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INVERTED AND EVERTED SLOPE WALKING LEADS TO INCREASED KNEE COMPENSATION IN ANKLE FUSION COMPARED TO TOTAL ANKLE ARTHROPLASTY
No full textAnkle fusion (AF), a durable intervention for ankle arthritis, has been the management of choice but restricts mobility. Recently, total ankle replacement (TAR) has been offered to patients looking to maintain mobility. The aim was to compare the biomechanics of AF and TAR while walking on inverted and everted slopes which create a greater demand for complex foot mobility than level walking. A ten-camera motion detection setup captured trials as patients walked in both directions over a 5⁰ lateral slope with embedded force plates. Moments (Nm/Kg) across the knee and ankle were exported from Visual 3D in the sagittal and frontal plane, and data were reported as means with 95% confidence intervals. 15 patients were recruited (6 TAR, 9 AF). The median age, follow-up and BMI was 67 years, 4 years and 35.8 kg/m² in AF, and 73 years, 7 years and 28.1 kg/m² in TAR, respectively. During inverted slope walking (4 TAR, 7 AF), abduction moments across (i) the knee: TAR 0.38 (0.37–0.39) vs AF 0.37 (0.27–0.52) and (ii) the ankle: TAR 0.20 (0.13–0.27) vs AF 0.25 (0.18–0.32), and extension moments across (i) the knee: TAR 0.68 (0.38–0.97) vs AF 0.85 (0.69–1.01) and (ii) the ankle: TAR 1.46 (1.30–1.62) vs AF 1.30 (1.08–1.52). During everted walking (5 TAR, 7 AF), abduction moments across (i) the knee: TAR 0.41 (0.30–0.52) vs AF 0.46 (0.27–0.66) and (ii) the ankle: TAR 0.24 (0.11–0.38) vs AF 0.26 (0.18–0.33), and extension moments across (i) the knee: TAR 0.76 (0.54–0.99) vs AF 0.93 (0.72–1.14) and (ii) the ankle: TAR 1.39 (1.19–1.59) vs AF 1.26 (1.04–1.48). There were no differences in abduction moments during inverted or everted slope walking. However, patients with AF had increased extension moments across the knee, particularly on inverted slopes, suggesting that AF creates a greater demand for knee compensation than TAR
Teamwork Makes the Dream Work
Get PDFIn the spring of 2022, clinicians from the University of Central Lancashire’s Advice and Resolution Centre and Lancaster University’s Law Clinic launched a pilot environmental law policy clinic. A primary motivation for starting the policy clinic was to involve a wider range of students in clinic work, including those who may not have volunteered for the main legal advice clinic due to either a lack of confidence or a lack of desire to enter the legal profession.
Through participation in a CLEO workshop on policy clinics, the writers were introduced to the work of the Environmental Law Foundation (ELF). ELF provides free information and guidance on environmental issues for individuals and communities through a university-based law clinic policy network. The aim of our policy clinic project with ELF was to investigate the extent to which local authorities in a UK region are considering climate emergency declarations in their decision making and are on track to achieve net zero emissions. Participation in the project did not require any previous experience in environmental law or policy work, and the supervisors of the project did not have expertise in this niche area of law.
This paper will reflect on the experiences of running a pilot, cross-institutional environmental law policy clinic and the lessons learned (both good and bad) from the undertaking
Sense-O-Nary: Exploring Children's Crossmodal Metaphors Through Playful Crossmodal Interactions
Get PDFMetaphors enrich language by allowing us to express complex ideas through familiar concepts, enhancing both understanding and creativity in communication. Crossmodal metaphors are metaphors where one sensory modality is understood in terms of another (e.g, a sharp smell). Crossmodality is an integral part of how we make sense of and create meaning about the world. However, there is a lack of research on how children generate crossmodal metaphors and the interpretation of such metaphors. We present Sense-O-Nary, a game we designed to explore how children react when asked to create crossmodal metaphors in a novel environment. Children are presented with one sensory input and then asked to describe it using a different sense, for another team to guess what the original sensory input is. We engaged children (n=65, aged 8-10) to play this crossmodal metaphor generation game. We qualitatively analysed children’s exchange of crossmodal metaphors to define a set of crossmodal association strategies and then use this to categorise the metaphors they created. We discuss how engaging with crossmodal metaphors can enhance children’s linguistic development and how our findings can inform the design of interactions that involve multiple senses
Trauma or autism? – understanding how the effects of trauma and disrupted attachment can be mistaken for autism
Get PDFPurpose
Early bio-psycho-social experiences can dramatically impact all aspects of development. Both autism and traumagenic histories can lead to trans-diagnostic behavioural features that can be confused with one another during diagnostic assessment, unless an in-depth differential diagnostic evaluation is conducted that considers the developmental aetiology and underpinning experiences and triggers to trans-diagnostic behaviours.
Design/methodology/approach
This paper will explore the ways in which biological, cognitive, emotional and social sequelae of early trauma and attachment challenges, can look very similar to a range of neurodevelopmental disorders, including autism. Relevant literature and theory will be considered and synthesised with clinical knowledge of trauma and autism.
Findings
Recommendations are made for how the overlap between features of autism and trauma can be considered during assessments alongside consideration for interventions to enable people to access the most appropriate support for their needs.
