bluuebunny/crossref_metadata_2025 huggingface dataset:
Turkey's Test with Its Deep State
Authors: Kavakci Merve
Published: November 2009

Modern Turkey is experiencing one of its most defining moments since its inception. If the passage from one-party system to multiparty system in 1940 was one such turning point and if the period of Turgut Ozal's governance, which gave the country access to the international market for the first time, was a second, then the recent developments concerning Ergenekon, a layer of an undiscovered world of the Turkish deep state, is the third of its kind. Until almost the end of the 1990s, most Turks were oblivious to the somewhat enigmatic concept of a state within a state. In the days of discussion following the coup d'état of 1997, then-president Suleyman Demirel pointed out that the Turkish military was the deep state. Twelve years after Demirel's concession, observers know that the deep state goes beyond certain factions within the Turkish military and percolates into various facets of the state machinery. This article sheds light on the organization of the deep state, some of the underlying reasons behind its emergence, and its activities affecting the country's course of democratization or lack thereof. It argues that with the recent efforts of deconstructing the deep state, Turkey has ushered in a new era of democratization.
Disappearing Acts
Authors: Salvatori Mariolina Rizzi , Donahue Patricia
Published: November 2009

This article examines the disappearance of the student as a site for theoretical investigation. It considers the ramifications of this development for the disciplinary self-identification of composition studies and for a larger understanding of pedagogy as self-reflexive praxis.
Globalism and Multimodality in a Digitized World
Authors: Hawisher Gail E. , Selfe Cynthia L. , Kisa Gorjana , Ahmed Shafinaz
Published: November 2009

In this article we focus on new methods of multimodal digital research and teaching that allow for the increasingly rich representation of language and literacy practices in digital and nondigital environments. These methodologies—inflected by feminist research, new literacy studies, critical theory, and digital media studies—provide teacher-scholars a promising set of strategies for conducting research and for representing students' work and our own scholarship in digital contexts.
Can We Teach a Transnational Queer Studies?
Authors: Hall Donald E.
Published: November 2009

This article examines the challenges of addressing pedagogically the international dialogue on queer sexual identities. It focuses on the essayist's experiences preparing an anthology proposal for a queer studies volume that embraces the field in its transnational complexity and richness, using the problems encountered in that process to discuss what is omitted in queer classrooms and scholarly practices today.
Lore, Practice, and Social Identity in Creative Writing Pedagogy
Authors: Lim Shirley Geok-lin
Published: November 2009

The article examines the significance of lore in creative writing pedagogy discourse, the problem posed by the historical distinction between teaching craft and drawing out talent in workshops, and the role of social identity as it is rejected, theorized, or ignored in discussions on teaching creative writing. Taking into account students' subjectivity as also constituted by the dynamics of collective identities such as those suggested by the terms gender, race, ethnicity, and so forth, the essay offers examples of workshop strategies that encourage dialogic voicing.
Contexts for Canons
Authors: Lauter Paul
Published: November 2009

This article interrogates the meaning of multiculturalism in literary study today, exploring a shift in focus from student-centered to subject-centered course work. It questions how teaching will be affected by efforts to roll back exploitative employment practices like part-time and non-tenure-track appointments.
The Figure of Writing and the Future of English Studies
Authors: Bousquet Marc
Published: November 2009

With the long-term decline in the cultural capital of literature and a steep decline in tenure-track hires in literary studies, faculty across English are rethinking their relationship to writing. As interest in digital media grows, together with rising enrollment in courses in creative, civic, and professional composition, can the figure of writing provide a sense of disciplinary coherence? What will it take for literature faculty to agree that they, too, are interested in writers and writing?
Bringing Our Brains to the Humanities
Authors: Cavanagh Sheila T.
Published: November 2009

This article argues that English faculty do not avail themselves sufficiently of research on cognition and learning in their classrooms or in their training of graduate students. The tenets of brain-based learning would enhance our ability to teach practical skills and to hone aesthetic appreciation, but most faculty and graduate students are not familiar with this research and do not incorporate it into their pedagogy.
Why Assessment?
Authors: Graff Gerald
Published: November 2009

Outcomes assessment is necessary in higher education partly because it can counteract courseocentrism, the assumption teaching naturally occurs in isolated classrooms that leave teachers knowing little about one another and that leave students vulnerable to confusingly mixed messages as they go from course to course and subject to subject.
What's the Trouble with Knowing Students? Only Time Will Tell
Authors: Lindquist Julie
Published: November 2009

This article examines the pervasive disciplinary commonplace that it's imperative to know students. Posing questions about what it means to know students, the essay recommends ways to acquire useful knowledge about students—typically a long-term process—under conditions of insufficient time.
The English Curriculum after the Fall
Authors: Scholes Robert
Published: November 2009

Ten years ago in The Rise and Fall of English, I argued that the fall of English studies might be fortunate if the field could be reconstituted as a discipline. That no longer seems possible to me. In this article, I therefore argue for a shift from a field organized around the concept of literature to one organized around textuality: the production and reception of texts in all the media that use the English language. This will only be possible if we first recognize that English studies has really fallen.
Loss of correlation between HIV viral load and CD4+ T-cell counts in HIV/HTLV-1 co-infection in treatment naïve Mozambican patients
Authors: Bhatt N B , Gudo E S , Semá C , Bila D , Di Mattei P , Augusto O , Garsia R , Jani I V
Published: November 2009

