bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteosynthesis of displaced intra-articular fractures of the calcaneum
Authors: Makki D. , Alnajjar H. M. , Walkay S. , Ramkumar U. , Watson A. J. , Allen P. W.
Published: April 2010

We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders’ classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale.

There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler’s angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders’ classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler’s angle.
Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damage
Authors: Haviv B. , Singh P. J. , Takla A. , O’Donnell J.
Published: April 2010

This study evaluates the outcome of arthroscopic femoral osteochondroplasty for cam lesions of the hip in the absence of additional pathology other than acetabular chondral lesions. We retrospectively reviewed 166 patients (170 hips) who were categorised according to three different grades of chondral damage. The outcome was assessed in each grade using the modified Harris Hip Score (MHHS) and the Non-Arthritic Hip Score (NAHS).

Overall, at the last follow-up (mean 22 months, 12 to 72), the mean MHHS had improved by 15.3 points (95% confidence interval (CI), 8.9 to 21.7) and the mean NAHS by 15 points (95% CI, 9.4 to 20.5). Significantly better results were observed in hips with less severe chondral damage. Microfracture in limited chondral lesions showed superior results.

Arthroscopic femoral osteochondroplasty for cam impingement with microfracture in selected cases is beneficial. The outcome correlates with the severity of acetabular chondral damage.
Trends in varicose vein therapy in England: radical changes in the last decade
Authors: Kanwar Aditya , Hansrani Monica , Lees Tim , Stansby Gerard
Published: April 2010

INTRODUCTION

We aimed to analyse national trends in varicose vein treatment in the UK National Health Service (NHS).

PATIENTS AND METHODS

The National Hospital Episode Statistics website (< http://www.Hesonline.nhs.uk >) was interrogated for patients treated (1998–2008) in the NHS for varicose veins.

RESULTS

There has been a 34% decline in patients presenting for an intervention for varicose veins. For surgical procedures alone, the waiting times have fallen by 59%. In 2007–2008, 30,663 (72%) fewer bed days were used in comparison to 1998; accompanied by a 49% decline in the number of patients undergoing surgery. After a 47% decrease between 1998 and 2001, the number of patients requesting sclerotherapy treatment has increased by a substantial 311% over the subsequent 7 years. Transluminal procedures were used almost twice as often in 2007–2008 as in 2006–2007.

CONCLUSIONS

There has been a steady decline in the number of patients treated for varicose veins. Fewer patients are undergoing surgery but are being managed more efficiently, with an increase in day cases and a reduction in total bed days. The demand for minimally invasive procedures has increased substantially. These trends will be of great importance for the future planning of vascular surgical services.
Benign disease and unexpected histological findings after pancreaticoduodenectomy: the role of endoscopic ultrasound fine needle aspiration
Authors: Manzia Tommaso Maria , Toti Luca , Lenci Ilaria , Attia Magdy , Tariciotti Laura , Bramhall Simon R , Buckels John AC , Mirza Darius F
Published: April 2010

INTRODUCTION

We assessed the incidence and outcome of pancreaticoduodenectomy for patients with a pre-operative benign diagnosis and in patients who had an unexpected diagnosis of benign disease following resection. We have also compared how the introduction of endoscopic ultrasound fine needle aspiration (EUS-FNA) has altered our pre-operative assessment.

PATIENTS AND METHODS

Between January 1997 and April 2006, 499 patients underwent pancreaticoduodenectomy at the Queen Elizabeth Hospital. Data were collected prospectively. A further 85 patients between 2006 and 2008 had a different diagnostic approach (after imaging these patients have been also studied by EUS-FNA).

RESULTS

Overall, 78 (15.6%) patients had no malignant disease on final histology. Out of 459 patients who underwent pancreaticoduodenectomy for presumed malignancy, 49 (10.6%) had benign disease (sensitivity, 97%; positive predictive value, 89%). In a further 40 patients with a pre-operative benign diagnosis, we found 11 cases (27%) of malignancy (sensitivity, 37%; negative predictive value, 72%). Following the introduction of EUS-FNA, the sensitivity and specificity of the diagnostic work were 92% and 75%, respectively (positive predictive value, 93%; negative predictive value, 63%). The median follow-up was 35 months (range, 1–116 months).

CONCLUSIONS

Prior to the introduction of EUS-FNA, a significant number of patients, in whom pancreaticoduodenectomy is carried out for suspected benign disease, turn out to have an underlying malignancy. The use of EUS-FNA has improved the specificity of diagnostic work-up.
Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland
Authors: Sanjay P , Kulli C , Polignano FM , Tait IS
Published: April 2010

INTRODUCTION

There is debate on optimal techniques that reduce bile duct injury during laparoscopic cholecystectomy (LC). A national survey of Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) members was carried out to determine current surgical practice for gallstones, including the use of intra-operative cholangiography (IOC) or critical view of safety to reduce the risk of bile duct injury.

