bluuebunny/crossref_metadata_2025 huggingface dataset:
Intellectual Development of Preservice and Novice Music Educators
Authors: Palmer C. Michael
Published: September 2011

Teaching is a complex process that demands a high level of cognitive or intellectual ability to face poorly structured challenges in education. Teacher education programs are responsible for preparing preservice teachers for meeting such challenges and developing their capacity for employing appropriate courses of action based on knowledge of available evidence and each situation’s context. The purpose of this article is to outline two cognitive development models, Perry’s Intellectual Development Model and King and Kitchener’s Reflective Judgment Model, and to discuss how they can assist teacher educators in recognizing and developing the cognitive development levels of preservice teachers. Additionally, the article provides examples of each model’s application within research on preservice and novice teachers. Suggestions for practice and future research are made in the conclusion.
Why Are Gender Quotas Adopted? Party Pragmatism and Parity in France
Authors: Murray Rainbow , Krook Mona Lena , Opello Katherine A. R.
Published: September 2011

The passage of electoral gender quotas raises questions about why male elites would support policies that seemingly go against their self-interests. Recent work on France suggests that quota adoption is self-interested because male legislators benefit from alleged voter bias against female candidates. This article evaluates this explanation as a means for understanding quota adoption globally. It argues that the key actors are not legislators but political parties. Developing an alternative causal story centered on “party pragmatism,” it finds that decisions to introduce quotas are rational and consistent once a range of incentives—ideological, electoral, and strategic—are taken into account.
Direct and Mediated Effects of Nativity and Other Indicators of Acculturation on Hispanic Mothers’ Use of Physical Aggression
Authors: Altschul Inna , Lee Shawna J.
Published: September 2011

This study used data from 845 foreign-born ( n = 328) and native-U.S. born ( n = 517) Hispanic mothers who participated in the Fragile Families and Child Wellbeing Study (FFCWS) to examine four indicators of acculturation—nativity, years lived in the United States, religious attendance, and endorsement of traditional gender norms—as predictors of maternal physical aggression directed toward young children. The authors also examined whether psychosocial risk factors associated with child maltreatment and acculturation—maternal alcohol use, depression, parenting stress, and intimate partner aggression and violence—mediate relationships between acculturation and maternal aggression. Foreign-born Hispanic mothers had significantly lower rates of physical aggression than native-born Hispanic mothers. In path modeling results, U.S. nativity, along with maternal alcohol use, parenting stress, and child aggressive behavior, emerged as the strongest risk factors for maternal physical aggression. Among the four acculturation indicators, only foreign birth was directly associated with lower maternal aggression. Study findings suggest immigrant status is a unique protective factor that contributes to lower levels of physical aggression among Hispanic mothers.
Illinois’ Municipal Telecommunications Tax
Authors: Wu Yonghong , Merriman David
Published: September 2011

In this article, the tax base elasticity and revenue potential of the municipal telecommunications tax in Illinois over the period 2004 to 2007 are studied. The hypothesis that the municipal telecommunications tax base is perfectly inelastic with respect to variation in the tax rate cannot be rejected. Under the assumption that the tax base is purely inelastic, the maximum revenue potential of this local option tax is estimated. This study suggests that municipal telecommunications taxes have the potential to provide much needed relief to the current and future fiscal stress of municipal governments with minimal economic efficiency costs.
A Strategy for Neighborhood Decline and Regrowth
Authors: Savitch H. V.
Published: September 2011

This paper examines neighborhood decline and takes up the larger issue of formulating a strategy for regrowth. A case study of Marseille France highlights this strategy along with possible criteria for policy transfer to American cities. The strategy is designated by the author as High-Intensity Concentrated Area Development (HICAD). The HICAD strategy differs from those used in the United States and employs five basic ideas—selection, pressure, magnification (connectivity), leverage and a holistic perspective. HICAD proved to be transformative in Marseille. Over the course of 15 years it brought back densities, increased employment, rebuilt infrastructure and renewed a community. HICAD is also portable and may be used in conjunction with other strategies currently applied in American cities. Notwithstanding these benefits the strategy gives rise to issues of social equity. The French experience also enables us to understand that urban decline may differ in cause and consequence. Accordingly the strategic responses will also vary.
Local Development Policies and the Foreclosure Crisis in California
Authors: Glasgow Garrett , Lewis Paul G. , Neiman Max
Published: September 2011

Can local governments shape the long-run fortunes of their communities through their own policies, or is the autonomy of localities swamped by larger macroeconomic forces? This study considers the relationship between California municipalities’ policy orientations toward residential development at the start of the housing boom in the late 1990s and the subsequent incidence of foreclosures during the housing crisis in 2008 and 2009. The authors find that cities reported to have stronger city council opposition to residential growth had a lower incidence of foreclosures a decade later, even after controlling for the rate of increase in the housing stock and other local economic, demographic, and geographic characteristics. Although the foreclosure crisis was driven by national and global forces, more cautious local government policy approaches to residential growth appeared to moderate the damage.
Hospitalization Among Medicare-Reimbursed Skilled Home Health Recipients
Authors: O’Connor Melissa
Published: September 2011

