bluuebunny/crossref_metadata_2025 huggingface dataset:
Readiness for enhanced self-health management among people with diabetes mellitus
Authors: Araújo Márcio Flávio Moura de , Alencar Ana Maria Parente Garcia , Araújo Thiago Moura de , Damasceno Marta Maria Coelho , Caetano Joselany Áfio , Ximenes Lorena Barbosa , Viera Neiva Francenely da Cunha
Published: March 2012

OBJECTIVE: To identify the nursing diagnosis, readiness for enhanced self-health management, among people with type 2 diabetes who are adherent to pharmacological treatment. METHODS: The sample consisted of 579 subjects from 12 primary care services who received home visits. To determine adherence to the pharmacological treatment, the pill count test was conducted. Those classified as adherent were given a checklist with the defining characteristics of the nursing diagnosis, readiness for enhanced self-health management. RESULTS: Subjects with type 2 diabetes who presented with the nursing diagnosis were not alcoholics (p = 0.003), did not miss their diabetes consultations (p = 0.000), and had no difficulties / inappropriate behaviors with regard to taking their oral antidiabetic agents (p = 0.000). CONCLUSION: The identification of human responses to the clinical treatment of type 2 diabetes should be continuous, so that nurses can understand the factors involved in the readiness to enhance therapeutic control.
Incidentes transfusionais imediatos: revisão integrativa da literatura
Authors: Sousa Neto Adriana Lemos de , Barbosa Maria Helena
Published: March 2012

Este estudo de revisão integrativa da literatura teve como objetivo analisar as pesquisas que abordam a ocorrência de incidentes transfusionais imediatos e ações de hemovigilância implantadas. Os dados foram obtidos por meio de busca nas bases de dados - LILACS, MEDLINE e PUBMED - abrangendo o período de 1980 a 2009, nos idiomas português, inglês e espanhol. Foram identificados 1.382 artigos, dos quais 29 atenderam aos critérios de inclusão estabelecidos. Destes artigos, 20 (69,0%) eram estudos retrospectivos transversais, 8 (27,5%) prospectivos e um (3,5%) caso-controle. Em relação à abordagem, os estudos foram classificados em dois focos temáticos: tipos de incidentes transfusionais imediatos e ações de hemovigilância implantadas associadas aos tipos de incidentes transfusionais imediatos. A análise dos trabalhos destacou a maior ocorrência de reação febril não hemolítica e alérgica, avanço em ações de hemovigilância e maior preocupação com a qualidade da assistência hemoterápica.
An Unusual Accessory Mandible and a Submucosal Cleft Palate—A Case Report and Review of the Literature
Authors: Borzabadi-Farahani Ali , Gross John , Sanchez-Lara Pedro A. , Yen Stephen L.-K.
Published: March 2012

An accessory mandible is a rare congenital anomaly that requires multidisciplinary management. This case report describes a female patient with an unusual accessory mandible, a dysplastic overgrowth of bone, containing teeth that extended from the midsymphyseal region. A submucosal cleft palate and cleft of the lower lip were also present. Her treatment plan took a staged approach with initial surgical resection of the accessory bone and teeth. The second stage, still in the planning phase, will correct the secondary deformity of an anterior open bite and will restore the missing lower anterior teeth. The original deformity and subsequent growth are discussed with the relevant literature.
Long-Term Maxillomandibular Changes after Maxillary Distraction Osteogenesis in Growing Children with Cleft Lip with or without Palate
Authors: Honda Aya , Baba Yoshiyuki , Ogawa Takuya , Suzuki Shoichi , Moriyama Keiji
Published: March 2012

Objective

To evaluate the long-term maxillomandibular changes after maxillary distraction osteogenesis in growing children having cleft lip with or without cleft palate.

Patients

Eight Japanese patients with cleft lip with or without cleft palate aged 9.3 to 13.1 years.

Measures

The maxillary and mandibular positions before (TO), immediately after (T1), and 1, 3, and 5 years after distraction osteogenesis (T2, T3, and T4, respectively) measured on cephalograms superimposed at the sella turcica with the Frankfort horizontal plane as the horizontal reference. The anterior nasal spine (x, y), pogonion (x), and menton (y) were used for linear measurements, and sella turcica-nasion-point A, sella turcica-nasion-point B, and point A-nasion-point B angles were used for angular measurements.

Results

The mean horizontal maxillary advancement (anterior nasal spine [x]) was 12.3 mm during TO to T1, but -2.7, -1.1, and -0.1 mm of the posttreatment changes were observed during T1 to T2, T2 to T3, and T3 to T4, respectively. Anterior nasal spine (y) shifted 2.3 mm downward during TO to T1, and further downward changes were observed during T1 to T2 and T2 to T3 ( P < .05). Pogonion (x) did not show distinct changes due to individual variance, but menton (y) shifted downward from T1 to T4. Sella turcica-nasion-point A significantly decreased during T1 to T2 and T2 to T3 but not during T3–T4. Point A-nasion-point B significantly decreased only during T2 to T3, and sella turcica-nasion-point B did not show any distinct change.

