Patient experiences of an ankle fracture and the most important factors in their recovery : a qualitative interview study

Objective The objective of this qualitative research study is to explore patient experiences of ankle fracture and the factors most important to them in recovery. Design Semistructured interviews exploring patient experiences of ankle fracture recovery at 16–23 weeks following injury. Interviews followed a topic guide and were recorded with an encrypted audio recorder and then transcribed verbatim. Thematic content analysis was used to identify themes in the data. Setting Individuals were recruited from a sample of participants of a UK-based clinical trial of immobilisation methods for ankle fracture (ISRCTN15537280 at the pre-results stage at time of writing). Interviews were conducted at the participants’ own homes or on a university campus setting. Participants A purposive sample was used to account for key variables of age, gender and fracture management. Participants recruited from the clinical trial sample were adults aged 18 years or over with a closed ankle fracture. Results Ten participants were interviewed, five of whom were female and six of whom needed an operation to fix their ankle fracture. The age range of participants was 21–75 years with a mean of 51.6 years. Eight themes emerged from the data during analysis; mobility, loss of independence, healthcare, psychological effects, social and family life, ankle symptoms, sleep disturbance and fatigue, and activities of daily living. Factors of importance to participants included regaining their independence, sleep quality and quantity, ability to drive, ability to walk without walking aids or weight-bearing restrictions, and radiological union. Conclusions The results of this research demonstrates the extensive impact of ankle fracture on individuals’ lives, including social and family life, sleep, their sense of independence and psychological well-being. The results of this study will enable an increased understanding of the factors of relevance to individuals with ankle fracture, allowing collection of appropriate outcomes in clinical studies for this condition. Ultimately these results will help formulate appropriate patient-centred rehabilitation plans for these patients

A Movement Account of Long-Distance Reflexives

This thesis examines reflexive pronouns, such as Icelandic sig (Cf. Thráinsson 2007), which may be bound from outside of an infinitive clause (which I call MD "medium distance" binding) in addition to being bound locally. I propose that such reflexives are linked to their antecedents via sisterhood followed by movement: the reflexive and antecedent are first merged together as sisters, and the antecedent subsequently moves to receive its first theta-role, as schematized below: 1. He ordered Harold to shave he+sig This links the properties of bound simplex reflexives to the properties of movement. I argue that reflexives such as sig must be bound within the first finite clause because finite CP is a spell-out domain and its escape hatch is inaccessible to A-movement. Furthermore, I derive the subject-orientation of sig and other simplex reflexives from merge-over-move, combined with a numeration divided into phases including vP. Since the antecedent is moving into its first theta-role, and merge is preferable to move, the antecedent will end up in the highest position in the phase: that is, the subject. I then examine long-distance (LD) uses of sig as well as Chinese ziji, Japanese zibun, and Kannada tannu. I propose that in such cases the reflexive still has a double, which is not the antecedent but a null element, possibly an operator. It undergoes A' movement to a position in the left periphery of a finite clause, associated with point-of- view (with a divided left periphery as in Speas 2004)--and this operator is in turn associated with an antecedent either outside the finite clause, or outside the sentence entirely. This accounts for the observation that LD reflexives often must refer to POV holders (Sells 1987). Evidence for LD reflexives being mediated by an A' position comes from the interaction of binding with wh-movement in Kannada (Lidz 2008), and is one way of describing where blocking effects do and do not occur in Chinese (Anand 2006). Furthermore, in Japanese there are sometimes overt morphemes, potentially left- periphery heads, that indicate POV and can co-occur with the use of LD reflexives (Nishigauchi 2005, 2010)

The Pyramid Method: Incorporating human content selection variation in summarization evaluation.

