Physiotherapy management of lower limb osteoarthritis

© The Author 2017. Published by Oxford University Press. Background Osteoarthritis (OA) of the lower limb affects millions of people worldwide, and results in pain and reduced function. We reviewed guidelines and Cochrane reviews for physical therapy interventions to manage the condition. Sources of data Evidence from meta-analyses and systematic reviews was included. We also identified the recommendations from guidelines relevant to practice in the UK. Areas of agreement There is strongest evidence to support the use of exercise to improve pain, function and quality of life. Areas of controversy There is limited evidence to support the use of some commonly utilized physiotherapy interventions. National Institute for Health and Clinical Excellence do not recommend the use of acupuncture. Growing points Programmes that include single exercise type may be more beneficial than combined strengthening and aerobic interventions. Areas timely for developing research Further research is required to determine how to facilitate long-term engagement with exercise to sustain the beneficial effects on pain, function and quality of life. Studies that investigate packages of care, combining interventions require further investigation

Phase I Cultural Resources Survey of the Proposed Index 1-36 Replacement and Relocation Project Smith County, Texas

Perennial Environmental Services, LLC (Perennial), on behalf of Gulf South Pipeline Company, LP (Gulf South), a subsidiary of Boardwalk Pipeline Partners, LP (Boardwalk), conducted an intensive cultural resources survey of the proposed Index 1-36 Replacement and Relocation Project (Project) located approximately 2.2 miles (mi) (3.5 kilometers [km]) northwest of Lindale in Smith County, Texas. The Project involves the replacement of approximately 930.0 feet (ft) (283.5 meters [m]) of 6-inch natural gas pipeline along Gulf South’s existing Index 1-36 pipeline via Horizontal Directional Drilling (HDD). Additionally, Gulf South intends to utilize approximately 0.9 mi (1.5 km) of temporary access roads to connect County Road (CR) 431 with the proposed HDD workspace location. Where possible, Gulf South intends to utilize existing pipeline corridors to facilitate temporary access to the HDD workspace for construction vehicles. The proposed Project may require the usage of a Nationwide Permit (NWP) issued by the US Army Corps of Engineers (USACE). As such, portions of the Project may fall under the jurisdiction of the USACE. Additionally, as the Index 1-36 pipeline is regulated by the Federal Energy Regulatory Commission (FERC), cultural resources surveys were conducted for the Project in accordance with the provisions outlined in Boardwalk’s Blanket Environmental Clearance (effective January 2016 to December 2019). The survey was designed to inventory and assess cultural resources across the Project. These efforts involved both surface and subsurface archaeological survey conducted accordance with Section 106 of the National Historic Preservation Act (NHPA). The workspace required for the HDD efforts measures approximately 3.1 acres in size. This workspace lies adjacent to the Gulf South Index 1-36 pipeline and includes both permanent and temporary workspaces. The access road measures approximately 0.9 mi (1.5 km) in length and approximately 25.0 ft (7.6 m) in width with a total acreage of 2.8 acres. The area of potential effect (APE) measures approximately 5.9 acres with depths of impact extending to depths of 1.0 to 2.0 ft (0.3 to 0.6 m) within the temporary workspace and access road locations. Deep impacts (greater than 6.0 ft [1.8 m]) will only occur within Gulf South’s existing pipeline corridor at the 2.0 by 2.0 ft (0.6 by 0.6 m) diameter HDD drill locations. To allow for flexibility in engineering design, Gulf South requested that Perennial complete an intensive cultural resources survey within an expanded Environmental Survey Area (ESA) for the Project. The total area surveyed within the Project ESA measures approximately 28.1 acres. Perennial conducted the intensive Phase I archaeological investigation within the boundaries of the Project ESA between July 5-8, 2016 and July 25-28, 2016. Jennifer L. Cochran served as the Principal Investigator (PI) for the Project and conducted the fieldwork with the assistance of Michael Maddox. In total, 154 shovel tests were excavated across the entire ESA. The survey investigations resulted in the documentation of five newly recorded sites (41SM474, 41SM475, 41SM476, 41SM477, and 41SM478) and the revisit of site 41SM391 mapped within the Project ESA. These include one historic-age artifact scatter (41SM474), three Transitional Archaic/Early Woodland period open campsites (41SM475, 41SM476, and 41SM477), one multiple component site consisting of historic-age artifacts and prehistoric lithic debris (41SM478), and one historic-age farmstead (41SM391). In regard to the revisit of site 41SM391, no evidence of any cultural materials or features were observed within surface or subsurface contexts along the portion of the Project ESA in proximity to site 41SM391. As such, it is Perennial’s opinion that site 41SM391 does not extend into the Project ESA and will not be impacted by any construction activities associated with the Project. No further work is recommended for site 41SM391 within the Project ESA. Site 41SM474 consists of a late-nineteenth to mid-twentieth century historic artifact scatter composed of non-diagnostic materials, while site 41SM478 consists of a multiple component site represented by late-nineteenth to mid-twentieth