Conclusions

There was no further maxillary advancement after distraction osteogenesis in the growing children with cleft lip with or without cleft palate. Therefore, long-term observation and management of occlusion in case of the mandibular growth pattern are important.
Arubaito, or Short-Term Working Abroad in Japan: A Case Study of Brazilian University Students of Japanese Descent
Authors: Sasaki Lindsey
Published: March 2012

International migration between Japan and Brazil dates back to 1908, when the first group of Japanese migrated to Brazil. However, in the 1980s, a reverse flow occurred, as thousands of Brazilians of Japanese descent traveled to Japan to work in manufacturing and construction factories ( dekasegi workers). Japanese Brazilians up until the third generation were permitted to enter. Many recruiting companies turned to university students who could work the factory jobs during their three-month summer vacation ( arubaito workers). This article draws upon a larger ethnographic case study that the author conducted in São Paulo, Brazil and Aichi, Japan in 2009 and 2010. The results of the study indicate that not only economic, but cultural underpinnings contribute to the motivations by Japanese-Brazilian university students to work in Japan. Different forms of non-traditional student mobility are explored that can shape a student's experience abroad.
International Student Mobility and the Bologna Process
Authors: Teichler Ulrich
Published: March 2012

The Bologna Process is the newest of a chain of activities stimulated by supra-national actors since the 1950s to challenge national borders in higher education in Europe. Now, the ministers in charge of higher education of the individual European countries have agreed to promote a similar cycle-structure of study programmes and programmes based on the strategic aim of enhancing student mobility in two directions: to increase the attractiveness for students from other parts of the world to study – primarily for the whole study programme – in European countries, and to facilitate intra-European – primarily temporary – mobility. Studies aiming at establishing the results of this policy face various problems. Statistics move only gradually from ‘foreign’ to ‘mobile’ students, but remain insufficient with respect to temporary mobility. Individual European countries opt for such varied solutions that an overall overview is hardly feasible. Yet, some general trends are visible. First, Bologna has contributed to greater internal mobility of students from other parts of the world, but not to a more rapid increase of intra-European student mobility. Second, the event of outwards mobility during the course of study up to graduation has turned out to be more frequent than expected by many experts, but differences by country do not fade away. Third, the value of student mobility gradually declines as a consequence of gradual loss of exclusiveness.
Research on Study Abroad, Mobility, and Student Exchange in Comparative Education Scholarship
Authors: Streitwieser Bernhard T. , Le Emily , Rust Val
Published: March 2012

For many years there has been research on study abroad, student mobility and international student exchange; however in the last two decades the volume and scope of this work has increased significantly. There are now specific academic journals, a host of new books each year, expansive reports by international research organizations, and an increasing number of annual conferences that are all publishing on trends and issues related to this phenomenon. Yet surprisingly, in comparative education scholarship much of this research still appears relatively infrequently in its main journals. This article examines the seeming contradiction of, on the one hand, more student and institutional participation in worldwide international education each year and new research accompanying this trend and, on the other hand, the relative scarcity of reflection on this activity in the core comparative education journals. The article takes stock of the international education-themed research that has appeared in the past in a selection of comparative education journals, shares the editors' advice to future authors seeking to submit research on these areas, and concludes with some reflections on the future direction of scholarship in international education and comparative education.
Frontiers Journal and the Forum on Education Abroad: Building a Research Tradition on Education Abroad for the Comparative Education Scholarship
Authors: Whalen Brian
Published: March 2012

Drawing on the author's experience as a founder and editor of the first academic journal devoted to education abroad ( Frontiers: the interdisciplinary journal of education abroad), and his work leading the first membership association devoted exclusively to education abroad (the Forum on Education Abroad), this article provides suggestions for areas of education abroad that would benefit from comparative education abroad research. The article argues that comparative education has much to contribute to education abroad research by helping us to understand educational systems around the world through examining education abroad structures, processes and topics; by informing us about how education abroad practices reflect the host culture and society, thereby enlightening us about the relationships between education and society; and by helping to advance education abroad practices and thereby improve education. Comparative research on the topics proposed in the article will provide important information needed by governments, institutions, organizations and program sponsors, and the professionals involved in creating and managing education abroad programs. Ultimately, the best reason for conducting such research is to benefit the many students who participate in education abroad programs as part of their education.
Seek Knowledge Throughout the World? Mobility in Islamic Higher Education
Authors: Welch Anthony
Published: March 2012

While Southeast Asia as a region is generally poorly represented in scholarship on higher education, this is even more the case when considering Islamic higher education in the region. While patterns of mobility within the Islamic world are ancient, with mediaeval scholarly centres such as Baghdad, Cairo and Alexandria attracting scholars and students from many parts, scholarly mobility in Southeast Asia also has its own history. The earlier part of this article concentrates on the flowering of Islamic scholarly centres, with a particular focus on mobility. Subsequently, contemporary Islamic higher education in Southeast Asia, particularly in countries such as Malaysia, and Indonesia, is analyzed, focusing particularly on international mobility patterns, particularly of students. This includes both regionalism (students from Southeast Asia travelling to other countries within the region to pursue Islamic higher education), and efforts by countries such as Malaysia to recruit significant numbers of students from the Gulf states and Arab world, thereby reversing traditional paths of mobility.
Current Research on Chinese Students Studying Abroad
Authors: Henze Jürgen , Zhu Jiani
Published: March 2012