Seven hundred and four HIV-1/2-positive, antiretroviral therapy (ART) naïve patients were screened for HTLV-1 infection. Antibodies to HTLV-1 were found in 32/704 (4.5%) of the patients. Each co-infected individual was matched with two HIV mono-infected patients according to World Health Organization clinical stage, age ±5 years and gender. Key clinical and laboratory characteristics were compared between the two groups. Mono-infected and co-infected patients displayed similar clinical characteristics. However, co-infected patients had higher absolute CD4+ T-cell counts ( P = 0.001), higher percentage CD4+ T-cell counts ( P < 0.001) and higher CD4/CD8 ratios ( P < 0.001). Although HIV plasma RNA viral loads were inversely correlated with CD4+ T-cell-counts in mono-infected patients ( P < 0.0001), a correlation was not found in co-infected individuals ( P = 0.11). Patients with untreated HIV and HTLV-1 co-infection show a dissociation between immunological and HIV virological markers. Current recommendations for initiating ART and chemoprophylaxis against opportunistic infections in resource-poor settings rely on more readily available CD4+ T-cell counts without viral load parameters. These guidelines are not appropriate for co-infected individuals in whom high CD4+ T-cell counts persist despite high HIV viral load states. Thus, for co-infected patients, even in resource-poor settings, HIV viral loads are likely to contribute information crucial for the appropriate timing of ART introduction.
Double standards in research ethics, health-care safety, and scientific rigour allowed Africa's HIV/AIDS epidemic disasters
Authors: Gisselquist D
Published: November 2009

Medical professionals practising double standards in research ethics, health-care safety and scientific rigour have allowed HIV epidemics to develop into national disasters in more than a dozen countries in sub-Saharan Africa. Researchers have followed HIV-positive Africans who did not know they were infected to study HIV-related morbidity, mortality and transmission to unsuspecting spouses and children. Public health managers do not warn Africans about risks to contract HIV from unsafe health care, and no African government has investigated any unexplained and suspected nosocomial HIV infection by tracing and testing people who attended suspected clinics. Researchers have avoided finding and talking about nosocomial HIV infections in countries with generalized epidemics. Rejecting double standards in health-care safety and scientific rigour may be essential to solve and stop Africa's HIV epidemic. Allowing competitive international trade in generic drugs to treat AIDS could mitigate some of the harm done by these double standards.
Horizontally-acquired HIV infection in Kenyan and Swazi children
Authors: Okinyi M , Brewer D D , Potterat J J
Published: November 2009

Despite many reports of HIV-infected African children who have HIV-uninfected mothers, little is known about the extent and modes of horizontal HIV transmission in African children. We estimated the extent of horizontal HIV transmission in Swazi children by comparing child and mother HIV statuses in the 2006–2007 Swaziland Demographic and Health Survey (DHS). To identify correlates of horizontal HIV transmission, we conducted a case-control study of Kenyan children with horizontally acquired HIV infections and their uninfected siblings. Of 50 HIV-positive Swazi children in the DHS, 11 (weighted percent = 20, 95% confidence interval 11–33%) had HIV-negative mothers. These 11 children represented 0.6% of all Swazi children aged 2–12 who lived with their mothers. In the Kenyan study, children with horizontally acquired HIV infections had more kinds of blood exposures than their uninfected siblings. In particular, punctures related to health care for suspected malaria (phlebotomy, injection and infusion), injections while hospitalized and dental surgery (especially by informal providers) were more common in infected children. Horizontal HIV transmission appears to be common in some sub-Saharan African countries, and blood exposures seem to be the most likely routes of transmission. Rigorous surveillance and investigation of horizontally acquired HIV infection in children are urgently needed, along with universal public education about risks of specific blood exposures and ways to avoid them.
Good treatment outcomes among foreigners receiving antiretroviral therapy in Johannesburg, South Africa
Authors: McCarthy K , Chersich M F , Vearey J , Meyer-Rath G , Jaffer A , Simpwalo S , Venter W D F
Published: November 2009

Foreigners, including displaced persons, often have limited health-care access, especially to HIV services. Outcomes of antiretroviral therapy (ART) in South Africans and foreigners were compared at a Johannesburg non-governmental clinic. Records were reviewed of 1297 adults enrolled between April 2004 and March 2007 (568 self-identified foreigners, 431 South Africans citizens and 298 with unknown origin). Compared with citizens, foreigners had fewer hospital admissions (39%, 90/303 versus 51%, 126/244; P < 0.001), less missed appointments for ART initiation (20%, 39/200 versus 25%, 51/206; P < 0.001), faster median time to ART initiation (14 versus 21 days, P = 0.008), better retention in care (88%, 325/369 versus 69%, 155/226; P < 0.001) and lower mortality (2.5%, 14/568 versus 10%, 44/431; P < 0.001) after 426 person-years. In logistic regression, after controlling for baseline CD4 count and tuberculosis status, foreigners were 55% less likely to fail ART than citizens (95% CI = 0.23–0.87). These findings support United Nations High Commissioner for Refugees recommendations that ART should not be withheld from displaced persons.
Political determinants of variable aetiology resonance: explaining the African AIDS epidemics
Authors: Hunsmann M
Published: November 2009