artifact scatter intermixed with a scatter of prehistoric artifacts of an undetermined age. Since each of the sites was only delineated within the boundaries of the original Project ESA, the full extent of each site is unknown. As such, the overall NRHP eligibility status of each site is considered to be undetermined. However, an oral history account from the current landowner of the property on which sites 41SM474 and 41SM478 are located did not reveal that the sites are associated with any persons or events of historical significance. Based on the landowner interviews, these sites likely represent the remnants of short-term tenant occupations within an expansive plantation owned by the Bowdoin family. It is unlikely that additional deed or archival research would provide definitive information on the tenant families that occupied these areas. Additionally, based on the lack of intact structures or features and the lack of significant, intact cultural deposits, it is Perennial’s opinion that the portion of site 41SM474 within the Project ESA and the historic-age component of site 41SM478 within the Project ESA be considered noncontributing elements to the overall NRHP eligibility of the site. Based upon the lack of temporally diagnostic tools fragments or significant, intact prehistoric cultural deposits it is also Perennial’s opinion that the prehistoric component of 41SM478 be considered a noncontributing element to the overall NRHP eligibility of the site. No additional investigations are recommended on sites 41SM474 and 41SM478 within the boundaries of the original Project ESA. Due to a change in engineering design for the Project footprint, sites 41SM474 and 41SM478 no longer fall within the current Project footprint and will not be impacted by any construction activities associated with the Project. Sites 41SM475, 41SM476, and 41SM477, all likely represent Transitional Archaic/Early Woodland period open campsites. In regards to site 41SM475, based upon the presence of temporally diagnostic tool fragments, in conjunction with prehistoric ceramic material, and the presence of buried deposits, it is Perennial’s opinion that the NRHP eligibility of site 41SM475 remains undetermined. In regards to site 41SM476, based upon the presence of temporally diagnostic tool fragments, prehistoric ceramic material, preserved floral and faunal remains and the presence of buried deposits, it also Perennial’s opinion that that the NRHP eligibility of site 41SM476 remains undetermined. It is unclear at this time if there are intact, features/occupation zones are present within unexcavated portions of either of these sites within the Project ESA. As such, Perennial recommends the avoidance and protection of the portion of sites 41SM475 and 41SM476 within the Project ESA until more comprehensive site delineation efforts or Phase II testing can be conducted on these sites. In regard to site 41SM477, the site was only delineated within the boundaries of the Project ESA and the full extent of the site is unknown. As such, the overall NRHP eligibility status of the site is considered to be undetermined. However, based on the lack of intact cultural features and the lack of significant, intact cultural deposits, it is Perennial’s opinion that the portion of site 41SM477 within the Project ESA be considered a noncontributing element to the overall NRHP eligibility of the site. No additional investigations are recommended within the boundaries of the current Project ESA. Due to Gulf South’s aggressive construction scheduling, Perennial consulted with the THC concerning interim clearance on a suitable strategy to avoid any impacts to sites 41SM475, 41SM476, and 41SM477. Gulf South intends to utilize 25.0 ft- (7.6-m) wide travel lanes for restricted access across the top of newly recorded site 41SM476. Gulf South also intends to place wooden timber construction matting across the surface of those travel lanes along the portion of site 41SM476 within the Project ESA in order to protect the subsurface deposits located on the site. Additionally, construction matting with be placed across the surface of a portion of the proposed HDD workspace (where the site extends into this location) and no subsurface activities will occur in any of these locations within the site boundary. Gulf South intends to place wooden timber construction matting across the surface of the portion of sites 41SM475 and 41SM477 within the Project ESA in order to protect the deposits located on these sites. Additionally, any vegetation removal necessary across any portions of these sites within the Project ESA will be removed by hand or removed at ground surface level, rather than pulled up from the ground in order to limit causing extensive ground disturbance to the sites. Gulf South has provided three travel lane alternatives that traverse site 41SM476 in different locales and requested interim clearance on all three alternatives across the site. This avoidance plan was initially presented to the THC during a July 20, 2016 meeting with Perennial and Gulf South in order to obtain interim clearance to accommodate Gulf South’s necessarily aggressive construction schedule to relocate portions their Index 1-36 pipeline. The THC concurred with Gulf South’s timber matting strategy to protect the subsurface deposits associated with sites 41SM475, 41SM476, and 41SM477 on August 9, 2016 via an email correspondence. Since Gulf South is planning to avoid any impacts to these sites, no additional work is recommended at this time for sites 41SM475, 41SM476, and 41SM477 in conjunction with the current Project

