Postoperative Deep Vein Thrombosis and Pulmonary Embolism after Ankle Fusion in a Patient with Hemophilia A: A Case Report

Deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) are uncommon postoperative complications of operative procedures for treating injuries of the foot and ankle. Because the disorder of hemophilia A prevents blood clotting and increases bleeding, patients with this condition have been even less likely to develop DVT and PE. We present a 36-year-old man with hemophilia A in whom operative ankle fusion for treating hemophilic arthropathy of the left ankle led to DVT and PE. After decreasing dosage of antihemophilic medication and administering enoxaparin, the symptoms improved and the patient was discharged from the hospital on postoperative day 5. At 3-month follow-up with continued dosage, no complications were reported. Surgeons should be aware of possible DVT and PE in patients with hemophilia A and consider multidisciplinary efforts to successfully treat the resultant symptoms

Marketing a tourism industry in late stage decline: The case of the Isle of Man

Qualitative interviews in the Isle of Man uncovered local perceptions of a tourism industry in late stage decline. Social impacts of decline are pronounced including facilities loss, cultural changes and a heightening of perceived peripherality: which taken together undermine local identity. Tourists are welcomed as they help to affirm the pride residents have in their island in creating a more active atmosphere, provide social interaction opportunities and to combat negative stereotyping. Thus findings emphasise the diverse, unique and persistent benefits of tourism in the Isle of Man, despite its decline. Destination marketing recommendations are therefore made to better address the experiences and desires of communities experiencing decline

Managing tourism decline: insights from the Isle of Man

Qualitative interviews conducted in the Isle of Man investigate local perceptions of a tourism industry in long-term decline: a development stage typically overlooked. Negative impacts of decline are revealed; including facilities loss, landscape erosion, and a heightened sense of peripherality. Together such impacts undermine local identity and attractiveness of place. Tourists are welcomed as they help to affirm the pride residents have in their island, create atmosphere, provide social interaction opportunities, stimulate positive emotions and combat negative stereotyping. Emphasised is the on-going importance of tourism impacts in a peripheral location. Practioner recommendations are therefore made calling attention to the need to more carefully manage the process of decline. Potential strategies for achieving this are signposted

Controls on Microbial and Oolitic Carbonate Sedimentation and Stratigraphic Cyclicity Within a Mixed Carbonate-Siliciclastic System: Upper Cambrian Wilberns Formation, Llano Uplift, Mason County, Texas, USA

The upper Cambrian Wilberns Formation in central Texas records deposition on a low-gradient shelf within a mixed carbonate–siliciclastic tidal-flat system that changes offshore to subtidal shelf and open-marine oolitic skeletal shoals with large microbial mounds. Siliciclastic sediment is interpreted to have been delivered to the tidal flat by aeolian processes because of the narrow range in grain size and paucity of clay. Tidal influence is dominant as evidenced by reversing currents and desiccation on the tidal flat, and megaripples with reversing current indicators in offshore shoals. Intraclastic conglomerates were deposited in broad channels on the tidal flats during storm surges. Microbialite deposition is interpreted to be controlled by accommodation favouring amalgamated thin biostromes developed in the tidal flat vs. larger mounds with greater synoptic relief in the offshore, and current energy resulting in preferential elongation of offshore mounds in a NE–SW orientation. Intertidal mounds and biostromes grew in the presence of significant siliciclastic flux and trapped it within their structure, whereas offshore large buildups incorporated little siliciclastic component. Oolite and skeletal grainstone formed in tide agitated shoals associated with large subtidal microbial mounds. Storms extensively recycled and redistributed skeletal and oolitic sands from the offshore shoals across the shelf as thin sand sheets. Spatial mixing of siliciclastic and carbonate sediment occurred across the tidal flat and shelf. Low-frequency and intermediate-frequency stratigraphic cycles were driven by shifts in the shoreline and changes in rate of siliciclastic flux in response to relative sea-level fluctuation. Random facies stacking and the lack of metre-scale cyclicity are interpreted to reflect stratigraphic incompleteness and an episodic signal introduced by storms

Stigma and Fear: the 'Psy Professional' in Cultural Artifacts

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.The loss of reason called madness provokes perhaps the greatest human fear, for it is reason that dignifies humanity and separates us from beasts. The ‘psy professionals’ - those who prescribe and administer treatments for madness - are frequently portrayed in fiction, film, comics, computer games and entertainments, along with the mad themselves and the asylums that confine them. Overall, these depictions are malign: the reader/watcher/player is encouraged to fear the mad, the madhouse and the mad-doctor. Choosing to use less abrasive vocabulary to name the condition of madness makes no difference to the terror the condition arouses, for the content of many books and games aims to inspire fear. In spite of considerable efforts over many years, the stigma which attaches to mental illness remains firmly in place for patients, while psy professionals also carry their share of “some of the discredit of the stigmatized” (Goffman 1968, p 43) and join patients in a stigmatized group. Popular belief often equates the psy professions with madness (Walter, 1989). This paper explores ways in which the fear of madness, and the stigma which clings to sufferers and their professional carers, is perpetuated by a constant stream of popular cultural artifacts