Human variation in content selection in summarization has given rise to some fundamental research questions: How can one incorporate the observed variation in suitable evaluation measures? How can such measures reflect the fact that summaries conveying different content can be equally good and informative? In this article, we address these very questions by proposing a method for analysis of multiple human abstracts into semantic content units. Such analysis allows us not only to quantify human variation in content selection, but also to assign empirical importance weight to different content units. It serves as the basis for an evaluation method, the Pyramid Method, that incorporates the observed variation and is predictive of different equally informative summaries. We discuss the reliability of content unit annotation, the properties of Pyramid scores, and their correlation with other evaluation methods

Groupism and the Gallop: Non-state nation branding in the Székelyföld

This article outlines a framework for understanding the non-state nation in a way that is distinct from the existing Nations and Nationalism literature as well as the contemporary Nation Branding scholarship. It argues that minority national groups can be seen both as if they were brands, and also as groups which collectively construct and pursue nation-branding. It explores brand identity, strategy, agents, communication, equity and architecture as lenses via which national identification and groupness can be deconstructed and understood. The article draws on observations made at one specific national event – the Székely Vágta (Szekler Gallop) – as a means of illustrating its theoretical premise

Primary outcome measures used in interventional trials for ankle fractures : a systematic review

Background Ankle fractures cause considerable pain, loss of function and healthcare resource use. High quality randomised controlled trials are required to evaluate the optimal management protocols for ankle fracture. However, there is debate regarding the most appropriate outcome measure to use when assessing patients with ankle fractures. The aim of this systematic review is to identify and summarise primary outcome measure use in clinical trials of non-pharmacological interventions for adults with an ankle fracture. Methods We performed comprehensive searches of the Medline, Embase, CINAHL, AMED and Cochrane CENTRAL databases, as well as ISRCTN and ClinicalTrials.gov online clinical trial registries on 19/06/2019 with no date limits applied. The titles and abstracts were initially screened to identify randomised or quasi-randomised clinical trials of non-pharmacological interventions for ankle fracture in adults. Two authors independently screened the full text of any articles which could potentially be eligible. Descriptive statistics we used to summarise the outcome measures collected in these articles including an assessment of trends over time. Secondary analysis included a descriptive summary of the multi-item patient reported outcome measures used in this study type. Results The searches returned a total of 3380 records. Following application of the eligibility criteria, 121 records were eligible for inclusion in this review. The most frequently collected primary outcome measures in this type of publication was the Olerud Molander Ankle Score, followed by radiographic and range of movement assessments. There was a total of 28 different outcome measures collected and five different multi-item, patient reported outcome measures collected as the primary outcome measure. There was a sequential increase in the number of this type of study published per decade since the 1980’s. Conclusion This review demonstrates the wide range of measurement methods used to assess outcome in adults with an ankle fracture. Future research should focus on establishing the validity and reliability of the outcome measures used in this patient population. Formulation of a consensus based core outcome set for adults with an ankle fracture would be advantageous for ensuring homogeneity across studies in order to meta-analyse trial results

A systematic review of the measurement properties of patient reported outcome measures used for adults with an ankle fracture

Background Ankle fractures are painful and debilitating injuries that pose a significant burden to society and healthcare systems. Patient reported outcome measures (PROMs) are commonly used outcome measures in clinical trials of interventions for ankle fracture but there is little evidence on their validity and reliability. This systematic review aims to identify and appraise evidence for the measurement properties of ankle specific PROMs used in adults with an ankle fracture using Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology. Methods We searched MEDLINE, Embase and CINAHL online databases for evidence of measurement properties of ankle specific PROMs. Articles were included if they assessed or described the development of the PROM in adults with ankle fracture. Articles were ineligible if they used the PROM to assess the measurement properties of another instrument. Abstracts without full articles and conference proceedings were ineligible, as were articles that adapted the PROM under evaluation without any formal justification of the changes as part of a cross-cultural validation or translation process. Two reviewers completed the screening. To assess methodological quality we used COSMIN risk of bias checklist and summarised evidence using COSMIN quality criteria and a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two reviewers assessed the methodological quality and extracted the data for a sample of articles. Results The searches returned a total of 377 articles. From these, six articles were included after application of eligibility criteria. These articles evaluated three PROMs: A-FORM, OMAS and AAOS. The A-FORM had evidence of a robust development process within the patient population, however lacks post-formulation testing. The OMAS showed sufficient levels of reliability, internal consistency and construct validity. The AAOS showed low quality evidence of sufficient construct validity. Conclusions There is insufficient evidence to support the recommendation of a particular PROM for use in adult ankle fracture research based on COSMIN methodology. Further validation of these outcome measures is required in order to ensure PROMs used in this area are sufficiently valid and reliable to assess treatment effects. This would enable high quality, evidenced-based management of adults with ankle fracture