Originality/value
Many features of the behaviours of individuals who have experienced early childhood trauma and disrupted or maladaptive attachments, may look similar to the behaviours associated with autism and hence diagnostic assessments of autism need to carefully differentiate traumagenic causes, to either dual diagnose (if both are present) or exclude autism, if it is not present. This has for long been recognised in child and adolescent autism specialist services but is less well developed in adult autism specialist services
The Dental Practicality Index - to treat or not to treat
No full textThe Dental Practicality Index (DPI) has been designed to describe, on a clinical level, the ‘practicality' of restoring a tooth versus referring to secondary care or extraction.
The systematic approach of DPI has been shown to improve decision-making and confidence in treatment planning when used by young dentists. In addition, there is good evidence demonstrating that it provides an accurate estimation of the outcome of treatment. The DPI enhances clinician-patient communication and ultimately the consent process
What Are Angioplasty And Stents?
No full textAngioplasty is a medical procedure used to open clogged or blocked coronary arteries, which feed your heart muscle with blood that contains nutrients for life. If your arteries are blocked this is commonly caused by atherosclerosis. It can be done with or without using stents
Evaluation of current evidence and practice to inform development of a Standardised Neurological Observation Schedule for Stroke (SNOBSS)
Get PDFEarly neurological deterioration (END) is a poorly defined, but common complication significantly affecting outcome post-stroke. This thesis uses mixed methods in 3 phases to inform development of a consistent approach for neurological assessment and monitoring in acute stroke; allowing a range of staff to promptly identify changes, and take corrective action. Phase 1 A scoping review identified 26 scales for neurological assessment and monitoring in acute stroke. Several reviews allowed comparison of the clinimetric properties of 20 scales where data utility was available. There was limited evidence to support the use of specific scale(s), and none had been fully tested across a whole stroke population. Yet, the review clarified the importance of assessments allowing early detection of change in individual items, rather than the total score, for END detection. The review clarified the key clinimetric properties to be established by future research. Phase 2 A UK-wide survey of stroke units (n=125) demonstrated extensive variation in neurological assessment and monitoring practice. Most units use the Glasgow Coma Scale or AVPU (Alert, Voice, Pain, Unresponsive), for monitoring, which are not stroke-specific and only highlight late signs of deterioration (e.g. altered consciousness). Phase 3 Semi-structured interviews (n=23) utilising Normalisation Process Theory explored current practice and barriers and facilitators for implementation of a new standardised assessment. Staff recognised the need for better guidance and practice change for this important element of care. An expert group agreed on the Standardised Neurological OBservation Schedule for Stroke (SNOBSS). The SNOBSS and decision flowchart were presented to clinicians to consider acceptability and implementation concerns. Recommendations which reduce variations in clinical practice and inform future research will progress SNOBSS development and implementation. SNOBSS development is a first step towards consistent stroke-specific monitoring to identify neurological changes, specifically END in acute stroke
WILDetect - Part I
Get PDFA new non-parametric approach, WILDetect, has been built using an ensemble of supervised Machine Learning (ML) and Reinforcement Learning (RL) techniques. We present here the first part of the paper. The concluding part will be published in the next issue. The habitats of marine life, characteristics of species, and the diverse mix of maritime industries around these habitats are of interest to many researchers, authorities, and policymakers whose aim is to conserve the earth’s biological diversity in an ecologically sustainable manner while being in line with indispensable industrial developments. Automated detection, locating, and monitoring of marine life along with the industry around the habitats of this ecosystem may be helpful to (i) reveal current impacts, (ii) model future possible ecological trends, and (iii) determine required policies which would lead accordingly to a reduced ecological footprint and increased sustainability. New automatic techniques are required to observe this large environment efficiently. Within this context, this study aims to develop a novel platform to monitor marine ecosystems and perform bio census in an automated manner, particularly for birds in regional aerial surveys since birds are a good indicator of overall ecological health. In this manner, a new non-parametric approach, WILDetect, has been built using an ensemble of supervised Machine Learning (ML) and Reinforcement Learning (RL) techniques. It employs several hybrid techniques to segment, split and count maritime species — in particular, birds — in order to perform automated censuses in a highly dynamic marine ecosystem. The efficacy of the proposed approach is demonstrated by experiments performed on 26 surveys which include Northern gannets (Morus bassanus) by utilising retrospective data analysis techniques. With this platform, by combining multiple techniques, gannets can be detected and split automatically with very high sensitivity (Se) (0.97), specificity (Sp) (0.99), and accuracy (Acc) (0.99) — these values are validated by precision (Pr) (0.98). Moreover, the evaluation of the system by the APEM staff, which uses a completely new evaluation dataset gathered from recent surveys, shows the viability of the proposed techniques. The experimental results suggest that similar automated data processing techniques — tailored for specific species — can be helpful both in performing time-intensive marine wildlife censuses efficiently and in establishing ecological platforms/models to understand the underlying causes of trends in species populations along with the ecological change
Vibration Suppression of Graphene Reinforced Laminates Using Shunted Piezoelectric Systems and Machine Learning
Get PDFThe implementation of a machine learning approach to predict vibration suppression, as derived from nanocomposite laminates with piezoelectric shunted systems, is studied in this article. Datasets providing the vibration response and vibration attenuation are developed using parametric finite element simulations. A graphene/fibre-reinforced laminate cantilever beam is used in those simulations. Parameters, including the graphene and fibre reinforcements content, as well as the fibre angles, are among the inputs. Output is the vibration suppression achieved by the piezoelectric shunted system. Artificial Neural Networks are trained and tested using the derived datasets. The proposed methodology can be used for a fast and accurate prediction of the vibration response of nanocomposite laminates