SUBJECTS AND METHODS

An anonymous postal survey was sent to all 417 AUGIS members. Data on grade of surgeon, place of work (district general hospital, teaching), subspecialty, number LC per year, use of IOC, critical view of safety, and management of stones detected during surgery were collated.

RESULTS

There was a 36% (152/417) response – 134 (88%) from consultant surgeons (36, HPB; 106,OG; 64, DGH; 88, teaching hospital). Of these, 38% performed > 100 LC per year, 36% 50–100 LC per year, and 22% 25–50 LC per year. IOC was routine for 24%; and selective for 72%. Critical view of Calot's triangle was advocated by 82%. Overall, 55% first clip and divide the cystic artery, whereas 41% first clip and divide the cystic duct. Some 39% recommend IOC and 23% pre-oper-ative MRCP if dilated common bile duct (CBD) is noted on pre-operative ultrasound. When bile duct stones are identified on IOC, 61% perform laparoscopic CBD exploration (LCBDE), 25% advise postoperative ERCP, and 13% perform either LCBDE or ERCP. Overall, 88% (n = 134) recommend index cholecystectomy for acute pathology, and this is more likely in a teaching hospital setting (P= 0.003). Laparoscopic CBD exploration was more likely to be performed in university hospitals (P< 0.05).

CONCLUSIONS

A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83%) to minimise risk of bile duct injury, in contrast to 24% that recommend routine IOC. The majority (88%) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease.
Methicillin-resistant Staphylococcus aureus in surgical patients: identification of high-risk populations for the development of targeted screening programmes
Authors: Fraser Stephanie , Brady Richard R , Graham Catriona , Paterson-Brown Simon , Gibb Alan P
Published: April 2010

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA)-related hospital-acquired infection (HAI) in surgical patients is associated with high morbidity, mortality and financial cost. The identification and characterisation of populations of patients who are at high risk of developing MRSA infection or colonisation could inform the design of more effective strategies to prevent HAIs and reduce transmission of MRSA.

PATIENTS AND METHODS

An analysis of historical discharge data for the whole of 2005 (7145 surgical in-patients) was performed, for all patients admitted to general surgery at the Royal Infirmary of Edinburgh. Analysis specifically focused on MRSA laboratory data and coding data for patient demographics, medical co-morbidities, and progress of in-patient stay.

RESULTS

A total of 134 (1.88%) individual patients with colonisation or infection by MRSA were identified from indicated laboratory testing. Univariate analysis identified a significant association of concurrent MRSA-positive status with patients aged over 60 years (P < 0.01), a duration of inpatient stay > 7 days (P < 0.01), presence of a malignant neoplasm (P < 0.01), circulatory disease (P < 0.01), respiratory disease (P < 0.01), central nervous system disease (P < 0.01), renal failure (P < 0.01), and concurrent admission to ITU/HDU (P < 0.01). Multivariate analysis suggested MRSA colonisation or infection was strongest in those with co-morbid malignancy (P < 0.0001) or admission to ITU/HDU (P < 0.0001).

CONCLUSIONS

This large observational study has identified cancer patients as a UK surgical patient subpopulation which is at significantly higher risk of colonisation by MRSA. These data could inform the development of focused hospital in-patient screening protocols and provide a means to stratify patient risk.
Low ninety-day re-admission rates after emergency and elective laparoscopic cholecystectomy in a district general hospital
Authors: Down Sue K , Nicolic Marko , Abdulkarim Hibba , Skelton Nick , Harris Adrian H , Koak Yashwant
Published: April 2010

INTRODUCTION

Re-admission rate following laparoscopic cholecystectomy is currently defined as within 30 days of the initial operation. This may underestimate the true incidence and financial cost of postoperative morbidity. This study aimed to analyse re-admissions within 90 days of elective and emergency laparoscopic cholecystectomy at a district general hospital, and to compare outcomes to larger teaching centres.

PATIENTS AND METHODS

We undertook a retrospective analysis of all patients re-admitted within 90 days of laparoscopic cholecystectomy during an 18-month period (June 2006 to December 2007). Patient characteristics, details of the primary operation, and reasons for re-admission were identified, and a comparison of re-admissions following elective versus emergency procedures was performed.

RESULTS

A total of 326 laparoscopic cholecystectomies were performed during the 18-month period (246 elective, 80 emergency). No operations required conversion to an open procedure. Twenty-five patients were re-admitted within 90 days of their operation, of whom only 14 had complications directly related to their surgery (overall re-admission rate 4.3%). There was no statistical difference in re-admission rate or cause of re-admission between elective and emergency procedures. However, the mean time to re-admission following elective procedures was significantly longer (36 days; P = 0.0003).

