Dynamic plantar loading index detects altered foot function in individuals with rheumatoid arthritis but not changes due to orthotic use

Background Altered foot function is common in individuals with rheumatoid arthritis. Plantar pressure distributions during gait are regularly assessed in this patient group; however, the association between frequently reported magnitude-based pressure variables and clinical outcomes has not been clearly established. Recently, a novel approach to the analysis of plantar pressure distributions throughout stance phase, the dynamic plantar loading index, has been proposed. This study aimed to assess the utility of this index for measuring foot function in individuals with rheumatoid arthritis.Methods Barefoot plantar pressures during gait were measured in 63 patients with rheumatoid arthritis and 51 matched controls. Additionally, 15 individuals with rheumatoid arthritis had in-shoe plantar pressures measured whilst walking in standardized footwear for two conditions: shoes-only; and shoes with prescribed custom foot orthoses. The dynamic plantar loading index was determined for all participants and conditions. Patient and control groups were compared for significant differences as were the shod and orthosis conditions.Findings The patient group was found to have a mean index of 0.19, significantly lower than the control group's index of 0.32 (p > 0.001, 95% CI [0.054, 0.197]). No significant differences were found between the shoe-only and shoe plus orthosis conditions. The loading index was found to correlate with clinical measures of structural deformity.Interpretation The dynamic plantar loading index may be a useful tool for researchers and clinicians looking to objectively assess dynamic foot function in patients with rheumatoid arthritis; however, it may be unresponsive to changes caused by orthotic interventions in this patient group.</p

Let me Google that for you:a time series analysis of seasonality in internet search trends for terms related to foot and ankle pain

BACKGROUND: The analysis of internet search traffic may present the opportunity to gain insights into general trends and patterns in information seeking behaviour related to medical conditions at a population level. For prevalent and widespread problems such as foot and ankle pain, this information has the potential to improve our understanding of seasonality and trends within these conditions and their treatments, and may act as a useful proxy for their true incidence/prevalence characteristics. This study aimed to explore seasonal effects, general trends and relative popularity of internet search terms related to foot and ankle pain over the past decade. METHODS: We used the Google Trends tool to obtain relative search engine traffic for terms relating to foot and ankle pain and common treatments from Google search and affiliated pages for major northern and southern hemisphere English speaking nations. Analysis of overall trends and seasonality including summer/winter differences was carried out on these terms. RESULTS: Searches relating to general foot pain were on average 3.4 times more common than those relating to ankle pain, and twice as common as searches relating to heel pain. Distinct seasonal effects were seen in the northern hemisphere, with large increases in search volumes in the summer months compared to winter for foot (p = 0.004, 95 % CI [22.2–32.1]), ankle (p = 0.0078, 95 % CI [20.9–35.5]), and heel pain (p = 0.004, 95 % CI [29.1–45.6]). These seasonal effects were reflected by data from Australia, with the exception of ankle pain. Annual seasonal effects for treatment options were limited to terms related to foot surgery and ankle orthoses (p = 0.031, 95 % CI [3.5–20.9]; p = 0.004, 95 % CI [7.6–25.2] respectively), again increasing in the summer months. CONCLUSIONS: A number of general trends and annual seasonal effects were found in time series internet search data for terms relating to foot and ankle pain. This data may provide insights into these conditions at population levels. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13047-015-0074-9) contains supplementary material, which is available to authorized users

From Service to Experience: Understanding and Defining the Hospitality Business

Failure adequately to define or understand hospitality as a commercial phenomenon has created a fragmented academic environment and a schizophrenia in the industry that has the potential to limit its development as a global industry. This article suggests that, by redefining hospitality as behaviour and experience, a new perspective emerges that has exciting implications for the management of hospitality businesses. A framework to describe hospitality in the commercial domain is proposed. This framework suggests a focus on the host–guest relationship, generosity, theatre and performance, ‘lots of little surprises’, and the security of strangers – a focus that provides guests with experiences that are personal, memorable and add value to their lives