Vitamin D in obesity

Purpose of review: Vitamin D is essential for bone health, and may also have important functions in immunity and other systems. Vitamin D deficiency is common, and testing and supplementation is increasing. Serum vitamin D is lower in obese people; it is important to understand the mechanism of this effect and whether it indicates clinically significant deficiency. Recent findings: Vitamin D is fat soluble, and distributed into fat, muscle, liver, and serum. All of these compartments are increased in volume in obesity, so the lower vitamin D likely reflects a volumetric dilution effect and whole body stores of vitamin D may be adequate. Despite lower serum vitamin D, obese adults do not have higher bone turnover or lower bone mineral density. Patients undergoing bariatric surgery do have bone loss, and ensuring vitamin D sufficiency in these patients may help to attenuate bone loss. Summary: Lower vitamin D in obese people is a consistent finding across age, ethnicity, and geography. This may not always reflect a clinical problem. Obese people need higher loading doses of vitamin D to achieve the same serum 25-hydroxyvitamin D as normal weight

The MASSIVE Survey - VIII. Stellar Velocity Dispersion Profiles and Environmental Dependence of Early-Type Galaxies

We measure the radial profiles of the stellar velocity dispersions, $\sigma(R)$, for 90 early-type galaxies (ETGs) in the MASSIVE survey, a volume-limited integral-field spectroscopic (IFS) galaxy survey targeting all northern-sky ETGs with absolute $K$-band magnitude $M_K < -25.3$ mag, or stellar mass $M_* > 4 \times 10^{11} M_\odot$, within 108 Mpc. Our wide-field 107" $\times$ 107" IFS data cover radii as large as 40 kpc, for which we quantify separately the inner (2 kpc) and outer (20 kpc) logarithmic slopes $\gamma_{\rm inner}$ and $\gamma_{\rm outer}$ of $\sigma(R)$. While $\gamma_{\rm inner}$ is mostly negative, of the 56 galaxies with sufficient radial coverage to determine $\gamma_{\rm outer}$ we find 36% to have rising outer dispersion profiles, 30% to be flat within the uncertainties, and 34% to be falling. The fraction of galaxies with rising outer profiles increases with $M_*$ and in denser galaxy environment, with 10 of the 11 most massive galaxies in our sample having flat or rising dispersion profiles. The strongest environmental correlations are with local density and halo mass, but a weaker correlation with large-scale density also exists. The average $\gamma_{\rm outer}$ is similar for brightest group galaxies, satellites, and isolated galaxies in our sample. We find a clear positive correlation between the gradients of the outer dispersion profile and the gradients of the velocity kurtosis $h_4$. Altogether, our kinematic results suggest that the increasing fraction of rising dispersion profiles in the most massive ETGs are caused (at least in part) by variations in the total mass profiles rather than in the velocity anisotropy alone.Comment: Accepted/in press, MNRA

A Mixed-Methods Exploration of Magazine Use and Safe Sex in Emerging Adulthood.