As a result of China's growing participation and importance in the process of internationalization and globalization a continuously rising number of Chinese students has gone abroad for further study. By the end of the last decade the number of Chinese students abroad made up the largest group of international students in the USA (surpassing those from India) and during the next decade this group will become the world's largest floating student population. Because of its size and the growing recognition of China and Chinese culture around the world, research on a wide range of problem areas among Chinese students abroad has been initiated, especially in Australia, Great Britain, New Zealand, the USA and Hong Kong. This article looks at the variety of research issues and attempts to provide a first overview in the light of international and comparative research on international students, their mobility and their recognition by host countries as well as their influence as cultural ‘irritators’.
Effects of Financial Efficiency and Choice to Restrict Contributions on Individual Donations
Authors: Li Wei , McDowell Evelyn , Hu Michael
Published: March 2012

SYNOPSIS

This study examines whether and how a nonprofit organization's financial efficiency and its solicitation type—namely, whether it allows donors the ability to restrict contributions to their preferred choices—influence individual donations. We find that a nonprofit organization's financial efficiency indirectly influences individual donations through its effect on donors' confidence. We also find that a nonprofit organization receives significantly more donations when it allows donors to restrict donations to their preferred choices than when it does not. This positive effect is greater when the organization reports low efficiency than when it reports high efficiency. Thus, allowing the restriction of donations not only influences individual donations directly, but also compensates for the effect of low efficiency on donations.
Clinical and Magnetic Resonance Imaging Outcomes following Platelet Rich Plasma Injection for Chronic Midsubstance Achilles Tendinopathy
Authors: Owens Richard F. , Ginnetti John , Conti Stephen F. , Latona Carmen
Published: March 2012

Background:

The successful treatment of chronic mid-substance Achilles tendinopathy remains elusive. Approximately 25% to 50% of patients fail conservative treatment modalities. Scientific evidence has supported the use of platelet rich plasma (PRP) in the tendon healing process, however despite initial promise there is a paucity of clinical data to validate a role for PRP in the treatment of tendon disorders including chronic midsubstance Achilles tendinopathy.

Methods:

As an alternative to operative treatment, our practice offers patients with chronic midsubstance Achilles tendinopathy intratendinous injection of PRP. We retrospectively reviewed all patients treated for Achilles tendinopathy with PRP injection over a 2-year period. Baseline and post injection functional scores including the Foot and Ankle Ability Measure (FAAM), Foot and Ankle Ability Measure - Sports (FAAMS), and the Short Form health survey (SF-8) were examined. Patients also underwent post-injection magnetic resonance imaging (MRI), which were compared to available pre-injection MRI data.

Results:

Ten patients were identified for this study. Pre- and post-injection functional outcome scores were available for eight of ten patients. The average SF-8 score improved from 24.9 to 30.0, the average FAAM score improved from 55.4 to 65.8, and the average FAAMS score improved from 14.8 to 17.4. Complete MRI data was available for six patients. Only one in six Achilles tendons demonstrated qualitative MRI improvement post-injection.

Conclusion:

Patients who received PRP injection demonstrated modest improvement in functional outcome measures, however MRI appearance of diseased Achilles tendons remained largely unchanged following PRP injection. Level of Evidence: IV, Case Series
Osteochondral Lesions of the Talus: Predictors of Clinical Outcome
Authors: Cuttica Daniel J. , Smith W. Bret , Hyer Christopher F. , Philbin Terrence M. , Berlet Gregory C.
Published: March 2012

Background:

Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome.

Methods:

A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment.

Results:

A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm2. There were 20 lesions larger than 1.5 cm2 and 110 lesions smaller than 1.5 cm2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm2 and uncontained lesions were associated with a poor clinical outcome.

Conclusions:

The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure. Level of Evidence: IV, Retrospective Case Series
Complications Associated with Open Calcaneus Fractures
Authors: Wiersema Brent , Brokaw David , Weber Timothy , Psaradellis Telly , Panero Carlo , Weber Chad , Musapatika Dana
Published: March 2012

Background:

Literature on open calcaneus fractures is limited and inconsistent. This study's purpose was to report complications such as osteomyelitis, amputations, and soft tissue infections in open calcaneus fractures that were treated at a Level I Trauma Center.

