Foot and ankle pathologies in juvenile idiopathic arthritis: A narrative review

Derek Santos - ORCID 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XIntroduction: Foot and ankle pathologies are common in juvenile idiopathic arthritis (JIA) and can cause physical disability and reduce quality of life (1). Early detection and evidence-based treatment of these symptomatic pathologies are an important first step in preventing ongoing pain and long-term disabilities in children with JIA.Objectives: To search the literature and provide an update on the types of foot and ankle pathologies reported in children with JIA.Methods: MEDLINE (Ovid) was searched for relevant papers published in English with preference given to papers published in the last 10 years, and older highly regarded cited papers.Results: Foot and ankle pathologies are highly prevalent in JIA (1–3). Foot and ankle pathologies in JIA include joint disease, tenosynovitis, muscle atrophy, enthesitis, digital deformities and biomechanical abnormalities (1–9). One study surveying foot problems found that in a cohort of 30 children with JIA, 63% reported some level of foot-related impairment and 60% with foot-related participation restriction (1). This review outlines and describes each of these foot and ankle pathologies.Joint disease – Joint disease in JIA may include joint swelling, tenderness, pain, warmth and stiffness (4). These symptoms typically occur as a result of synovitis (4) and may be involved in 35-58% of cases (2, 3, 5, 10). Tenosynovitis – inflammation of the tendon sheath in JIA commonly affects the tibialis posterior and peroneal tendons (5). Muscle atrophy – Plantar-flexor muscle atrophy may be observed in children with JIA. This may be more noticeable when there is active joint disease in the ankle (6, 7). A reduction of plantar-flexion strength at the ankle may have implications in the propulsive phase of the gait, by delaying heel lift and increasing plantar pressures on the rear and midfoot. Enthesitis – Inflammation at the site of insertion of a tendon or ligament to the bone is common at the Achilles tendon and the medial tubercle of the calcaneus. These are typically seen in male patients with the enthesitis-related subtype of JIA (4). One recent study with 26 JIA participants (average age of 11.6 years) reported a prevalence of 45% for the Achilles tendon and 20% for the plantar fascia (8). The mean recorded pain on a 100 mm visual analogue scale was 48 mm (8). Quality of life was not measured in this study; however, this level of pain may reduce physical and social well-being. Digital deformities – Inflammation in the forefoot may lead to digital deformities such as clawed toes in children and adolescents with JIA. One study reported a prevalence of 17% in 144 participants (average age = 10.6) with JIA and hallux abducto valgus (2). Children with polyarticular subtype of JIA and those with a longer duration of disease were more likely to have hallux abducto valgus (2). Biomechanical abnormalities – Biomechanical abnormalities of the foot and ankle are associated with prolonged synovitis (3). Synovitis can disrupt normal articulation of the rear and midfoot joints, and can contribute to an excessively pronated foot and abnormal plantar pressures (9). One study found that the prevalence of excessively pronated rear and midfoot joints in 144 JIA participants, was 73% and 72% respectively (2).Conclusion: A range of foot and ankle pathologies are highly prevalent in JIA and contribute to physical morbidity. Allied health professionals may be involved as part of the paediatric rheumatology multidisciplinary team to assist in the early detection and management of these lower limb pathologies. Further research is required to attain accurate prevalence rates and the long-term implications that these foot and ankle conditions may have on a child or adolescent with JIA.https://doi.org/10.1186/s12969-017-0187-815pubpubSuppl.

Proceedings of the 24th Paediatric Rheumatology European Society Congress: Part three

From Springer Nature via Jisc Publications Router.Publication status: PublishedHistory: collection 2017-09, epub 2017-09-0

Reading Differences from Children’s Picture Books: Constructing and De-constructing Images and Texts

My thesis questions how pictures are read; it raises questions about what has to be in place for a reading and what has to be in place for something to be seen as such in a text or a picture. It analyses claims from a wide and multidisciplinary array of sources: from children’s literature and art criticism, from literary theory, philosophy and neuroscience in order to think through a series of problems and issues to do with the reading of pictures and the reading of pictures within children’s picture books specifically. Because reading difference is a key approach and a recurring issue, I will read Gilles Deleuze’s Difference and Repetition in order to think through the relationship between these two underpinning aspects of reading and go on to draw on Jacques Derrida’s Memoirs of the Blind; and this is because I read this text as constituting ‘drawing’ as the repetition of differences. These texts are read in relation to Anthony Browne’s picture book, One Gorilla, a text that as a counting book, is necessarily fundamentally engaged in both repetition and the articulation of difference. This thesis is also one that engages with extant critical notions about reading, the ‘child reader’, and notions of reader competence. It subjects these ideas to scrutiny in order to think through what is at stake in the claims about the putative educational intention or purpose of children’s literature that these notions lead to; they will be read in relation to Aliki’s My Five Senses and Paul Shower’s picture book, Use Your Brain. Finally, this thesis is about the impossibility of interpretative mastery. Indeed, this thesis unpicks many apparent attempts at mastery, including its own, acknowledging in the end the impossibility of arriving at an interpretation without remainder