This article presents a summary and critique of the published empirical evidence between the years 2002 and 2011 regarding rehospitalization among Medicare-reimbursed, skilled home health recipients. The knowledge gained will be applied to a discussion regarding ACH among geriatric home health recipients and areas for future research. The referenced literature in MEDLINE, PubMed and Cochrane databases was searched using combinations of the following search terms: home care and home health and Medicare combined with acute care hospitalization, rehospitalization, hospitalization, and adverse events and limited to studies conducted in the United States. Twenty-five research studies published in the last eight years investigated hospitalization among patients receiving Medicare-reimbursed, skilled home health. Empirical findings indicate telehomecare can reduce hospitalizations and emergency room use. The identification of risk factors for hospitalization relate to an elder’s sociodemographic, clinical and functional status that can be identified upon admission and interventions taken in order to reduce hospitalizations. Disease management, frontloading nurse visits, the structure of home health services and OBQI are also among the interventions identified to reduce hospitalizations. However, the body of evidence is limited by a paucity of research and the over reliance on small sample sizes. Few published studies have explored methods that effectively reduce hospitalization among Medicare-reimbursed skilled home health recipients. Further research is needed to clarify the most effective ways to structure home health services to maximize benefits and reduce hospitalization among this chronically ill geriatric population.
In-cylinder soot imaging and emissions of stratified combustion in a spark-ignited spray-guided direct-injection gasoline engine
Authors: Hemdal S , Andersson M , Dahlander P , Ochoterena R , Denbratt I
Published: September 2011

The combustion in a spark-ignited spray-guided gasoline direct-injection engine operating in a stratified mode has been studied by in-cylinder imaging of the fuel, OH*, and soot distributions. Information on the fuel distribution was obtained by laser-induced fluorescence imaging of the aromatic molecules in the gasoline. The OH* and soot distributions were simultaneously visualized by detection of the natural emissions at 306 nm (OH*) and around 530 nm (soot) using two intensified charge-coupled device cameras. In addition to the in-cylinder observations, engine-out soot emissions, NOx, and HC were measured. The engine was operated at a speed of 2000 r/min and an indicated mean effective pressure of 2.5 bar, with a fully open throttle, resulting in a globally lean combustion with a fuel–air equivalence ratio of about 0.25. The gasoline was injected in single or double injections by an outward-opening piezo-actuated injector. The combustion was ignited efficiently at locally fuel-rich conditions. The soot formation and oxidation were investigated for the two injection strategies, each with three injection timings and two fixed ignition timings. The results showed that soot was efficiently formed and oxidized. From the in-cylinder measurements, it could be seen that the soot luminescence intensity quickly rose and then declined, while the combustion temperature was still increasing. Furthermore, the OH* intensity was still increasing as the soot luminescence was declining. The soot incandescence peak intensity occurred at a crank angle degree close to 50 per cent mass burned, and the OH* intensity peak arose later, shortly before the maximum soot temperature around top dead centre (TDC). When the injection timing was retarded, with constant ignition timing with respect to injection, it was found that the total soot luminosity increased. In addition, less OH* chemiluminescence was observed during the decrease of the soot incandescence, implying conditions less favourable for efficient soot oxidation in the later part of the combustion for retarded injections. This was confirmed by the engine-out soot emission measurements, which showed increased soot levels as the injection was retarded. It was also found that fuel impinged on the spark plug during the injections, resulting in a persistent jet flame close to the spark plug in the centre of the cylinder, which is believed to contribute to engine-out soot emissions.
Distributive and relational equality
Authors: Schemmel Christian
Published: September 2011

Is equality a distributive value or does it rather point to the quality of social relationships? This article criticizes the distributive character of luck egalitarian theories of justice and fleshes out the central characteristics of an alternative, relational approach to equality. It examines a central objection to distributive theories: that such theories cannot account for the significance of how institutions treat people (as opposed to the outcomes they bring about). I discuss two variants of this objection: first, that distributive theories fail to account for the importance of how institutions cause good shortfalls and, second, that they fail to account for the normative attitude of social and political institutions expressed in different ways of treating people. The article argues that the causal variant of the objection has only very limited reach, and endorses the expressive variant: the attitudes expressed by institutions in their treatment of persons, such as contempt or neglect, generate potentially unjust social relationships and hierarchies. This should be the focus of a relational egalitarian approach to social justice. The article proceeds to explain how it is possible that artificial agents such as institutions have attitudes and how these attitudes are not reducible to those of the individuals that sustain them, and argues that distributive theories cannot be so modified as to account for such attitudes. It concludes by indicating several directions for the development of more worked-out conceptions of relational equality on this basis.
Friendship and politics in Aristotle’s Nicomachean Ethics
Authors: Ward Ann
Published: September 2011

