Arthritis of the base of the thumb

The purpose of this article is to outline the pathophysiology and epidemiology of arthritis of the base of the thumb. The usual presentation and diagnosis will be discussed along with the current conservative treatment options. Surgical treatment options are determined by the stage of the arthritis as well as the demands of the patient. The current standard surgical treatment options will be reviewed along with their results in the literature

Knowledge and attitudes of university students toward pandemic influenza: a cross-sectional study from Turkey

<p>Abstract</p> <p>Background</p> <p>During an influenza pandemic, higher education institutions with large populations of young adults can become serious outbreak centers. Since outbreak management is essential to disease control, we aimed to examine university students' knowledge of and attitudes toward the pandemic influenza A/H1N1 and vaccination and other preventive measures.</p> <p>Methods</p> <p>A cross-sectional study was conducted among 402 first year university students at Yeditepe University in Istanbul, Turkey between 1^stand 30^thof November 2009. Data regarding socio-demographic characteristics of the students, perceptions, level of knowledge and attitudes toward influenza pandemic and prevention measures were collected by means of a self-administered questionnaire. The questionnaire was distributed by the students affiliated with SANITAS, a university club of students in health related sciences.</p> <p>Results</p> <p>25.1% (101/402) of the study group perceived their personal risk of influenza as "high", while 40.5% (163/402) perceived it as "moderate", 20.6% (107/402) viewed it as "low" and 7.7% (31/402) indicated that it was "unknown". The risk perception of males was significantly lower than that of females (p = 0.004) and the risk perception among the students of health sciences was significantly lower than that of students of other sciences (p = 0.037). Within the study group, 72.1% (290/402) indicated that their main information source regarding H1N1 was the mass media. Health sciences students tended to rely more on the internet as an information source than other students (p = 0.015). The vast majority (92.8%; 373/402) of those interviewed indicated that they would not be vaccinated. The major concerns regarding vaccination had to do with the safety and side effects of the vaccine. Most of the participants (343/402, 85.3%) were carrying out one of prevention measures and the vast majority believed that hand washing, face mask and quarantina were effective measures for prevention.</p> <p>Conclusion</p> <p>The participants had enough knowledge about H1N1 pandemic about the disease although there were still gaps and confusions in some areas. In the future, when planning management strategies regarding pandemics or outbreaks in higher education institutions, new strategies should be developed to promote positive health behaviour among university students compatible with the international guidelines. Main information source is mass media, so it seems that new policies must be developed to attract attention of students to use different and more scientific-based information sources.</p

Ulnar-sided wrist pain. Part I: anatomy and physical examination

Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain

Habitat use and predicted range for the mainland clouded leopard Neofelis nebulosa in Peninsular Malaysia

Ongoing deforestation in Southeast Asia is leading to increased fragmentation and reduction of habitat for the mainland clouded leopard (Neofelis nebulosa). Using the largest detection/non-detection camera trap survey dataset known for the species throughout its range, we investigated factors affecting clouded leopard habitat use across Peninsular Malaysia. Habitat use was modelled using fine scale covariates and recently developed analytical techniques to account for spatial autocorrelation. Clouded leopard habitat use increased with increasing distance fromwater bodies, higher numbers of discontinuous core areas per unit area and higher elevation. In addition, clouded leopard habitat use was higher in sites with higher average forest change values. After extrapolating the predicted habitat use of clouded leopards across the whole of Peninsular Malaysia, we assessed the suitability of proposed ecological linkages, and identified other suitable forest patches notwithin the current Central Forest Spine. Our findings are valuable for land use planning and management, in particular, for determining the suitability of forest remnants to support populations of clouded leopard and predicting how this species will respond in human-dominated landscapes