The Extent and Role of Domestic Tourism in a Small Island: The Case of the Isle of Man

This article presents a case concerning microdomestic tourism on the Isle of Man, British Isles. Despite being a small island, research highlights that considerable domestic tourism occurs (referred to as microdomestic tourism to reflect the small island size and distinguish from wider British Isles tourism), including day trips and overnight stays. Participants identified such behavior as touristic, and distinct from other leisure activities. Qualitative interviews with residents explore the nature of and reasons for microdomestic tourism within a small island. Breaks from routine, entertaining friends and family, and exploring less well known landscapes are shown to underpin. Highlighted is that microdomestic tourism has a variety of potential benefits, which may counter some of the restrictions typically faced by a small island community. Support for an otherwise ailing tourism industry may help to protect facilities and infrastructure used by the wider community, maintain tourism capacity, and provide atmosphere attractive to foreign visitors

A New Saurolophine Dinosaur from the Latest Cretaceous of Far Eastern Russia

Background: Four main dinosaur sites have been investigated in latest Cretaceous deposits from the Amur/Heilongjiang Region: Jiayin and Wulaga in China (Yuliangze Formation), Blagoveschensk and Kundur in Russia (Udurchukan Formation). More than 90% of the bones discovered in these localities belong to hollow-crested lambeosaurine saurolophids, but flat-headed saurolophines are also represented: Kerberosaurus manakini at Blagoveschensk and Wulagasaurus dongi at Wulaga. Methodology/Principal Findings: Herein we describe a new saurolophine dinosaur, Kundurosaurus nagornyi gen. et sp. nov. from the Udurchukan Formation (Maastrichtian) of Kundur, represented by disarticulated cranial and postcranial material. This new taxon is diagnosed by four autapomorphies. Conclusions/Significance: A phylogenetic analysis of saurolophines indicates that Kundurosaurus nagornyi is nested within a rather robust clade including Edmontosaurus spp. Saurolophus spp. and Prosaurolophus maximus, possibly as a sister-taxon for Kerberosaurus manakini also from the Udurchukan Formation of Far Eastern Russia. The high diversity and mosaic distribution of Maastrichtian hadrosaurid faunas in the Amur-Heilongjiang region are the result of a complex palaeogeographical history and imply that many independent hadrosaurid lineages dispersed without any problem between western America and eastern Asia at the end of the Cretaceous. © 2012 Godefroit et al.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

New ophthalmosaurid ichthyosaurs from the European lower cretaceous demonstrate extensive ichthyosaur survival across the Jurassic–Cretaceous boundary

Background Ichthyosauria is a diverse clade of marine amniotes that spanned most of the Mesozoic. Until recently, most authors interpreted the fossil record as showing that three major extinction events affected this group during its history: one during the latest Triassic, one at the Jurassic–Cretaceous boundary (JCB), and one (resulting in total extinction) at the Cenomanian-Turonian boundary. The JCB was believed to eradicate most of the peculiar morphotypes found in the Late Jurassic, in favor of apparently less specialized forms in the Cretaceous. However, the record of ichthyosaurs from the Berriasian–Barremian interval is extremely limited, and the effects of the end-Jurassic extinction event on ichthyosaurs remains poorly understood. Methodology/Principal Findings Based on new material from the Hauterivian of England and Germany and on abundant material from the Cambridge Greensand Formation, we name a new ophthalmosaurid, Acamptonectes densus gen. et sp. nov. This taxon shares numerous features with Ophthalmosaurus, a genus now restricted to the Callovian–Berriasian interval. Our phylogenetic analysis indicates that Ophthalmosauridae diverged early in its history into two markedly distinct clades, Ophthalmosaurinae and Platypterygiinae, both of which cross the JCB and persist to the late Albian at least. To evaluate the effect of the JCB extinction event on ichthyosaurs, we calculated cladogenesis, extinction, and survival rates for each stage of the Oxfordian–Barremian interval, under different scenarios. The extinction rate during the JCB never surpasses the background extinction rate for the Oxfordian–Barremian interval and the JCB records one of the highest survival rates of the interval. Conclusions/Significance There is currently no evidence that ichthyosaurs were affected by the JCB extinction event, in contrast to many other marine groups. Ophthalmosaurid ichthyosaurs remained diverse from their rapid radiation in the Middle Jurassic to their total extinction at the beginning of the Late Cretaceous

Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands

BACKGROUND: There is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated. METHODS: Each therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five. RESULTS: Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p < .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and pedorthotists. CONCLUSION: The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups