Acceptability of childhood screening: a systematic narrative review.

OBJECTIVES: A systematic narrative literature review was undertaken to assess the acceptability of childhood screening interventions to identify factors to consider when planning or modifying childhood screening programs to maximize participation and uptake. STUDY DESIGN: This is a systematic narrative literature review. METHODS: Electronic databases were searched (MEDLINE, EMBASE, PsycINFO via Ovid, CINAHL, and Cochrane Library) to identify primary research studies that assessed screening acceptability. Studies were categorized using an existing theoretical framework of acceptability consisting of seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. A protocol was developed and registered with PROSPERO (registration no. CRD42018099763) RESULTS: The search identified 4529 studies, and 46 studies met the inclusion criteria. Most studies involved neonatal screening. Programs identified included newborn blood spot screening (n = 22), neonatal hearing screening (n = 13), Duchenne muscular dystrophy screening (n = 4), cystic fibrosis screening (n = 3), screening for congenital heart defects (n = 2), and others (n = 2). Most studies assessed more than one construct of acceptability. The most common constructs identified were affective attitude (how a parent feels about the program) and intervention coherence (parental understanding of the program, and/or the potential consequences of a confirmed diagnosis). CONCLUSIONS: The main acceptability component identified related to parental knowledge and understanding of the screening process, the testing procedure(s), and consent. The emotional impact of childhood screening mostly explored maternal anxiety. Further studies are needed to examine the acceptability of childhood screening across the wider family unit. When planning new (or refining existing) childhood screening programs, it is important to assess acceptability before implementation. This should include assessment of important issues such as information needs, timing of information, and when and where the screening should occur.

Evaluating the impact of information and support for people with nystagmus in the digital age: A patient and carer questionnaire study.

Background: Nystagmus is a disorder of rhythmic, involuntary oscillations of the eyes and can be classified as either infantile or acquired. Whether it occurs in isolation or as a part of other visual or neurological disorders, it causes significant visual dysfunction and problems with social functioning. In this study, we seek to understand ways in which people with nystagmus are currently supported across the UK and identify any geographical variations or disconnects between current practice and best practice, as judged by patients and their carers.Methods: A nationwide, qualitative, cross-sectional, questionnaire study of people with nystagmus and their carers. Recruitment was achieved through specialist clinics, charity events, online advertisements and social media calls. Data was gathered using five, age-appropriate questionnaires which were completed and returned to the research team between November 2016 and August 2018.Results: 184 respondents were included (89 carers, 47 patients aged 4-10 years, 5 aged 11-14 years, 4 aged 15-17 years and 39 > 18 years). Notably, respondents rated social media as the best source of information they have received, even compared with face-to-face consultation with medical professionals. Additionally, only 33% of the respondents had been offered visual impairment support. Notably, patterns of clinical practice and patient experience emerged according to geographical location, particularly provision of initial information and ongoing VI support.Conclusions: This study highlights a significant variation in the support and information received by people in the UK with nystagmus. It also supports the role of charities and increasingly, social media in the provision of patient information. The study also highlights the need for standardized guidelines for the management of patients with nystagmus, particularly with regard to support and information.

Management of nystagmus in children: a review of the literature and current practice in UK specialist services.

Nystagmus is an eye movement disorder characterised by abnormal, involuntary rhythmic oscillations of one or both eyes, initiated by a slow phase. It is not uncommon in the UK and regularly seen in paediatric ophthalmology and adult general/strabismus clinics. In some cases, it occurs in isolation, and in others, it occurs as part of a multisystem disorder, severe visual impairment or neurological disorder. Similarly, in some cases, visual acuity can be normal and in others can be severely degraded. Furthermore, the impact on vision goes well beyond static acuity alone, is rarely measured and may vary on a minute-to-minute, day-to-day or month-to-month basis. For these reasons, management of children with nystagmus in the UK is varied, and patients report hugely different experiences and investigations. In this review, we hope to shine a light on the current management of children with nystagmus across five specialist centres in the UK in order to present, for the first time, a consensus on investigation and clinical management.

Correction: Management of nystagmus in children: a review of the literature and current practice in UK specialist services.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Cross-disciplinarity in the advance of Antarctic ecosystem research.

The biodiversity, ecosystem services and climate variability of the Antarctic continent and the Southern Ocean are major components of the whole Earth system. Antarctic ecosystems are driven more strongly by the physical environment than many other marine and terrestrial ecosystems. As a consequence, to understand ecological functioning, cross-disciplinary studies are especially important in Antarctic research. The conceptual study presented here is based on a workshop initiated by the Research Programme Antarctic Thresholds - Ecosystem Resilience and Adaptation of the Scientific Committee on Antarctic Research, which focussed on challenges in identifying and applying cross-disciplinary approaches in the Antarctic. Novel ideas and first steps in their implementation were clustered into eight themes. These ranged from scale problems, through risk maps, and organism/ecosystem responses to multiple environmental changes and evolutionary processes. Scaling models and data across different spatial and temporal scales were identified as an overarching challenge. Approaches to bridge gaps in Antarctic research programmes included multi-disciplinary monitoring, linking biomolecular findings and simulated physical environments, as well as integrative ecological modelling. The results of advanced cross-disciplinary approaches can contribute significantly to our knowledge of Antarctic and global ecosystem functioning, the consequences of climate change, and to global assessments that ultimately benefit humankind.

Arm muscle plus bone area: anthropometry and CAT scan compared.

Arm muscle plus bone (M + B) cross-sectional area of the arm estimated from area circumference and skinfold thickness was compared with that estimated from CAT scans. The anthropometric technique overestimated M + B area, and the degree of overestimation varied directly with arm adiposity.

Cortical thickness and trabecular pattern of the femoral neck as a measure of osteopenia.

The pelvic radiographs of 312 patients aged 18 to 92 years were reviewed to determine if the Singh index was valid or not. The cortical thickness of the lower part of the femoral calcar, the stress index (body weight, physical activity, and femoral neck angle), and the Singh Index (trabecular pattern of the femoral neck) were measured in each patient and correlated with each other and with the patient's age, sex, and dominant side. It was found that the Singh index correlates well with age but not with the cortical thickness or stress index. Thus, the Singh index is an unreliable measure of osteopenia, and we conclude that other methods should be used for screening patients with osteoporosis.

Comparison of CT scanning with photon absorptiometric measurement of bone mineral content in the appendicular skeleton.

Traditional methods of bone mineral analysis were compared to a new technique using computerized tomography (or CT scanning). The correlation between the CT values for long bones in the dog and actual calcium content was 0.9942. The correlation between two photon absorptiometric techniques and CT values were also 0.9981 and 0.9962. The precision of repeated scans was +/-2%. It is suggested that the CT scanner will allow bone mineral analysis to be performed with accuracy and precision.

The role of calcium and fluoride in osteoporosis in rhesus monkeys.

Twenty-two female Rhesus monkeys were fed purified diets varying in calcium and fluoride content for five years and studied, using radiographic, photon absorptiometric and histologic techniques. The results suggested that: 1) the addition of fluoride (50 ppm) to a diet containing 1 per cent calcium resulted in a reduction in bone growth rate and resorption, without affecting bone size or density nor resulting in fluorosis; 2) a diet containing 0.15 per cent calcium resulted in osteoporosis due to an increase in bone resorption; and 3) fluoride added to a similar low calcium diet prevented osteroporosis by reducing bone growth rate and resorption resulting in bones with normal density, but at the same time fluoride interfered with mineralization of osteoid leading to osteomalacia.

The application of photographic reducers to autoradiographically intensified radiographs.

In autoradiographic intensification of underexposed images by the method of Askins, the lower densities are intensified by a much larger factor than the higher densities, thus decreasing the contrast of the intensified image. However, when the underexposed, developed, and processed image radiograph) is treated in a subtractive photographic reducer (potassium ferricyanide-sodium thiosulfate mixture) prior to activation with 35S thiourea, the fog is decreased greatly, thereby increasing the contrast of the intensified image. Of the six underexposed radiographys, involving both bone phantoms and various body regions studied after autoradiographic intensification, five were consistently rated adequate for their diagnostic certainty in comparison to the corresponding optimally exposed radiographs.

"Incisura" of the ascending aorta and vascular pedicle width in the cardiac transplant patient.