CONCLUSIONS

Re-admission rates at our district general hospital are comparable to those reported by larger teaching centres. Current 30-day re-admission data may significantly underestimate morbidity rates and socio-economic cost following elective laparoscopic cholecystectomy.
Five-year retrograde transpopliteal angioplasty results compared with antegrade angioplasty
Authors: Evans C , Peter N , Gibson M , Torrie EPH , Galland RB , Magee TR
Published: April 2010

INTRODUCTION

Retrograde transpopliteal angioplasty (PA) is a potentially useful alternative technique for endovascular treatment of infra-inguinal arterial disease when antegrade transfemoral puncture (FA) is technically not possible or appropriate. This study aimed to investigate the outcomes of PA compared with FA during a 5-year period.

PATIENTS AND METHODS

A retrospective study was performed to assess 88 PA and 275 FA performed between January 2003 and January 2008. Assessments of patients, indication for procedure, disease site, stenosis severity, procedure outcomes and time to further intervention were recorded.

RESULTS

FA was used to treat more patients with critical ischaemia (42.2% vs 30.7%; P = 0.014)). PA was used to treat more proximal superficial femoral lesions (P < 0.001) and occlusive lesions (P = 0.001). Overall, 84.1% of PA and 82.5 % of FA were technically successful. There was no difference in local puncture site complication rates. Significantly more FA resulted in distal thrombus/embolism (8.4% vs 3.4%; P = 0.044). Further intervention was required in 27.3% of PA and 36.0% of FA. The time interval to re-intervention was not different between the groups.

CONCLUSIONS

PA is safe with comparable success rates and long-term outcomes to an FA. PA is a useful alternative approach or treating occlusive, proximal disease.
Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland
Authors: Scurr James RH , Brigstocke Julian R , Shields David A , Scurr John H
Published: April 2010

INTRODUCTION

The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated.

SUBJECTS AND METHODS

A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990–2007).

RESULTS

A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported.

CONCLUSIONS

Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.
Which mesh for hernia repair?
Authors: Brown CN , Finch JG
Published: April 2010

INTRODUCTION

The concept of using a mesh to repair hernias was introduced over 50 years ago. Mesh repair is now standard in most countries and widely accepted as superior to primary suture repair. As a result, there has been a rapid growth in the variety of meshes available and choosing the appropriate one can be difficult. This article outlines the general properties of meshes and factors to be considered when selecting one.

MATERIALS AND METHODS

We performed a search of the medical literature from 1950 to 1 May 2009, as indexed by Medline, using the PubMed search engine (< http://www.pubmed.gov >). To capture all potentially relevant articles with the highest degree of sensitivity, the search terms were intentionally broad. We used the following terms: ‘mesh, pore size, strength, recurrence, complications, lightweight, properties’. We also hand-searched the bibliographies of relevant articles and product literature to identify additional pertinent reports.

RESULTS AND CONCLUSIONS

The most important properties of meshes were found to be the type of filament, tensile strength and porosity. These determine the weight of the mesh and its biocompatibility. The tensile strength required is much less than originally presumed and light-weight meshes are thought to be superior due to their increased flexibility and reduction in discomfort. Large pores are also associated with a reduced risk of infection and shrinkage. For meshes placed in the peritoneal cavity, consideration should also be given to the risk of adhesion formation. A variety of composite meshes have been promoted to address this, but none appears superior to the others. Finally, biomaterials such as acellular dermis have a place for use in infected fields but have yet to prove their worth in routine hernia repair.
Transmural eosinophilic gastritis with gastric outlet obstruction: case report and review of the literature
Authors: Holroyd David J , Banerjee Saswata , Chaudhary Khurram S , Reshamwalla Sophie , Vijay Vardhini , Ward Michael W
Published: April 2010

Eosinophil-associated gastrointestinal disorders (EGIDs) are uncommon conditions whose aetiologies are unclear, but which are characterised by eosinophilic infiltration and inflammation of the gastrointestinal tract in the absence of other causes of eosinophilia. We report the case of a 65-year-old woman with eosinophilic gastritis who underwent a Polya gastrectomy for a suspected gastric tumour with gastric outflow obstruction. Subsequent histological examination showed a non-malignant transmural eosinophilic infiltration of the stomach wall, a rare pathological entity. We present a review of the literature and discuss the management of such cases.
Surprise met in minor ops
Authors: Mulgrew Stephen , Newton Richard , Khoo Anna , Camp David
Published: April 2010

The case of a woman who was initially diagnosed as having a sebaceous cyst but who died from metastatic lung carcinoma 2 weeks after her initial ’minor op’ procedure. Minor surgical procedures are increasingly being performed by specialist nurses and by general practitioners in primary care. However, such non-experts may lack the resources to cope with surprises such as was found in this case. It is, therefore, imperative that adequate training and support is provided as the model of care changes.
Ectopic thyroid presenting as a gallbladder mass
Authors: Liang Kuo , Liu Jia Feng , Wang Yue Hua , Tang Guo Cai , Teng Liang Hong , Li Fei
Published: April 2010

