Do orthopaedic shoes improve local dynamic stability of gait? An observational study in patients with chronic foot and ankle injuries.

BACKGROUND: Complex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS: METHODS: Twenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed. RESULTS: Orthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed. CONCLUSIONS: Footwear adaptation led to pain relief and to improved foot & ankle proprioception. It is likely that that enhancement allows patients to better control foot placement. As a result, higher dynamic stability has been observed. LDS seems therefore a valuable index that could be used in early evaluation of footwear outcome in clinical settings

Subjective perceptions as prognostic factors of time to fitness for work during a 4-year period after inpatient rehabilitation for orthopaedic trauma.

INTRODUCTION: Time to fitness for work (TFW) was measured as the number of days that were paid as compensation for work disability during the 4 years after discharge from the rehabilitation clinic in a population of patients hospitalised for rehabilitation after orthopaedic trauma. The aim of this study was to test whether some psychological variables can be used as potential early prognostic factors of TFW. MATERIAL AND METHODS: A Cox proportional hazards model was used to estimate the associations between predictive variables and TFW. Predictors were global health, pain at hospitalisation and pain decrease during the stay (all continuous and standardised by subtracting the mean and dividing by two standard deviations), perceived severity of the trauma and expectation of a positive evolution (both binary variables). RESULTS: Full data were available for 807 inpatients (660 men, 147 women). TFW was positively associated with better perceived health (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.13-1.19), pain decrease (HR 1.46, 95% CI 1.30-1.64) and expectation of a positive evolution (HR 1.50, 95% CI 1.32-1.70) and negatively associated with pain at hospitalisation (HR 0.67, 95% CI 0.59-0.76) and high perceived severity (HR 0.72, 95% CI 0.61-0.85). DISCUSSION: The present results provide some evidence that work disability during a four-year period after rehabilitation may be predicted by prerehabilitation perceptions of general health, pain, injury severity, as well as positive expectation of evolution

Predicting Non Return to Work after Orthopaedic Trauma: The Wallis Occupational Rehabilitation RisK (WORRK) Model.

BACKGROUND: Workers with persistent disabilities after orthopaedic trauma may need occupational rehabilitation. Despite various risk profiles for non-return-to-work (non-RTW), there is no available predictive model. Moreover, injured workers may have various origins (immigrant workers), which may either affect their return to work or their eligibility for research purposes. The aim of this study was to develop and validate a predictive model that estimates the likelihood of non-RTW after occupational rehabilitation using predictors which do not rely on the worker's background. METHODS: Prospective cohort study (3177 participants, native (51%) and immigrant workers (49%)) with two samples: a) Development sample with patients from 2004 to 2007 with Full and Reduced Models, b) External validation of the Reduced Model with patients from 2008 to March 2010. We collected patients' data and biopsychosocial complexity with an observer rated interview (INTERMED). Non-RTW was assessed two years after discharge from the rehabilitation. Discrimination was assessed by the area under the receiver operating curve (AUC) and calibration was evaluated with a calibration plot. The model was reduced with random forests. RESULTS: At 2 years, the non-RTW status was known for 2462 patients (77.5% of the total sample). The prevalence of non-RTW was 50%. The full model (36 items) and the reduced model (19 items) had acceptable discrimination performance (AUC 0.75, 95% CI 0.72 to 0.78 and 0.74, 95% CI 0.71 to 0.76, respectively) and good calibration. For the validation model, the discrimination performance was acceptable (AUC 0.73; 95% CI 0.70 to 0.77) and calibration was also adequate. CONCLUSIONS: Non-RTW may be predicted with a simple model constructed with variables independent of the patient's education and language fluency. This model is useful for all kinds of trauma in order to adjust for case mix and it is applicable to vulnerable populations like immigrant workers

Cross-cultural adaptation, reliability, internal consistency and validation of the Trinity Amputation and Prosthetic Experience Scales-Revised (TAPES-R) for French speaking patients with lower limb amputation

AimThe aim of this study was the French cross-cultural adaptation and validation of The Trinity Amputation and Prosthetic Experience Scales-Revised (TAPES-R-F), in a lower limb amputation population. This self-reported multidimensional amputee-specific questionnaire [1] evaluates with 33 items psychosocial adjustment (3 subscales), activity restriction (1 subscale) and satisfaction with prosthesis (2 subscales).Patients and methodsOne hundred and twenty-nine patients with a mean age of 62 years and with lower limb amputations for at least 1 year were recruited in 5 clinical centers. Translation and cross-cultural adaptation were made according to international guidelines. Internal consistency of each subscale was measured with Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation in a sub- group of 24 subjects who completed the TAPES-R twice with an interval of 7 days. Construct validity was estimated through correlations with 2 main components of SF-36 (MCS, PCS). Correlations were also calculated with 3 scales of the Brief Pain Inventory (BPI).ResultsCronbach's alpha was high, ranging from 0.85 to 0.95. Reliability was acceptable to high (ICC=0.72 to 0.91) for all subscales with the exception of the Social adjustment (ICC=0.67) and Adjustment to limitation (ICC=0.42) subscales. The 2 component of SF-36 was significantly correlated with all subscales (PCS: r=0.24 to 0.66); MCS: r=0.30 to 0.58), except with aesthetic satisfaction and adjustment to limitation. Regarding the BPI, significant correlations were found for all subscales (r=–0.20 to –0.68) with the exception of adjustment to limitation. Ceiling or floor effects (>15%) were found for all but Activity Restriction and Functional Satisfaction Scales.DiscussionThe TAPES-R-F has acceptable psychometric properties for most of its subscales. Our results may suggest that the French version is more useful in a population research perspective than in an individual perspective. Other studies are necessary to clarify the role and the psychometric properties of this measurement

