Paired Samples Analysis of Isolated Gastrocnemius Contracture in Patients with Foot and Ankle Pathology

INTRODUCTION: Prior studies have demonstrated that patients with foot and ankle pain have an associated isolated gastrocnemius contracture (decrease in ankle dorsiflexion). It remains unclear if this is a casual, or a causal relationship. The purpose of the current study is to report validated ankle dorsiflexion in both legs of patients with unilateral foot and ankle pain to provide some insight into the relationship between an isolated gastrocnemius contracture and foot and ankle pain. Our hypothesis was that patients presenting with foot and ankle pain would have similar measured ankle range of motion in both ankles despite having unilateral foot and ankle symptoms. METHODS: Institutional review board approval was obtained and a prospective case-control study was performed. We utilized a previously validated device to measure ankle range motion and isolated gastrocnemius contracture in 21 patients diagnosed with foot and ankle pathology. Measurements were repeated three times on each side with the knee extended to isolate the effect of the gastrocnemius muscle. We additionally performed a clinical examination and goniometer measurement of ankle range of motion. Patient history and demographics were also obtained. RESULTS: Mean dorsiflexion was 12.1 degrees in the extremity with foot and ankle pathology compared to a mean of 15.4 degrees in the unaffected limb, which was a statistically significant difference, (p0.05). The difference in dorsiflexion was significantly less utilizing a goniometer than using the validated device, which may be due to measurement technique and external landmarks, (

Evidence-B(i)ased Medicine: Limitations and Non-Superstition-Based Alternatives

The Evidence-Based Medicine (EBM) movement crystallized in the early 1990\u27s at McMaster University in Canada. The movement originally challenged practitioners to validate their treatments based on reasoning and clinical studies rather than personal authority. In this essay, I will argue that, contrary to this wholesome intention, EBM is authoritarian in spirit and actually constricts discourse about how to make clinical decisions

Transcriptional regulation of bacterial virulence gene expression by molecular oxygen and nitric oxide

© Jeffrey Green, Matthew D Rolfe, and Laura J Smith. Molecular oxygen (O2) and nitric oxide (NO) are diatomic gases that play major roles in infection. The host innate immune system generates reactive oxygen species and NO as bacteriocidal agents and both require O2 for their production. Furthermore, the ability to adapt to changes in O2 availability is crucial for many bacterial pathogens, as many niches within a host are hypoxic. Pathogenic bacteria have evolved transcriptional regulatory systems that perceive these gases and respond by reprogramming gene expression. Direct sensors possess iron-containing co-factors (iron-sulfur clusters, mononuclear iron, heme) or reactive cysteine thiols that react with O2 and/or NO. Indirect sensors perceive the physiological effects of O2 starvation. Thus, O2 and NO act as environmental cues that trigger the coordinated expression of virulence genes and metabolic adaptations necessary for survival within a host. Here, the mechanisms of signal perception by key O2and NO-responsive bacterial transcription factors and the effects on virulence gene expression are reviewed, followed by consideration of these aspects of gene regulation in two major pathogens, Staphylococcus aureus and Mycobacterium tuberculosis

A quantum mechanical approach to establishing the magnetic field orientation from a maser zeeman profile

Recent comparisons of magnetic field directions derived from maser Zeeman splitting with those derived from continuum source rotation measures have prompted new analysis of the propagation of the Zeeman split components, and the inferred field orientation. In order to do this, we first review differing electric field polarization conventions used in past studies. With these clearly and consistently defined, we then show that for a given Zeeman splitting spectrum, the magnetic field direction is fully determined and predictable on theoretical grounds: when a magnetic field is oriented away from the observer, the left-hand circular polarization is observed at higher frequency and the right-hand polarization at lower frequency. This is consistent with classical Lorentzian derivations. The consequent interpretation of recent measurements then raises the possibility of a reversal between the large-scale field (traced by rotation measures)and the small-scale field (traced by maser Zeeman splitting)

Detection of structure in asteroid analogue materials and Titan’s regolith by a landing spacecraft