The ectopic thyroid tissue is the result of abnormality in embryological development and migration. Ectopic thyroid tissue located in or adjacent to the gallbladder wall is extremely rare with only two cases reported since 1969. These cases were all identified incidentally by pathological examination after cholecystectomy for acute or chronic cholecystitis. We here report a case of ectopic thyroid tissue presenting as a gallbladder mass in a 60-year-old woman who underwent cholecystectomy. Ectopic thyroid tissue in the gallbladder wall was confirmed by histopathology.
Small Dense LDL Cholesterol and Coronary Heart Disease: Results from the Framingham Offspring Study
Authors: Ai Masumi , Otokozawa Seiko , Asztalos Bela F , Ito Yasuki , Nakajima Katsuyuki , White Charles C , Cupples L Adrienne , Wilson Peter W , Schaefer Ernst J
Published: April 2010

Objective: We sought to establish reference values for a new direct assay for small dense LDL cholesterol (sdLDL-C) and to measure sdLDL-C concentrations in patients with established coronary heart disease (CHD) vs controls.

Methods: Direct LDL-C and sdLDL-C were measured in samples from 3188 male and female participants of the Framingham Offspring Study, including 173 men and 74 women with CHD.

Results: Postmenopausal status and male sex were associated with higher sdLDL-C concentrations (P < 0.0001). Cholesterol-lowering medication use was more frequent (P < 0.0001) in CHD patients than in controls (46.8% vs 11.4% in men; 35.1% vs 8.8% in women). In men, mean LDL-C was lower in CHD than in controls (3.22 vs 3.51 mmol/L, P < 0.0001), whereas mean sdLDL-C concentrations were similar (0.83 vs 0.84 mmol/L, P = 0.609). In women, mean LDL-C was similar in CHD and controls (3.53 vs 3.46 mmol/L, P = 0.543), but mean sdLDL-C was higher (0.83 vs 0.68 mmol/L, P = 0.0015). The mean percentage of LDL-C as sdLDL-C was higher in both men and women with CHD than controls (P < 0.01). Increased LDL-C and sdLDL-C were found in 10.4% and 22.0% of men and in 24.3% and 27.8% of women with CHD, respectively.

Conclusions: Despite 4-fold greater cholesterol-lowering therapy use, CHD patients had mean LDL-C concentrations above the LDL-C goal of <2.6 mmol/L (<100 mg/dL). Although women with CHD had higher sdLDL-C concentrations than controls, this difference was not seen in men. These findings may explain some of the high residual risk of future CHD events in CHD patients.
The Silencing of MicroRNA 148a Production by DNA Hypermethylation Is an Early Event in Pancreatic Carcinogenesis
Authors: Hanoun Naïma , Delpu Yannick , Suriawinata Arief A , Bournet Barbara , Bureau Christophe , Selves Janick , Tsongalis Gregory J , Dufresne Marlène , Buscail Louis , Cordelier Pierre , Torrisani Jérôme
Published: April 2010

Background: The poor prognosis of pancreatic ductal adenocarcinoma (PDAC) is accounted for by the absence of early diagnostic markers and effective treatments. MicroRNAs inhibit the translation of their target mRNAs. The production of microRNAs is strongly altered in cancers, but the causes of these alterations are only partially known. DNA hypermethylation is a major cause of gene inactivation in cancer. Our aims were to identify microRNAs whose gene expression is inactivated by hypermethylation in PDAC and to determine whether this hypermethylation-mediated repression is an early event during pancreatic carcinogenesis. We also sought to investigate whether these differentially methylated regions can serve as a diagnostic marker for PDAC.

Methods: MicroRNA production was measured by microarray hybridization and reverse-transcription quantitative PCR. The level of DNA methylation was measured by bisulfite mapping and semiquantitative methylation-specific PCR.

Results: We identified 29 microRNAs encoded by genes whose expression is potentially inactivated by DNA hypermethylation. We focused our study on microRNA 148a (miR-148a) and found its production to be repressed, not only in PDAC samples but also in preneoplastic pancreatic intraepithelial neoplasia (PanIN) lesions. More importantly, we found that hypermethylation of the DNA region encoding miR-148a is responsible for its repression, which occurs in PanIN preneoplastic lesions. Finally, we show that the hypermethylated DNA region encoding miR-148a can serve as an ancillary marker for the differential diagnosis of PDAC and chronic pancreatitis (CP).

