Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA

<b>Background</b>: Foot and ankle problems are a common but relatively neglected manifestation of juvenile idiopathic arthritis. Studies of medical and non-medical interventions have shown that clinical outcome measures can be improved. However existing data has been drawn from small non-randomised clinical studies of single interventions that appear to under-represent the adult population suffering from juvenile idiopathic arthritis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with foot and ankle problems exists. <b>Methods/design</b>: An exploratory phase II non-pharmacological randomised controlled trial where patients including young children, adolescents and adults with juvenile idiopathic arthritis and associated foot/ankle problems will be randomised to receive integrated podiatric care via a new foot care programme, or to receive standard podiatry care. Sixty patients (30 in each arm) including children, adolescents and adults diagnosed with juvenile idiopathic arthritis who satisfy the inclusion and exclusion criteria will be recruited from 2 outpatient centres of paediatric and adult rheumatology respectively. Participants will be randomised by process of minimisation using the Minim software package. The primary outcome measure is the foot related impairment measured by the Juvenile Arthritis Disability Index questionnaire's impairment domain at 6 and 12 months, with secondary outcomes including disease activity score, foot deformity score, active/limited foot joint counts, spatio-temporal and plantar-pressure gait parameters, health related quality of life and semi-quantitative ultrasonography score for inflammatory foot lesions. The new foot care programme will comprise rapid assessment and investigation, targeted treatment, with detailed outcome assessment and follow-up at minimum intervals of 3 months. Data will be collected at baseline, 6 months and 12 months from baseline. Intention to treat data analysis will be conducted. A full health economic evaluation will be conducted alongside the trial and will evaluate the cost effectiveness of the intervention. This will consider the cost per improvement in Juvenile Arthritis Disability Index, and cost per quality adjusted life year gained. In addition, a discrete choice experiment will elicit willingness to pay values and a cost benefit analysis will also be undertaken

The use of 3D surface scanning for the measurement and assessment of the human foot

<p>Abstract</p> <p>Background</p> <p>A number of surface scanning systems with the ability to quickly and easily obtain 3D digital representations of the foot are now commercially available. This review aims to present a summary of the reported use of these technologies in footwear development, the design of customised orthotics, and investigations for other ergonomic purposes related to the foot.</p> <p>Methods</p> <p>The PubMed and ScienceDirect databases were searched. Reference lists and experts in the field were also consulted to identify additional articles. Studies in English which had 3D surface scanning of the foot as an integral element of their protocol were included in the review.</p> <p>Results</p> <p>Thirty-eight articles meeting the search criteria were included. Advantages and disadvantages of using 3D surface scanning systems are highlighted. A meta-analysis of studies using scanners to investigate the changes in foot dimensions during varying levels of weight bearing was carried out.</p> <p>Conclusions</p> <p>Modern 3D surface scanning systems can obtain accurate and repeatable digital representations of the foot shape and have been successfully used in medical, ergonomic and footwear development applications. The increasing affordability of these systems presents opportunities for researchers investigating the foot and for manufacturers of foot related apparel and devices, particularly those interested in producing items that are customised to the individual. Suggestions are made for future areas of research and for the standardization of the protocols used to produce foot scans.</p

On the coevolution of social norms in primitive societies

We study the evolutionary origin of a social norm of the kind "cooperate frequently and share fully" observed in modern hunter-gatherers. In order to do this, a two-stage game in which a pie has first to be produced and then divided is proposed. We assume that the bargaining rule is sensitive to investment behavior and to the degree of property rights protection. We show that, when a unique stochastically stable outcome exists, a norm of investment and a norm of division coevolve supporting the efficient investment profile and the egalitarian distribution of the surplus, respectively. The conditions needed for norms to coevolve depend on whether property rights over the fruits of one's own independent investment are secured or not

Making the Dead Visible: Problems and Solutions for “Big” Picture Approaches to the Past, and Dealing with Large “Mortuary” Datasets

There can be few “bigger” questions than the nature and development of human experience and self-awareness and few better ways to study it than through the changing treatment of the dead over time. Funded by the John Templeton Foundation, the ‘Invisible Dead’ project (Durham University) is exploring diachronic changes in mortuary practices across two regions: Britain and the Levant. In doing so, it uses archaeology as a way to approach fundamental questions about the human condition. This paper explores the principal difficulties faced during the construction of a database for this project and their wider relevance for the development of robust and successful methods for the study of large “mortuary” datasets in the future. It discusses the issues and biases identified within the mortuary record and how the project has sought to mitigate some of these. By adopting a flexible and ultimately expandable approach to data entry and analysis, value can be added to legacy datasets and “grey” literature, allowing us to make comparisons between regions which are both geographically and chronologically distinct