“They just scraped off the calluses”: a mixed methods exploration of foot care access and provision for people with rheumatoid arthritis in south-western Sydney, Australia

Background: There is little indication that foot health services in Australia are meeting modern day recommendations for Rheumatoid Arthritis (RA) patients. The overall objective of this study was to explore the current state of foot health services for patients with RA with an emphasis on identifying barriers to the receipt of appropriate foot care in South-West Sydney, New South Wales, Australia.Methods: A mixed (quantitative and qualitative) approach was adopted. Indications for appropriate access to foot care were determined by comparing the foot health, disease and socio-demographic characteristics of patients with unmet foot care demands, foot care users and patients with no demands for foot care. Perceptions of provision of, and access to, foot care were explored by conducting telephone-based interviews using an interpretative phenomenology approach with thematic analysis.Results: Twenty-nine participants took part in the cross-sectional quantitative research study design, and 12 participants took part in the interpretative phenomenological approach (qualitative study). Foot care access appeared to be driven predominantly by the presence of rearfoot deformity, which was significantly worse amongst participants in the foot care user group (p = 0.02). Five main themes emerged from the qualitative data: 1) impact of disease-related foot symptoms, 2) footwear difficulties, 3) medical/rheumatology encounters, 4) foot and podiatry care access and experiences, and 5) financial hardship.Conclusions: Foot care provision does not appear to be driven by appropriate foot health characteristics such as foot pain or foot-related disability. There may be significant shortfalls in footwear and foot care access and provision in Greater Western Sydney. Several barriers to adequate foot care access and provision were identified and further efforts are required to improve access to and the quality of foot care for people who have RA. Integration of podiatry services within rheumatology centres could resolve unmet needs of people with RA by permitting rapid access to expert-led multidisciplinary foot care for people with RA

An On-Line Study of Japanese Nesting Complexity

This paper reports the results of a self-paced reading experiment in Japanese in which the materials consisted of four versions of successively more nested syntactic structures. It was found that (1) people read the more nested materials slower than the less nested materials; and (2) the locus of the relative slowdown occurred early in the nested structures. There was no corresponding slowdown when processing the verbs at the end of each clause. The results are therefore not predicted by retrieval-based integration accounts of syntactic complexity. Rather, the results support expectation-based accounts of syntactic complexity for these materials

The X-Ray Properties of the Optically Brightest Mini-BAL Quasars from the Sloan Digital Sky Survey

We have compiled a sample of 14 of the optically brightest radio-quiet quasars ($m_{i}$~$\le$~17.5 and $z$~$\ge$~1.9) in the Sloan Digital Sky Survey Data Release 5 quasar catalog that have C IV mini-BALs present in their spectra. X-ray data for 12 of the objects were obtained via a Chandra snapshot survey using ACIS-S, while data for the other two quasars were obtained from archival XMM-Newton observations. Joint X-ray spectral analysis shows the mini-BAL quasars have a similar average power-law photon index ($\Gamma\approx1.9$) and level of intrinsic absorption ($N_H \lesssim 8\times 10^{21} \ {\rm cm}^{-2}$) as non-BMB (neither BAL nor mini-BAL) quasars. Mini-BAL quasars are more similar to non-BMB quasars than to BAL quasars in their distribution of relative X-ray brightness (assessed with $\Delta\alpha_{\rm ox}$). Relative colors indicate mild dust reddening in the optical spectra of mini-BAL quasars. Significant correlations between $\Delta\alpha_{\rm ox}$ and UV absorption properties are confirmed for a sample of 56 sources combining mini-BAL and BAL quasars with high signal-to-noise ratio rest-frame UV spectra, which generally supports models in which X-ray absorption is important in enabling driving of the UV absorption-line wind. We also propose alternative parametrizations of the UV absorption properties of mini-BAL and BAL quasars, which may better describe the broad absorption troughs in some respects.Comment: ApJ accepted; 21 pages, 11 figures, and 9 table

Dynamic plantar loading index detects altered foot function in individuals with rheumatoid arthritis but not changes due to orthotic use