Notwithstanding the massive social and economic disruptions caused by HIV/AIDS in many sub-Saharan countries, the epidemic does not pose a serious political threat to African governments. Based on an analysis of today's dominant aetiologic framing of HIV/AIDS in sub-Saharan Africa, this paper argues that the behaviour-centred explanatory approach contributes to the political domestication of the epidemic. The behavioural aetiology suffers from a double reductionism: It concentrates on sexual transmission only and, within sexual transmission, it focuses exclusively on the immediate cause of transmission (unprotected sex), omitting that biological co-factors increase populations' vulnerability to infection. By overlooking these non-behaviour-related determinants of sexual HIV transmission, this explanatory approach implicitly blames individual behaviours for the spread of the virus. Conversely, the likely underestimation (if not the outright denial) of iatrogenic HIV transmission exonerates governments and donor agencies. The variable political resonance of different explanatory approaches is not random and the translation of the available bio-medical and epidemiological evidence into prevention measures is politically mediated.
AIDS epidemiology in Africa: a changing of the guard
Authors: Potterat J J
Published: November 2009

With recent implementation of studies specifically designed to empirically assess the contribution of both sexual and blood-borne exposures to local HIV transmission in sub-Saharan Africa, and with the arrival of a new generation of investigators, a picture of HIV transmission routes of improved validity is emerging. Seven years ago the International Journal of STD & AIDS ( IJSA) began actively encouraging reexamination of the prevailing view that penile–vaginal sex was driving African HIV epidemics, welcoming debate via manuscript submission and presentation of fresh scientific evidence. Although the IJSA-published dissenting views have largely been ignored, dismissed or fiercely resisted by established HIV researchers and allied health agencies, new approaches may yet elicit more rational, evidence-based responses. Several such contributions appear in IJSA's present theme issue on aspects of HIV epidemiology in Africa. The focus on recent empiric data, rather than on modelling or speculation, no longer leaves reasonable doubt that sexual behaviours are insufficient to explain ‘Why Africa?’ It is fitting that this progress was encouraged, from beginning to end, by long-time, and now departing IJSA Editor-in-Chief, Dr Wallace Dinsmore.
Overestimation of heterosexually attributed AIDS deaths is associated with immature psychological defence mechanisms and clitoral masturbation during penile–vaginal intercourse
Authors: Brody S , Costa R M
Published: November 2009

Research shows that (1) greater use of immature psychological defence mechanisms (associated with psychopathology) is associated with lesser orgasmic consistency from penile–vaginal intercourse (PVI), but greater frequency of other sexual behaviours and greater condom use for PVI, and (2) unlike the vectors of receptive anal intercourse and punctures, HIV acquisition during PVI is extremely unlikely in reasonably healthy persons. However, the relationship between overestimation of AIDS deaths due to ‘heterosexual transmission’ (often misunderstood as only PVI), sexual behaviour and mental health has been lacking. Two hundred and twenty-one Scottish women completed the Defense Style Questionnaire, reported past month frequencies of their various sexual activities, and estimated the total number of women who died from AIDS in Scotland nominally as a result of heterosexual transmission in the UK from a partner not known to be an injecting drug user, bisexual or infected through transfusion. The average respondent overestimated by 226,000%. Women providing lower estimates were less likely to use immature psychological defences, and had a lower frequency of orgasms from clitoral masturbation during PVI and from vibrator use. The results indicate that those who perceive ‘heterosexual transmission’ led to many AIDS deaths have poorer psychological functioning, and might be less able to appreciate PVI.
A web-based remote radiation treatment planning system using the remote desktop function of a computer operating system: a preliminary report
Authors: Suzuki Keishiro , Hirasawa Yukinori , Yaegashi Yuji , Miyamoto Hideki , Shirato Hiroki
Published: November 2009

We developed a web-based, remote radiation treatment planning system which allowed staff at an affiliated hospital to obtain support from a fully staffed central institution. Network security was based on a firewall and a virtual private network (VPN). Client computers were installed at a cancer centre, at a university hospital and at a staff home. We remotely operated the treatment planning computer using the Remote Desktop function built in to the Windows operating system. Except for the initial setup of the VPN router, no special knowledge was needed to operate the remote radiation treatment planning system. There was a time lag that seemed to depend on the volume of data traffic on the Internet, but it did not affect smooth operation. The initial cost and running cost of the system were reasonable.
The physician at a distance: the use of videoconferencing in the treatment of patients with hypertension
Authors: Nilsson Mats , Rasmark Ulf , Nordgren Helena , Hallberg Per , Skönevik Johan , Westman Göran , Rolandsson Olov
Published: November 2009

