The biopsychosocial-digital continuum of foot orthosis practice and research : the VALUATOR model

Foot orthoses have been used for decades despite uncertainty surrounding their therapeutic efficacy. Orthoses have been used exclusively to affect neuro-biomechanical input and outcome variables, however, there is emerging evidence that therapeutic efficacy may be affected by a psychological stimulus. Critical appraisal of the literature highlights that there is no holistic model upon which foot orthosis practice is taught, practised nor investigated. This paper introduces a conceptual model of foot orthosis practice (Value Based Foot Orthosis Practice (VALUATOR) model) that embraces a broader range of factors that are pertinent to orthosis practice, incorporating contemporary health service behaviours and values into orthosis practice for the first time. Within the VALUATOR model, foot orthosis design and clinical value is considered along a bio-psycho-social-digital continuum that reflects the reality of foot orthosis practice. The model contextualises the variable outcomes that are observed in research and practice within 6 key areas: 1) value, 2) person-centered approach, 3) zone of optimal bio-psycho-social stress, 4) bio-psycho-social assessment, 5) monitoring, 6) primary and secondary clinical strategies. The VALUATOR model is targeted at students, lecturers, scientists and practitioners and includes carefully chosen terminology to support a robust basis for educational and scientific discussion. It is believed that it provides a contemporary viewpoint and a structured conceptual metaphor that builds on existing evidence from a wide range of sources, invites constructive intellectual debate, and is anchored in the experiences of practitioners too. Stress testing the VALUATOR model will help determine its model and support further developments and evolution of orthotic practice in a evidence based way

A conceptual framework for contemporary professional foot care practice : ''The value based digital foot care framework''

Background: A small minority of countries around the globe have podiatry as a recognized profession, hence, there are considerable differences among these countries when it comes to the curricula, the duration of training and legislation regulating the profession. The growth in research led evidence based practice, and the emerging digital landscape of health care practice, occur alongside trends in disease and health behaviours that strongly impact on foot health. As such, the changing complex role of the podiatrist requires critical reflection on current frameworks of practice and whether they are fit for purpose. This commentary presents a conceptual framework which sets the scene for further development of concepts in a podiatry context, reflecting contemporary health care beliefs and the changing expectations of health care and society. The proposed conceptual framework for podiatry practice utilizes the metaphor of an electronic circuit to reflect the vast and complex interconnections between factors that affect practice and professional behaviours. The framework helps in portraying and defining drivers of practice, actual practice as well potential barriers for current and future practice. The circuit emphasis the interconnectedness/interaction of three clusters: 1) internal factors, 2) interaction factors, 3) external factors. Conclusion: Whatever promise this new framework holds, it will only be realised through conscious development of community consensus, respectful dialogue, constructive critical appraisal, and maintaining passion and focus on improving the health of people with foot related problems

The transcriptome of lung tumor-infiltrating dendritic cells reveals a tumor-supporting phenotype and a microRNA signature with negative impact on clinical outcome

Targeting immunomodulatory pathways has ushered a new era in lung cancer therapy. Further progress requires deeper insights into the biology of immune cells in th

The variability of surgical practice during total knee arthroplasty: results of a national survey amongst Belgian knee surgeons

Implant registries have been effective in detecting poorly performing implants and surgical strategies. They learn us however little about many variables that may be equally important to the final result. Today, no standards of care exist for performing total knee arthroplasties (TKA), and little is known about the variability that exists amongst surgeons performing this procedure. A questionnaire with 39 aspects regarding standard surgical routine during TKA was sent to all 112 members of the Belgian Knee Society. Surgeons were stratified according to surgical experience and surgical volume. An important number of routines were performed as standard by the majority (> 70%) of surgeons. Surgeons however significantly differed in the following aspects of the procedure: radiographic evaluation, use of minimally invasive surgery (MIS), preferred landmark for femoral component rotation, method of closure and activities allowed postoperatively. Both surgical experience and surgical volume had a significant effect, but their influence on strategies was different. Less-experienced surgeons used the posterior condylar line as their reference for femoral component rotation significantly more frequent than more-experienced surgeons and were more aggressive towards postoperative sports activities compared to more-experienced surgeons. High-volume surgeons used significantly more frequent MIS and low-volume surgeons preferred a more extensive postoperative radiographic evaluation. Data of this study show that an important number of routines are performed similarly by the majority of surgeons, and that minor but significant differences exist between high-volume versus low-volume surgeons, and between experienced versus less-experienced surgeons

Revisiting Silicalite‑1 Nucleation in Clear Solution by Electrochemical Impedance Spectroscopy

Electrochemical impedance spectroscopy (EIS) was used to detect and investigate nucleation in silicalite-1 clear solutions. Although zeolite nucleation was previously assumed to be a step event, inducing a sharp discontinuity around a Si/OH^– ratio of 1, complex bulk conductivity measurements at elevated temperatures reveal a gradual decay of conductivity with increased silicon concentrations. Inverse Laplace transformation of the complex conductivity allows the observation of the chemical exchange phenomena governing nanoaggregate formation. At low temperatures, the fast exchange between dissociated ions and ion pairs leads to a gradual decay of conductivity with an increasing silicon content. Upon heating, the exchange rate is slower and the residence time of ion pairs inside of the nanoaggregates is increasing, facilitating the crystallization process. This results in a bilinear chemical exchange and gives rise to the discontinuity at the Si/OH^– ratio of 1, as observed by Fedeyko et al. EIS allows the observation of slow chemical exchange processes occurring in zeolite precursors. Until now, such processes could be observed only using techniques such as nuclear magnetic or electron paramagnetic resonance spectroscopy. In addition, EIS enables the quantification of interfacial processes via the double layer (DL) capacitance. The electrical DL thickness, derived from the DL capacitance, shows a similar gradual decay and confirms that the onset of nanoaggregate formation is indeed not narrowly defined