Background Altered foot function is common in individuals with rheumatoid arthritis. Plantar pressure distributions during gait are regularly assessed in this patient group; however, the association between frequently reported magnitude-based pressure variables and clinical outcomes has not been clearly established. Recently, a novel approach to the analysis of plantar pressure distributions throughout stance phase, the dynamic plantar loading index, has been proposed. This study aimed to assess the utility of this index for measuring foot function in individuals with rheumatoid arthritis.Methods Barefoot plantar pressures during gait were measured in 63 patients with rheumatoid arthritis and 51 matched controls. Additionally, 15 individuals with rheumatoid arthritis had in-shoe plantar pressures measured whilst walking in standardized footwear for two conditions: shoes-only; and shoes with prescribed custom foot orthoses. The dynamic plantar loading index was determined for all participants and conditions. Patient and control groups were compared for significant differences as were the shod and orthosis conditions.Findings The patient group was found to have a mean index of 0.19, significantly lower than the control group's index of 0.32 (p > 0.001, 95% CI [0.054, 0.197]). No significant differences were found between the shoe-only and shoe plus orthosis conditions. The loading index was found to correlate with clinical measures of structural deformity.Interpretation The dynamic plantar loading index may be a useful tool for researchers and clinicians looking to objectively assess dynamic foot function in patients with rheumatoid arthritis; however, it may be unresponsive to changes caused by orthotic interventions in this patient group.</p

Staphylococcus Aureus and Atopic Dermatitis

This study discovered that numbers of S. aureus and coagulase negative staph/micro cocci (CNS/M) correlated between contact plate sampling and the surface wash technique of Williamson and Kligman, 1965. No correlation was found for the diphtheroids. One way analysis of variance across atopic dermatitis (A. D. ) scores showed a trend of increasing S. aureus counts with increasing A. D. score for the contact plate method (p< 0.001) and to a lesser extent for the surface wash technique (p <0.001). It is suggested that defective delta-6-desaturase (an enzyme of unsaturated fatty acid metabolism) function could be the cause of the abnormal bacterial flora of A. D

Humanitarian space - the quest for a protected niche in the global arena : with particular reference to the work of the International Red Cross and Red Crescent Movement

There has been much searching in scholarship as to why the contemporary pattern of humanitarian assistance seems so often to fail gaining popular support in its aim of bringing relief of suffering to peoples affected by crisis. This study searches to open new avenues for explanation by looking afresh at the agency of affected peoples and the creative power which humanity in distress can manifest. By examining some of the arguments in social constructivist theory presented by scholars’ sympathetic to this theoretical approach, my thesis explores ways to revitalise a publicly legitimated space to address this diminished gap. It considers why the paths are so distant and divergent, and seeks a least-contested place to locate its authority which is as close as possible to the populations it seeks to serve. It begins by examining the historical and ideological background to the foundation of the contemporary humanitarian landscape. It frames the current challenges by considering four case-studies which encompass the principal environments of modern complex emergencies, combining challenges of human conflict in situations of natural disaster. Changes in interpretation, action, construction, values and attitudes are considered to ascertain how perceptions of core humanitarian principles have altered, leading to growing public disillusionment with its aims. By considering stakeholder reactions against the emerging dominant patterns in humanitarianism, and identifying some of the challenges a ‘democratisation of aid’ presents, it concludes with suggestions as to how humanity can regain control of its own recovery from crisis, protected as far as possible from national and international political manipulation. This urges re-acknowledgement of the normative power of humanitarianism, and a re-consideration of what it means to be ‘humanitarian’. It summons a revival of the spirit of un-coerced - and non-coercive - voluntary service, and calls for endorsement of a fresh locus of authority to guard its values

Hardware/software co-design of fractal features based fall detection system

Falls are a leading cause of death in older adults and result in high levels of mortality, morbidity and immobility. Fall Detection Systems (FDS) are imperative for timely medical aid and have been known to reduce death rate by 80%. We propose a novel wearable sensor FDS which exploits fractal dynamics of fall accelerometer signals. Fractal dynamics can be used as an irregularity measure of signals and our work shows that it is a key discriminant for classification of falls from other activities of life. We design, implement and evaluate a hardware feature accelerator for computation of fractal features through multi-level wavelet transform on a reconfigurable embedded System on Chip, Zynq device for evaluating wearable accelerometer sensors. The proposed FDS utilises a hardware/software co-design approach with hardware accelerator for fractal features and software implementation of Linear Discriminant Analysis on an embedded ARM core for high accuracy and energy efficiency. The proposed system achieves 99.38% fall detection accuracy, 7.3&times; speed-up and 6.53&times; improvements in power consumption, compared to the software only execution with an overall performance per Watt advantage of 47.6&times;, while consuming low reconfigurable resources at 28.67%

Social Justice Practicum in Non-clinical Online Programs: Engagement Strategies and Lessons Learned

Social justice, the equitable distribution of resources within a community, can be nourished through structured practical experiences that align with content in educational programs. A significant body of research demonstrates the benefits of including practicum when training adult learners (Sanabria, &amp; DeLorenzi, 2019). Further, research elucidates the need for formal social justice training, which may increase equity within our society. This paper summarizes the launch of a social justice practicum within seven non-clinical programs offered through an online campus. Facets of student experience are examined through the lens of adult learning theory. Model adjustments and future directions are also discussed