Aristotle’s discussion of political friendship points to perfect friendship and the possibility that the good citizen can be the good person. This conclusion is arrived at by reflection on three problems raised in Aristotle’s analysis. First, citizen friendships of utility are the cause of civil strife. Second, there is a tension between citizen friendship in timocracy and justice. Although citizen friendship in a timocracy can aspire to perfect friendship, political justice requires kingship. Third, familial friendship, although natural, is more limited in scope than political friendship. This article concludes with Aristotle’s discussion of conflicting obligations that opens up two grounds of natural friendship: relations to persons through body, and relations to persons who are virtuous. Virtue relations in timocracy allow citizen friendship to resemble perfect friendship.
Adhesive Strips for the Closure of Surgical Incisional Sites
Authors: Gkegkes Ioannis D. , Mavros Michael N. , Alexiou Vangelis G. , Peppas George , Athanasiou Stavros , Falagas Matthew E.
Published: September 2011

Background. The authors evaluated the available evidence regarding the use of adhesive strips for the management of surgical incisions and compared them with sutures and other closure materials. Study design. Systematic review and meta-analysis of randomized controlled trials (RCTs). Results. Twelve RCTs studying 1317 incisions in 1023 patients were included. No difference was found regarding the development of infection (odds ratio [OR] = 0.47; 95% Confidence interval [CI] = 0.12-1.85), dehiscence (OR = 1.22; 95% CI = 0.32-4.64), and overall cosmetic result (standardized mean difference = 0.01; 95% CI = −0.19 to 0.20). Closure with strips resulted in significantly lower incidence of redness (OR = 0.57; 95% CI = 0.37-0.89). The available data on pain, need for resuturing, swelling, patient satisfaction, and closure time with the use of strips could not be synthesized; however, regarding the latter 2 outcomes, application of strips seemed favorable. There was significant heterogeneity among the studies. Conclusions. The findings suggest that adhesive strips may be an efficient closure material for certain small-length incisions. Further research is warranted on outcomes such as dehiscence and the need for resuturing.
A New Technique for Spleen Autotransplantation
Authors: Di Carlo Isidoro , Pulvirenti Elia , Toro Adriana
Published: September 2011

Purpose. Although the efficacy of spleen autotransplantation is debated, this approach remains the only possibility for preserving splenic function after traumatic splenectomy. This report describes an alternative method for splenic autotransplantation in case of splenic trauma. Methods. After splenectomy, the organ was weighed and the undamaged part was cut transversely to prepare a segment of approximately 4 × 3 × 2 cm in size and of 35 g of weight to be transplanted. The greater omentum was pedunculated in its left lateral portion, and the previously prepared splenic tissue was implanted in a pouch created at the lower edge of the omentum. The omental peduncle containing the splenic tissue was fixed to the parietal peritoneum of posterior left upper quadrant of the abdomen where the native spleen was previously located. Results. This technique was performed in 4 patients after informed consent had been obtained. The functionality of the splenic implant was assessed after 3 months by abdominal computed tomography and scintigraphy. These exams showed the functioning of the trasplanted splenic tissue in all patients. Conclusion. This new technique needs further evaluation, but it appears to be an easy and safe alternative for spleen autotransplantation.
Reducing Inflammation
Authors: Gillespie Nicole D. , Lenz Thomas L.
Published: September 2011

An elevated C-reactive protein level is an inflammatory marker associated with an increased risk in cardiovascular disease. Regular long-term exercise, a cholesterol-lowering diet (a diet low in saturated fat and high in viscous fiber and plant sterols), and statin pharmacotherapy have all been shown to reduce C-reactive protein levels. The purpose of this article is to describe the research available regarding lowering of C-reactive protein levels and reducing incidence of cardiovascular disease. Specifically, the article will compare the use of statin therapy, regular physical activity, and a cholesterol-lowering diet. The effectiveness of each intervention will be evaluated along with the risks and benefits associated with treatment.
Home health nurses coping with practice care errors
Authors: Abusalem Said K. , Coty Mary-Beth
Published: September 2011

The Institute of Medicine report from 2000 ( To Err Is Human: Building a Safer Health System, National Academy Press, Washington, DC) highlighted the magnitude of practice care errors in the US healthcare system as well as the potentially life-threatening consequences they create. Nurses who make care errors experience a devastating mental and emotional impact and do not know how to deal with the experience. This study assessed how nurses cope with care errors and what strategies they use. A survey design was used for this study and 192 home health nurses completed the survey in a southeastern state. Packets containing sealed surveys, a flier, and a description of the study were mailed to the nurses. Results of the study with home health nurses indicate that nurses felt angry at themselves for making the care errors. Planful problem-solving was the most frequently used coping technique followed by accepting responsibility. The most commonly reported change in practice following a care error experience was paying more attention to detail, followed by personally confirming patient data and changing the organisation of data. Intervention research is needed to help nurses better deal and cope with care errors and to better assess the need for providing such nurses with professional support and counselling after becoming involved in a care error experience.
Induction of decreased fecundity by tetanus toxoid hyper-immunization in C57BL/6 mice depends on the applied adjuvant
Authors: Živković Irena , Petrušić Vladimir , Stojanović Marijana , Inić-Kanada Aleksandra , Stojićević Ivana , Dimitrijević Ljiljana
Published: September 2011