The Very Highly Ionized Broad Absorption Line System of the QSO SBS1542+541

We have analyzed the broad absorption line system of the bright (V=16.5) high-redshift (z=2.361) QSO SBS1542+541 using UV spectra from the HST FOS along with optical data from the MMT and the Steward Observatory 2.3m telescope. These spectra give continuous wavelength coverage from 1200 to 8000 Angstroms, corresponding to 340 to 2480 Angstroms in the QSO rest frame. This object therefore offers a rare opportunity to study broad absorption lines in the rest-frame extreme UV. We find that the absorption system is dominated by very high-ionization species, including O VI, NeVIII, and SiXII. We also identify apparently saturated broad Lyman-series lines of order Ly-gamma and higher. There is strong evidence for partial occultation of the QSO emission source, particularly from the higher-order Lyman lines which indicate a covered fraction less than 0.2. Overall, the data suggest a correlation between a larger covered fraction and a higher state of ionization. We suggest that the different covered fractions can be explained by either a special line of sight through a disk-like geometry or by the existence of density fluctuations of a factor >2 in the BAL gas. Our photoionization models of the system indicate a large column density and high ionization state similar to that found in X-ray ``warm absorbers''.Comment: 31 pages, 13 figures, to be published in Ap

Psychometric Analysis of the Adult Sickle Cell Quality of Life Measurement Information System (ACSQ-Me) in a UK Population

Background: The Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) has been shown to be a reliable and valid questionnaire measuring health-related quality of life (HRQoL) in the US sickle cell disease (SCD) population. The study objective was to test the validity and reliability of the ASCQ-Me for use in the UK. Methods: The US ASCQ-Me, Hospital Anxiety and Depression Scale (HADS), self-reported symptoms, and Medical Outcome Survey Short Form 36 (SF-36) were administered to 173 patients with SCD. Clinical severity was assessed by the number of painful episodes indicated by hospital admissions. Results: The results showed that the item banks of the UK ASCQ-Me had good internal consistency. Anxiety and depression were strongly correlated with the emotional, and social item banks of the UK ASCQ-Me, with moderate correlations between the UK ASCQ-Me item banks and SF-36 components suggesting convergent validity. A confirmatory factor analysis confirmed the conceptual framework of the scale as being the same as the US ASCQ-Me, indicating construct validity. Known groups validity was found, with the ASCQ-Me being able to differentiate by SCD severity groups. Conclusion: The analysis of the sample shows evidence of both validity and reliability of the ACCQ-Me for use in the UK SCD population

Knee joint kinetics in response to multiple three-dimensional printed, customised foot orthoses for the treatment of medial compartment knee osteoarthritis

The knee adduction moment is consistently used as a surrogate measure of medial compartment loading. Foot orthoses are designed to reduce knee adduction moment via lateral wedging. The 'dose' of wedging required to optimally unload the affected compartment is unknown and variable between individuals. This study explores a personalised approach via three-dimensional printed foot orthotics to assess the biomechanical response when two design variables are altered: orthotic length and lateral wedging. Foot orthoses were created for 10 individuals with symptomatic medial knee osteoarthritis and 10 controls. Computer-aided design software was used to design four full and four three-quarter-length foot orthoses per participant each with lateral posting of 0° 'neutral', 5° rearfoot, 10° rearfoot and 5° forefoot/10° rearfoot. Three-dimensional printers were used to manufacture all foot orthoses. Three-dimensional gait analyses were performed and selected knee kinetics were analysed: first peak knee adduction moment, second peak knee adduction moment, first knee flexion moment and knee adduction moment impulse. Full-length foot orthoses provided greater reductions in first peak knee adduction moment (p = 0.038), second peak knee adduction moment (p = 0.018) and knee adduction moment impulse (p = 0.022) compared to three-quarter-length foot orthoses. Dose effect of lateral wedging was found for first peak knee adduction moment (p < 0.001), second peak knee adduction moment (p < 0.001) and knee adduction moment impulse (p < 0.001) indicating greater unloading for higher wedging angles. Significant interaction effects were found for foot orthosis length and participant group in second peak knee adduction moment (p = 0.028) and knee adduction moment impulse (p = 0.036). Significant interaction effects were found between orthotic length and wedging condition for second peak knee adduction moment (p = 0.002). No significant changes in first knee flexion moment were found. Individual heterogeneous responses to foot orthosis conditions were observed for first peak knee adduction moment, second peak knee adduction moment and knee adduction moment impulse. Biomechanical response is highly variable with personalised foot orthoses. Findings indicate that the tailoring of a personalised intervention could provide an additional benefit over standard interventions and that a three-dimensional printing approach to foot orthosis manufacturing is a viable alternative to the standard methods.Full Tex

NdBaScO4: aristotype of a new family of geometric ferroelectrics?