Mainstream women’s and men’s lifestyle magazines are widely read and contain large amounts of sexual content, giving them great potential to influence safe sex outcomes in emerging adulthood. However, previous media effects research has failed to examine magazine reading or involvement, to consider a variety of safe sex outcomes, and to investigate pathways through which influence on outcomes may occur. This dissertation addresses these gaps by exploring associations between magazine reading and involvement and a variety of safe sex outcomes using the framework of the Theory of Planned Behavior (TPB) and multiple research methods. Study 1 used structural equation modeling to assess TPB mediators of the connections between magazine use and safe sex intentions among first-year college students (N=457, 61.9% female). Models showed a variety of positive associations between magazine reading and safe sex outcomes, particularly for men who had never engaged in intercourse. Associations between magazine involvement and outcomes were mixed. Study 2 assessed connections between magazine use and safe sex outcomes longitudinally. A subsample of Study 1 participants (N=175, 65.1% female) provided additional data 4 months later, and we assessed how magazine use at Wave 1 related to TPB constructs at Wave 2. Cross-lagged models showed women’s earlier magazine reading was frequently related to their later safe sex outcomes. Finally, Study 3 examined experimental effects of exposure to safe sex content from women’s magazines on safe sex outcomes among college women (N=95). This study demonstrated the ability of brief exposure to magazine content to improve safe sex attitudes and intentions. These effects were often stronger for women who had never engaged in intercourse. These studies for the first time address the potential impact of magazine reading on safe sex outcomes using the framework of TPB, showing that magazine reading may contribute to positive outcomes in the arenas of condom use, safe sex discussion, and HIV/STI testing. Mainstream magazines’ popularity with young people makes them a powerful vehicle through which to share sexual health information and promote safe sex behavior. Future research should continue to investigate the potential for these magazines to positively impact young people’s sexual decision making.Ph.D.PsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/78736/1/walshjen_1.pd

The MASSIVE Survey - VII. The Relationship of Angular Momentum, Stellar Mass and Environment of Early-Type Galaxies

We analyse the environmental properties of 370 local early-type galaxies (ETGs) in the MASSIVE and ATLAS3D surveys, two complementary volume-limited integral-field spectroscopic (IFS) galaxy surveys spanning absolute $K$-band magnitude $-21.5 > M_K > -26.6$, or stellar mass $8 \times 10^{9} < M_* < 2 \times 10^{12} M_\odot$. We find these galaxies to reside in a diverse range of environments measured by four methods: group membership (whether a galaxy is a brightest group/cluster galaxy, satellite, or isolated), halo mass, large-scale mass density (measured over a few Mpc), and local mass density (measured within the $N$th neighbour). The spatially resolved IFS stellar kinematics provide robust measurements of the spin parameter $\lambda_e$ and enable us to examine the relationship among $\lambda_e$, $M_*$, and galaxy environment. We find a strong correlation between $\lambda_e$ and $M_*$, where the average $\lambda_e$ decreases from $\sim 0.4$ to below 0.1 with increasing mass, and the fraction of slow rotators $f_{\rm slow}$ increases from $\sim 10$% to 90%. We show for the first time that at fixed $M_*$, there are almost no trends between galaxy spin and environment; the apparent kinematic morphology-density relation for ETGs is therefore primarily driven by $M_*$ and is accounted for by the joint correlations between $M_*$ and spin, and between $M_*$ and environment. A possible exception is that the increased $f_{\rm slow}$ at high local density is slightly more than expected based only on these joint correlations. Our results suggest that the physical processes responsible for building up the present-day stellar masses of massive galaxies are also very efficient at reducing their spin, in any environment.Comment: Accepted to MNRA

The MASSIVE Survey - X. Misalignment between Kinematic and Photometric Axes and Intrinsic Shapes of Massive Early-Type Galaxies