Methods:

From January 1995 through December 2007, 1,157 calcaneus fractures were identified with 127 fractures being open (11.0%). Average followup time was 9.1 (range, 2 to 53) months. All open fractures were treated by a similar protocol of intravenous (IV) antibiotics, emergent irrigation and debridement (I&D), initial fracture stabilization if possible, subsequent I&Ds as needed, and delayed definitive fixation. One hundred fifteen open calcaneus fractures in 112 patients had sufficient followup for study inclusion. For this study complications were classified into four categories: superficial infections, deep infections, osteomyelitis, and amputations.

Results:

Medial based wounds occurred in 63 (54.8%) fractures. The overall complication rate was 23.5% with 16 fractures (13.9%) requiring a reoperation. Eleven (9.6%) fractures experienced superficial wound infection and 14 (12.2%) had deep wound infection. Six (5.2%) amputations were required with three being for either soft tissue infection or wound necrosis. Culture-positive osteomyelitis occurred in six (5.2%) patients.

Conclusion:

Utilizing a standardized protocol, open calcaneus fractures were found to have a lower complication rate than has been previously reported. Level of Evidence: III, Retrospective Comparative Study
Intraoperative Incidence of Hallux Valgus Interphalangeus following Basilar First Metatarsal Osteotomy and Distal Soft Tissue Realignment
Authors: Park Jae-Yong , Jung Hong-Geun , Kim Tae-Hoon , Kang Min-Seok
Published: March 2012

Background:

The premise of this study was that after the correction of hallux-metatarsophalangeal pronation, the intraoperative interphalangeal angle (HIA) increases significantly, and that an additional Akin osteotomy (AO) is often needed. Therefore, the purpose of this study was to evaluate whether HIAs in hallux valgus (HV) feet were underestimated, and to assess the need for AO during HV correction.

Method:

This study was conducted on 54 feet with moderate to severe HV treated from June 2007 to December 2008. HIAs and medial sesamoid subluxations (MSS) were measured initially and intraoperatively after a distal soft tissue procedure (DSTP) and proximal chevron metatarsal osteotomy (PCMO). An intraoperative technique was used to evaluate the incongruency of the metatarsophalangeal joint (MTPJ) to determine the need for additional Akin osteotomy.

Results:

After performing DSTP and PCMO, HIAs significantly increased from an average of 9 to 13.3 degrees and MSS reduced from average grade 2.5 to 0.5 ( p < 0.05). Akin ostetomy was added in 44 (81%) feet. After an average followup of 13.2 months in Akin group, average VAS pain score decreased from 5.7 to 1.2 and average AOFAS score increased from 57.8 to 90.2 ( p < 0.05). Final hallux MTPJ dorsiflexion in the Akin group was significantly larger than in the without-Akin group ( p < 0.05).

Conclusion:

Average HIA significantly increased after DSTP and PCMO for moderate to severe HV necessitating additional Akin osteotomy, to achieve ideal HV correction and, to preserve MTPJ motion. Level of Evidence: IV, Case Series
Surgical Treatment of Mallet Toe of the Hallux with the Extension Block Method: A Case Report
Authors: Wada Keiji , Yui Mitsuru
Published: March 2012

Level of Evidence: V, Expert Opinion
Reduction and Fixation of Metatarsal Neck Fractures Using Closed Antegrade Intramedullary Nailing: Technique Tip
Authors: Kim Hyong-Nyun , Park Yong-Wook
Published: March 2012

Level of Evidence: V, Expert Opinion
Paratenonitis of the Foot and Ankle in Young Female Dancers
Authors: Steinberg Nili , Hershkovitz Israel , Peleg Smadar , Dar Gali , Masharawi Youssef , Siev-Ner Itzhak
Published: March 2012

Background:

In their pursuit of excellence, dancers continually face the risk of injuries, such as paratenonitis. This attests to the strong need for preventive action, which is possible only if major risk factors are identified. The aim of the present descriptive study was to determine the association between risk factors and paratenonitis in young recreational female dancers.

Methods:

One thousand eighty-two non-professional female dancers, aged 8 to 16 years, were screened. The risk factors considered for paratenonitis were: joint range of motion (ROM), body structure, anatomic anomalies, dance technique, and dance discipline. All dancers were clinically examined for current ankle/foot paratenonitis.

Results:

Ninety-three dancers (8.6%) manifested a paratenonitis at the ankle or foot joints. ROM such as hyper ankle plantarflexion and hyper hip external rotation, false dance technique, and hours of practice per week were found to be associated with increased rate of injury. Regression analysis indicated that dancers with paratenonitis had greater hip external rotation ROM compared to dancers without paratenonitis. No association with injury was found with age of onset of menarche, body structure, and anatomic anomalies such as scoliosis.

Conclusion:

Precautionary steps, such as screening for joint ROM and dance technique, may reduce the risk of dance injury. Furthermore, our results led to a very significant justification of the dance maxim “don't force your natural joint ROM and especially your ‘turnout’ position,” as it could increase your chance to develop paratenonitis. Level of Evidence: IV, Case Series
Tendoscopic Treatment of Intrasheath Subluxation of the Peroneal Tendons
Authors: Vega Jordi , Golanó Pau , Dalmau Antoni , Viladot Ramón
Published: March 2012

Background:

Intrasheath subluxation of the peroneal tendons does not have an injury of the proximal retinaculum. The aim of this study was to describe the tendoscopic technique and preliminary results.

