Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group) versus usual care (control group) after plaster removal in adults with surgically treated ankle fractures.</p> <p>Methods</p> <p>In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS) which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36), timed walking tests, ankle mobility tests, muscle strength tests and radiological status.</p> <p>Results</p> <p>52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028), muscle strength in the plantar flexors (p = 0.029) and dorsiflexors (p = 0.030).</p> <p>Conclusion</p> <p>The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three out of nine outcome measures showed a difference, the beneficial effect from an additional standardised individually suited training program can be expected to be limited. There is need for further studies to elucidate how a training program should be designed to increase and optimise function in patients middle-aged or older.</p> <p>Trial Registration</p> <p>Current Controlled Trials ACTRN12609000327280</p

Wilmer’s Park Inspiration Pop-Up

This project includes an archive of 12 x 12 inch airbrush designs meant to cover a tent/canopy that could be used for pop-up appearances at Wilmer’s Park events. The designs highlight the experience, history, and stories of the historic park.In order to contribute to the continuing scenario planning and development of the Wilmer’s Park historical site, students in Professor Brandon Donahue’s Art 427 Advanced Painting: Art and Community apply their course learnings in the form of airbrush application and painting. Students researched the history of Wilmer’s Park, visited the site, met with relevant guests, and Prince George’s County staff familiar with the project. They used these experiences to translate the stories and memories of the park into an archive of 12 x 12 inch airbrush designs. These designs will cover a tent/canopy that will be used for a pop-up appearance at any event associated with Wilmer’s Park. The tent/canopy will serve as an archive of the “revival” of Wilmer’s Park’s legacy

Organs at\ua0Risk (OAR) Tolerance in Hypofractionated Radiosurgery

For CyberKnife radiosurgery, the precise interpretation of the normal probability of tissue complications (NTCP) is extremely important due to the reverse planning algorithm and the non-isocentric irradiation geometry adopted by the system, which requires the setting of dose constraints for any organ at risk (OAR). Despite eight decades of practice in radiation therapy, the current understanding of radiobiology remains fairly imprecise, especially the tolerance limits of OAR at hypofractioned schedules. Here, we provide an overview of the radiation tolerance limits of the optic pathway, spinal cord, brain and other central nervous system OARs. Above all, we summarize the basic principles of radiobiology and describe how these can be used to aid decision making for hypofractionated treatments. Basically, we provide radiobiological bases to build models that can be used to safely and effectively extrapolate the doses to be delivered in hypofractioned schedules starting from single fraction clinical data and conventionally fractionated radiotherapy. Although this approach has several limitations, it can provide some practical suggestions and help users to increase confidence with hypofractionated approache

Stereotactic Radiosurgery for Skull Base Meningiomas

Complete resection of meningiomas occurring at the skull base may be difficult, due to the proximity of critical neurovascular structures. Due to the benign nature of these lesions, most patients with skull base meningiomas have an extended life expectancy. The goal of treatment for these lesions, therefore, revolves around long-term tumor control without worsening neurological function. Stereotactic radiosurgery is one of three main treatment options for the treatment of cranial base meningiomas, and has been shown to have similar rates of tumor control with safe administration within 3–5 mm of cranial nerves and brainstem. In this chapter, we review the literature reporting outcomes following use of stereotactic radiosurgery for these lesions, and the rationale for decision-making about treatment for these lesions