We compare measurements made by two impact penetrometers of different sizes and with different tip shapes to further understand penetrometer design for performing pentrometry on an asteroid. To this end we re-visit the interpretation of data from the Huygens' penetrometer, ACC-E, that impacted Titan's surface. In addition we investigate the potential of a spacecraft fitted with a penetrometer to bounce using a test rig, built at The Open University (UK). Analysis of ACC-E laboratory data, obtained from impacts into ~4 mm diameter gravel, was found to produce an unusual decrease in resistance with depth (force-depth gradient) which was also seen in the Huygens' ACCE data from Titan and originally interpreted as a wet or moist sand. The downward trend could also be reproduced in a hybrid Discrete Element Model (DEM) if it was assumed that the near surface particles are more readily mobilised than those deeper in the target. With regard to penetrometer design penetration resistance was found to be sensitive to the ratio of particle to tip diameter. A clear trend was observed with a conical tip penetrometer, X-PEN, of decreasing force-depth gradients with increasing particle sizes most likely due to a transformation from a bulk displacement of material by the penetrating tip to more local interactions. ACC-E, which has a hemispherical tip, was found to produce a wider range of force-depth gradients than X-PEN, which had a conical tip, possibly due to difficulties dislodging jammed particles. Both penetrometers were able to determine particle diameter and mass after post-processing of the data. Laboratory simulations of landings with the test rig suggest that a large impact penetrometer under certain circumstances could absorb a significant amount of the elastic energy of the spacecraft possibly aiding landing. Alternatively a small impact penetrometer would allow the spacecraft to bounce freely on the surface to make a measurement at another location

Barriers to Depression Treatment among Low-income, Latino Emergency Department Patients

Objectives. Low-income and Latinos use the emergency department (ED) as a primary source of care. Also, the depression prevalence in ED patients is high, making the ED a compelling venue for depression screening and intervention. This study examined barriers and facilitators to depression treatment among low-income, predominantly Latino ED patients. Methods. We conducted telephone interviews with 24 ED patients (18-62 years of age, 79% female) who dropped out of a depression treatment intervention. Using grounded theory, we analyzed perceptions of depression and treatment, and barriers and facilitators to mental health treatment. Results. Although most patients acknowledged signs of depression, there was a lack of readiness to seek help. Patients reported negative perceptions about anti-depressant medication, even if they had no previous use. Barriers to treatment included transportation concerns, employment/unemployment, patient-provider issues, and immigrant documentation. Identified facilitators included consistent provider advice and “talking.” This study introduced new misunderstanding and miscommunication barriers

High-Tc via electron polar coupling: relation to low-Tc superconductivity and to chiral symmetry in particle physics

Directional coupling of Thornber-Feynman polarization with the high-Tc ARPES distribution specifies the optimum flatband pseudogap \Delta and mobile localized quasiparticle. This coupling peaks by tuning the statistics and interaction energy to produce stable short-ranged directional pairing that reflects the lattice asymmetry. Analogous energy gap and BCS ratio parameters are identified for low-Tc long-range acoustical phonons and for quark-anti-quark tightly bound chiral pions in particle physics.Comment: 25 pages, 4 figures, accepted for publication in Physica

A Systems Approach to Improving Tdap Immunization Within 5 Community-Based Family Practice Settings: Working Differently (and Better) by Transforming the Structure and Process of Care.

OBJECTIVES: We examined how family medicine clinic physicians and staff worked in collaborative teams to implement an automated clinical reminder to improve tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine administration and documentation. METHODS: A clinical reminder was developed at 5 University of Michigan family medicine clinics to identify patients 11 to 64 years old who were in need of the Tdap booster vaccine. Quality improvement cycles were used to improve clinic care processes. Immunization rates from 2008 to 2011 were compared with rates at 4 primary care control clinics. RESULTS: Vaccination rates among eligible patients increased from 15.5% to 47.3% within the family medicine clinics and from 14.1% to 30.2% within the control clinics. After adjustment for covariates, family medicine patients had a higher probability of vaccination than control patients during each measurement period (0.17 vs 0.15 at baseline, 0.53 vs 0.22 during year 1, and 0.50 vs 0.30 during year 2). CONCLUSIONS: Automated clinical reminders, when designed and implemented via a consensus-based framework that addresses the process of care, can dramatically improve provision of preventive health care

Mathematical Modeling of Boson-Fermion Stars in the Generalized Scalar-Tensor Theories of Gravity

A model of static boson-fermion star with spherical symmetry based on the scalar-tensor theory of gravity with massive dilaton field is investigated numerically. Since the radius of star is \textit{a priori} an unknown quantity, the corresponding boundary value problem (BVP) is treated as a nonlinear spectral problem with a free internal boundary. The Continuous Analogue of Newton Method (CANM) for solving this problem is applied. Information about basic geometric functions and the functions describing the matter fields, which build the star is obtained. In a physical point of view the main result is that the structure and properties of the star in presence of massive dilaton field depend essentially both of its fermionic and bosonic components.Comment: 16 pages, amstex, 5 figures, changed conten

Multibeam Maser Survey of methanol and excited OH in the Magellanic clouds: new detections and maser abundance estimates

‘The definitive version is available at www.blackwell-synergy.com.’ Copyright Blackwell Publishing DOI: 10.1111/j.1365-2966.2008.12888.xPeer reviewe