Conclusions: We show that the hypermethylation of the DNA region encoding miR-148a is responsible for its repression in PDAC precursor lesions and can be a useful tool for the differential diagnosis of PDAC and CP.
Effect of Cladding on Biaxially Loaded Underclad Part-Through Cracks
Authors: Scibetta M. , Lucon E. , Houben T.
Published: April 2010

Fracture toughness testing on standard specimens in the ductile to brittle transition regime is well established and standardized by the ASTM since 1997. However, its applicability to structural components and its potential conservatism remain a subject of concern. In structural integrity assessment of reactor pressure vessels submitted to an accidental loading condition called pressurized thermal shock, the cladding is generally considered not to play any role and is neglected. However, cladding has the ability to restrain the crack from opening due to its good ductility. To investigate the potential safety margin, a semielliptical crack introduced by fatigue is covered by a stainless steel cladding and specimens are tested under biaxial conditions in the ductile to brittle transition regime. Test results shows that cladding plays a significant role and contributes to an additional safety margin. In addition, cladding increases the potential for crack arrest.
A Brief Survey of the Russian Historiography of Russian America of Recent Years
Authors: Grinëv Andrei. V. , Bland Richard L.
Published: April 2010

Many people have written about the history of the Russian-American Company (RAC), some for scholars, others for a lay audience. Numerous writers have been Americans and Europeans who have had access to the records of the RAC that are held in the U.S. National Archives. But more records-preserved in Russia-were rarely accessible to Western scholars until the end of the Cold War. Dr. Andrei V. Grinëv is one of the leading authorities on the history of Russian America. In the past two decades he has published two monographs, ten chapters in the three-volume Istoriya Russkoi Ameriki [The History of Russian America], and seventy-five articles in Russian, English, and Japanese. He writes not just about the Europeans who settled in Russia's transoceanic territories but also about Native Americans. Many of his works are unique in that he draws on both the ethnography and history of Native Americans. With regard to Russian America, he deals not only with the policies of governments and companies but with individuals as well. In pursuit of this task, Grinëv has now written a book about everyone who had connections with Russian America. It contains more than 5,800 biographical sketches and was published in 2009. In the work below, he analyzes the writings of scholars who have tried to unravel historical details about individuals, companies, and governments that related to the Russian-American Company.

This article was translated from Russian. Since a great deal of Russian literature is cited, it is important to understand the form of transliteration used with these titles. For a detailed description of the transliteration, please see the Translator's Note in the appendix.
Acute Renal Failure in the Neonate
Authors: Ringer Steven Alan
Published: April 2010

Although the exact prevalence of acute renal failure (ARF) in the neonate is difficult to determine precisely, patients who have mild-to-severe ARF are common in most neonatal intensive care units (NICUs). In most instances, the cause of failure is prerenal, in which cardiac output or renal blood flow are diminished, but intrinsic renal injury or postrenal obstructive processes also occur. By considering normal renal physiology, the mechanisms through which renal failure develops can be understood. This understanding is important in limiting the extent of injury and in developing therapies to control the effects of renal dysfunction on fluid and electrolyte balance, acidosis, and nutrition. Outcome and prognosis depend on comorbidities and the presence of failure in other organs as well as the cause and severity of ARF. Permanent effects may not be apparent until later in childhood, mandating careful follow-up and monitoring.
Safety and Immunogenicity of a 13-Valent Pneumococcal Conjugate Vaccine
Authors: Bryant Kristina A. , Block Stan L. , Baker Sherryl A. , Gruber William C. , Scott Daniel A. ,   for the PCV13 Infant Study Group
Published: April 2010

OBJECTIVE:

Invasive pneumococcal disease rates have declined since immunization with 7-valent pneumococcal conjugate vaccine (PCV7) (Prevenar/Prevnar [Wyeth Pharmaceuticals, Philadelphia, PA]) became routine. Certain nonvaccine Streptococcus pneumoniae serotypes (1, 3, 5, 6A, 7F, and 19A) still cause significant morbidity and mortality. The safety and immunogenicity of PCV7 were compared with those of 13-valent PCV (PCV13), which contains saccharides from serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F conjugated to CRM197.

PATIENTS AND METHODS:

Infants were randomly assigned to receive PCV13 or PCV7 at ages 2, 4, and 6 months with other vaccines. Post–third-dose antibodies to each pneumococcal polysaccharide were measured by immunoglobulin G enzyme-linked immunosorbent assay. Antibacterial functional antibodies were measured by opsonophagocytic assay (OPA).

RESULTS:

Subjects received PCV13 (n = 122) or PCV7 (n = 127). All PCV13 serotypes were immunogenic, with 88% to 98% of infants achieving antibody concentrations of ≥0.35 μg/mL to shared PCV7 serotypes. For the 6 additional serotypes, 97% to 100% of PCV13-vaccinated infants achieved antibody concentrations of ≥0.35 μg/mL. Geometric mean antibody concentration for PCV13 recipients ranged from 1.32 μg/mL (serotype 23F) to 4.26 μg/mL (serotype 14). The ratio of OPA geometric mean titers for the 7 shared serotypes (PCV13:PCV7) ranged from 0.6 to 1.4, suggesting no clinically meaningful differences. For PCV13-only serotypes, OPA geometric mean titers were significantly higher in the PCV13 group than in the PCV7 group. Local reactions and systemic events were similar between groups.