It has already been shown that tetanus toxoid (TTd) hyper-immunization is a suitable experimental method for creating the animal model of antiphospholipid syndrome (APS) in BALB/c mice. The severity of APS pathology in BALB/c mice mainly correlates to the affinity of anti-β2 glycoprotein I (β2GPI) antibodies. In this study we have investigated reproductive pathology induced in C57BL/6 mice by TTd hyper-immunization using a combination of different pretreatments (complete Freund's adjuvant or glycerol) and adjuvants (alhydrogel or glycerol). A decrease in fecundity was recorded in only C57BL/6 mice immunized with alhydrogel adjuvant, irrespective of the kind of applied pretreatment; it was associated with an increase in abundance of low affinity anti-β2GPI IgG antibodies and Th1 prevalence.
Helicobacter pylori attenuates lipopolysaccharide-induced nitric oxide production by murine macrophages
Authors: Lu Dah-Yuu , Tang Chin-Hsin , Chang Chia-Hsian , Maa Ming-Chei , Fang Shih-Hua , Hsu Yuan-Man , Lin Yu-Hsin , Lin Chun-Jung , Lee Wan-Chi , Lin Hwai-Jeng , Lee Che-Hsin , Lai Chih-Ho
Published: September 2011

Intragastric growth of Helicobacter pylori and non- Helicobacter microorganisms is thought to be associated with elevated levels of pro-inflammatory cytokines and the production of NO these effects can lead to chronic inflammation. Microorganisms can activate the expression of iNOS and the production of NO by macrophages through stimulation with bacterial LPS. Helicobacter pylori can evade these vigorous immune responses, but the underlying mechanism remains unknown. In this study, we used a murine model of macrophage infection to demonstrate that H. pylori inhibits LPS-induced expression of iNOS and production of NO by macrophages. Suppression of LPS-induced NO production by macrophages led to elevated survival of H. pylori in a trans-well system. This effect was abrogated in macrophages from iNOS–/– mice. Analysis of iNOS mRNA and protein levels revealed that H. pylori inhibits iNOS expression at both transcriptional and post-transcriptional levels, and that these effects occurred with live bacteria. Furthermore, the effect of H. pylori involved down-regulation of the mitogen-activated protein kinase pathway and the translocation of active NF-κB into the nucleus. Taken together, our results reveal a new mechanism by which H. pylori modulates the innate immune responses of the host and maintains a persistent infection within the stomach.
Lipopolysaccharide infusion up-regulates hepcidin mRNA expression in equine liver
Authors: Oliveira-Filho José P , Badial Peres R , Cunha Paulo HJ , Peiró Juliana R , Araújo João P , Divers Thomas J , Winand Nena J , Borges Alexandre S
Published: September 2011

Hepcidin has been found to be the key regulator of iron metabolism that leads to hypoferremia during inflammation. Recent work has shown that equine hepcidin is predominantly expressed in the liver of horses. In this study, hepcidin gene expression was determined in the liver and bone marrow of six healthy horses after iv infusion of Escherichia coli O55:B5 LPS. The IL-6 gene expression was also determined in liver and bone marrow samples. Clinical and laboratory evaluations were measured at multiple time points between 0 and 240 h post-LPS infusion (PI). Liver and bone marrow biopsies were taken immediately before (baseline) and at 6 and 18 h PI. In response to endotoxin infusion, all horses showed characteristic clinical signs of endotoxemia. Plasma iron concentration was decreased significantly from the pre-infusion level at 8 h PI. Hypoferremia peak was observed at 12 h and returned to normal levels at 30 h PI. Relative real-time RT-PCR analysis showed that liver hepcidin and IL-6 mRNA expression was up-regulated at 6 h PI. Bone marrow hepcidin relative expression was not influenced by LPS infusion. In another experiment, equine monocyte cultures were stimulated with LPS (1 µg/ml). Monocyte hepcidin and IL-6 gene expression was significantly induced after 2 h of LPS stimulus and returned to baseline levels thereafter. The present study describes that, in horses, LPS infusion up-regulates hepatic hepcidin mRNA expression resulting in early observed hypoferremia and suggests that hepcidin may act as an acute-phase protein in horses.
The potential for crizotinib in non-small cell lung cancer: a perspective review
Authors: Bang Yung-Jue
Published: September 2011

Tyrosine kinases have a crucial role as key regulators of signaling pathways that influence cell differentiation and growth. Dysregulation of tyrosine kinase-mediated signaling is understood to be an important oncogenic driver. Genetic rearrangements involving the tyrosine kinase anaplastic lymphoma kinase ( ALK) gene occur in non-small cell lung cancer (NSCLC), anaplastic large cell lymphomoas, inflammatory myofibroblastic tumors, and other cancers. Cells with abnormal ALK signaling are sensitive to ALK inhibitors such as crizotinib. This review will highlight the discovery of the fusion between echinoderm microtubule-associated protein-like 4 (EML4) and ALK as an oncogenic driver, recognition of other ALK gene rearrangements in NSCLC, and the confirmation that crizotinib is an effective treatment for patients with ALK-positive NSCLC. Work is underway to further define the role for crizotinib in the treatment of ALK-positive lung cancer and other cancers and to investigate the molecular mechanisms for resistance to ALK inhibition with crizotinib.
Contracture of the Third Toe as a Delayed Presentation of a Foreign Body in the Foot
Authors: Dar Tahir Ahmed , Sultan Asif , Hussain Shahid , Dhar Shabir Ahmed , Ali Murtaza Fazal
Published: September 2011

Foreign body retention in the foot after a penetrating injury is an unusual occurrence with varied presentation. A degree of suspicion needs to be present in situations where there is an inexplicable swelling, sinus, abscess, or tenderness. The authors present a case with a contracture of the third toe that had been caused by plantar fascial fibrosis secondary to retention of a rubber foreign body in the foot. This case report highlights the fact that an ultrasound to rule out retention of the foreign body might be a judicious investigation if common causes of toe contracture are excluded. It may also have therapeutic implications.