Multipole Ordering and Fluctuations in f-Electron Systems

We investigate effects of multipole moments in f-electron systems both from phenomenological and microscopic viewpoints. First, we discuss significant effects of octupole moment on the magnetic susceptibility in a paramagnetic phase. It is found that even within mean-field approximation, the magnetic susceptibility deviates from the Curie-Weiss law due to interactions between dipole and octupole moments. Next, we proceed to a microscopic theory for multipole ordering on the basis of a j-j coupling scheme. After brief explanation of a method to derive multipole interactions from the $f$-electron model, we discuss several multipole ordered phases depending on lattice structure. Finally, we show our new development of the microscopic approach to the evaluation of multipole response functions. We apply fluctuation exchange approximation to the f-electron model, and evaluate multipole response functions.Comment: 7 pages, 4 figures, Proceedings of ASR-WYP-200

Modelling and parametric study of the re-anchorage of ruptured tendons in bonded post-tensioned concrete

The contribution of ruptured tendons to the residual strength of bonded post-tensioned concrete structures is currently assessed based on pre-tensioned concrete bond models. However, this approach is inaccurate due to the inherent differences between pre-tensioned and post-tensioned concrete. In this paper, a non-linear 3D finite element model is developed for the re-anchoring of a ruptured tendon in post-tensioned concrete. The model is validated using full-field displacement measurement from 33 post-tensioned concrete prisms and previous experimental data on beams from the literature. The influence of different parameters was investigated, including tendon properties (i.e. diameter, roughness), duct properties (i.e. diameter, thickness, material), initial prestress, concrete strength, grout strength, grout voids, stirrups, and strands, on the tendon re-anchorage. The most influential parameters are found to be tendon and duct properties

A deep cut ellipsoid algorithm for convex programming

This paper proposes a deep cut version of the ellipsoid algorithm for solving a general class of continuous convex programming problems. In each step the algorithm does not require more computational effort to construct these deep cuts than its corresponding central cut version. Rules that prevent some of the numerical instabilities and theoretical drawbacks usually associated with the algorithm are also provided. Moreover, for a large class of convex programs a simple proof of its rate of convergence is given and the relation with previously known results is discussed. Finally some computational results of the deep and central cut version of the algorithm applied to a min—max stochastic queue location problem are reported

Global profiling of co- and post-translationally N-myristoylated proteomes in human cells

Protein N-myristoylation is a ubiquitous co- and post-translational modification that has been implicated in the development and progression of a range of human diseases. Here, we report the global N-myristoylated proteome in human cells determined using quantitative chemical proteomics combined with potent and specific human N-myristoyltransferase (NMT) inhibition. Global quantification of N-myristoylation during normal growth or apoptosis allowed the identification of >100 N-myristoylated proteins, >95% of which are identified for the first time at endogenous levels. Furthermore, quantitative dose response for inhibition of N-myristoylation is determined for >70 substrates simultaneously across the proteome. Small-molecule inhibition through a conserved substrate-binding pocket is also demonstrated by solving the crystal structures of inhibitor-bound NMT1 and NMT2. The presented data substantially expand the known repertoire of co- and post-translational N-myristoylation in addition to validating tools for the pharmacological inhibition of NMT in living cells

Blockade of IL-33 release and suppression of type 2 innate lymphoid cell responses by helminth secreted products in airway allergy

Helminth parasites such as the nematode Heligmosomoides polygyrus strongly inhibit T helper type 2 (Th2) allergy, as well as colitis and autoimmunity. Here, we show that the soluble excretory/secretory products of H. polygyrus (HES) potently suppress inflammation induced by allergens from the common fungus Alternaria alternata. Alternaria extract, when administered to mice intranasally with ovalbumin (OVA) protein, induces a rapid (1–48 h) innate response while also priming an OVA-specific Th2 response that can be evoked 14 days later by intranasal administration of OVA alone. In this model, HES coadministration with Alternaria/OVA suppressed early IL-33 release, innate lymphoid cell (ILC) production of IL-4, IL-5, and IL-13, and localized eosinophilia. Upon OVA challenge, type 2 ILC (ILC2)/Th2 cytokine production and eosinophilia were diminished in HES-treated mice. HES administration 6 h before Alternaria blocked the allergic response, and its suppressive activity was abolished by heat treatment. Administration of recombinant IL-33 at sensitization with Alternaria/OVA/HES abrogated HES suppression of OVA-specific responses at challenge, indicating that suppression of early Alternaria-induced IL-33 release could be central to the anti-allergic effects of HES. Thus, this helminth parasite targets IL-33 production as part of its armory of suppressive effects, forestalling the development of the type 2 immune response to infection and allergic sensitization