We evaluated the feasibility and quality of uncomplicated hypertension care based on telemedicine in a rural area of northern Sweden. The intervention subjects were 91 consecutive patients with primary hypertension. For comparison, 182 age- and sex-matched patients with hypertension were randomly selected from a similar health centre. The telemedicine equipment consisted of a video link between the physician and the patients, supported by a system for accessing medical data via the Internet. During a 21-month study period, telemedicine was used in 270 (91%) of the 297 consultations in the intervention group. All health personnel involved in the telemedicine treatment rated the method as feasible. Both systolic and diastolic blood pressure improved in the two groups during the study period. In the intervention group, a higher proportion had their blood pressure within treatment goals (systolic blood pressure <140 mmHg, diastolic blood pressure <90 mmHg) both at baseline and at follow-up than in the comparison group. An adjusted multivariate model (adjustment for sex, age, time between visits, change in number of drugs between first and last visit, blood pressure at first visit) showed that the intervention group had a higher probability (OR 2.7, 95% CI 1.4–5.2) of reaching the target blood pressure levels than the reference group. Treatment of hypertension by means of telemedicine was quite feasible and at least as effective as face-to-face consultations with a physician.
Comparison of the American Diabetes Association and World Health Organization criteria for gestational diabetes mellitus and the outcomes of pregnancy
Authors: Sahu Latika , Satyakala R , Rani Reddi
Published: November 2009

Two to five percent of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus.The aims and objectives of this study were to analyse the screening and diagnostic procedure for gestational diabetes mellitus (GDM) recommended by American Diabetes Association (ADA) in comparison with the World Health Organization (WHO) criteria and to study the outcome of GDM diagnosed by both the criteria. This prospective study was carried out in the Department of Obstetrics and Gynaecology, JIPMER between August 2006 and July 2008. Three-hundred-and-fifty antenatal cases of gestational age ≥24 weeks attending the outpatient department, with any one of the risk factors for GDM, were included in the study. A seventy-five gram oral glucose tolerance test (GTT) was performed on each subject. Results were interpreted using both ADA and WHO criteria. Antenatal complications of GDM, mode of delivery, intrapartum or postnatal maternal and neonatal complications in cases diagnosed with GDM by either criterion were noted. The data collected were analysed using the SPSS software program. The prevalence of GDM was 4% by ADA criteria versus 19.4% by WHO criteria. The diagnostic pick-up rate was approximately five times more with WHO than with ADA criteria. In total, 43% (ADA) and 29% (WHO) of GDM cases had antenatal complications. Seventy-four percent of mothers with macrosomic babies were identified by WHO criteria whereas only 26% of mothers with macrosomic babies were diagnosed by ADA criteria. ADA criteria identify more severe cases of GDM but mild cases diagnosed by WHO are missed. The GTT by WHO criteria was abnormal in a greater percentage of women with adverse outcomes especially macrosomia, than the GTT using ADA criteria.
Typhoid fever during pregnancy: case report and review
Authors: Touchan Faraj , Hall John D , Lee Richard V
Published: November 2009

Typhoid fever, like many gastroenteric infections, is considered a particular risk during pregnancy because of reduced peristaltic activity in the gastrointestinal and biliary tracts and increased prevalence of biliary ‘sludge’ and concretions. Antibiotic resistance among salmonellae makes the choice of antibiotics for initial treatment of infection difficult before cultures and sensitivities are reported. Because of the potential risks of some antimicrobial agents for pregnancy, the selection of antibiotic therapy is further complicated.
Intracranial haemorrhage in pregnancy
Authors: Fairhall Jacob M , Stoodley Marcus A
Published: November 2009

Intracranial haemorrhage (ICH) is a rare, yet potentially devastating event in pregnancy. There is a risk of maternal mortality or morbidity and a significant risk to the unborn child. The risk of haemorrhage increases during the third trimester and is greatest during parturition and the puerperium. ICH can be extradural, subdural, subarachnoid or intraparenchymal. Causes of bleeding include trauma, arteriovenous malformations, aneurysms, preeclampsia/eclampsia and venous thrombosis. Urgent neurosurgical conditions generally outweigh obstetric considerations in management decisions, although anaesthetic and surgical modifications can be made to minimize adverse effects to the fetus.
Risk factors for inflammatory pseudotumour formation following hip resurfacing
Authors: Glyn-Jones S. , Pandit H. , Kwon Y.-M. , Doll H. , Gill H. S. , Murray D. W.
Published: November 2009

Metal-on-metal hip resurfacing is commonly performed for osteoarthritis in young active patients. We have observed cystic or solid masses, which we have called inflammatory pseudotumours, arising around these devices. They may cause soft-tissue destruction with severe symptoms and a poor outcome after revision surgery. The aim of this study was to determine the incidence of and risk factors for pseudotumours that are serious enough to require revision surgery.

Since 1999, 1419 metal-on-metal hip resurfacings have been implanted by our group in 1224 patients; 1.8% of the patients had a revision for pseudotumour. In this series the Kaplan-Meier cumulative revision rate for pseudotumour increased progressively with time. At eight years, in all patients, it was 4% (95% confidence interval (CI) 2.2 to 5.8). Factors significantly associated with an increase in revision rate were female gender (p < 0.001), age under 40 (p = 0.003), small components (p = 0.003), and dysplasia (p = 0.019), whereas implant type was not (p = 0.156). These factors were inter-related, however, and on fitting a Cox proportional hazard model only gender (p = 0.002) and age (p = 0.024) had a significant independent influence on revision rate; size nearly reached significance (p = 0.08). Subdividing the cohort according to significant factors, we found that the revision rate for pseudotumours in men was 0.5% (95% CI 0 to 1.1) at eight years wheras in women over 40 years old it was 6% (95% CI 2.3 to 10.1) at eight years and in women under 40 years it was 13.1% at six years (95% CI 0 to 27) (p < 0.001).