Level of Evidence: Therapeutic, Level IV
Correlation of MRI Edema and Clinical Outcomes Following Microfracture of Osteochondral Lesions of the Talus
Authors: Cuttica Daniel J. , Shockley Joel A. , Hyer Christopher F. , Berlet Gregory C.
Published: September 2011

Background. Magnetic resonance imaging (MRI) is an accurate, noninvasive method used to assess healing of osteochondral lesions postoperatively. The purpose of the current study was to evaluate the presence of postoperative edema on MRI following osteochondral lesion of the talus (OLT) drilling and to correlate MRI findings with clinical outcome. Materials and Methods. A retrospective chart and MRI review was performed on all OLTs treated by arthroscopic drilling or microfracture. A musculoskeletal radiologist reviewed MRIs performed at a minimum of 9 months postoperatively and the amount of edema present at OLT drilling site was graded. MRI findings were correlated with clinical outcome. Results. A total of 29 patients with 30 OLTs were included. The average patient age at the time of surgery was 31.9 years (range = 13-52 years, SD = 11.87). The average time from arthroscopic drilling to MRI was 81.47 weeks (range 36-242 weeks, SD = 51.31). The intensity of edema was classified as none, mild, moderate, or severe based on MRI findings. Those patients with a moderate or severe edema intensity had inferior clinical outcomes (P = .011). Conclusion. The presence of edema on MRI following drilling of OLTs may be a valuable predictor of clinical outcome, with those patients with greater edema intensity having inferior clinical outcomes.

Level of Evidence: Prognostic, Level II
Ankle Impingement Syndromes
Authors: Hess Gregory William
Published: September 2011

Ankle injuries are common occurrences in athletics involving and requiring extreme ranges of motion. Ankle sprains specifically occur with a 1 in 10 000 person rate in active individuals each day. If trauma is repetitive, the ankle structures have potential to experience secondary injury and dysfunction. Included in this category of dysfunction are both anterior and posterior ankle impingement syndromes where disruption of the bony structures, joint capsule, ligaments, and tendons typically occurs. Ankle impingement is described as ankle pain that occurs during athletic activity, with recurrent, extreme dorsiflexion or plantar flexion with the joint under a load. Ankle impingements can be classified according to what structures become involved both anteriorly and posteriorly. Osseous impingement, soft tissue impingement, impingement of the distal fascicle of anterior inferior tibiofibular ligament, and meniscoid lesions are all documented causes of ankle impingement. These changes tend to be brought about and exacerbated by extreme ranges of motion. Understanding various impingement types will better enable the clinician to prevent, identify, treat, and rehabilitate affected ankles. Acknowledging activities that predispose to ankle impingement syndrome will enhance prevention and recovery processes. Description of ankle impingement etiology and pathology is the objective of the current review.

Level of Evidence: Therapeutic, Level IV
Are Metatarsal Fractures Indicative of Osteoporosis in Postmenopausal Women?
Authors: Bridges Matthew J. , Ruddick Sheila
Published: September 2011

Patients who sustain low trauma fractures are at a higher risk of osteoporosis. However, there are conflicting data concerning whether metatarsal fractures are also associated with low bone mineral density. The authors retrospectively analyzed data on 68 postmenopausal women who had sustained a low trauma metatarsal fracture. Routine assessment of these patients included identification of risk factors for fracture, height and weight measurement, and measurement of peripheral bone density at the heel by dual-energy X-ray absorptiometry (Calscan, Demetech AB, Täby, Sweden). Bone density in the patients was compared with manufacturer’s reference database. The mean Z-score for the patients was −0.08. In total, 14 women (20.5% [confidence interval 10.5 to 29.5]) had a Z-score ≤−1, and 1 patient (1.5% [confidence interval −1.4 to 4.4]) had a Z-score ≤−2. Mean T-score in these women was −1.95. Since the number of women with a Z-score ≤−1 was not significantly greater than the 16% that would be expected, and the number of women with a Z-score ≤−2 was not significantly greater than the 2.5% expected, it is concluded that low trauma metatarsal fracture is not a risk factor for low calcaneal bone mineral density.

