A randomized pilot study of a comprehensive postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment

BACKGROUND: Total Hip Arthroplasty (THA) is being used more commonly in younger higher demand patients. The purpose of this randomized pilot study was to explore a) feasibility of comprehensive postoperative rehabilitation compared to usual care following primary THA in subjects <65 years, b) appropriate outcome measures including performance-based measures and c) timing of assessments. METHODS: 21 subjects who underwent primary THA were randomized to receive a three-month out-patient rehabilitation program (Intervention) or usual postoperative care (Control). Subjects were assessed preoperatively, six-weeks postoperatively (Pre-intervention) and four and 12 months postoperatively (Post-intervention). Self-report measures were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and Rand 36-Item Health Survey (RAND-36). Performance-based measures included lower extremity strength, walking speed and endurance, and gait laboratory assessment. RESULTS: Ten Control and 11 Intervention subjects with an average age of 53.4 (SD9.3) years were randomized. All Intervention subjects completed the program without adverse effects. Although no statistically significantly results were reported, four months postoperatively, Intervention subjects had clinically important differences (CID) in strength compared with Control subjects. Walking endurance, WOMAC and RAND scores improved significantly with no CID noted between groups. Ten (48%) subjects reported a ceiling effect on the WOMAC (9 (43%) subjects on Pain; 1 (5%) subject on Function). No group CID were noted in gait measures. CONCLUSIONS: Our recommendations would be that performance-based strength measures should be considered for the primary outcome in this younger cohort. Because of the ceiling effects with WOMAC Pain, a different pain measure is indicated. Other more challenging functional performance-based tests should be considered such as a more prolonged endurance test. There is merit in one-year follow-up as strength improved after four months in both groups

Near-Field Interference for the Unidirectional Excitation of Electromagnetic Guided Modes

