonexistent. Patients’ physical security is also at risk if adequate cybersecurity measures are not taken. Currently, data privacy and security protections are not robust enough to address the privacy and security risks and stymies the current and future benefits of CGM and the platforms and apps that communicate with them.
Reduced subarachnoid fluid diffusion in enlarged subarachnoid spaces of infancy
Authors: Whitehead Matthew T , Lee Bonmyong , McCarron Audrey , Fricke Stanley T , Vezina Gilbert
Published: February 2017

Background and purpose

Enlargement of the subarachnoid spaces in infancy (ESSI) is a common cause of macrocephaly without proven explanation. We have observed subarachnoid diffusion to be decreased in these patients. We aim to quantify the diffusivity of ventricular and subarachnoid cerebrospinal fluid in ESSI patients, to determine if diffusion characteristics deviate from normocephalic infants, and to propose a unique mechanism for ESSI.

Materials and methods

227 consecutive brain magnetic resonance exams from different macrocephalic children were retrospectively reviewed after institutional review board waiver. Patients with noncommunicating hydrocephalus, substantial ventriculomegaly, atrophy, structural bone and/parenchymal abnormalities, abnormal brain signal, hemorrhages, meningitis, and normal imaging were excluded. A total of 53 exams from macrocephalic patients and 21 normocephalic subjects were analyzed. Mean quantitative apparent diffusion coefficient (ADC) values were obtained from the ventricular frontal horn and frontal subarachnoid spaces. The subarachnoid:ventricular ADC ratios were compared using a Mann–Whitney U-test.

Results

The mean age was 13 +/−8 months (macrocephalic cohort) and 13 +/− 6 months (normocephalic cohort). The subarachnoid fluid mean ADC was 2.50+/−0.26 × 10−3 mm2/s in the macrocephalic group and 2.84+/−0.29 × 10−3 mm2/s in the normocephalic group. The ventricular fluid mean ADC was 2.97+/−0.37 × 10−3 mm2/s and 2.74 +/−0.32 × 10−6 mm2/s, respectively. The mean quantitative ADC ratios in the macrocephalic group were 0.85, significantly smaller than the normocephalic group (1) ( z = −6.3; p = 0).

Conclusion

Subarachnoid space fluid diffusivity is reduced in patients with enlarged subarachnoid spaces of infancy. We propose insufficient frontotemporal capillary protein resorption to be the initiating factor in ESSI, leading to unbalanced osmotic/hydrostatic pressures, and secondary congestion.
Representing Swiss vocational education and training teachers’ domain-specific conceptions of financial literacy using concept maps
Authors: Leumann Seraina
Published: February 2017

Issues related to financial matters are an integral component of the curricula in vocational education and training in Switzerland. However, the differences between students’ competences are caused not only by the curricula but by multiple factors. One key factor is teachers’ characteristics that support successful learning processes. Teachers’ conceptions with respect to general or domain-specific aspects of teaching-related phenomena and processes play a particularly important role. In contrast to subjects such as mathematics, little is known about teachers’ conceptions in the domain of economics and financial literacy. This applies in particular to the investigation of the deep structure of teachers’ conceptions, which goes beyond the designation of contents. A structural representation in the form of concept maps is a possible instrument for the collection and analysis of data to that end. Consequently, it is the aim of this study to demonstrate, how concept maps can be used as a methodological instrument in order to gain information about the domain-specific conceptions of vocational education and training teachers regarding the subject matter of financial literacy. Results show that concept maps are a targeted instrument for the exploration of the deep structure of conceptions and have therefore a great potential for research and teacher education.
Utilization of cholera toxin B as a mucosal adjuvant elicits antibody-mediated protection against S. pneumoniae infection in mice
Authors: Wiedinger Kari , Pinho Daniel , Bitsaktsis Constantine
Published: February 2017

Backgound:

The introduction of the pneumococcal conjugate and polysaccharide vaccines have been valuable tools for combating invasive pneumococcal infection in children and healthy adults. Despite the available vaccination strategies, pneumococcal pneumonia and associated diseases continue to cause substantial morbidity and mortality, particularly in individuals with chronic disease and ageing populations. Next-generation pneumococcal vaccines will need to be highly immunogenic across patient populations providing both mucosal and systemic protective immunity. Mucosal immunization is an effective strategy for stimulating the immune response at the site of pathogen entry while increasing systemic immunity. In this study we utilized intranasal immunization with pneumococcal surface protein A (PspA), in combination with the mucosal adjuvant cholera toxin B (CTB), to characterize the immune components providing protection against S. pneumoniae challenge.

