Contribution of vision, touch, and hearing to the use of sham devices in acupuncture-related studies

Derek Santos - ORCID 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XThis study investigates whether visual deprivation influences participants' accuracy in differentiating between real and sham acupuncture needles. It also evaluates the relative contributions of tactile, visual, and auditory cues that participants use in their decision-making processes. In addition, a simple sensory decision-making model for research using acupuncture sham devices as comparative controls is proposed. Forty healthy individuals underwent two conditions (blindfolded and sighted) in random sequence. Four sham and four real needles were randomly applied to the participants' lower limb acupoints (ST32 to ST39). Participants responded which needle type was applied. Participants then verbally answered a questionnaire on which sensory cues influenced their decision-making. The proportion of correct judgments, P(C), was calculated to indicate the participants' accuracy in distinguishing between the needle types. Visual deprivation did not significantly influence the participants' discrimination accuracy. Tactile cues were the dominant sensory modality used in decision-making, followed by visual and auditory cues. Sharp and blunt sensations were associated with the real and sham needles, respectively, for both conditions. This study confirmed that tactile cues were the main sensory modalities used in participant decision-making during acupuncture administration. Also, short-term blindfolding of participants during procedures will unlikely influence blinding effectiveness.https://doi.org/10.1016/j.jams.2019.12.00313pubpub

The development of a system to measure the effects of plantar foot pressure on the microcirculation of the foot

An investigation into the effects of plantar foot pressure on the microcirculation of healthy subjects and patients with Rheumatoid Arthritis was carried out. In the light of no equipment available to carry out this study a new system was developed. A shoe device was built with a combined pressure/skin blood flow transducer embedded in a three-tier piston mechanism in the heel so that plantar foot pressure could be applied/removed and quantified. The skin blood flow transducer made contact with the skin and was able to collect data about the microcirculatory state of the skin. The first system developed consisted of the laser Doppler Fluxmeter (Moor Instruments Ltd., UK) used to collect skin blood flow information and incorporating a strain gauge (Kyowa Electronic Instruments Co. Ltd., Japan) to quantify plantar foot pressure applied to the centre of the heel. This system was visually/sound synchronised and due to the time delay error it was modified. For the final system developed, the strain gauge was replaced with a custom-made Novel capacitative transducer (Novel, Germany) to quantify pressure. This allowed for the pressure system to be electronically synchronised in real time with the laser Doppler fluxmeter using an electronic synchronisation box. A number of studies were carried out to validate the systems. The developed systems were used to: (a) investigate the effects of the venoarteriolar response in healthy subjects with regards to the effects of plantar foot pressure on skin blood flow. The study concluded that subject positioning (that is, supine or semi-weight bearing) has an effect on how the microcirculation of the skin reacts to applied pressure. Thus, studies investigating the effects of external pressure on skin blood flow must have their subjects in a position that is related to what is being studies; (b) investigate the effects of plantar foot pressure on skin blood flow in patients with Rheumatoid Arthritis. A healthy control group was compared with a cohort of patients with Rheumatoid Arthritis with no evidence of vasculitis. The study concluded that there were no significant differences between both groups. A number of articles have been published from this thesis (see Appendix 14).EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Repeatability and Reproducibility of the F-Scan System in Healthy Children