Wave interference is a fundamental manifestation of the superposition principle with numerous applications. Although in conventional optics, interference occurs between waves undergoing different phase advances during propagation, we show that the vectorial structure of the near field of an emitter is essential for controlling its radiation as it interferes with itself on interaction with a mediating object. We demonstrate that the near-field interference of a circularly polarized dipole results in the unidirectional excitation of guided electromagnetic modes in the near field, with no preferred far-field radiation direction. By mimicking the dipole with a single illuminated slit in a gold film, we measured unidirectional surface-plasmon excitation in a spatially symmetric structure. The surface wave direction is switchable with the polarization.This work has been supported in part by the Engineering and Physical Sciences Research Council (grant EP/H000917/2). F.J.R.-F. acknowledges support from grant FPI of Generalitat Valenciana. A. M. acknowledges financial support from the Spanish government (contracts Consolider EMET CSD2008-00066 and TEC2011-28664-C02-02). P. G. acknowledges the Royal Society for a Newton International Fellowship.Rodríguez Fortuño, FJ.; Marino, G.; Ginzburg, P.; O’connor, D.; Martínez Abietar, AJ.; Wurtz, GA.; Zayats, AV. (2013). Near-Field Interference for the Unidirectional Excitation of Electromagnetic Guided Modes. Science. 340(6130):328-330. https://doi.org/10.1126/science.1233739S3283303406130Yu, N., Genevet, P., Kats, M. A., Aieta, F., Tetienne, J.-P., Capasso, F., & Gaburro, Z. (2011). Light Propagation with Phase Discontinuities: Generalized Laws of Reflection and Refraction. Science, 334(6054), 333-337. doi:10.1126/science.1210713Ni, X., Emani, N. K., Kildishev, A. V., Boltasseva, A., & Shalaev, V. M. (2011). Broadband Light Bending with Plasmonic Nanoantennas. 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V., & Bergman, D. J. (2002). Coherent Control of Femtosecond Energy Localization in Nanosystems. Physical Review Letters, 88(6). doi:10.1103/physrevlett.88.067402Aeschlimann, M., Bauer, M., Bayer, D., Brixner, T., Cunovic, S., Fischer, A., … Voronine, D. V. (2012). Optimal open-loop near-field control of plasmonic nanostructures. New Journal of Physics, 14(3), 033030. doi:10.1088/1367-2630/14/3/033030Sukharev, M., & Seideman, T. (2006). Phase and Polarization Control as a Route to Plasmonic Nanodevices. Nano Letters, 6(4), 715-719. doi:10.1021/nl0524896Barnes, W. L., Dereux, A., & Ebbesen, T. W. (2003). Surface plasmon subwavelength optics. Nature, 424(6950), 824-830. doi:10.1038/nature01937Schuller, J. A., Barnard, E. S., Cai, W., Jun, Y. C., White, J. S., & Brongersma, M. L. (2010). Plasmonics for extreme light concentration and manipulation. Nature Materials, 9(3), 193-204. doi:10.1038/nmat2630Kim, H., & Lee, B. (2009). Unidirectional Surface Plasmon Polariton Excitation on Single Slit with Oblique Backside Illumination. Plasmonics, 4(2), 153-159. doi:10.1007/s11468-009-9086-2Bonod, N., Popov, E., Li, L., & Chernov, B. (2007). Unidirectional excitation of surface plasmons by slanted gratings. Optics Express, 15(18), 11427. doi:10.1364/oe.15.011427Bouillard, J.-S., Vilain, S., Dickson, W., Wurtz, G. A., & Zayats, A. V. (2012). Broadband and broadangle SPP antennas based on plasmonic crystals with linear chirp. Scientific Reports, 2(1). doi:10.1038/srep00829Li, X., Tan, Q., Bai, B., & Jin, G. (2011). Experimental demonstration of tunable directional excitation of surface plasmon polaritons with a subwavelength metallic double slit. Applied Physics Letters, 98(25), 251109. doi:10.1063/1.3602322Radko, I. P., Bozhevolnyi, S. I., Brucoli, G., Martin-Moreno, L., Garcia-Vidal, F. J., & Boltasseva, A. (2009). Efficient unidirectional ridge excitation of surface plasmons. Optics Express, 17(9), 7228. doi:10.1364/oe.17.007228Liu, Y., Palomba, S., Park, Y., Zentgraf, T., Yin, X., & Zhang, X. (2012). Compact Magnetic Antennas for Directional Excitation of Surface Plasmons. Nano Letters, 12(9), 4853-4858. doi:10.1021/nl302339zCurto, A. G., Volpe, G., Taminiau, T. H., Kreuzer, M. P., Quidant, R., & van Hulst, N. F. (2010). Unidirectional Emission of a Quantum Dot Coupled to a Nanoantenna. Science, 329(5994), 930-933. doi:10.1126/science.1191922Laroche, M., Arnold, C., Marquier, F., Carminati, R., Greffet, J.-J., Collin, S., … Pelouard, J.-L. (2005). Highly directional radiation generated by a tungsten thermal source. Optics Letters, 30(19), 2623. doi:10.1364/ol.30.002623Roelkens, G., Vermeulen, D., Van Laere, F., Selvaraja, S., Scheerlinck, S., Taillaert, D., … Baets, R. (2010). Bridging the Gap Between Nanophotonic Waveguide Circuits and Single Mode Optical Fibers Using Diffractive Grating Structures. 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743-2 Superiority of 3D Echo vs 2D Echo for Quantitating Wall Motion Abnormality as an Index of Myocardial Infarction Size

Two-dimensional echo estimations of the fraction of myocardium showing abnormal wall motion (AWM) are often used as an index of infarct size, to establish prognosis and guide therapy. However 2D echo methods rely on image plane and geometric assumptions which may not be valid when infarction affects ventricular shape. 3D echo reconstruction of the endocardial surface can eliminate the need for these assumptions. Purpose; To use 3D echo and 2D echo to quantitate AWM in experimental acute infarction, and to correlate the extent of AWM with the pathologic determination of infarct size.MethodsCoronary ligation was performed in 14 open chest dogs, and echo imaging performed after 6 hours. 3D echo used 7–8 spatially registered short axis cross-sections to measure % of endocardial surface showing AWM. Two 2D echo methods using multiple, non-spatially registered images were evaluated. Both compared summed endocardial length showing AWM to the total of the endocardial circumferences, expressed as %. Method #1 used 7-8 short-axis slices. Method #2 used basal, mid, apical short axis + apical 4-and 2-chamber views. Percent LV mass (% mass) infarcted was determined by a standard technique.Resultsregression of [x = echo %AWM] vs [y = %mass infarcted]Echo Methodr valueStandard Error of the EstimateEquationp value3D0.94±2.6%y =0.71x-1.81%&lt;0.000120-#10.82±4.3%y =0.50x-0.66%0.001520-#2074±5,1%Y =0.47x-1.25%0.0058ConclusionThree-dimensional echocardiography is a more accurate means of non-invasively estimating myocardial infarct size in this animal model, compared to 2D echo methods