Methods:

Mice were immunized intranasally with CTB and PspA individually, and in combination, followed by lethal bacterial challenge with S. pneumoniae, strain A66.1. Animals were monitored for survival and tested for lung bacterial burden, cytokine production as well as S. pneumoniae-specific antibody titer in mouse sera. The primary immunological contributor to the observed protection was confirmed by cytokine neutralization and serum passive transfer.

Results:

The combination of CTB and PspA provided complete protection against bacterial challenge, which coincided with a significant decrease in lung bacterial burden. Increases in the T-helper (Th) 1 cytokines, interferon (IFN)-γ and interleukin (IL)-2 were observed in the lung 24 h post-challenge while decreases in proinflammatory mediators IL-6 and tumor necrosis factor (TNF)-α were also recorded at the same time point. The adjuvanted PspA immunization induced significant titers of S. pneumoniae-specific antibody in the serum of mice prior to infection. Serum adoptive transfer passively protected animals against subsequent challenge while IFN-γ neutralization had no impact on the outcome of immunization, suggesting a primary role for antibody-mediated protection in the context of this immunization strategy.

Conclusion:

Mucosal immunization with CTB and PspA induced a local cellular immune response and systemic humoral immunity which resulted in effective reduction of pulmonary bacterial burden and complete protection against S. pneumoniae challenge. While induction of the pleiotropic cytokine IFN-γ likely contributes to control of infection through activation of effector pathways, it was not required for protection. Instead, immunization with PspA and CTB-induced S. pneumoniae-specific antibodies in the serum prior to infection that were sufficient to protect against mucosal challenge.
Short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 radiosynoviorthesis
Authors: TY Prasanna , Menon Jagadish , AR Nataraj , Halanaik Dhanapathi , Kramadhari Harshith
Published: February 2017

Purpose:

Various modes of therapy have been directed at breaking the vicious cycle at early stage of synovitis in haemophilia patients. This study was planned to assess the short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 (P-32) radiosynoviorthesis.

Methods:

P-32 samarium radiocolloid was injected into the knee and patients were followed up at 1 and 3 months, respectively. Clinical outcomes was assessed using Tegner Lysholm scores (TLSs), Modified Knee Society Clinical Rating System (MKSS) score and circumference of the knee joint. The radiological outcomes were assessed using X-ray, ultrasonography and bone scan.

Results:

Among the fifteen haemophilia A patients studied, there was statistically significant difference in TLS ( χ2(2) = 27.887 and p value < 0.001), MKSS scores ( χ2(2) = 27.745 and p < 0.001) and circumference of the knee joint ( χ2(2) = 21.333 and p < 0.001) at preoperatively, 1- and 3-month follow-up. There were no changes noted in follow-up X-rays compared with the preoperative X-ray. Ultrasonography showed that clinical improvement was more in suprapatellar and medial parapatellar regions in the last 2 months compared to the first month of follow-up. Post P-32 bone scan showed marked decrease in uptake in the affected knee joint suggestive of radio ablation of synovial tissue.

Conclusion:

P-32 radiosynoviorthesis done for chronic synovitis among haemophilia A patients showed significant improvement in both clinical and radiological parameters. Ultrasonography can be utilized as non-invasive radiological modality for follow-up of P32 response for knee joint.
Removal of interlocking intramedullary nail for relieve of knee pain after tibial fracture repair
Authors: Zhang Shaodong , Wu Xiaotao , Liu Lei , Wang Chen
Published: February 2017

Objective:

To investigate the effects of intramedullary nail removal after tibial fracture repair.

Methods:

Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) ≥ 4) and mild/no knee pain (VAS < 4) groups after interlocking intramedullary nailing. Variables studied included the distance from the tip of the nail to the tibial plateau and the front of the tibia on a normalized lateral X-ray, the VAS score of knee and ankle pain, the range of motion of the knee and ankle, and Johner–Wruhs criteria before, 6 weeks after operation, and at the last follow-up.