Methods:

Six patients with intrasheath subluxation of the peroneal tendons were treated tendoscopically. All patients had preoperative pain and a clicking sensation at the lateral retromalleolar area. Mean followup was 18.3 (range, 14 to 24) months. These six patients included three males and three females, with a mean age of 23.5 (range, 18 to 33) years. The AOFAS and Visual Analog Score for pain were used to evaluate the patients.

Results:

During tendoscopy, two patients had a peroneus quartus tendon which was removed; three had a low-lying peroneus brevis muscle that was resected; and in two cases deepening of the peroneal groove was performed. At followup, all patients reported excellent results, without pain or clicking sensation. The mean AOFAS score increased from 79 to 99, and Visual Analog Score at followup was 0 in four patients and 1 in two patients.

Conclusion:

Tendoscopic treatment of these pathologies led to improved function in a less aggressive manner than open surgery. Level of Evidence: IV, Retrospective Case Series
Validation and Precision of Model-Based Radiostereometric Analysis (MBRSA) for Total Ankle Arthroplasty
Authors: Fong Jason Wai-Yip , Veljkovic Andrea , Dunbar Michael J. , Wilson David A. , Hennigar Allan W. , Glazebrook Mark A.
Published: March 2012

Background:

The goal of this study was to design a RSA marker insertion protocol to evaluate the stability of the bone-implant interface of a TAA prosthesis, and to validate that this marker insertion protocol can be combined with MBRSA technology to provide clinically adequate precision in assessing the micromotion of the TAA prosthesis.

Methods:

The Mobility™ Total Ankle System was used in this study. A marker placement protocol was developed with a Phantom Protocol. The Improved Marker Placement Protocol was used in 20 patients. Postoperative RSA double exams were taken. Condition Numbers (CN) were used to assess the marker distribution. The system precision was defined as the standard deviation of the double exams (MTE, MRE). MBRSA software was used to evaluate the double exams.

Results:

The RSA marker insertion technique for the 20 in vivo cases provided satisfactory results. CNs in all subjects but one were below 50 mm−1 and implied a desirable marker configuration. The tibial sphere MTE was 0.07 mm and the talar was 0.09 mm. The talar MRE was 0.51 degrees.

Conclusion:

The system precision for these in vivo TAA implants was within the normal range identified by RSA studies, and comparable to the existing TAA RSA studies. This study demonstrated a reliable RSA marker insertion technique in both the tibia and talus. The study confirms that the insertion and MBRSA technique allows the typical high precision demonstrated in other RSA studies
Association of Hindfoot Ligament Tears and Osteochondral Lesions
Authors: Cromeens Barrett , Patterson Rita , Sheedlo Harold , Motley Travis A. , Stewart Donald , Fisher Cara , Suzuki Sumihiro , Su Fenghsiu , Reeves Rustin
Published: March 2012

Background:

This study aimed to identify the prevalence of ligament and joint surface anatomy variants, ligament tears, and osteochondral lesions (OCLs) in the hindfoot. These data were used to identify associations between anatomic variants or ligament tears and OCLs.

Methods:

Seventy-two cadaver hindfoot specimens were examined. Hindfoot ligament presence, number of ligament fascicles, variable ligament attachment sites, ligament tears, presence of joint facets, variable joint surface shape, and the location and grade of OCLs were identified in each specimen. The data were analyzed for significant associations between variables.

Results:

Fourteen of the 30 studied ligaments were always present and 14 had variable number of fascicles. The lateral talocalcaneal and dorsolateral calcaneocuboid ligaments had varying positional attachments. Osteochondral lesions were present in 86% of specimens with the majority in the talocrural joint. Of the 235 lesions identified, 31 were grade 3 or above. Ligament tears occurred in 2% of all ligaments observed. Tears in the lateral talocalcaneal, medial calcaneocuboid, and dorsolateral calcaneocuboid ligaments were associated with an increased number of hindfoot OCLs.

Conclusion:

We demonstrated the prevalence of morphologic ligament and joint surface variants, ligament tears, and osteochondral lesions in the hindfoot. Tears in ligaments stabilizing the calcaneocuboid joint were implicated in an increase in hindfoot joint damage. Clinical Relevance: We believe anatomic studies can be used to clarify the association between traumatic injuries and their sequelae.
Quality of Research and Level of Evidence in Foot and Ankle Publications
Authors: Barske Heather L. , Baumhauer Judith
Published: March 2012

Background: The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Methods: Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. Results: A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Conclusion: Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.
Proximal Medial Gastrocnemius Release in the Treatment of Recalcitrant Plantar Fasciitis
Authors: Abbassian Ali , Kohls-Gatzoulis Julie , Solan Matthew C.
Published: March 2012