This study investigated the repeatability and reproducibility of the F-scan system with regards to Peak Pressure Values (PP) and Pressure Time Integral (PTI) in healthy children, ranging between 5 to 18 years of age. Participants took part in two non-invasive clinical assessments, at baseline and one week later. Standardized footwear was supplied and each child was fitted with the equivalent F-scan insole size. A total of 3 trials of 7 meters distance each were conducted. Plantar pressure analysis was carried out using a novel approach of masking the recordings into 10 different areas; both peak pressure (PP) and pressure time integrals (PTI) values were investigated. The PP and PTI were investigated for the left, right and both feet analysed together. Interclass Correlation Coefficient (ICC) test was adopted for statistical analysis. Overall, 30 healthy children were recruited and 60 appointments were completed; 53.3% (n = 16) were female, mean age was 13.3 years (SD = 4.5). Results highlighted that overall the ICC for repeatability was > 0.75 for 95.8% (no = 115) and between 0.5 and 0.75 for 4.2% (no = 5); the ICC for reproducibility was > 0.75 for 85% (no = 51), and between 0.5 and 0.75 for 15% (no = 9). In conclusion, the F-Scan system can be utilised to record repeatable and reproducible data in paediatric gait analysis.sch_pod1. Ahroni JH, Boyko EJ, Forsberg R. Reliability of F-scan in-shoe measurements of plantar pressure. Foot Ankle Int. 1998;19(10):668-73. 2. Chen B, Bates B. Comparison of F-Scan in-sole and AMTI forceplate system in measuring vertical ground reaction force during gait. Physiotherapy Theory & Practice. 2000;16(1):43-53. doi:10.1080/095939800307601. 3. Joanne S Paton, Elizabeth A Stenhouse, Graham Bruce, Daniel Zahra, and Ray B Jones. A comparison of customised and prefabricated insoles to reduce risk factors for neuropathic diabetic foot ulceration: a participantblinded randomised controlled trial. J Foot Ankle Res. 2012; 5: 31. doi: 10.1186/1757-1146-5-31. 4. Luo ZP, Berglund LJ, An KN. Validation of F-Scan pressure sensor system: a technical note. J Rehabil Res Dev. 1998;35(2):186-91. 5. Randolph AL, Nelson M, Akkapeddi S, Levin A, Alexandrescu R. Reliability of measurements of pressures applied on the foot during walking by a computerized insole sensor system. Arch Phys Med Rehabil. 2000;81(5):573-8. 6. Quesada P, Rash G, Jarboe N. Assessment of pedar and F-Scan revisited. Clin Biomech (Bristol, Avon). 1997;12(3):S15. 7. Tekscan. F-scan user manual Tekscan; 2010. 8. SIGN. Management of Obesity, a national clinical guideline. Scottish Intercollegiate Guidelines Network, Part of NHS Quality Improvement Scotland. 2010. 9. Bolton W. Instrumentation and measurement, 3rd ed. Newnes B-H, editor. 2000. p. 3-40. 10. Bircher A, DeBoer E, Agner T, Wahlberg J, Serup J. Guidelines for Measurement of cutaneous blood flow by laser Doppler flowmetry. Contact Dermatitis. 1994;30(2):65-72. 11. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Prentice Hall Health, Upper Saddle River; 2000. 12. Fleiss JL. The Design and Analysis of Clinical Experiments. 1st Ed. New York: Wyley; 1986. 13. Li Lu M, Nawar S. Reliability analysis: Calculate and Compare Intraclass Correlation Coefficients (ICC) in SAS. Epidemiology DoBa, editor. Hyattsville: The MedStar Research Institute; 2007. 14. Bland JM, Altman DG. Measurement error and correlation coefficients. BMJ. 1996;313(7048):41-2. 15. Menz H. Two feet, or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine. The Foot. 2004;14(1):2-5. 16. Brostrom E, Haglund-Akerlind Y, Hagelberg S, Cresswell AG. Gait in children with juvenile chronic arthritis. Timing and force parameters. Scand J Rheumatol. 2002;31(6):317-23. 17. Dixon SJ, McNally K. Influence of orthotic devices prescribed using pressure data on lower extremity kinematics and pressures beneath the shoe during running. Clin Biomech (Bristol, Avon). 2008;23(5):593-600. doi: 10.1016/j.clinbiomech.2008.01.015. 18. Fairburn PS, Panagamuwa B, Falkonakis A, Osborne S, Palmer R, Johnson B, et al. The use of multidisciplinary assessment and scientific measurement in advanced juvenile idiopathic arthritis can categorise gait deviations to guide treatment. Arch Dis Child. 2002;87(2):160-5. 19. Hadfield MH, Snyder JW, Liacouras PC, Owen JR, Wayne JS, Adelaar RS. Effects of medializing calcaneal osteotomy on Achilles tendon lengthening and plantar foot pressures. Foot Ankle Int. 2003;24(7):523- 9. 20. Hendry GJ, Turner DE, McColl J, Lorgelly PK, Sturrock RD, Watt GF, et al. Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA. J Foot Ankle Res. 2009;2:21. doi: 10.1186/1757- 1146-2-21. 21. Gurney JK, Kersting UG, Rosenbaum D. Between-day reliability of repeated plantar pressure distribution measurements in a normal population. Gait Posture. 2008;27(4):706-9. 22. Castro M, Abreu S, Sousa H, Machado L, Santos R, Vilas-Boas JP. Ground reaction forces and plantar pressure distribution during occasional loaded gait. Appl Ergon. 2013;44(3):503-9. doi: 10.1016/j. apergo.2012.10.016. 23. Coda A, Carline T, Santos D. Repeatability and reproducibility of the Tekscan HR-Walkway system in healthy children. Foot (Edinb). 2014;24(2):49-55. doi: 10.1016/j.foot.2014.02.004.1pub4215pub

Inductive learning spatial attention

This paper investigates the automatic induction of spatial attention from the visual observation of objects manipulated on a table top. In this work, space is represented in terms of a novel observer-object relative reference system, named Local Cardinal System, defined upon the local neighbourhood of objects on the table. We present results of applying the proposed methodology on five distinct scenarios involving the construction of spatial patterns of coloured blocks