Applying the Pyramid Method in DUC 2005

In DUC 2005, the pyramid method for content evaluation was used for the first time in a crosssite evaluation. We discuss the method used in creating pyramid models and performing peer annotation. Analysis of score averages for the peers indicates that the best systems score half as well as humans, and that systems can be grouped into better and worse performers. There were few significant differences among systems. High score correlations between sets from different annotators, and good interannotator agreement, indicate that participants can perform annotation reliably. We found that a modified pyramid score gave good results and would simplify peer annotation in the future

Applying the Pyramid Method in the 2006 Document Understanding Conference

The pyramid evaluation effort for the 2006 Document Understanding Conference involved twenty-two sites on twenty document sets. Each pyramid content model (one per document set) was constructed from four human summaries. Peer systems were scored using the modified pyramid score introduced in DUC 2005. ANOVAs with score as the independent variable and nine factors yielded three significant factors: document set, peer, and content responsiveness. There were many more significant differences among peer systems in 2006 than for DUC 2005. We speculate this is due to a combination of improved systems and improvements in our evaluation procedures

Attachment, Coping, and Suicidal Behavior in Male Prisoners

The present study explored the differences between adult male prisoners with and without a history of suicidal behavior on adult attachment dimensions, coping styles, and hopelessness. The role of adult attachment and coping styles as predictors of hopelessness was also explored. The sample included 206 male prisoners from two Category B prisons in the United Kingdom. The Attachment Styles Questionnaire (ASQ), Coping Styles Questionnaire (CSQ-3), and Beck Hopelessness Scale (BHS) measured attachment, coping, and hopelessness. Prisoners with a history of suicidal behavior reported significantly higher levels of attachment anxiety, attachment avoidance, and maladaptive coping strategies. Elevated levels of attachment difficulties and maladaptive coping styles were associated with heightened levels of hopelessness. Emotional coping strategies mediated the influence of attachment anxiety and attachment avoidance on hopelessness. The study highlights the potential utility of adult attachment conceptualizations and coping skills interventions with prisoners at risk of suicidal behavior

An evaluation of the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture

Objectives The aim of this study is to evaluate the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture. Methods Patients completed outcome measure questionnaires at baseline, six, 10- and 16-weeks post-injury as part of an ongoing clinical trial on ankle fracture rehabilitation. The internal consistency, convergent validity, structural validity and interpretability of the Olerud Molander Ankle Score was assessed. This was achieved through using the respective analysis methods of Cronbach's alpha, correlation coefficients, principal component analysis, evaluation of floor and ceiling scores and estimation of the minimally important change using anchor-based methods. Results The Olerud Molander Ankle Score showed adequate convergent validity against hypotheses set in relation to scores of comparator instruments. Principal component analysis demonstrated that the measure has two subscales: ankle function and ankle symptoms. The internal consistency of the measure and the ankle function subscale was sufficient, but inconclusive for the ankle symptoms subscale. There were no floor and ceiling effects present within the scores and the estimated minimally important change was 9.7 points. Conclusion The Olerud Molander Ankle Score demonstrates sufficient measurement properties and is likely to be primarily measuring the construct of patient reported function following ankle fracture. Further research should evaluate the relevance of other domains to individuals recovering from and ankle fracture, such as social participation and psychological wellbeing. The development of a core outcome set would be advantageous to standardise outcome measurement collection in this area