What do we actually know about a common cause of plantar heel pain?:A scoping review of heel fat pad syndrome

BACKGROUND: The heel fat pad is an important structure of the foot as it functions as a cushion to absorb shock and distribute plantar force during ambulation. Clinical practice guidelines or decision support platforms emphasize that heel fat pad syndrome (HFPS) is a distinct pathology contributing to plantar heel pain. We aimed to identify and synthesize the prevalence, etiology and diagnostic criteria, and conservative management of HFPS. METHODS: A comprehensive search was conducted in May 2021 and updated in April 2022, using MEDLINE, Scopus, Cinahl, EMBASE, Cochrane Library, SPORTDiscus, and PEDro and ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP) for pertinent registrations. We included all study types and designs describing the prevalence; etiology and diagnostic criteria; and non-pharmacological, non-surgical interventions for HFPS. RESULTS: We found a small body of original research for HFPS (n = 7). Many excluded full-text articles were expert-opinion articles or studies of heel fat pad in participants with plantar fasciitis/fasciopathy or unspecified heel pain. HFPS may be the second leading cause of plantar heel pain, based on two studies. A number of differentiating pain characteristics and behaviors may aid in diagnosing HFPS vs. plantar fasciopathy. Thinning heel fat pad confirmed by ultrasonography may provide imaging corroboration. Randomized controlled trials assessing the efficacy of viscoelastic heel cups or arch taping for managing HFPS do not exist. CONCLUSIONS: The research literature for HFPS is sparse and sometimes lacking scientific rigor. We have identified a substantial knowledge gap for this condition, frequent inattention to distinguishing HFPS from plantar fasciopathy when describing plantar heel pain, and an absence of robust clinical trials to support the commonly recommended conservative management of HFPS

Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial

Background: Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing. Method/design: A randomised controlled trial (RCT) will be conducted involving pregnant women who are overweight (BMI > 25 to 29.9 k/gm(2)) or obese (BMI > 30 kgm/(2)), less than 14 weeks gestation and recruited from the Barwon South West region of Victoria, Australia. From recruitment until birth, women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing. Brief (less than 5 minute) phone contact will alternate with a text message/email and will involve goal setting, behaviour change reinforcement with weekly weighing and charting, and the provision of health information. Those in the control group will receive usual care. Data for primary and secondary outcomes will be collected from medical record review and a questionnaire at 36 weeks gestation. Discussion: Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care. Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health settings is required so women can be accessed as early in pregnancy as possible. Using a sound theoretical base to inform such an intervention will add depth to our understanding of this approach and to the interpretation of results, contributing to the evidence base for practice and policy

Soil minerals mediate climatic control of soil C cycling on annual to centennial timescales

Climate and parent material both affect soil C persistence, yet the relative importance of climatic versus mineralogical controls on soil C dynamics remains unclear. To test this, we collected soil samples in 2001, 2009, and 2019 along a combined gradient of parent material (andesite, basalt, granite) and climate (mean annual temperature (MAT): 6.5 &deg;C &ldquo;cold&rdquo;, 8.6 &deg;C &ldquo;cool&rdquo;, 12.0 &deg;C &ldquo;warm&rdquo;). We measured the radiocarbon of heterotrophically respired CO2 (∆14Crespired) and bulk soil C (∆14Cbulk) as proxies for transient and persistent soil C, and characterized mineral assemblages using selective dissolution. Using linear regression, we observed that MAT was not a significant predictor of either ∆14Cbulk or ∆14Crespired, yet climate was highly significant as a categorical variable. Climate explained more variance in ∆14Cbulk and ∆14Crespired over 0&ndash;0.1 m, but parent material explained more from 0.1&ndash;0.3 m. Cool site soil C was more persistent (lower ∆14Cbulk) than cold or warm climate sites, and also more persistent on andesitic soils, followed by basaltic and then granitic soils. Poorly crystalline metal oxides (PCMs) (but not crystalline metal oxides) were significantly (p &lt; 0.1) correlated with ∆14Cbulk, ∆14Crespired, and ∆14Crespired - ∆14Cbulk, indicating their importance for soil C cycling on both short and long timescales. The change in ∆14Crespired observed over the study period was linearly related to MAT for the granite soils with the lowest PCM content, but not in the andesitic and basaltic soils with higher PCM content. This link between PCM abundance and the decoupling of MAT and soil C cycling rates suggests PCMs may attenuate the temperature sensitivity of decomposition.</p

A model for assessment of telemedicine applications: MAST

Objectives: Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009 the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study. Methods: MAST was developed through workshops with users and stakeholders of telemedicine. Results: Based on the workshops and using the EUnetHTA Core HTA Model as a starting point a three-element model was developed, including: (i) preceding considerations, (ii) multidisciplinary assessment, and (iii) transferability assessment. In the multidisciplinary assessment, the outcomes of telemedicine applications comprise seven domains, based on the domains in the EUnetHTA model. Conclusions: MAST provides a structure for future assessment of telemedicine applications. MAST will be tested during 2010-13 in twenty studies of telemedicine applications in nine European countries in the EC project Renewing Health