CONCLUSIONS:

PCV13 was well tolerated and immunogenic, with most infants developing antipolysaccharide antibody concentrations of ≥0.35 μg/mL, as well as OPA responses, to each of the 13 serotypes.
Trends in Incidence Rates of Congenital Hypothyroidism Related to Select Demographic Factors: Data From the United States, California, Massachusetts, New York, and Texas
Authors: Hinton Cynthia F. , Harris Katharine B. , Borgfeld Lynette , Drummond-Borg Margaret , Eaton Roger , Lorey Fred , Therrell Bradford L. , Wallace Jill , Pass Kenneth A.
Published: April 2010

Primary congenital hypothyroidism (CH) is a common and preventable cause of intellectual disability. The incidence rate of CH has been reported to be increasing in the United States, but the factors behind the observed rate increase are not known. We summarize here the data presented at a workshop on CH, at which factors potentially related to the CH-incidence-rate increase (namely, race, ethnicity, sex, and birth outcomes) were evaluated. Data sources for the analyses included a national data set of newborn-screening results and state-specific data from newborn-screening programs in California, Massachusetts, New York, and Texas. The incidence rate of CH increased in the United States by 3% per year; however, an increase did not occur in all states, at a constant rate, or even at the same rate. Analysis of US data (1991–2000) showed a CH-incidence-rate increase only among white newborns. More recently, in California (2000–2007), the rate was constant in non-Hispanic newborns, but it increased among Hispanic newborns. In the national data, the CH-incidence rate increased similarly among boys and girls, whereas in Texas (1992–2006), the rate among boys increased significantly more than among girls and varied according to race and ethnicity. In Massachusetts (1995–2007), low birth weight newborns or newborns who had a delayed rise in thyrotropin concentration accounted for the majority of the recent rate increase. Race, ethnicity, sex, and pregnancy outcomes have affected the observed increasing incidence rate of CH, although there have been some inconsistencies and regional differences. The association with preterm birth or low birth weight could reflect the misclassification of some cases of transient hypothyroxinemia as true CH. Future studies of risk factors should focus on correct initial identification and reporting of demographic characteristics and pregnancy outcomes for cases of CH. In addition, long-term follow-up data of presumed cases of CH should be ascertained to differentiate true cases of CH from cases of transient hypothyroidism.
Future Research Directions to Identify Causes of the Increasing Incidence Rate of Congenital Hypothyroidism in the United States
Authors: Shapira Stuart K. , Lloyd-Puryear Michele A. , Boyle Coleen
Published: April 2010

A workshop to evaluate the reported increasing trend in the incidence rate of primary congenital hypothyroidism (CH) identified by newborn screening was held February 27 and 28, 2008, in Atlanta, Georgia, and was sponsored by the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Newborn Screening and Genetics Resource Center. Through a series of presentations and discussions, this group of experts considered a variety of factors that could be contributing to the perceived increasing trend of the CH-incidence rate, the gaps in knowledge that need to be overcome to identify the causes of the observed trend, and possible future research activities that might resolve the uncertainties surrounding the increasing incidence rate of CH in the United States. On the basis of these discussions, workshop participants concluded that the initial focus of future efforts should be to determine if the increasing CH-incidence rate persists once there is standardization of the diagnostic criteria for the classification of CH versus transient hypothyroidism. In discussions, workshop participants suggested that if the increasing incidence rate of CH could not be explained by definitional issues, then future research could focus on the identification and evaluation of risk factors for CH that might be changing among the US population and, thus, contributing to the observed increasing incidence rate of CH.
Hook of the Hamate Fracture
Authors: Gill Norman W. , Rendeiro Daniel G.
Published: April 2010

The patient was a 44-year-old man who reported palmar/ulnar-sided right wrist pain after injuring his wrist while playing golf. Although pain and function were improved at 6 months following the injury with conservative treatment measures and golfing with a modified grip, the patient was still limited during golf. This prompted the ordering of additional wrist radiographs, which included a carpal tunnel view, that revealed a fracture at the base of the hook of the hamate. The patient was referred to an orthopaedic surgeon and underwent a hook of hamate excision, and at 12 weeks following surgery, he had returned to full golfing activities without limitations. J Orthop Sports Phys Ther 2010;40(5):325. doi:10.2519/jospt.2010.0408
Psychometric Properties of a Peer-Assessment Program to Assess Continuing Competence in Physical Therapy
Authors: Miller Patricia A. , Nayer Marla , Eva Kevin W.
Published: April 2010

Background

The College of Physiotherapists of Ontario implemented an Onsite Assessment to evaluate the continuing competence of physical therapists.

Objective

This study was undertaken to examine the reliability of the various tools used in the Onsite Assessment and to consider the relationship between the final decision and demographic factors.

Design

This was a psychometric study.

Methods

Trained peer assessors (n=63) visited randomly selected physical therapists (n=106) in their workplace. Fifty-three physical therapists were examined by 2 assessors simultaneously. The assessment included a review of practice issues, record keeping, billing practices, the physical therapist's professional portfolio, and a chart-stimulated recall process. The Quality Management Committee made the final decision regarding the physical therapist's performance using the assessor's summary report. Generalizability theory was used to examine the interrater reliability of the tools. Correlation coefficients and regression analyses were used to examine the relationships between demographic factors and performance.