BACKGROUND: The purpose of this study was to evaluate three findings in cardiac transplant patients: the appearance, etiology, and incidence of "incisura" (a characteristic indentation) of the ascending aorta; the vascular pedicle width, which usually appears enlarged on standard chest radiographs; and clearing of the retrosternal clear space. MATERIAL: Two hundred sixty-one cardiac transplantations were performed at the University of Minnesota before December 31, 1992. The appearance, etiology, and incidence of an incisura were studied; the vascular pedicle width was measured; and the rate of clearing of the retrosternal clear space was determined. RESULTS: Forty-six percent of the patients whose ascending aorta could be visualized on the lateral chest radiogram showed an incisura. Approximately one third of the patients showed continued opacification of the retrosternal space postoperatively. The width of the vascular pedicle in this series of cardiac transplant patients measured 60.9 +/- 22.8 mm (standard deviation, 11.4 mm), in comparison to a normal of 48 +/- 5.0 mm. CONCLUSIONS: An incisura of the ascending aorta and the widened vascular pedicle are normal postoperative chest radiographic findings in cardiac transplant patients and should not be misconstrued as abnormalities.

Orthopedic complications.

This overview of the complications encountered in orthopedic cases focuses on, among other things, complications of spinal surgery. The incidence of infection in spinal instrumentation and other orthopedic procedures is discussed and followed by a review of the complications of total joint replacement. Finally, a few words on the radiologist's responsibility for the reporting of orthopedic complications are given.

The radiology of bone allografts.

Bone allograft surgery provides an attractive and effective solution to many orthopedic problems. Nevertheless, the entire process is technically demanding and associated with many potential complications of which infection is one of the most difficult to treat. Many advances have been made in the procurement and use of bone allografts, and further investigation should expand the applications of allograft surgery and continue to diminish the incidence of complications.

Staging of musculoskeletal tumors.

Staging of musculoskeletal neoplasms is important for planning chemotherapy and surgical procedures. Accurate staging has increased in importance with advancements in limb salvage procedures. This article outlines concepts, techniques, and potential problems with staging of neoplasms. It is important to remember that biopsy should be preformed after consultation with an orthopedic surgeon specialized in tumor surgery.

Total hip replacement and other orthopedic hip procedures.

The history of total hip replacement including that of the Girdlestone procedure and resurfacing procedures is discussed. An overview of total hip replacement and its indications and complications forms the bulk of this section. Also, the use of porous-coated prostheses and endoprostheses as well as pins and plates is discussed and illustrated.

Calcaneal fractures in diabetic patients.

We would like to present 23 calcaneal fractures in 22 patients of whom 21 had type I diabetes mellitus. There appear to be three basic fracture types: (1) a superiorly displaced extra-articular avulsion fracture of the posterior calcaneus (or Iowa fracture), which occurred in 12 patients (five men, seven women); (2) a mid-calcaneal compression fracture in six patients (four men, two women), and (3) a cleavage or "wedge" type fracture in four patients extending from the calcaneal tubercle (one man, 3 women). All four of this last group of patients had a history of a chronic penetrating ulcer, and this is noteworthy since only one other patient out of the remaining 18 in groups 1 and 2 had a similar history. Most patients had decreased bone mineralization: 15 patients were on long-term, high-dose steroids, and 18 patients had either poor renal function or complete renal failure (11 of 12). Fourteen patients had received either renal or pancreas transplants. Eight patients were on restricted weight bearing prior to their fractures. We believe that diabetic patients are more prone to calcaneal fractures than the general population, and early diagnosis is imperative, followed by early treatment to prevent significant bony deformity.

Scanning electron-microscopic and magnetic resonance-imaging studies of injuries to the patellofemoral joint after acute transarticular loading.