We recommend that resurfacings are undertaken with caution in women, particularly those under 40 years of age but they remain a good option in young men. Further work is required to understand the aetiology of pseudotumours so that this complication can be avoided.
Comparison of patient-reported outcomes between hip resurfacing and total hip replacement
Authors: Lingard E. A. , Muthumayandi K. , Holland J. P.
Published: November 2009

This study compared the demographic, clinical and patient-reported outcomes after total hip replacement (THR) and Birmingham Hip Resurfacing (BHR) carried out by a single surgeon. Patients completed a questionnaire that included the WOMAC, SF-36 scores and comorbid medical conditions. Data were collected before operation and one year after. The outcome scores were adjusted for age, gender, comorbid conditions and, at one year, for the pre-operative scores. There were 214 patients with a THR and 132 with a BHR. Patients with a BHR were significantly younger (49 vs 67 years, p < 0.0001), more likely to be male (68% vs 42% of THR, p < 0.0001) and had fewer comorbid conditions (1.3 vs 2.0, p < 0.0001). Before operation there was no difference in WOMAC and SF-36 scores, except for function, in which patients awaiting THR were worse than those awaiting a BHR.

At one year patients with a BHR reported significantly better WOMAC pain scores (p = 0.04) and in all SF-36 domains (p < 0.05). Patients undergoing BHR report a significantly greater improvement in general health compared with those with a THR.
Proximal row carpectomy with capsular interposition arthroplasty for advanced arthritis of the wrist
Authors: Kwon B. C. , Choi S.-J. , Shin J. , Baek G. H.
Published: November 2009

Advanced osteoarthritis of the wrist or the distal articulation of the lunate with the capitate has traditionally been treated surgically by arthrodesis. In order to maintain movement, we performed proximal row carpectomy with capsular interposition arthroplasty as an alternative to arthrodesis in eight patients with advanced arthritis and retrospectively reviewed their clinical and radiographic outcomes after a mean follow-up of 41 months (13 to 53). The visual analogue scale (VAS) for pain at its worst and at rest, and the patient-rated wrist evaluation score improved significantly after surgery, whereas ranges of movement and grip strength were maintained at the pre-operative levels. Progression of arthritis in the radiocapitate joint was observed in three patients, but their outcomes were not significantly different from those without progression of arthritis.

Proximal row carpectomy with capsular interposition arthroplasty is a reasonable option for the treatment of patients with advanced arthritis of the wrist.
Comparative anatomy of the rotator cuff
Authors: Sonnabend D. H. , Young A. A.
Published: November 2009

While the evolution of the bony skeleton of the shoulder girdle is well described, there is little information regarding the soft tissues, in particular of the rotator cuff. We dissected the shoulders of 23 different species and compared the anatomical features of the tendons of the rotator cuff. The alignment and orientation of the collagen fibres of some of the tendons were also examined histologically. The behaviour of the relevant species was studied, with particular reference to the extent and frequency of forward-reaching and overhead activity of the forelimb.

In quadrupedal species, the tendons of supraspinatus, infraspinatus and teres minor were seen to insert into the greater tuberosity of the humerus separately. They therefore did not form a true rotator cuff with blending of the tendons. This was only found in advanced primates and in one unusual species, the tree kangaroo. These findings support the suggestion that the appearance of the rotator cuff in the evolutionary process parallels anatomical adaptation to regular overhead activity and the increased use of the arm away from the sagittal plane.
Total hip replacement in Gaucher’s disease
Authors: Bubbar V. , Heras F. Las , Amato D. , Pritzker K. P. H. , Gross A. E.
Published: November 2009

Total hip replacement in patients with Gaucher’s disease with symptomatic osteonecrosis of the femoral head is controversial because of the high early failure rates. We describe four patients who had an uncemented total hip replacement following enzyme replacement therapy for a median of two years and one month (1 to 9.8 years) prior to surgery, and who remained on treatment. At operation, the bone had a normal appearance and consistency. Histopathological examination showed that, compared with previous biopsies of untreated Gaucher’s disease, the Gaucher cell infiltrate had decreased progressively with therapy, being replaced by normal adipose tissue. The surfaces of viable bone beyond the osteonecrotic areas showed osteoblasts, indicating remodelling. In one case acetabular revision was carried out after 11 years and eight months. The three remaining patients had a mean follow-up of six years and four months (3.3 to 12 years). We recommend initiating enzyme replacement therapy at least one to two years prior to total hip replacement to facilitate bone remodelling and to allow implantation of uncemented components in these young patients.
Competencies for a Canadian orthopaedic surgery core curriculum
Authors: Wadey V. M. R. , Dev P. , Buckley R. , Walker D. , Hedden D.
Published: November 2009

We have developed a list of 281 competencies deemed to be of importance in the training of orthopaedic surgeons. A stratified, randomised selection of non-university orthopaedic surgeons rated each individual item on a scale 1 to 4 of increasing importance. Summary statistics across all respondents were given. The mean scores and sds were computed. Secondary analyses were computed in general orthopaedics, paediatrics, trauma and adult reconstruction. Of the 156 orthopaedic surgeons approached 131 (84%) responded to the questionnaire. They rated 240 of the 281 items greater than 3.0 suggesting that competence in these was necessary by completion of training.