Results

The majority of the physical therapists (88%) completed the program successfully, 11% required remediation, and 1% required further assessment. The interrater reliability of the components was above .70 for 2 raters’ evaluations, with the exception of billing practices. There was no relationship between the final decision and age or years since graduation (r<.05).

Limitations

Limitations include a small sample and a lack of data on system-related factors that might influence performance.

Conclusions

The vast majority of the physical therapists met the College of Physiotherapists of Ontario's professional standards. Reliability analysis indicated that the number of charts reviewed could be reduced. Strategies to improve the reliability of the various components must take into account feasibility issues related to financial and human resources. Further research to examine factors associated with failure to adhere to professional standards should be considered. These results can provide valuable information to regulatory agencies or managers considering similar continuing competence assessment programs.
Trunk and Hip Muscle Activation Patterns Are Different During Walking in Young Children With and Without Cerebral Palsy
Authors: Prosser Laura A. , Lee Samuel C.K. , VanSant Ann F. , Barbe Mary F. , Lauer Richard T.
Published: April 2010

Background

Poor control of postural muscles is a primary impairment in people with cerebral palsy (CP).

Objective

The purpose of this study was to investigate differences in the timing characteristics of trunk and hip muscle activity during walking in young children with CP compared with children with typical development (TD).

Methods

Thirty-one children (16 with TD, 15 with CP) with an average of 28.5 months of walking experience participated in this observational study. Electromyographic data were collected from 16 trunk and hip muscles as participants walked at a self-selected pace. A custom-written computer program determined onset and offset of activity. Activation and coactivation data were analyzed for group differences.

Results

The children with CP had greater total activation and coactivation for all muscles except the external oblique muscle and differences in the timing of activation for all muscles compared with the TD group. The implications of the observed muscle activation patterns are discussed in reference to existing postural control literature.

Limitations

The potential influence of recording activity from adjacent deep trunk muscles is discussed, as well as the influence of the use of an assistive device by some children with CP.

Conclusions

Young children with CP demonstrate excessive, nonreciprocal trunk and hip muscle activation during walking compared with children with TD. Future studies should investigate the efficacy of treatments to reduce excessive muscle activity and improve coordination of postural muscles in CP.
A Noncentral t Regression Model for Meta-Analysis
Authors: Camilli Gregory , de la Torre Jimmy , Chiu Chia-Yi
Published: April 2010

In this article, three multilevel models for meta-analysis are examined. Hedges and Olkin suggested that effect sizes follow a noncentral t distribution and proposed several approximate methods. Raudenbush and Bryk further refined this model; however, this procedure is based on a normal approximation. In the current research literature, this approximate procedure has not been compared to one based directly on the noncentral t distribution, which is the approach taken in this article. A multilevel model is presented, and estimation is carried out on a real data set using the Markov chain Monte Carlo (MCMC) procedure. A simulation study is then conducted to examine the properties of the noncentral t approach in more depth. Finally, an example of code written in WinBUGS is given, which may be useful to researchers across a broad range of disciplines.
A Modified General Location Model for Noncompliance With Missing Data
Authors: Jin Hui , Barnard John , Rubin Donald B.
Published: April 2010

Missing data, especially when coupled with noncompliance, are a challenge even in the setting of randomized experiments. Although some existing methods can address each complication, it can be difficult to handle both of them simultaneously. This is true in the example of the New York City School Choice Scholarship Program, where both the covariates and the outcomes were sometimes missing, and there was complicated noncompliance. The authors propose a modified general location model to integrate the ideas of missing data techniques and principal stratification and then analyze the same data as in Barnard, Frangakis, Hill, and Rubin (2003) , where a pattern-mixture model was used. Their results are presented and compared with those in Barnard et al.
Facilitating Early Intervention: Experiences of Young People and Implications for the Shaping of Headspace Services
Authors: Medlow Sharon , Kelk Norm , Cohen Anjalee , Hickie Ian
Published: April 2010

Objective: The aim of this study was to gain an understanding of the factors that facilitate entry of young people into the Australian mental health care system with a view to developing headspace service delivery in youth-friendly directions.

Method: Fifteen semi-structured interviews were conducted with experienced mental health help-seekers in early adulthood.

Results: Social factors involving families, friends and professionals dominated discussions about the initiation and voluntary continuation of mental health care.