Narrative change in psychotherapy: differences between good and bad outcome cases in cognitive, narrative, and prescriptive therapies

This study aimed to clarify the relationship between changes in the patients’ narratives and therapeutic outcomes. Two patients were selected from three psychotherapeutic models (cognitive, narrative, and prescriptive therapies), one with good therapeutic outcome and the other with bad therapeutic outcome. Sessions from the initial, middle, and final phases for each patient were evaluated in terms of narrative structural coherence, process complexity, and content diversity. Differences between patients’ total narrative production were found at the end of the therapeutic process. Good outcome cases presented a higher statistically significant total narrative change than poor outcome case

Factors affecting maternal participation in the genetic component of the National Birth Defects Prevention Study—United States, 1997–2007

As epidemiological studies expand to examine gene–environment interaction effects, it is important to identify factors associated with participation in genetic studies. The National Birth Defects Prevention Study is a multisite case–control study designed to investigate environmental and genetic risk factors for major birth defects. The National Birth Defects Prevention Study includes maternal telephone interviews and mailed buccal cell self-collection kits. Because subjects can participate in the interview, independent of buccal cell collection, detailed analysis of factors associated with participation in buccal cell collection was possible

Argon behaviour in an inverted Barrovian sequence, Sikkim Himalaya: the consequences of temperature and timescale on ⁴⁰Ar/³⁹Ar mica geochronology

40Ar/39Ar dating of metamorphic rocks sometimes yields complicated datasets which are difficult to interpret in terms of timescales of the metamorphic cycle. Single-grain fusion and step-heating data were obtained for rocks sampled through a major thrust-sense shear zone (the Main Central Thrust) and the associated inverted metamorphic zone in the Sikkim region of the eastern Himalaya. This transect provides a natural laboratory to explore factors influencing apparent 40Ar/39Ar ages in similar lithologies at a variety of metamorphic pressure and temperature (P–T) conditions. The 40Ar/39Ar dataset records progressively younger apparent age populations and a decrease in within-sample dispersion with increasing temperature through the sequence. The white mica populations span ~ 2–9 Ma within each sample in the structurally lower levels (garnet grade) but only ~ 0–3 Ma at structurally higher levels (kyanite-sillimanite grade). Mean white mica single-grain fusion population ages vary from 16.2 ± 3.9 Ma (2σ) to 13.2 ± 1.3 Ma (2σ) from lowest to highest levels. White mica step-heating data from the same samples yields plateau ages from 14.27 ± 0.13 Ma to 12.96 ± 0.05 Ma. Biotite yield older apparent age populations with mean single-grain fusion dates varying from 74.7 ± 11.8 Ma (2σ) at the lowest structural levels to 18.6 ± 4.7 Ma (2σ) at the highest structural levels; the step-heating plateaux are commonly disturbed. Temperatures > 600 °C at pressures of 0.4–0.8 GPa sustained over > 5 Ma, appear to be required for white mica and biotite ages to be consistent with diffusive, open-system cooling. At lower temperatures, and/or over shorter metamorphic timescales, more 40Ar is retained than results from simple diffusion models suggest. Diffusion modelling of Ar in white mica from the highest structural levels suggests that the high-temperature rocks cooled at a rate of ~ 50–80 °C Ma− 1, consistent with rapid thrusting, extrusion and exhumation along the Main Central Thrust during the mid-Miocene

Experiences and perceptions of people with headache: a qualitative study

BACKGROUND: Few qualitative studies of headache have been conducted and as a result we have little in-depth understanding of the experiences and perceptions of people with headache. The aim of this paper was to explore the perceptions and experiences of individuals with headache and their experiences of associated healthcare and treatment. METHODS: A qualitative study of individuals with headache, sampled from a population-based study of chronic pain was conducted in the North-East of Scotland, UK. Seventeen semi-structured interviews were conducted with adults aged 65 or less. Interviews were analysed using the Framework approach utilising thematic analysis. RESULTS: Almost every participant reported that they were unable to function fully as a result of the nature and unpredictability of their headaches and this had caused disruption to their work, family life and social activities. Many also reported a negative impact on mood including feeling depressed, aggressive or embarrassed. Most participants had formed their own ideas about different aspects of their headache and several had searched for, or were seeking, increased understanding of their headache from a variety of sources. Many participants reported that their headaches caused them constant worry and anguish, and they were concerned that there was a serious underlying cause. A variety of methods were being used to manage headaches including conventional medication, complementary therapies and self-developed management techniques. Problems associated with all of these management strategies emerged. CONCLUSION: Headache has wide-ranging adverse effects on individuals and is often accompanied by considerable worry. The development of new interventions or educational strategies aimed at reducing the burden of the disorder and associated anxiety are needed