Level of Evidence: Prognostic, Level II
Measurement of Mid-Calcaneal Length on Plain Radiographs
Authors: Dayton Paul , Wienke Jeffrey C. , Prins Dustin B. , Haulard Jean Paul , Feilmeier Mindi J. , Wiarda Christy
Published: September 2011

The authors present a new method to reliably measure the length of the mid-portion of the calcaneus. The authors defined the “mid-calcaneal length” as the line connecting the high point of the convex arc of the posterior subtalar joint facet and the low point of the concave arc of the calcaneocuboid joint. Statistical analysis of 810 measurements taken by 6 observers confirmed high intraobserver reliability, interobserver reliability, and internal consistency (Cronbach coefficient α = .98) and low error rate (Pearson correlation coefficient = .0001). The authors have used this measurement as a tool to determine the change in calcaneal length after osteotomy lengthening procedures and present it as a tool for clinical practice and research.

Level of Evidence: Diagnostic, Level III
A User-Friendly Method of Pin Site Management for External Fixators
Authors: Dayton Paul , Prins Dustin B. , Hensley Nathan , Wienke Jeffrey
Published: September 2011

Pin tract inflammation and/or infection are common with the use of external fixation devices. Pin sites need to be managed to help prevent complications. There are a variety of regimens proposed for pin care in the literature. The authors present an efficient and simplified approach for addressing pin care protocol using cord locks with the use of compression sponges for external fixation devices. This method obviates the need for extensive bandaging and makes pin care easy for the patient to carry out. A brief review of the current evidence on pin care is presented, and an evidence-based pin care protocol is presented.

Level of Evidence: Therapeutic, Level V
Solitary Navicular Metastasis of a Pulmonary Adenocarcinoma
Authors: Iselin Lukas D. , Symeonidis Panagiotis D. , Stavrou Peter
Published: September 2011

The authors present a case of a 62-year-old male with a symptomatic isolated midfoot metastasis as the first clinical presentation of a primary pulmonary tumor. In this case of a metastatic adenocarcinoma, the lesion leading to diagnosis was located in the foot. The poor outcome and the sparse relevant literature are presented in brief.

Level of Evidence: Therapeutic, Level IV
Isolated Medial Cuneiform Fractures
Authors: Guler Ferhat , Baz Ali Bulent , Turan Adil , Kose Ozkan , Akalin Serdar
Published: September 2011

Although fractures of the midfoot are common, cuneiform fractures are rarely seen. These fractures are frequently associated with other fractures of the midfoot such as Lisfranc fracture-dislocations. However, isolated cuneiform fractures are extremely rare, with few cases reported in the relevant literature. Herein, the authors report 2 cases of isolated medial cuneiform fractures. One of the patients was treated with headless screw fixation due to displacement in fracture configuration, and the other was treated conservatively. Fractures were united without any complication in both patients. In this report, the authors discuss the mechanism of injury, diagnostic challenges, and treatment options of isolated medial cuneiform fractures.

Level of Evidence: Therapeutic, Level IV
Associated Intra-articular Ankle Pathologies in Patients With Chronic Lateral Ankle Instability: Arthroscopic Findings at the Time of Lateral Ankle Reconstruction
Authors: Lee Jake , Hamilton Graham , Ford Lawrence
Published: September 2011

Chronic lateral ankle instability (CLAI) can be a debilitating condition. The literature has shown that it is also associated with a number of intra-articular pathologies of the ankle. Some argue that if unaddressed, these intra-articular pathologies can predispose patients to osteoarthritis. Previous studies of patients who underwent prelateral stabilization ankle arthroscopy have shown a high number of pathologies, including osteochondral lesions of the talus. Purpose: The current study reviewed a consecutive series of patients diagnosed with CLAI who underwent ankle arthroscopy followed by a modified Brostrom-Gould procedure to validate the previous studies. Methods: Intraoperative reports on 28 ankles in 28 consecutive patients were reviewed from 2004 to 2008. Result: All 28 ankles (100%) demonstrated varying degrees of synovitis. Talar cartilage fibrillation was observed in 7 patients (25%), and talar dome cartilage defect was visualized in 4 patients (14%). Talar dome osteochondral defect was seen in 2 patients (7%), loose bodies were found in 3 patients (11%), Bassett’s lesion was seen in 2 patients (7%), and anterolateral impingement was seen in 4 patients (14%). Distal anterior tibial osteophytosis was seen in 4 patients (14%). Conclusion: This study confirms the high number of intra-articular pathologies in association with CLAI.

Level of Evidence: Therapeutic, Level IV
Wound Complications With Posterior Midline and Posterior Medial Leg Incisions
Authors: Highlander Peter , Greenhagen Robert M.
Published: September 2011

There is no consensus on the optimal incisional approach at the posterior leg to avoid wound healing complications. The purpose of this systematic review is to report and compare complication rates associated with two common incisions used to approach the Achilles tendon in order to provide additional recommendations for optimal incision placement. Materials and Methods. Four electronic databases were searched using keywords for procedures using posterior leg incisions. A total of 8724 studies were analyzed and subjected to inclusion and exclusion criteria. Once inclusion criteria were met, each article was placed in 1 of 2 groups based on incision placement: midline (group 1) or posterior medial (group 2). Study format, patient demographics, surgical indication and other details, and wound complications were recorded. The data obtained was reviewed for trends between the two groups. Results. 38 articles met the inclusion criteria. Seven articles used the midline approach (group 1) whereas 31 articles used the posterior medial incision (group 2). The 38 articles included 1287 patients, of whom 25.6% were female with an average age of 43.9 years. Group 1 included 142 patients and group 2 had 1145 patients. The total wound complication rate among all reports was determined to be 8.2%, with 7.0% and 8.3% between groups 1 and 2, respectively. Discussion. Although incision placement may influence wound healing complications, it appears that additional factors such as advanced age, delay in surgical intervention, gender, comorbid conditions, prior surgery, and postoperative protocols also play a role. This report suggests that a midline approach is no less precarious in avoidance of wound complications regardless of patient demographics or other surgical details in comparison with a posterior medial incision.