Background: Isolated gastrocnemius contracture has been implicated as the cause of a number of foot and ankle conditions. Plantar fasciitis (PF) is one such condition that can be secondary to altered foot biomechanics as a result of gastrocnemius contracture. In this paper, we report our results with an isolated release of the proximal medial head of gastrocnemius for recalcitrant PF. Methods: We prospectively followed a consecutive series of 21 heels in 17 patients following a Proximal Medial Gastrocnemius Release (PMGR). PF was diagnosed clinically and confirmed radiologically in all cases. To be included, at least 1 year of conservative treatment must have been tried and an isolated gastrocnemius contracture confirmed clinically using Silfverskiold's test preoperatively. Outcome measures included a 5-point Likert scale as well as subjective and objective calf weakness assessments. Final followup was on average 24 (range, 8 to 36) months after the surgery. Results: Seventeen of the 21 heels (81%) reported total or significant pain relief following the surgery and none reported worsening of their symptoms. The majority did not have subjective or objective evidence of calf weakness. There were no ‘major’ complications and only one case that suffered a ‘minor’ complication. Conclusion: We believe a PMGR is a simple way of treating a patient with PF who has failed to respond to conservative management. In our series, the results were favorable, the recovery fast and the morbidity low.

Level of Evidence: IV, Retrospective Case Series
Functional Outcome of Endoscopic Plantar Fasciotomy
Authors: Bader Lucas , Park Ken , Gu Yang , O'Malley Martin J.
Published: March 2012

Background: The majority of cases of plantar fasciitis can be treated nonoperatively; however, a small number of patients remain refractory to nonoperative treatment and operative intervention is indicated. Historically, open treatment has been recommended, but more recently endoscopic plantar fasciotomy (EPF) has produced promising results. Methods: Forty-eight patients (56 feet) were identified who underwent endoscopic plantar fasciotomy. Forty-one patients (49 feet) were available for followup. There were 15 men and 26 women, with an average age of 53.8 (range, 42 to 68) years. The mean followup time was 49.5 (range, 6 to 142) months. An AOFAS Hind foot Scale was used for analysis. The influence of gender, duration of symptoms, severity of symptoms, and bilateral verses unilateral release were examined. Results: Pain resolved completely in 37 feet, decreased in 11 feet, and increased in one foot. The mean postoperative AOFAS Hindfoot score improved 39 points (54 to 93, p < 0.001). Patients with severe symptoms achieved higher mean improvement than the moderate symptom group ( p < 0.0001). Patients with symptoms greater than 24 months trended towards lower mean improvement and lower post operative AOFAS Hindfoot scores. Both gender and laterality did not significantly influence outcome. There was one superficial infection, one third and fourth metatarsal stress fracture in the same patient, and transient lateral hindfoot pain in five patients. Conclusion: EPF was an effective operation with reproducible results, low complication rate, and little risk of iatrogenic nerve injury with proper technique.

Level of Evidence: IV, Retrospective Case Series
Mobility of the First Ray in Various Foot Disorders
Authors: Greisberg Justin , Sperber Lisa , Prince Daniel E.
Published: March 2012

Background: Instability of the first ray has been proposed by Morton and others to be a major cause of several foot disorders, including hallux valgus, transfer metatarsalgia, lesser metatarsal stress fractures, and second metatarsophalangeal diseases. However, there are few studies to support these theories. In this study, we have used a simple device to measure first ray elevation and translation in a consecutive series of foot and ankle patients. We propose that mobility of the first ray will be increased in patients with hallux valgus, metatarsalgia, hallux rigidus, lesser metatarsal stress fractures, posterior tibial tendinitis, and interdigital neuromas. Methods: Measurements of first ray translation and elevation were made in 345 feet in 315 patients. One or more pathologic diagnoses were recorded for each foot, and data was analyzed by a statistician. Results: First ray mobility was increased in females compared to males. Patients with hallux valgus and metatarsalgia had greater mobility than other patients. Those feet with low arches showed greater mobility than those with high arches. Patients with hallux rigidus showed decreased mobility. We failed to find any differences for patients with stress fractures, posterior tibial tendinitis, or neuromas, but some of these groups may have had insufficient power. Conclusion: First ray translation and elevation are two different measures of medial column instability. Although they are distinct measures, they closely paralleled each other in this series. An association was found between increased first metatarsal elevation and several foot disorders. Although such an association does not prove causation, and it is likely other factors may play a role in many patients, this data does link instability of the first ray to some diseases. The decreased mobility seen in patients with hallux rigidus may offer new insights into the etiology of that disorder.