A comparative investigation into knowledge of object attributes of name, unique function and category membership, in healthy elders and older people with Alzheimer-type dementia

The progressive lexical-semantic deterioration which accompanies dementia of the Alzheimer type (DAT) has been highlighted by recent explorations of knowledge of object attributes, object naming, and recognition of object categories. An Experimental Battery for Semantic Processing devised for this research comprised six tests examining these semantic skills in older people with probable Alzheimer-type dementia at very mild to moderate levels of severity. An innovative set of sixty 'unique feature' or distinctive attribute cues were utilised in a recognition test of concrete nouns from fifteen common semantic categories. The recognition test, presented in both picture and written form, verified that specific attributes were more successful than semantic category in facilitating lexical comprehension in older people with DAT. A naming test afforded the opportunity to evaluate the efficacy of the unique feature cues in facilitating name recall for the noun set. The DAT participants utilised the attribute cues to enable object naming, despite measurable deficits in cognitive and linguistic processing abilities. These findings therefore highlight the potential clinical application of semantic cueing techniques in aiding name recall with this client group. A generative naming test further verified a residual 'core' vocabulary, within each of the fifteen semantic categories, which remained resistant to disease progression in the DAT participants. However, the finding that DAT participants were less successful in accessing broader category information contrasts with reports in the recent literature and warrants further investigation. The performance of the Control subjects, representing healthy elders aged from 65 to 85+ years, confirmed the resistance to advancing chronological age of every lexical test in the Experimental Battery for Semantic Processing. The Standard Measures Battery for Cognitive and Language Function, a screening battery of six cognitive and language tests also compiled for the research, verified that the DAT group were performing at levels significantly below the baseline established by the Controls on every measure. Nevertheless, the DAT participants maintained comparative levels of performance on the semantic tests after an interval of mean nine months, demonstrating the resistance of these lexical measures to advancing duration and severity of disease

Nursing as an Aesthetic Praxis

This Thesis focuses on the experience of being human as process in order to reveal being. Illness and health are seen as reflections of this process of revelation. This work argues that health and illness are physical expressions of consciousness and therefore an outcome of what a human being has thought. In this way, this work shows how thought/intent serves to create life in the moment. In this understanding lies the potential to change reality, to change life. The Thesis identifies self-responsibility as the key to changing consciousness. Taking responsibility for the creation of one's reality eliminates the human tendency to blame another for what is experienced in life. To that end, this work argues, we are each free to choose what is felt in response to life. In so doing, we can become conscious that life is a choice approached from either the position of perfection, or excellence. This work argues that as human beings we have grounded thinking in perfection. In this playing out of rights and wrongs, an independent form of surrender, the outcome is the reification of the thought that we are separate from God. I think, therefore I Am. Such thinking it is argued, is the basis of disease and thus illness is an outcome of thought that as experience has been judged. The thesis develops the position that human beings approach life from the position of perfection thereby creating an appraisal from the outcome of life's experiences. Excellence as a state of being creates the appraisal from the effort of an outcome. Thus excellence, is to experience life as an Isness, and then make a conscious choice to feel love. Perfection makes a judgement about life, and so pronounce life and therefore thinking as good and bad, or right and wrong. In the understanding that human beings are the creators of their reality, it is possible to conceive of care in nursing that is directed at changing thinking/thought. Such change would be to focus on the excellence of life, and in that way enact care in nursing that is an enabling through a process of being that is an emotional allowance in response to life. To this end, this work is titled Nursing as an Aesthetic Praxis. The aesthetic is emotion and feeling. Praxis, is presented in its dialectical relationship of thought and action that is then bound to emotion and feeling in such a way that it illuminates the nature of thinking. This way of thinking, this work shows, is transformatory. Where transformation is a process of being that as a state of excellence is one of incremental human freedom accompanied by incremental responsibility