The authors acknowledge the University of St Andrews and the EPSRC (DTG: EP/K503162/1) for a studentship (to CALD). WZ and PSH thank the Welch Foundation (Grant E-1457), NSF DMR-1503573, and the Texas Center for Superconductivity for support. EB thanks the FRS-FNRS for supports and the Consortium des Equipements de Calcul Intensif (CECI), funded by the FRS-FNRS (Grants No. 2.5020.11 and No. 1175545). The research data supporting this publication can be accessed atat http://dx.doi.org/10.17630/197519dd-5b67-49f8-bd50-7f1fb98bec73NdBaScO4 represents the aristotype structure of a new series of -cut layered perovskites; it is suggested that compositional fine-tuning is likely to produce a family of new geometric ferroelectrics, driven primarily by octahedral tilting.PostprintPostprintPeer reviewe

A Composite HST Spectrum of Quasars

We construct a composite quasar spectrum from 284 HST FOS spectra of 101 quasars with redshifts z > 0.33. The spectrum covers the wavelengths between 350 and 3000 A in the rest frame. There is a significant steepening of the continuum slope around 1050 A. The continuum between 1050 and 2200 A can be modeled as a power law with alpha = -0.99. For the full sample the power-law index in the extreme ultraviolet (EUV) between 350 and 1050 A is alpha = -1.96. The continuum flux in the wavelengths near the Lyman limit shows a depression of about 10 percent. The break in the power-law index and the slight depression of the continuum near the Lyman limit are features expected in Comptonized accretion-disk spectra.Comment: 10 figures To appear in the February 1, 1997, issue of the Ap.

Extremely metal-poor Lyman limit system at z = 2.917 toward the quasar HE 0940-1050

We report on detailed Monte Carlo inversion analysis of the Lyman limit system observed at z = 2.917 in the VLT/UVES spectrum of the quasar HE 0940-1050. Metal absorption lines of carbon and silicon in three ionization stages and numerous atomic hydrogen lines have been analyzed simultaneously. It is found that in order to match the observations, the shape of the ultraviolet background ionizing spectrum of Haardt & Madau (1996) should be modified: a spectrum with a higher intensity of the emission feature at 3 Ryd is required. It is also found that synthetic galactic spectra (or different mixtures of them with power law spectra) cannot reproduce the observations, indicating that the stellar contribution to the ionizing background is negligible at z ~= 3. For the first time a very low carbon abundance of [C/H] = -2.93+/-0.13 and the abundance ratio [Si/C] = 0.35+/-0.15 are directly measured in the Lyman limit system with N(H I) = 3.2 10^{17} cm^{-2}. If the absorber at z = 2.917 provides an example of a pristine gas enriched by the nucleosynthetic products of early generations of stars, then the measured value of [Si/C] seems to indicate that the initial mass functions for these stellar populations are constrained to intermediate masses, M_up <= 25M_solar.Comment: 7 pages, 4 figures, A&A in pres

A near-solar metallicity damped Lyman-alpha system toward the BAL quasar Tol 1037-2703

We report the detection of a Broad Absorption Line (BAL) outflow in the spectrum of Tol 1037-2703 with three main BALs at 36000, 25300 and 22300~\kms outflow velocities. Although the overall flow is dominated by high ionization lines like and C IV, the gas of highest velocity shows absorption from Mg I, Mg II and Fe II. Covering factor arguments suggest that the absorbing complexes are physically associated with the QSO and have transverse dimensions smaller than that of the UV continuum emitting region (r<0.1 pc). We show that the C IV absorption at \zabs=2.082 has a covering factor $\sim$ 0.86 and the absorption profile has varied over the last four years. The detection of absorption from excited fine structure levels of C II and Si II in narrow components embedded in the C IV trough reveals large density inhomogeneities. IR pumping is the most likely excitation process. The \zabs=2.139 system is a damped system with log N(H I) ~ 19.7. The weakness of the metal lines together with the high quality of the data make the metallicity measurements particularly reliable. The absolute metallicity is close to solar with [Zn/H]=-0.26. The $\alpha$-chain elements have metallicities consistently solar (respectively +0.05, -0.02, -0.03 and -0.15 for [Mg/H], [Si/H], [P/H] and [S/H]) and iron peak elements are depleted by a factor of about two ([Fe/Zn], [Cr/Zn], [Mn/Zn] and [Ni/Zn] are equal to -0.39, -0.27, -0.49, -0.30). Lines from C I are detected but H$_2$ is absent with a molecular fraction less than 8$\times10^{-6}$. High metallicity and low nitrogen abundance, [N/Zn]=-1.40, favor the idea that metals have been released by massive stars during a starburst of less than 0.5 Gyr of age. (abridged)Comment: To appear in A & A, 12 pages, latex, 15 figure