Conclusions: A range of social interactions combine to facilitate the entry of young people into care. The actions of families and friends are very important for the initiation of care while the clinicians’ modes of communicating with young people are critical in making the experience of care comfortable and worth the perseverance. If genuine service delivery reform is to be achieved, taking account of the views of young people who have overcome the well-documented obstacles to care is invaluable for the ongoing development of youth-friendly services such as those offered by headspace.
How the Philosophy of Merleau-Ponty Can Help Us Understand the Gulf Between Clinical Experience and the Doctrine of Evidence-Based Psychotherapy
Authors: Morstyn Ron
Published: April 2010

Objective: The aim of this paper is to examine the gulf between clinical experience and the doctrine of evidence-based psychotherapy from the perspective of the philosophy of Maurice Merleau-Ponty.

Conclusions: Evidence-based psychotherapy, which requires that psychotherapists ignore their thoughts and feelings with individual patients in favour of following standardized manuals and guidelines, is being increasingly promoted as part of evidence-based medicine (EBM). However, this represents an inappropriate extension of logical empiricist philosophy and significance testing methodology, on which evidence-based medicine is founded, to psychotherapy. It sacrifices a search for truth in psychotherapy, for an illusory search for certainty. The inevitable consequence of this is that psychotherapy becomes a commoditised pseudorelationship. Merleau-Ponty provides an alternative ontology, based on the primacy of perception, that gives an epistemological foundation for the search for truth and integration as a basis for psychotherapy. The practice of evidence-based psychotherapy raises serious ethical concerns about pseudorelationships being passed off as authentic, which could lead to missed opportunities to engage mentally ill patients in treatment and to reinforcement of their damaging sense of alienation.
Editorial Vol.6(1)
Authors: Jha KK
Published: April 2010

DOI: 10.3126/saarctb.v6i1.3057 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (1)
Involving Family Members in the Delivery of TB Care in the Kandy District, Sri Lanka
Authors: Jayawardena KAS , Medagedara D
Published: April 2010

Objective : To determine the effectiveness of using family members in the delivery of Directly Observed Treatment (DOT) in a local community, Sri Lanka Method : Thirty nine TB patients detected at the Chest Clinic, Kandy between 1st of September and 31st of December 2007 were given DOT using family members (study group). Treatment outcome of the study group was evaluated in December 2008 and compared with the outcome of 42 patients, who had undergone DOT at peripheral health centres during the same period. Results : Sputum conversion rate at the end of the intensive phase of treatment of the study group was 95% and the rate of comparison group was 88%. Treatment was successfully completed in 95% of patients in the study group and 86% of patients in the comparison group. No defaulters were found in the study group whereas 4 defaulters were in the comparison group. Observed outcome differences between two groups were not statistically significant (p > 0.05). Conclusion : The present study reveals that the treatment outcome is good among patients who receive family DOT. The important prerequisites to ensure successful family DOT include correct selection of patients and DOT providers, giving adequate instruction for treatment adherence, and monitoring of the progress. Keywords : DOTS; family DOT; Sri Lanka DOI: 10.3126/saarctb.v6i1.3059 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (1) 12-15
An Epidemiological Study on Pattern of Smoking, Alcohol and Other Drugs Consumption among Femal Tea Pluckers in Nuwara-Eliya District, Sri Lanka
Authors: Weerakoon AP , Jha RK , Wijeweera PR , Abeywardana Yapa , Gamage W , Gunaratne Hearth , Hearth HMS
Published: April 2010

Introduction : Smoking and alcohol consumption among the estate population are considered to be high. However there is little documented evidence on the prevalence of smoking and alcohol consumption among female estate workers in Sri Lanka. The aim of this study was to find out the prevalence of smoking, alcohol and other dugs consumption among female estate workers and to find out factors associated with these habits. Methodology : A community based cross sectional study was carried out with a sample of 928 females on a presumptive prevalence of 10% of alcohol users, using simple random sampling technique. Data was collected by trained field public health midwives using an interviewer administered questionnaire. Statistical analysis of data was carried out using SPSS version 11. Results : The response rate was 97.8%. Prevalence of smoking, alcohol and other drugs were 7.27%, 34.7% and 0% respectively. Among smokers, most smoked cigar (55%), followed by Beedi (39%) and cigarette (6%). None indulged in dangerous drugs like Heroin and cannabis. Most consumed alcoholic beverage was toddy (64%) followed by arrack (31%). Seventy four percent of women stated that they consume alcohol because they were influenced by their husbands. A significant positive association was observed between smoking and (a)illiteracy (p<0.05) (b) marriage(p<0.05) (c) age more than 35 years (p < 0.01) .There was a significant positive association observed between alcohol consumption and (a)illiteracy (p<0.001) (b) marriage(p<0.001) (c) parental drinking (p<0.001).There was a significant positive association between the use of alcohol and dispute within the family (p<0.001) as well as dispute with the neighbours (p<0.01) Conclusion : One third of estate women consume alcohol and 7% indulge in smoking, which is very much more than for the rest of the country. There is an urgent need for health awareness to be implemented in the estate sector to overcome this problem. Keywords : Alcohol; smoking; estate women; Sri Lanka; prevalence DOI: 10.3126/saarctb.v6i1.3062 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (1) 31-38