Complex procedures were rated to be less important. The structure, delivery and implementation of the curriculum needs further study. Learning activities are ‘driven’ by the evaluation of competencies and thus competency-based learning may soon be in the forefront of training programmes.
Mid-term results of the modular ANCA-Fit femoral component in total hip replacement
Authors: Blakey C. M. , Eswaramoorthy V. K. , Hamilton L. C. , Biant L. C. , Field R. E.
Published: November 2009

We report the minimum five-year follow-up of 352 primary total hip replacements using the uncemented hydroxyapatite-coated ANCA-Fit femoral component with a modular neck and head. The series comprised 319 patients (212 men, 107 women) with a mean age at operation of 64.4 years (28 to 97). The principal diagnosis was osteoarthritis. A total of 18 patients (21 hips) died before their follow-up at five years, nine patients (11 hips) were lost to follow-up, and four (four hips) declined further follow-up. Patient-reported outcomes have been recorded for 288 patients (316 hips).

Their mean Oxford Hip Score improved significantly from 41 points (16 to 57) pre-operatively to 20 points (12 to 44) at five-year follow-up. Radiological assessment showed good bony stability in 98% of implants. There were two cases of aseptic loosening of the femoral component. There were no clinical or radiological complications related to modularity. In our series we did not see the high rate of intra-operative fracture previously reported for this implant.

This medium-term follow-up study demonstrates that the clinical outcome of the ANCA-Fit femoral component is, to date, comparable with that of other metaphyseal loading femoral components.
Intra-articular injection of the acromioclavicular joint
Authors: Pichler W. , Weinberg A. M. , Grechenig S. , Tesch N. P. , Heidari N. , Grechenig W.
Published: November 2009

Intra-articular punctures and injections are performed routinely on patients with injuries to and chronic diseases of joints, to release an effusion or haemarthrosis, or to inject drugs. The purpose of this study was to investigate the accuracy of placement of the needle during this procedure.

A total of 76 cadaver acromioclavicular joints were injected with a solution containing methyl blue and subsequently dissected to distinguish intra- from peri-articular injection. In order to assess the importance of experience in achieving accurate placement, half of the injections were performed by an inexperienced resident and half by a skilled specialist. The specialist injected a further 20 cadaver acromioclavicular joints with the aid of an image intensifier. The overall frequency of peri-articular injection was much higher than expected at 43% (33 of 76) overall, with 42% (16 of 38) by the specialist and 45% (17 of 38) by the resident. The specialist entered the joint in all 20 cases when using the image intensifier.

Correct positioning of the needle in the joint should be facilitated by fluoroscopy, thereby guaranteeing an intra-articular injection.
Lengthening of the shortened first metatarsal after Wilson’s osteotomy for hallux valgus
Authors: Singh D. , Dudkiewicz I.
Published: November 2009

Metatarsalgia is a recognised complication following iatrogenic shortening of the first metatarsal in the management of hallux valgus. The traditional surgical treatment is by shortening osteotomies of the lesser metatarsals.

We describe the results of lengthening of iatrogenic first brachymetatarsia in 16 females. A Scarf-type osteotomy was used in the first four cases and a step-cut of equal thicknesses along the axis of the first metatarsal was performed in the others.

The mean follow-up was 21 months (19 to 26). Relief of metatarsalgia was obtained in the six patients in whom 10 mm of lengthening had been achieved, compared to only 50% relief in those where less than 8 mm of lengthening had been gained.

One-stage step-cut lengthening osteotomy of the first metatarsal may be preferable to shortening osteotomies of the lesser metatarsals in the treatment of metatarsalgia following surgical shortening of the first metatarsal.
The Avon patellofemoral joint replacement
Authors: Starks I. , Roberts S. , White S. H.
Published: November 2009

We present a prospective review of the two-year functional outcome of 37 Avon patellofemoral joint replacements carried out in 29 patients with a mean age of 66 years (30 to 82) between October 2002 and March 2007. No patients were lost to follow-up. This is the first independent assessment of this prosthesis using both subjective and objective analysis of outcome. At two years the median Oxford knee score was 39 (interquartile range 32 to 44), the median American Knee Society objective score was 95 (interquartile range 90 to 100), the median American Knee Society functional score was 85 (interquartile range 60 to 100), and the median Melbourne Knee score was 28 (interquartile range 21 to 30). Two patients underwent further surgery. Only one patient reported an unsatisfactory outcome.

We conclude that the promising early results observed by the designing centre are reproducible and provide further support for the role of patellofemoral joint replacement.
Obesity in total hip replacement
Authors: CHOONG P. F. M. , DOWSEY M. M. , LIEW D.
Published: November 2009

We welcome letters to the Editor concerning articles which have recently been published. Such letters will be subject to the usual stages of selection and editing; where appropriate the authors of the original article will be offered the opportunity to reply.