Dentists with extended skills:the challenge of innovation

BACKGROUND: The aim was to obtain stakeholders' views on the former London Deanery's joint educational service development initiative to train dentists with a special interest (DwSIs) in endodontics in conjunction with the National Health Services (NHS) and examine the models of care provided. METHODS: A convergent parallel mixed methods design including audit of four different models of care, semi-structured interviews of a range of key stakeholders (including the DwSI trainees) and questionnaire surveys of patients and primary care dentists. RESULTS: Eight dentists treated over 1,600 endodontic cases of moderate complexity over a two year training period. A retrospective audit of four schemes suggested that first molars were the most commonly treated tooth (57%; n = 341). Patients who received care in the latter stages of the initiative were 'satisfied' or 'very satisfied' with the service (89%; n = 98). Most dental practitioners agreed that having access to such services would support the care of their patients (89%; n = 215) with 88%; (n = 214) supporting the view that DwSIs should accept referrals from outside of their practice. CONCLUSION: This initiative, developed to provide endodontic care of medium complexity in a primary care setting, received wide support from stakeholders including patients and primary care dentists. The implications for care pathways, commissioning and further research are discussed

Predicting biodiversity richness in rapidly changing landscapes: Climate, low human pressure or protection as salvation?

Rates of biodiversity loss in Southeast Asia are among the highest in the world, and the Indo-Burma and South-Central China Biodiversity Hotspots rank among the world’s most threatened. Developing robust multi-species conservation models is critical for stemming biodiversity loss both here and globally. We used a large and geographically extensive remote-camera survey and multi-scale, multivariate optimization species distribution modelling to investigate the factors driving biodiversity across these two adjoining biodiversity hotspots. Four major findings emerged from the work. (i) We identified clear spatial patterns of species richness, with two main biodiverse centres in the Thai-Malay Peninsula and in the mountainous region of Southwest China. (ii) Carnivores in particular, and large ungulates to a lesser degree, were the strongest indicators of species richness. (iii) Climate had the largest effect on biodiversity, followed by protected status and human footprint. (iv) Gap analysis between the biodiversity model and the current system of protected areas revealed that the majority of areas supporting the highest predicted biodiversity are not protected. Our results highlighted several key locations that should be prioritized for expanding the protected area network to maximize conservation effectiveness. We demonstrated the importance of switching from single-species to multi-species approaches to highlight areas of high priority for biodiversity conservation. In addition, since these areas mostly occur over multiple countries, we also advocate for a paradigmatic focus on transboundary conservation planning

Multi-scale habitat modelling identifies spatial conservation priorities for mainland clouded leopards (Neofelis nebulosa)

Diversity and Distributions Published by John Wiley &amp; Sons Ltd. Aim: Deforestation is rapidly altering Southeast Asian landscapes, resulting in some of the highest rates of habitat loss worldwide. Among the many species facing declines in this region, clouded leopards rank notably for their ambassadorial potential and capacity to act as powerful levers for broader forest conservation programmes. Thus, identifying core habitat and conservation opportunities are critical for curbing further Neofelis declines and extending umbrella protection for diverse forest biota similarly threatened by widespread habitat loss. Furthermore, a recent comprehensive habitat assessment of Sunda clouded leopards (N. diardi) highlights the lack of such information for the mainland species (N. nebulosa) and facilitates a comparative assessment. Location: Southeast Asia. Methods: Species–habitat relationships are scale-dependent, yet &lt;5% of all recent habitat modelling papers apply robust approaches to optimize multivariate scale relationships. Using one of the largest camera trap datasets ever collected, we developed scale-optimized species distribution models for two con-generic carnivores, and quantitatively compared their habitat niches. Results: We identified core habitat, connectivity corridors, and ranked remaining habitat patches for conservation prioritization. Closed-canopy forest was the strongest predictor, with ~25% lower Neofelis detections when forest cover declined from 100 to 65%. A strong, positive association with increasing precipitation suggests ongoing climate change as a growing threat along drier edges of the species’ range. While deforestation and land use conversion were deleterious for both species, N. nebulosa was uniquely associated with shrublands and grasslands. We identified 800 km2 as a minimum patch size for supporting clouded leopard conservation. Main conclusions: We illustrate the utility of multi-scale modelling for identifying key habitat requirements, optimal scales of use and critical targets for guiding conservation prioritization. Curbing deforestation and development within remaining core habitat and dispersal corridors, particularly in Myanmar, Laos and Malaysia, is critical for supporting evolutionary potential of clouded leopards and conservation of associated forest biodiversity