Level of Evidence: III, Comparative Study
Treatment of Lisfranc Fracture-Dislocations with Primary Partial Arthrodesis
Authors: Reinhardt Keith R. , Oh Luke S. , Schottel Patrick , Roberts Matthew M. , Levine David
Published: March 2012

Background: The optimal method of treatment for Lisfranc fracture-dislocations remains controversial, and the role of primary partial arthrodesis for combined osseous-ligamentous Lisfranc injuries is unclear. This study reviewed the outcomes of Lisfranc injuries treated by primary partial arthrodesis. Methods: Patients who underwent primary partial arthrodesis for a primarily ligamentous or combined osseous and ligamentous Lisfranc fracture-dislocation were reviewed retrospectively and assessed at followup according to radiographic, clinical and standardized patient-based outcomes. Twenty-five patients (12 ligamentous, 13 combined), median age of 46 (range, 20 to 73) years, were followed for an average of 42 (range, 24 to 96) months. Results: The average American Orthopedic Foot and Ankle Society (AOFAS) score was 81 points (scale 0 to 100), with patients in general losing points for mild pain, limitations of recreational activities, and fashionable footwear requirements. There was no statistical difference between ligamentous and combined injuries with regard to the physical or mental component scores on the SF-36. At latest followup, patients reported an average return to 85% of their preinjury activity level (range, 50% to 100%). Twenty-one patients (84%) expressed satisfaction with their outcome and at latest followup, the mean visual analog pain scale (VAS) score was 1.8 out of 10 (range, 0 to 8). Three patients showed radiographic signs of posttraumatic arthritis of adjacent joints. Conclusion: Treatment of both primarily ligamentous and combined osseous and ligamentous lisfranc injuries with primary partial arthrodesis produced good clinical and patient-based outcomes.

Level of Evidence: III, Retrospective Comparative Study
Responsiveness and Validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in End Stage Ankle Arthritis
Authors: Madeley N. Jane , Wing Kevin J. , Topliss Claire , Penner Murray J. , Glazebrook Mark A. , Younger Alastair SE
Published: March 2012

Background: We examined four commonly used scores, the SF-36, the Ankle Osteoarthritis Scale (AOS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot Function Index (FFI) to determine their responsiveness and validity. Methods: Patients with end stage ankle arthritis were recruited into a prospective multicenter cohort study and baseline and one year outcome scores were compared. The Standardized Response Mean and Effect Size for the AOS, AOFAS, and FFI were calculated and the three region- or disease-specific scores were compared with the SF-36 to determine their criterion validity. Results: All four scores showed acceptable responsiveness, and when using the validated SF-36 as the standard the three region or disease specific scores all showed similar criterion validity. Conclusion: All four scores are responsive and can be considered for use in this population. The objective component of the AOFAS Ankle Hindfoot Score may make it harder to perform than the other three scores which have subjective components only, and as yet its objective component has not been shown to demonstrate reliability. We recommend use of a purely subjective score such as the Ankle Osteoarthritis Scale or Foot Function Index as the region- or disease-specific score of choice in this population. As the SF-36 shows acceptable responsiveness, using it alone could also be considered.

Level of Evidence: II, Prospective Comparative Study
Locked Floating First Metatarsal: Open Reduction and no Fixation - Case Report
Authors: Jeong Jae Jung , Ji Jong-Hoon , Park Sang Eun , Kim Young Yul
Published: March 2012

Level of Evidence: V, Expert Opinion
Testing the effect of water in crevasses on a physically based calving model
Authors: Cook S. , Zwinger T. , Rutt I.C. , O'Neel S. , Murray T.
Published: March 2012

A new implementation of a calving model, using the finite-element code Elmer, is presented and used to investigate the effects of surface water within crevasses on calving rate. For this work, we use a two-dimensional flowline model of Columbia Glacier, Alaska. Using the glacier’s 1993 geometry as a starting point, we apply a crevasse-depth calving criterion, which predicts calving at the location where surface crevasses cross the waterline. Crevasse depth is calculated using the Nye formulation. We find that calving rate in such a regime is highly dependent on the depth of water in surface crevasses, with a change of just a few metres in water depth causing the glacier to change from advancing at a rate of 3.5 kma–1 to retreating at a rate of 1.9 km a–1. These results highlight the potential for atmospheric warming and surface meltwater to trigger glacier retreat, but also the difficulty of modelling calving rates, as crevasse water depth is difficult to determine either by measurement in situ or surface mass-balance modelling.
Modeling Long-Term Trends in Russet Burbank Potato Growth and Development in Wisconsin
Authors: Goeser Nicholas J. , Mitchell Paul D. , Esker Paul D. , Curwen David , Weis Gavin , Bussan Alvin J.
Published: March 2012

Improving understanding and prediction of the potato (Solanum tuberosum) tuber size over the growing season is important due to its effects on crop price and marketing. Several models have been proposed to describe potato growth and development, but are based on short-term data and have little use for predicting yields or in-season management decisions. This analysis uses long-term data collected from 1979 to 1993 in central Wisconsin to describe growth and development of the Russet Burbank potato variety. This paper describes average number of potato tubers per plant and tuber length as influenced by thermal time and stem number per plant over 14 years. For each plant variable, data analysis uses multivariate techniques to fit a hierarchical logistic model with parameters potentially depending on stem number per plant. Analysis finds that the average number of potato tubers and average tuber length were affected by thermal time and stem number per plant. Estimated models are biologically relevant, provide an understanding of seasonal thermal variability and stem number per plant effects on average tuber set and growth, and can be used to describe yearly variation in average potato growth and development. Increased understanding of potato growth in response to thermal time and stem number per plant can improve management recommendations and predictions of crop economic value.
Evaluation of Maize Germplasm for Resistance to Aflatoxin Accumulation
Authors: Henry W. Brien , Windham Gary L. , Blanco Michael H.
Published: March 2012