Letters should normally be under 300 words in length, double-spaced throughout, signed by all authors and fully referenced. The edited version will be returned for approval before publication.
Self‐paced study time as a cue for recall predictions across school age
Authors: Hoffmann‐Biencourt Anja. , Lockl Kathrin. , Schneider Wolfgang. , Ackerman Rakefet. , Koriat Asher.
Published: November 2009

Recent work on metacognition indicates that monitoring is sometimes based itself on the feedback from control operations. Evidence for this pattern has not only been shown in adults but also in elementary schoolchildren. To explore whether this finding can be generalized to a wide range of age groups, 160 participants from first to eighth grade participated in a study based on a self‐paced study time (ST) allocation paradigm. In contrast to previous studies, picture pairs instead of word pairs were used as stimuli to compensate for reduced reading skills in younger participants. Actual ST and judgments of learning (JOLs) made at the end of each study trial were used as core variables. The results are in line with previous findings, in that children's JOLs decreased with increasing ST, suggesting that JOLs were based on the memorizing effort heuristic that easily learned items are more likely to be remembered. Weaker inverse relationship between JOLs and ST was found for the younger children. Overall, these results underline the importance of mnemonic cues in shaping metacognitive feelings not only in adults but also in older children and expose a developmental trend in their use along childhood.
Growth of reading skills in children with a history of specific language impairment: The role of autistic symptomatology and language‐related abilities
Authors: Clair Michelle C. , Durkin Kevin , Conti‐Ramsden Gina , Pickles Andrew
Published: November 2009

Individuals with a history of specific language impairment (SLI) often have subsequent problems with reading skills, but there have been some discrepant findings as to the developmental time course of these skills. This study investigates the developmental trajectories of reading skills over a 9‐year time‐span (from 7 to 16 years of age) in a large sample of individuals with a history of SLI. Relationships among reading skills, autistic symptomatology, and language‐related abilities were also investigated. The results indicate that both reading accuracy and comprehension are deficient but that the development of these skills progresses in a consistently parallel fashion to what would be expected from a normative sample of same age peers. Language‐related abilities were strongly associated with reading skills. Unlike individuals with SLI only, those with SLI and additional autistic symptomatology had adequate reading accuracy but did not differ from the individuals with SLI only in reading comprehension. They exhibited a significant gap between what they could read and what they could understand when reading. These findings provide strong evidence that individuals with SLI experience continued, long‐term deficits in reading skills from childhood to adolescence.
Spiritual, religious, and personal beliefs are important and distinctive to assessing quality of life in health: A comparison of theoretical models
Authors: O'Connell Kathryn A. , Skevington Suzanne M.
Published: November 2009

Objectives. The study investigates theoretical debates on the contribution of spiritual, religious, and personal beliefs (SRPB) to quality of life (QoL) in health, by examining contrasting models.

Design and method. The WHOQOL‐SRPB assesses QoL relating to SRPB where 33 QoL facets are scored in 6 domains, of which SRPB is one. The measure was completed by a heterogeneous sample of 285 sick and well people representing a cross‐section of religious, agnostic, and atheist beliefs in UK, and structured for gender (52% female) and age (mean 47 years).

Results. No evidence was found to support the model of spiritual QoL as a concept that overarches every other QoL domain. Confirmatory factor analysis showed that SRPB is an integral concept to overall QoL, with a very good fit (comparative fit index=.99). Spiritual QoL made a significant, relatively independent contribution, similar to the other five domains (β=0.68). Spiritual QoL is most closely associated with the psychological domain, particularly hope and optimism and inner peace; two of the nine SRPB facets. Spiritual QoL, but not most other aspects of QoL, is higher for religious people.

Conclusion. The results explain theoretical confusion arising from previous research. Spiritual QoL makes a significant and distinctive contribution to QoL assessment in health and should be assessed routinely in health care populations.
Purification and partial characterization of the lectin from the marine red algaTichocarpus crinitus(Gmelin) Rupr. (Rhodophyta)
Authors: Molchanova Valentina , Chernikov Oleg , Chikalovets Irina , Lukyanov Pavel
Published: November 2009

A new lectin from the red algaTichocarpus crinitus(TCL) was purified and partially characterized. The purification procedure consisted of extracting soluble proteins with 0.025 mTris-HCl buffer (pH 7.5), followed by ammonium sulphate precipitation (75% saturation), hydrophobic interaction chromatography on phenyl-Sepharose and gel filtration chromatography on Superdex 75 HR 10/30. TCL is a monomeric protein with a relative molecular weight of 41,000, as shown by gel filtration and sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) in the presence and absence of β-mercaptoethanol. Isoelectric focusing showed that TCL is an acidic protein with an isoelectric point (pI) of 4.93, and analysis of its amino acid composition revealed high contents of acidic amino acids (aspartic and glutamic acids), serine, threonine, proline and alanine. Its activity was not inhibited by any of the monosaccharides tested, but was inhibited by the complex glycoproteins porcine stomach mucin (type VII) (PSM) and fetuin, and was independent of divalent cations. The carbohydrate content of 6.9% suggested that the lectin is a glycoprotein. TCL had a weak mitogenic effect on human lymphocytes and an ability to stimulate synthesis of pro-inflammatory cytokines TNF-α, IFN-γ, IL-6 by human whole-blood cells.
Determination of median levels of the free β subunit of human chorionic gonadotropin in women from mainland China using a new time-resolved fluoroimmunoassay
Authors: Tang Yong-Ping , Wu Ying-Song , Yin Ai-Hua , Xu Wei-Wen , Yuan Peng-Hui , Li Ming
Published: November 2009

Background: The free β subunit of human chorionic gonadotropin (free β-hCG) is an important serum marker for biochemical screening. Its weekly median value varies with ethnicity. Most of the fluorometers for lanthanide chelates are designed for the detection of signals from europium (Eu3+) chelates only.

