Nonoperative Management of Shoulder Instability

Non-operative management following a shoulder dislocation or subluxation remains a challenging and complex task. Accurate diagnosis of the condition, and shared decision-making regarding operative and non-operative management, as well as timing of return to play is required. This clinical concept paper introduces a shoulder instability framework that addresses these fundamental clinical dilemmas. Valid clinical prognostic tools which can predict recurrent shoulder instability are reviewed. The process of shared decision-making within the realm of shoulder instability is also presented. Finally, a framework for progressive rehabilitation that addresses deficits in motor control, strength, and endurance in scapula and shoulder musculature is presented to guide patients from an initial instability event, through to return to play

Towards compliant distributed shared memory

Copyright © 2002 IEEEThere exists a wide spectrum of coherency models for use in distributed shared memory (DSM) systems. The choice of model for an application should ideally be based on the application's data access patterns and phase changes. However, in current systems, most, if not all of the parameters of the coherency model are fixed in the underlying DSM system. This forces the application either to structure its computations to suit the underlying model or to endure an inefficient coherency model. This paper introduces a unique approach to the provision of DSM based on the idea of compliance. Compliance allows an application to specify how the system should most effectively operate through a separation between mechanism, provided by the underlying system, and policy, pro-vided by the application. This is in direct contrast with the traditional view that an application must mold itself to the hard-wired choices that its operating platform has made. The contribution of this work is the definition and implementation of an architecture for compliant distributed coherency management. The efficacy of this architecture is illustrated through a worked example.Falkner, K. E.; Detmold, H.; Munro, D. S.; Olds, T

In children 18 years and under, what promotes recurrent shoulder instability after traumatic anterior shoulder dislocation? A systematic review and meta-analysis of risk factors

Background Skeletal maturity and age-related changes in the composition of the glenoid labrum and joint capsule may influence rates of recurrent instability in children. We systematically review risk factors which predispose children to recurrent shoulder instability. Methods The systematic review-concerned studies published before May 2015. Statistical analysis was undertaken to compare rates of recurrence for each extracted risk factor. Pooled ORs were analysed using random effects meta-analysis. Results 6 retrospective cohort studies met the inclusion criteria. 8 risk factors were identified across the studies including age, sex, shoulder dominance and injury side, mechanism of injury, state of physis closure, and Hill-Sachs and Bankart lesions. The rate of recurrent instability was 73%. Children aged 14–18 years were 24 times more likely to experience recurrent instability than children aged 13 years and less (93% vs 40%; OR=24.14, 95% CI (3.71 to 156.99), Z=3.33, p=0.001, I2=6.83%). There was a non-significant trend indicating males were 3.4 times more likely to experience recurrent instability (OR=3.44, 95% CI (0.98 to 12.06), Z=1.93, p=0.053, I2=0%). Analysis of one study found that children with a closed physis are 14 times more likely to experience recurrent instability compared with those with an open physis (OR=14.0, 95% CI (1.46 to 134.25), Z=2.29, p=0.02, I2=0%) . Conclusions Male children aged 14 years and over had the greatest risk of recurrent shoulder instability following a first-time traumatic anterior shoulder dislocation. This meta-analysis summarises a mix of 6 acceptable and poor quality level III retrospective cohort studies. Further examination of this population with blinded prospective cohort studies will assist clinicians in the appropriate management of first-time traumatic anterior shoulder dislocation

Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis

Recurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this population to events of recurrence

Does home equipment contribute to socioeconomic gradients in Australian children’s physical activity, sedentary time and screen time?

Abstract Background Activity behaviours (physical activity, sedentary time and screen time) have been linked to health outcomes in childhood. Furthermore, socioeconomic disparities have been observed in both children’s activity behaviours and health outcomes. Children’s physical home environments may play a role in these relationships. This study aimed to examine the associations and interactions between children’s physical home environment, socioeconomic status and moderate-to-vigorous physical activity, sedentary time and screen time. Methods Australian children (n = 528) aged 9–11 years from randomly selected schools participated in the cross-sectional International Study of Childhood Obesity, Lifestyle and the Environment. Children’s physical home environment (access to equipment), socioeconomic status (household income and parental education) and demographic variables (gender and family structure) were determined by parental questionnaire. Moderate-to-vigorous physical activity and sedentary time were measured objectively by 7-day 24-h accelerometry. Screen time was obtained from child survey. The associations between the physical home environment, socioeconomic status and moderate-to-vigorous physical activity, sedentary time and screen time were examined for 427 children, using analysis of covariance, and linear and logistic regression, with adjustment for gender and family structure. Results The presence of TVs (p < 0.01) and video game consoles (p < 0.01) in children’s bedrooms, and child possession of handheld video games (p = 0.04), cell phones (p < 0.01) and music devices (p = 0.04) was significantly and positively associated with screen time. Ownership of these devices (with the exception of music devices) was inversely related to socioeconomic status (parental education). Children’s moderate-to-vigorous intensity physical activity (p = 0.04) and possession of active play equipment (p = 0.04) were both positively associated with socioeconomic status (household income), but were not related to each other (with the exception of bicycle ownership). Conclusions Children with less electronic devices, particularly in their bedrooms, participated in less screen time, regardless of socioeconomic status. Socioeconomic disparities were identified in children’s moderate-to-vigorous physical activity, however socioeconomic status was inconsistently related to possession of active play equipment. Home active play equipment was therefore not a clear contributor to the socioeconomic gradients in Australian children’s moderate-to-vigorous physical activity

The Structure and Sensitivity of the Eye of Different Life History Stages of the Ontogenetic Migrator Gnathophausia ingens

The structure and ultrastructure of the photoreceptors of several life history stages of the ontogenetically migrating lophogastrid crustacean Gnathophausia ingens were examined. The younger instars of this species live in a much brighter light field than the older instars, and this difference is reflected in differences in their visual systems. The shallowest free living individuals (instars 3 and 4) possess a superposition eye with almost no clear zone, which minimizes the light shared between ommatidia and reduces the sensitivity of the eye. A progression to superposition optics with a large clear zone, usually associated with night-active or deep-living species, occurs as the animals move deeper in the water column. Regional differences within the eye are also evident, with a largely nonexistent clear zone in the dorsal region and a large clear zone in the ventral region in the eyes of instar 5 animals, the first instar to move to deeper depths. The deepest living instars (10–12) possess superposition optics with a large clear zone throughout the eye, and are significantly more sensitive to light than the younger, shallower instars

Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States

Published: 3 May 2016Background: International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. Methods: This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Results: Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons’ concern with security versus the need for timely access to medical care. Conclusion: Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians’ over-burden of cancer mortality and over-representation in the prison system, further research is needed to identify whether there are a unique set of barriers for this group.Jessica Olds, Rachel Reilly, Paul Yerrell, Janet Stajic, Jasmine Micklem, Kim Morey and Alex Brow