Results:

Fifty-seven patients were followed for a mean of 8.4 (2–17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions ( p < 0.05). A significantly shorter distance from the tip of the nail to the tibial plateau (<10 mm) and the anterior border of tibia (<6 mm) was found in the 24 patients with moderate or severe knee pain. Knee pain VAS scores significantly lowered 6 weeks postoperatively and at the last follow-up, compared to before the operation ( p < 0.05). However, no significant changes occurred with respect to ankle pain VAS scores, range of motion, and Johner–Wruhs criteria ( p > 0.05).

Conclusion:

For patients complaining knee pain after interlocking intramedullary nailing of tibial fractures, especially with a short distance from the tip of the nail tail to the tibial plateau (<10 mm) and the anterior border of the tibia (<6 mm) removal of the intramedullary nails relieved the pain significantly.
Reduced prothrombinase inhibition by tissue factor pathway inhibitor contributes to the factor V Leiden hypercoagulable state
Authors: Wood Jeremy P. , Baumann Kreuziger Lisa M. , Ellery Paul E. R. , Maroney Susan A. , Mast Alan E.
Published: February 2017

Key Points

FVL platelet-poor and platelet-rich plasma have a reduced threshold for the activation of blood coagulation, which is modulated by TFPIα. Prothrombinase assembled with FVL is less susceptible to inhibition by TFPIα than is prothrombinase assembled with FV.
Mosaic chromosome 20q deletions are more frequent in the aging population
Authors: Machiela Mitchell J. , Zhou Weiyin , Caporaso Neil , Dean Michael , Gapstur Susan M. , Goldin Lynn , Rothman Nathaniel , Stevens Victoria L. , Yeager Meredith , Chanock Stephen J.
Published: February 2017

Key Points

The frequency of 20q deletions increases with age and is more common than myeloid disorders. Mosaic 20q deletions spanning regions deleted in myeloid disorders are found in individuals without diagnosis of myeloid disorders.
A Detailed Inventory of Non-Ductile Concrete Shear Wall Buildings
Authors: Yathon Jeff , Adebar Perry , Elwood Kenneth J.
Published: February 2017

A detailed inventory of about 350 concrete shear wall buildings in western Canada with 7 or more stories and built prior to 1980 was created. About one hour was spent collecting information from drawings for each building so wall capacities could be estimated and simplified linear dynamic analysis could be used to estimate seismic demands on the building. Non-ductile behavior is expected in many of the buildings because of insufficient and/or poor arrangement of shear walls to adequately control building drifts, thin walls that are poorly detailed, and discontinuities in the shear walls. The analysis indicated that the drift demands on the buildings for the 2% in 50-year hazard level were not particularly large, however the flexural capacities of the walls are low considering their limited ductility. The shear capacities of the walls were typically less critical. The current study demonstrates that a detailed inventory can be used to distinguish between the performance of similar buildings, which can be used to refine a regional risk assessment or inform policy decisions for the group of buildings.
Implementing a Method for Evaluating Patient-Reported Outcomes Associated With Oral Oncolytic Therapy
Authors: Mackler Emily , Petersen Laura , Severson Jane , Blayney Douglas W. , Benitez Lydia L. , Early Caitlin R. , Hough Shannon , Griggs Jennifer J.
Published: February 2017

Introduction:

The paradigm shift in health care toward value-based reimbursement has brought emphasis to providing better quality of care to patients with chronic diseases, including patients with cancer. In accordance with providing better quality of care to patients, there has been a growing interest in evaluating quality of life through patient-reported outcomes (PROs). The revised Edmonton Symptom Assessment Scale (ESAS-r) is a tool that can be used to assess PROs and has been validated for use in patients with cancer. This initiative sought to use this standard assessment tool to acquire PROs concerning symptom burden from patients prescribed oral oncolytics.

Patients and Methods:

Eight oncology practices in the state of Michigan used a modified ESAS-r to evaluate symptom burden of patients prescribed oral oncolytics before each outpatient visit. Thirteen symptoms were categorized as mild (0 to 3), moderate (4 to 6), or severe (7 to 10).

Results:

A total of 1,235 modified ESAS-r surveys were collected and analyzed; 82.5% of symptoms were categorized as mild, 11.9% of symptoms were categorized as moderate, and 5.6% of symptoms were categorized as severe.

Conclusion:

PROs can be evaluated through the use of a standardized tool, such as the ESAS-r, in oncology patients receiving oral oncolytic therapy. Implementing such a tool in both community and academic practices is feasible and may facilitate improvements in the quality of care.