To examine the effects of transarticular loading on articular cartilage and subchondral bone, we used a canine model that we had developed previously, in which a standardized load of approximately 2000 newtons is delivered across the patellofemoral joint. The purpose of the study was to define and describe the initial changes, as seen on histopathological and magnetic resonance-imaging studies, that occur in the early stages after injury to the joint by transarticular loading. Scanning electron microscopy was used to define the extent and characteristics of the fractures produced in the subchondral bone of four patellae that were examined on the day of loading. We found multiple, extensive fractures through the zone of calcified cartilage and the subchondral bone, frequently with step-off displacement, and with little or no change in the gross appearance of the articular cartilage. Specimens from four patellae were examined histologically two weeks after loading, and the observed changes were correlated with those that had been demonstrated by scanning electron microscopy. Fractures through the zone of calcified cartilage and the subchondral bone, with step-off displacement, were prominent. Clefts were present in the surface of the articular cartilage and, in some areas, there was a focal loss of proteoglycan from the extracellular matrix, as indicated by the complete absence of staining with safranin O. Six dogs were examined one year after loading. There was healing of the subchondral fractures and restoration of proteoglycan in the extracellular matrix. However, superficial clefts and fissures were still present in the articular cartilage. Sequential magnetic resonance-imaging studies were also carried out on these six dogs, at two, eight, sixteen, thirty-six, and fifty-two weeks after loading. Two weeks after loading, all knees had soft-tissue swelling, effusion, and a decreased marrow signal in the medullary cavity of the patella. The decreased marrow signal and effusion were still present eight weeks after the impact, and then the findings gradually returned to normal. One year after loading, it was found that the histopathological changes had not been progressive; in fact, they had been ameliorated and, to some extent, reversed by repair processes. The early, severe magnetic resonance-imaging changes had also been reversed, so that this study demonstrated normal findings by one year after loading.

The biomechanics of gravity-dependent traction of the lumbar spine.

STUDY DESIGN: This study evaluated the biomechanical responses evoked by the use of a gravity-dependent, self-operated traction device. These responses were determined by radiographs and were correlated with the body weight of the patient who was supported by a seat strap. OBJECTIVES: To examine the biomechanical effectiveness of the LTX 3000 Lumbar Rehabilitation System. SUMMARY OF BACKGROUND DATA: The LTX 3000 Lumbar Rehabilitation System (Spinal Designs International, Minneapolis, MN) was used to administer the lumbar fraction. No previous study has been conducted on this device. METHODS: For each of the 14 healthy male patients (age range, 19-69 years), lumbar lengthening, alterations in spinal curvature, and thoracic spine movement were assessed using radiographs taken: 1) before traction; 2) at 2, 10, and 15 minutes after the onset of traction; and 3) 2 minutes after traction was completed. Strain on the buttocks-supporting seat strap was recorded continuously during study sessions. RESULTS: The entire patient pool displayed an average maximal lumbar lengthening of 6.39 +/- 4.21 mm. The amount of lumbar lengthening was influenced by the degree of thoracic immobilization and by the amount of prior LTX 3000 (Spinal Designs International) use. Significant curvature reduction was observed during and after traction for the entire patient pool. Strain measurements correlated well with the measured response in the radiographs. CONCLUSIONS: Proper use of the LTX 3000 (Spinal Designs International) induces significant lumbar lengthening and curvature reduction in healthy patients. Measurements of body weight supported by the seat strap could help determine if thoracic immobilization has been achieved and if the patient is responding to the lumbar unloading.

Magnification and high-resolution radiography in sports-related injuries.

Magnification, or high-resolution radiography, is a widely accepted technique and is currently used in angiography, mammography and pediatric chest radiographs. Small avulsion fractures of the bones of the hand and stress fractures of th tibia are examples of two areas where the fracture may not be apparent on conventional films, although in many cases magnification radiography will demonstrate the lesions. Six representative case histories are provided to illustrate the use of magnification radiography in sports-related injuries.

Open meniscus repair. Technique and two to nine year results.

An average 4.6 year follow-up study has been done on 80 of 104 open meniscus repairs of unstable peripheral tears. Two of nine retears were treated in the acute stage and seven were treated in the chronic stage. Eight retears were medial, one was lateral (repair ratio, 1.5:1 medial to lateral), three occurred through the repair site, and six occurred in different areas. Retears occurred in 1 of 26 isolated repairs, 2 of 38 repairs done with an ACL stabilization procedure, and 6 of 16 repairs done in ACL deficient knees that were not stabilized. Standing radiographs revealed normal compartments in 40 of 41 repairs.