We use spatially resolved two-dimensional stellar velocity maps over a $107"\times 107"$ field of view to investigate the kinematic features of 90 early-type galaxies above stellar mass $10^{11.5}M_\odot$ in the MASSIVE survey. We measure the misalignment angle $\Psi$ between the kinematic and photometric axes and identify local features such as velocity twists and kinematically distinct components. We find 46% of the sample to be well aligned ($\Psi < 15^{\circ}$), 33% misaligned, and 21% without detectable rotation (non-rotators). Only 24% of the sample are fast rotators, the majority of which (91%) are aligned, whereas 57% of the slow rotators are misaligned with a nearly flat distribution of $\Psi$ from $15^{\circ}$ to $90^{\circ}$. 11 galaxies have $\Psi \gtrsim 60^{\circ}$ and thus exhibit minor-axis ("prolate") rotation in which the rotation is preferentially around the photometric major axis. Kinematic misalignments occur more frequently for lower galaxy spin or denser galaxy environments. Using the observed misalignment and ellipticity distributions, we infer the intrinsic shape distribution of our sample and find that MASSIVE slow rotators are consistent with being mildly triaxial, with mean axis ratios of $b/a=0.88$ and $c/a=0.65$. In terms of local kinematic features, 51% of the sample exhibit kinematic twists of larger than $20^{\circ}$, and 2 galaxies have kinematically distinct components. The frequency of misalignment and the broad distribution of $\Psi$ reported here suggest that the most massive early-type galaxies are mildly triaxial, and that formation processes resulting in kinematically misaligned slow rotators such as gas-poor mergers occur frequently in this mass range.Comment: Accepted to MNRA

Buprenorphine Physician Supply: Relationship with State-Level Prescription Opioid Mortality

Background: Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation’s prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states. Methods: The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June 2013 to January 2016. States were divided into two groups: those with rates of prescription opioid overdose mortality in 2013 at or above the median (\u3e 5.5 deaths per 100,000 population) and those with rates below the median. State-level growth curves were estimated using mixed-effects regression to compare rates of growth between high and low overdose states. Results: The total supply and the supply of 100-patient buprenorphine physicians grew significantly (total supply from 7.7 to 9.9 per 100,000 population, p \u3c 0.001; 100-patient supply from 2.2 to 3.4 per 100,000 population, p \u3c 0.001). Rates of growth were significantly greater in high overdose states when compared to low overdose states (total supply b = 0.033, p \u3c 0.01; 100-patient b = 0.022, p \u3c 0.01). Conclusions: The magnitude of the US prescription opioid crisis, as measured by the rate of prescription opioid overdose mortality, is associated with growth in the number of buprenorphine physicians. Because this observational design cannot establish causality, further research is needed to elucidate the factors influencing physicians’ decisions to begin prescribing buprenorphine

Correlation of Formative Assessments as the Means of Predicting Summative Performance in Paramedic Students

Background: Paramedic programs use formative assessments to determine cognitive competency. Understanding the number of failed units as a probability of passing the summative exam will allow programs to set additional benchmarks. The purpose of this study was to determine whether failure in formative exams determines success on a summative exam. Methods: Formative and summative scores from 2011 - 2016 for paramedic students with accounts in Fisdap, an Internet-based administrative database, were retrospectively reviewed for the following criteria: provided consent for research, completed all six formative (unit) examinations, and completed a summative (comprehensive) examination. Analyses were performed with Pearson correlations and linear regression. Results: A total of 1,406 student records were included based on inclusion criteria. Correlation with each formative and the summative examination were all significant, p \u3c0.001: Cardiology 0.597; Airway 0.571; Medical 0.571; Trauma 0.566; Ob/Pediatrics 0.549; Operations 0.495. The cardiology exam was shown to have a moderate correlation on summative performance, whereas the operations exam had the weakest correlation. The number of formative examination failures was a significant predictor of the probability of passing the summative examination, t(1405) - -31.02 p\u3c0.001. Zero failed unit examinations yielded a 100% probability of passing. Three failed formative exams yielded a 60.4% probability. Four failed attempts yielded a 44.8% probability. Failure of all six formative exams yielded a 13.4% probability of passing the Paramedic Readiness Exam Version 3. Conclusion: Not all formative examinations hold the same predictive power on the probability of passing a summative examination. Each had their own correlation value. Students who did not fail formative examinations have a 100% likelihood of passing the summative examination

In Solidarity

This edition of Next Page is a departure from our usual question and answer format with a featured campus reader. Instead, we asked speakers who participated in the College’s recent Student Solidarity Rally (March 1, 2017) to recommend readings that might further our understanding of the topics on which they spoke