Simultaneous Mapping of T1 and T2 Using Cardiac Magnetic Resonance Fingerprinting in a Cohort of Healthy Subjects at 1.5T

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162735/2/jmri27155.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162735/1/jmri27155_am.pd

Prospective longitudinal associations between persistent sleep problems in childhood and anxiety and depression disorders in adulthood

The objective of this study was to examine the associations between persistent childhood sleep problems and adulthood anxiety and depression. Parents of 943 children (52% male) participating in the Dunedin Multidisciplinary Health and Development Study provided information on their children’s sleep and internalizing problems at ages 5, 7, and 9 years. When the participants were 21 and 26 years, adult anxiety and depression were diagnosed using a standardized diagnostic interview. After controlling for childhood internalizing problems, sex, and socioeconomic status, persistent sleep problems in childhood predicted adulthood anxiety disorders (OR (95% CI) = 1.60 (1.05– 2.45), p = .030) but not depressive disorders (OR (95% CI) = .99 (.63–1.56), p = .959). Persistent sleep problems in childhood may be an early risk indicator of anxiety in adulthood

The twilight of the Liberal Social Contract? On the Reception of Rawlsian Political Liberalism

This chapter discusses the Rawlsian project of public reason, or public justification-based 'political' liberalism, and its reception. After a brief philosophical rather than philological reconstruction of the project, the chapter revolves around a distinction between idealist and realist responses to it. Focusing on political liberalism’s critical reception illuminates an overarching question: was Rawls’s revival of a contractualist approach to liberal legitimacy a fruitful move for liberalism and/or the social contract tradition? The last section contains a largely negative answer to that question. Nonetheless the chapter's conclusion shows that the research programme of political liberalism provided and continues to provide illuminating insights into the limitations of liberal contractualism, especially under conditions of persistent and radical diversity. The programme is, however, less receptive to challenges to do with the relative decline of the power of modern states

Constitutivism

A brief explanation and overview of constitutivism

IL-1-induced Bhlhe40 identifies pathogenic T helper cells in a model of autoimmune neuroinflammation

The features that define autoreactive T helper (Th) cell pathogenicity remain obscure. We have previously shown that Th cells require the transcription factor Bhlhe40 to mediate experimental autoimmune encephalomyelitis (EAE), a mouse model of multiple sclerosis. Here, using Bhlhe40 reporter mice and analyzing both polyclonal and TCR transgenic Th cells, we found that Bhlhe40 expression was heterogeneous after EAE induction, with Bhlhe40-expressing cells displaying marked production of IFN-γ, IL-17A, and granulocyte-macrophage colony-stimulating factor. In adoptive transfer EAE models, Bhlhe40-deficient Th1 and Th17 cells were both nonencephalitogenic. Pertussis toxin (PTX), a classical co-adjuvant for actively induced EAE, promoted IL-1β production by myeloid cells in the draining lymph node and served as a strong stimulus for Bhlhe40 expression in Th cells. Furthermore, PTX co-adjuvanticity was Bhlhe40 dependent. IL-1β induced Bhlhe40 expression in polarized Th17 cells, and Bhlhe40-expressing cells exhibited an encephalitogenic transcriptional signature. In vivo, IL-1R signaling was required for full Bhlhe40 expression by Th cells after immunization. Overall, we demonstrate that Bhlhe40 expression identifies encephalitogenic Th cells and defines a PTX–IL-1–Bhlhe40 pathway active in EAE