The impact of wound pH on the antibacterial properties of Medical Grade Honey when applied to bacterial isolates present in common foot and ankle wounds. An in vitro study

From Springer Nature via Jisc Publications RouterHistory: received 2023-01-20, accepted 2023-08-13, registration 2023-08-14, epub 2023-10-02, online 2023-10-02, collection 2023-12Acknowledgements: Not applicable.Publication status: PublishedDerek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XBackground: Diabetic foot ulcers (DFUs) and post-surgical wound infections are amongst the most troublesome complications of diabetes and following foot and ankle surgery (FAS) respectively. Both have significant psychosocial and financial burden for both patients and the healthcare system. FAS has been reported to have higher than average post-surgical infections when compared to other orthopaedic subspecialties. Evidence also indicates that patients with diabetes and other co morbidities undergoing FAS are at a much greater risk of developing surgical site infections (SSIs). With the growing challenges of antibiotic resistance and the increasingly high numbers of resilient bacteria to said antibiotics, the need for alternative antimicrobial therapies has become critical. Aim: The aim of this study was to investigate the use of medical grade honey (MGH) when altered to environments typically present in foot and ankle wounds including DFUs and post-surgical wounds (pH6-8). Methods: MGH (Activon) was altered to pH 6, 7 and 8 and experimental inoculums of Pseudomonas aeruginosa (NCTC10782), Escherichia coli, (NCTC10418), Staphylococcus aureus (NCTC10655) and Staphylococcus epidermidis (NCTC 5955) were transferred into each pH adjusted MGH and TSB solution and the positive and negative controls. Results: MGH adjusted to various pH values had the ability to reduce bacteria cell survival in all pH variations for all bacteria tested, with the most bacterial reduction/elimination noted for Staphylococcus epidermidis. No correlations were noted among the pH environments investigated and the colony counts, for which there were small amounts of bacteria survived. Conclusion: This research would indicate that the antibacterial properties of honey remains the same regardless of the pH environment. MGH could therefore potentially be considered for use on non-infected foot and ankle wounds to reduce the bacterial bioburden, the risk of infections and ultimately to improve healing outcomes.pubpu

Phalangeal autologous bone graft for flail digit subluxation: A case report

Derek Santos - ORCID: 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XA 70-year-old patient was referred for a surgical opinion with a flail digit. Flail digit occurs as a result of over resection to the head of the proximal phalanx beyond the surgical neck and proximally into the shaft. The patient was complaining of a symptomatic right fourth digit (pain 7/10 on a Visual Analogue Scale) that had previously undergone two failed hammer toe surgeries resulting in symptomatic plantar hyperkeratosis with no history of ulceration or infection. The patient was surgically managed with autologous bone graft harvested from an adjacent digit biphalangic phalanx. Six months postoperative, the patient presented asymptomatic. Anatomical alignment, digital stabilisation and function were achieved. Full autologous graft consolidation was confirmed radiographically. Favourable patient-reported outcomes using the Manchester–Oxford Foot Questionnaire showed improvement in all domains. Currently, there is no published case study or description utilising our surgical technique to treat flail digit deformity.The funding for this publication was provided by Essex Partnership University NHS Foundation Trust.https://doi.org/10.1177/2050313X22110334910pubpu

Sclerosing alcohol injections for the management of intermetatarsal neuromas: a systematic review

An intermetatarsal neuroma is a plantar digital neuritis causing metatarsalgia of the affected inter-metatarsal space. At present the evidence to support the management of the condition is poor with only some quality evidence supporting the short-term management of intermetatarsal neuromas using steroid injections. Some authors have supported the use of alcohol sclerosing intra-lesional injections to treat intermetatarsal neuromas. Following a search of the evidence 11 articles were identified. The systematic review found that alcohol injections appear to be safe although some papers report a short-term side effect of a flogistic reaction and there are variances in the alcohol concentration used and guiding verses not guiding the injection using ultrasound imaging. Some of the evidence may suggest a sclerosing histological effect of the nerve. However, all the studies reviewed present a research design offering a low level of evidence that is open to methodological biases and interpretation. Thus, this review found insufficient high-quality research evidence to afford conclusions on the management of intermetatarsal neuromas with alcohol sclerosing agent injections.sch_pod35pub5134pu