Level of Evidence: Therapeutic, Level IV
Subungual Exostosis of the Great Toe
Authors: Singh Roop , Jain Mantu , Goel Rakesh , Siwach Ramchander , Kalra Rajneesh , Kaur Kiranpreet
Published: September 2011

Subungual exostosis is an acquired, benign, and solitary bone tumor of the distal phalanx occurring beneath or adjacent to nail. A 18-year-old man presented with a lump, ulceration, and pain on his right big toe. This complaint was present for the past 2 years. Initially, lump and pain were present, and since the past 6 months ulceration and superadded infection occurred. Plain radiograph showed a calcified lesion that was continuous with the phalangeal cortical surface in the distal dorsal aspect of the big toe. Excisional biopsy with complete nail removal and reconstruction of the tip of the toe were done. Histopathology confirmed the diagnosis of subungual exostosis. Clinical or radiological recurrence was not observed after 26 months of follow-up. The case is reported to present the tumor overview and to highlight that the diagnosis of this benign lesion should not be missed. Clinical and radiological features allow early diagnosis and treatment thus preventing the lesion to progress to the stage of onycholysis.

Level of Evidence: Therapeutic, Level IV
Accessory Flexor Digitorum Longus Presenting as Tarsal Tunnel Syndrome
Authors: Saar William E. , Bell Jennifer
Published: September 2011

The flexor digitorum accessory longus (FDAL) muscle is one of the most commonly encountered anomalous muscles in the foot and ankle. Literature has documented the prevalence of the FDAL anywhere from 4% to 12%, based on cadaveric limb dissection. The variability of the origin, insertion, size, and location of the FDAL muscle can cause a wide array of foot and ankle pathologies, most notably, tarsal tunnel syndrome and flexor hallucis longus syndrome. Accessory musculature should be included in the list of differential diagnoses for foot and ankle pain until proven otherwise. This report presents a patient who exhibited pain localized to the medial malleolar region and was initially diagnosed with likely tarsal tunnel syndrome. On magnetic resonance imaging, a FDAL muscle was identified and shown to be impinging on the posterior medial anatomic structures. The patient underwent excision of the FDAL and is symptom free to date. The discussion of this case report can prompt foot and ankle surgeons to be more aware of this infrequent finding as well as treatment options.

Level of Evidence: Therapeutic, Level IV
Combining Dissimilar Metals in Orthopaedic Implants: Revisited
Authors: Zartman Kevin C. , Berlet Gregory C. , Hyer Christopher F. , Woodard Joseph R.
Published: September 2011

The use of metals as implant materials has become common practice in the field of orthopaedics. A wide variety of conditions are treated with metallic implants, and designers have used an assortment of materials to meet the unique mechanical demands of each application. The majority of implants used today, whether pins, plates, screws, or total joints, are made of cobalt-chrome alloy, stainless steel, or titanium. Common metallurgic wisdom cautions against bonding dissimilar metals in a biologically active environment. Surgeons have therefore shied away from combining dissimilar metal implants because of the fear of inciting corrosion that could potentially compromise the implants and lead to aseptic loosening, implant failure, or adverse biological reaction in host tissue. As surgical reconstruction and arthroplasty options expand with the advent of newer implants and expanded operative techniques, the orthopaedic surgeon will increasingly be faced with weighing the risks and benefits of combining implants made of dissimilar metals in a patient. Here, the authors examine the origins of the concern over using mixed metals, discuss mechanisms of corrosion as they relate to surgical implants, and review both in vitro and in vivo studies concerning the most common combinations of dissimilar metals in order to guide the surgeon in choosing implants.

Levels of Evidence: Therapeutic, Level IV
Electromyographic Analysis of the Triceps Surae Muscle Complex During Achilles Tendon Rehabilitation Program Exercises
Authors: Mullaney Michael , Tyler Timothy F. , McHugh Malachy , Orishimo Karl , Kremenic Ian , Caggiano Jessica , Ramsey Abi
Published: September 2011

Background: Specific guidelines for therapeutic exercises following an Achilles tendon repair are lacking.

Hypothesis: A hierarchical progression of triceps surae exercises can be determined on the basis of electromyographic (EMG) activity.

Study Design: Randomized laboratory trial.

Methods: Bipolar surface electrodes were applied over the medial and lateral heads of the gastrocnemius as well as the soleus on 20 healthy lower extremities (10 participants, 27 ± 5 years old). Muscle activity was recorded during 8 therapeutic exercises commonly used following an Achilles repair. Maximal voluntary isometric contractions (MVICs) were also performed on an isokinetic device. The effect of exercise on EMG activity (% MVIC) was assessed using repeated measures analysis of variance with Bonferroni corrections for planned pairwise comparisons.