Aflatoxin contamination of maize grain threatens human food and animal feed safety. Breeding for reduced grain aflatoxin accumulation is one of the best strategies presently available to lower grain aflatoxin accumulation. Previously identified sources of germplasm with reduced grain aflatoxin accumulation are excessively tall and late maturing. The objective of this research was to screen germplasm and identify potential sources of aflatoxin resistance. KO679Y and CUBA117:S15-101-001-B-B-B-B inbreds were evaluated for aflatoxin accumulation alongside resistant and susceptible checks with both performing well. These two lines were also evaluated in various crosses. KO679Y performed especially well in crosses with Mp494 and Mp717, resulting in low ear rot and very low aflatoxin levels, but not well in other crosses. A breeding cross including CUBA117:S15-101-001-B-B-B-B as a parent accumulated low levels of aflatoxin both years it was evaluated. Lines resulting from these crosses are being advanced for further evaluation and improvement. KO679Y and CUBA117:S15-101-001-B-B-B-B may prove useful for breeders seeking germplasm sources for ear rot and mycotoxin reduction, especially KO679Y which matures a week earlier and is approximately 25% shorter than current lines resistant to grain aflatoxin accumulation.
Entropy and the Complexity of Graphs Revisited
Authors: Mowshowitz Abbe , Dehmer Matthias
Published: March 2012

This paper presents a taxonomy and overview of approaches to the measurement of graph and network complexity. The taxonomy distinguishes between deterministic (e.g., Kolmogorov complexity) and probabilistic approaches with a view to placing entropy-based probabilistic measurement in context. Entropy-based measurement is the main focus of the paper. Relationships between the different entropy functions used to measure complexity are examined; and intrinsic (e.g., classical measures) and extrinsic (e.g., Körner entropy) variants of entropy-based models are discussed in some detail.
Ultimate Scaling of High-κ Gate Dielectrics: Higher-κ or Interfacial Layer Scavenging?
Authors: Ando Takashi
Published: March 2012

Current status and challenges of aggressive equivalent-oxide-thickness (EOT) scaling of high-κ gate dielectrics via higher-κ ( > 20) materials and interfacial layer (IL) scavenging techniques are reviewed. La-based higher-κ materials show aggressive EOT scaling (0.5–0.8 nm), but with effective workfunction (EWF) values suitable only for n-type field-effect-transistor (FET). Further exploration for p-type FET-compatible higher-κ materials is needed. Meanwhile, IL scavenging is a promising approach to extend Hf-based high-κ dielectrics to future nodes. Remote IL scavenging techniques enable EOT scaling below 0.5 nm. Mobility-EOT trends in the literature suggest that short-channel performance improvement is attainable with aggressive EOT scaling via IL scavenging or La-silicate formation. However, extreme IL scaling (e.g., zero-IL) is accompanied by loss of EWF control and with severe penalty in reliability. Therefore, highly precise IL thickness control in an ultra-thin IL regime ( < 0.5 nm) will be the key technology to satisfy both performance and reliability requirements for future CMOS devices.
Biodegradability and Biocompatibility Study of Poly(Chitosan-g-lactic Acid) Scaffolds
Authors: Zhang Zhe , Cui Huifei
Published: March 2012

A biodegradable, biocompatible poly(chitosan-g-lactic acid) (PCLA) scaffold was prepared and evaluated in vitro and in vivo. The PCLA scaffold was obtained by grafting lactic acid (LA) onto the amino groups on chitosan (CS) without a catalyst. The PCLA scaffolds were characterized by Fourier Transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). The biodegradabilty was determined by mass loss in vitro, and degradation in vivo as a function of feed ratio of LA/CS. Bone marrow mesenchymal stem cell (BMSC) culture experiments and histological examination were performed to evaluate the PCLA scaffolds’ biocompatibility. The results indicated that PCLA was promising for tissue engineering application.
Phytoecdysteroids from the Roots of Achyranthes bidentata Blume
Authors: Zhang Mei , Zhou Zhong-Yu , Wang Jing , Cao Yong , Chen Xue-Xiang , Zhang Wei-Min , Lin Li-Dong , Tan Jian-Wen
Published: March 2012

Two new phytoecdysteroids, (25S)-20,22-O-(R-ethylidene)inokosterone (1) and 20,22-O-(R-3-methoxycarbonyl)propylidene-20-hydroxyecdysone (2), together with six known phytoecdysteroids 3–8 were isolated from the roots of Achyranthes bidentata Blume. The new structures were established on the basis of spectroscopic studies and chemical evidences. The absolute configuration at C-25 in the structure of known compound 3 was determined by chemical and spectroscopic means.