Foot and ankle pathologies in juvenile idiopathic arthritis: A narrative review

Derek Santos - ORCID 0000-0001-9936-715X https://orcid.org/0000-0001-9936-715XIntroduction: Foot and ankle pathologies are common in juvenile idiopathic arthritis (JIA) and can cause physical disability and reduce quality of life (1). Early detection and evidence-based treatment of these symptomatic pathologies are an important first step in preventing ongoing pain and long-term disabilities in children with JIA.Objectives: To search the literature and provide an update on the types of foot and ankle pathologies reported in children with JIA.Methods: MEDLINE (Ovid) was searched for relevant papers published in English with preference given to papers published in the last 10 years, and older highly regarded cited papers.Results: Foot and ankle pathologies are highly prevalent in JIA (1–3). Foot and ankle pathologies in JIA include joint disease, tenosynovitis, muscle atrophy, enthesitis, digital deformities and biomechanical abnormalities (1–9). One study surveying foot problems found that in a cohort of 30 children with JIA, 63% reported some level of foot-related impairment and 60% with foot-related participation restriction (1). This review outlines and describes each of these foot and ankle pathologies.Joint disease – Joint disease in JIA may include joint swelling, tenderness, pain, warmth and stiffness (4). These symptoms typically occur as a result of synovitis (4) and may be involved in 35-58% of cases (2, 3, 5, 10). Tenosynovitis – inflammation of the tendon sheath in JIA commonly affects the tibialis posterior and peroneal tendons (5). Muscle atrophy – Plantar-flexor muscle atrophy may be observed in children with JIA. This may be more noticeable when there is active joint disease in the ankle (6, 7). A reduction of plantar-flexion strength at the ankle may have implications in the propulsive phase of the gait, by delaying heel lift and increasing plantar pressures on the rear and midfoot. Enthesitis – Inflammation at the site of insertion of a tendon or ligament to the bone is common at the Achilles tendon and the medial tubercle of the calcaneus. These are typically seen in male patients with the enthesitis-related subtype of JIA (4). One recent study with 26 JIA participants (average age of 11.6 years) reported a prevalence of 45% for the Achilles tendon and 20% for the plantar fascia (8). The mean recorded pain on a 100 mm visual analogue scale was 48 mm (8). Quality of life was not measured in this study; however, this level of pain may reduce physical and social well-being. Digital deformities – Inflammation in the forefoot may lead to digital deformities such as clawed toes in children and adolescents with JIA. One study reported a prevalence of 17% in 144 participants (average age = 10.6) with JIA and hallux abducto valgus (2). Children with polyarticular subtype of JIA and those with a longer duration of disease were more likely to have hallux abducto valgus (2). Biomechanical abnormalities – Biomechanical abnormalities of the foot and ankle are associated with prolonged synovitis (3). Synovitis can disrupt normal articulation of the rear and midfoot joints, and can contribute to an excessively pronated foot and abnormal plantar pressures (9). One study found that the prevalence of excessively pronated rear and midfoot joints in 144 JIA participants, was 73% and 72% respectively (2).Conclusion: A range of foot and ankle pathologies are highly prevalent in JIA and contribute to physical morbidity. Allied health professionals may be involved as part of the paediatric rheumatology multidisciplinary team to assist in the early detection and management of these lower limb pathologies. Further research is required to attain accurate prevalence rates and the long-term implications that these foot and ankle conditions may have on a child or adolescent with JIA.https://doi.org/10.1186/s12969-017-0187-815pubpubSuppl.

The Influence of Walking Speed and Heel Height on Peak Plantar Pressure in the Forefoot of Healthy Adults: A Pilot Study

Article number: 1000239Background: The body of empirical research is suggestive of the fact that faster walking speed and increasing heel height can both give rise to elevated plantar pressures. However, there is little evidence of the interaction between walking speed and heel height on changes in plantar pressure. Therefore, the aim of this study was to investigate whether the effect of heel height on plantar pressure is the same for different walking speeds Methodology: Eighteen healthy adults, between the ages of 18 and 35 were assessed for changes in peak plantar pressure at walking speeds of 0.5 mph, 0.8 mph, 1.4 mph and 2.4 mph on a treadmill, wearing heels of 2 cm, 3 cm, 6 cm and 9 cm. Both the speed of walking and heels were randomly assigned to each participant. Peak plantar pressure values were determined in the forefoot region using the F-scan system which made use of in-shoe insoles. Data were analysed using two-way ANOVA. Results: Increasing heel height and walking speed resulted in significantly higher peak plantar pressure in the forefoot. Post-hoc analysis also confirmed the findings of two-way ANOVA of significant increase in peak plantar pressure with increments in heel height and walking speed. The two-way ANOVA illustrated significantly higher peak plantar pressures in both the forefeet due to interaction of walking speed and increasing heel heights. Conclusion: This study suggests that an interaction of walking speed and footwear design on distribution of plantar pressure exists. Therefore it is necessary to standardize walking speed and shoe design in future studies evaluating plantar pressures.sch_physch_pod5pub4758pub