Results: Seated toe raises (11% MVIC) had the least amount of activity compared with all other exercises ( P < 0.01), followed by single-leg balance on wobble board (25% MVIC), prone ankle pumps (38% MVIC), supine plantarflexion with red elastic resistance (45% MVIC), normal gait (47% MVIC), lateral step-ups (60% MVIC), single-leg heel raises (112% MVIC), and single-leg jumping (129% MVIC).

Conclusion: There is an increasing progression of EMG activity for exercises that target the triceps surae muscle complex during common exercises prescribed in an Achilles tendon rehabilitation program. Seated toe raises offer relatively low EMG activity and can be utilized as an early rehabilitative exercise. In contrast, the single-leg heel raise and single-leg jumping should be utilized only during later-stage rehabilitation.

Clinical Relevance: EMG activity in the triceps surae is variable with common rehab exercises.
Joint Line Fullness and Meniscal Pathology
Authors: Couture Jean-Francois , Al-Juhani Wazzan , Forsythe Michael E. , Lenczner Eric , Marien Robert , Burman Mark
Published: September 2011

Background: Meniscal tears have been associated with meniscal cysts and fullness of the knee joint line on physical examination.

Hypothesis: Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears.

Study Design: Prospective cohort study.

Methods: One hundred consecutive patients undergoing knee arthroscopy were included. All had physical examinations documenting the presence of joint line fullness, joint line tenderness, and the McMurray sign. Arthroscopy was the gold standard for tears. Accuracy, sensitivity, and specificity were calculated and correlated with type of tear. Sixty-one patients had a magnetic resonance imaging preoperatively (the gold standard for determining the presence of a cyst).

Results: Meniscal tears were found in 67 patients at arthroscopy. The accuracy, sensitivity, and specificity of joint line fullness were, respectively, 73%, 70%, and 82% in detecting meniscal tears; 68%, 87%, and 30% for joint line tenderness; and 47%, 32%, and 78% for the McMurray sign. The highest positive predictive value for detecting a tear was 88% for joint line fullness, compared with 77% for joint line tenderness and 76% for the McMurray sign. However, joint line fullness did not correlate well with the presence of a cyst, with a low positive predictive value (29%). Of those patients with joint line fullness on physical examination, 89% had a horizontal cleavage component of their tear at arthroscopy.

Conclusion: Joint line fullness is an accurate, sensitive, and specific test to detect meniscal tears.

Clinical Relevance: The findings support the routine use of joint line fullness during physical examination along with other common tests to improve the accuracy of clinically diagnosing meniscal tears.
Metabolic activation of clopidogrel: in vitro data provide conflicting evidence for the contributions of CYP2C19 and PON1
Authors: Polasek Thomas M. , Doogue Matthew P. , Miners John O.
Published: September 2011

The recent report that clopidogrel efficacy may be more dependent on paraoxonase-1 (PON1) than on cytochrome P450 2C19 (CYP2C19) activity raises questions about the roles of these and other enzymes in clopidogrel activation. To provide insight into the emerging PON1 versus CYP2C19 debate, this commentary summarizes the clinical evidence on the pharmacokinetic determinants of clopidogrel efficacy. We then review the in vitro studies investigating the enzymes involved in clopidogrel activation, and comment on their strengths and limitations. There is agreement amongst in vitro studies regarding the involvement of CYP1A2 and CYP2B6 in the metabolism of clopidogrel to 2-oxo-clopidogrel. However, the evidence for other CYP enzymes in the first activation step (e.g. CYP2C19 and CYP3A4) is inconsistent and dependent on the in vitro test system and laboratory. All major drug metabolizing CYP enzymes are capable of converting 2-oxo-clopidogrel to sulfenic acid intermediates that subsequently form the active thiol metabolite. However, the extent of CYP involvement in this second step has been challenged, and new evidence suggests that CYP-independent hydrolytic cleavage of the thioester bond may be more important than oxidative metabolism.
Exercise-Induced Bronchoconstriction in Children and Adolescents
Authors: Weiss Pnina
Published: September 2011

Exercise-induced bronchoconstriction (EIB) is common in children. This article reviews the epidemiology, clinical presentation, pathophysiology, diagnosis, and treatment of EIB. EIB is caused by transient narrowing of the airways during or most often after exercise and indicates airway hyperresponsiveness. EIB is an important cause of exercise limitation in children. However, the diagnosis of EIB can be challenging because symptoms poorly predict the presence of EIB. Bronchial challenges, such as cardiopulmonary exercise testing, are required to document EIB. The severity of EIB is worsened by exposure to inhalational toxicants such as chlorine in pools and air pollution. In most children, EIB can be effectively prevented by both nonpharmacological means and medications. Educating the child, his/her family, and supervising adults about asthma triggers and management is important. Prompt recognition and treatment of an asthma attack associated with exercise is critical; bronchodilators should be on the sidelines at all times, and an asthma action plan should be in place.