Methods: We developed a two-site, one-step assay using two monoclonal antibodies (MAbs) against free β subunit and β subunit with Eu3+ chelates as labels. Using the present assay, we evaluated 24,634 normal serum samples in Chinese pregnant women during 8–20 weeks of gestation.

Results: The detection limit using this assay was <0.05 ng/mL. The within-run and between-run imprecision was <6.0% and 7.0% using control material. Free β-hCG concentrations measured using the current assay in 999 maternal serum samples correlated well with those obtained by samarium (Sm3+)-labeled DELFIA free hCGβ assay (r=0.987). The medians for 8–20 weeks for maternal serum free β-hCG were higher in the women from mainland China compared to reports from other countries.

Conclusions: The present assay is suitable for use in biochemical screening of women in mainland China. Our study on the median concentrations of free β-hCG will help establish reference values that are specific for ethnic populations from the Chinese mainland. These will be useful for studying the importance of ethnic factors in biochemical screening.

Clin Chem Lab Med 2010;48:109–14.
Age- and gender-specific reference ranges for serum insulin-like growth factor I (IGF-I) and IGF-binding protein-3 concentrations on the Immulite 2500: results of the Study of Health in Pomerania (SHIP)
Authors: Friedrich Nele , Krebs Alexander , Nauck Matthias , Wallaschofski Henri
Published: November 2009

Background: The objective of the present study was to calculate age- and gender-specific reference ranges for serum insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) concentrations using quantile regression.

Methods: From the Study of Health in Pomerania (SHIP), 1798 men and women aged 25–85 years were recruited. Serum IGF-I and IGFBP-3 concentrations were determined using a chemiluminescent immunometric assay on an Immulite 2500® analyzer. Quantile regressions were performed to calculate the 2.5th and 97.5th percentiles.

Results: The reference ranges identified 43 (4.6%) women and 41 (4.8%) men with serum IGF-I concentrations, and 47 (5.0%) women and 42 (5.0%) men with serum IGFBP-3 concentrations outside the reference range.

Conclusions: The use of quantile regression results in accurate calculation of age- and gender-specific reference ranges for serum IGF-I and IGFBP-3.

Clin Chem Lab Med 2010;48:115–20.
Plasma osteopontin concentrations in preeclampsia – is there an association with endothelial injury?
Authors: Stenczer Balázs , Rigó Jr János , Prohászka Zoltán , Derzsy Zoltán , Lázár Levente , Makó Veronika , Cervenak László , Balogh Krisztián , Mézes Miklós , Karádi István , Molvarec Attila
Published: November 2009

Background: It has been previously reported that plasma osteopontin (OPN) concentrations are increased in cardiovascular disorders. The goal of the present study was to determine plasma OPN concentrations in healthy pregnant women and preeclamptic patients, and to investigate their relationship to the clinical characteristics of the study subjects and to markers of inflammation [C-reactive protein (CRP)], endothelial activation [von Willebrand factor antigen (VWF:Ag)] or endothelial injury (fibronectin), oxidative stress [malondialdehyde (MDA)] and trophoblast debris (cell-free fetal DNA).

Methods: Forty-four patients with preeclampsia and 44 healthy pregnant women matched for age and gestational age were involved in this case-control study. Plasma OPN concentrations were measured with ELISA. Serum CRP concentrations were determined with an autoanalyzer using the manufacturer's reagents. Plasma VWF:Ag was quantified by ELISA, while plasma fibronectin concentrations were measured by nephelometry. Plasma MDA concentrations were estimated by the thiobarbituric acid-based colorimetric assay. The amount of cell-free fetal DNA in maternal plasma was determined by quantitative real-time PCR analysis of the sex-determining region Y (SRY) gene. For statistical analyses, non-parametric methods were applied.

Results: Serum levels of CRP, as well as plasma concentrations of VWF:Ag, fibronectin, MDA and cell-free fetal DNA were significantly higher in preeclamptic patients than in healthy pregnant women. There was no significant difference in plasma OPN concentrations between controls and the preeclamptic group. However, preeclamptic patients with plasma fibronectin concentrations in the upper quartile had significantly higher plasma OPN concentrations than those below the 75th percentile, as well as healthy pregnant women [median (interquartile range): 9.38 (8.10–11.99) vs. 7.54 (6.31–9.40) and 7.40 (6.51–8.80) ng/mL, respectively, p<0.05 for both]. Furthermore, in preeclamptic patients, plasma OPN concentrations showed a significant positive linear association with plasma fibronectin (Spearman R=0.38, standardized regression coefficient (β)=0.41, p<0.05 for both).

Conclusions: Plasma OPN concentrations are increased in preeclamptic patients with extensive endothelial injury. However, further studies are warranted to explore the relationship between OPN and endothelial damage.

Clin Chem Lab Med 2010;48:181–7.