When should splint treatment start for a tendinous mallet finger? A retrospective review of 319 fingers.

In a 5-year retrospective review of 319 tendinous mallet fingers, we focused on the result after splint treatment. The splint we used was a 'no pressure' thermoformed customized Stack splint. The patients wore it strictly for 8 weeks. Based on the Patel criteria, we obtained 91% good or excellent results and 9% fair or poor results. The rate of excellent results increased significantly (p < 0.001) when treatment started 20 days after the trauma. Patients were 13 times more likely to have good or excellent results with a delayed treatment. We noticed that inflammation in the distal interphalangeal joint seemed to be detrimental to the healing process. We suggest assessing if there is inflammation to anticipate the failure of treatment, which will lead to a longer treatment. Further studies on the subject should confirm this.

Effects of antimicrobial exposure on the antimicrobial resistance of Escherichia coli in the digestive flora of dairy calves.

Veal calves are often identified as reservoirs for antimicrobial resistant Escherichia coli (E. coli). This production is closely linked with dairy production, as young calves - mostly males - are collected from dairy farms to enter the fattening process. The aim of this prospective study was to explore the factors on dairy farms that favour the selection of antimicrobial resistance (AMR) in the digestive E. coli strains of young calves and to assess whether the resistance levels and selection pressure were the same for males and females. The exposure of calves to antimicrobials was investigated through three factors: antimicrobial treatment of calves; feeding of calves with milk from cows treated with antimicrobials; and the consumption of colostrum from cows treated with antimicrobials at dry-off. The study design involved 100 dairy farms. A calf of each sex was selected from birth on each farm. Information on the calves' exposure to antimicrobials was collected daily and calves were sampled (rectal swab) two weeks after birth, then seven weeks after birth for females only. Laboratory analyses included culture on two distinct media: a non-selective medium (identifying dominant flora) and a medium containing ceftiofur to select the extended-spectrum beta-lactamase (ESBL) phenotype. Susceptibility testing was performed on an E. coli strain from each medium. Generalised linear models were used to assess associations between the resistance of E. coli strains and antimicrobial exposure. A set of 280 swabs from healthy calves were analysed. In dominant flora, high levels of resistance (>60 %) were identified for streptomycin, tetracycline and amoxicillin but AMR levels were low (3 %) for critically important antimicrobials (3rd- and 4th-generation cephalosporins and fluoroquinolones). For females staying in dairy farms, a marked decrease in resistance was observed for almost all antimicrobials between the age of 15 days and 7 weeks. A selective medium revealed an ESBL phenotype for 20.7 % of the calves. Whether for AMR or antimicrobial exposure, no significant difference was found between male and female calves. The antimicrobial treatment of calves was associated with an increased resistance of E. coli from dominant flora for amoxicillin (OR = 2.9), gentamicin (OR = 4.6), florfenicol (OR = 5.0) and trimethoprim-sulfonamide (OR = 5.6). The consumption by calves of milk from cows treated with antimicrobials was also associated with an increased resistance to amoxicillin (OR = 2.6), gentamicin (OR = 4.0), tetracycline (2.6) and trimethoprim-sulfonamide (OR = 2.2). In contrast, the models did not reveal any association between AMR and consumption of colostrum from cows treated with antimicrobials at dry-off.

Skiing and Snowboarding Injuries in Snow Parks: A Study Based on Self-Reported Practitioners' Statements.

INTRODUCTION: Snow parks (SPs) are an essential part of what draws individuals to winter resorts. When compared to traditional skiing and snowboarding, SPs heighten the risk and severity of injuries, as well as the rate of hospitalization. The aim of this study is to contribute to the knowledge on accidents in SPs based on the self-reported statements of practitioners. METHODS: A questionnaire measured self-reported accident frequency and type, the nature of injuries sustained, the duration of the discomfort caused, and contributing factors such as terrain features. Demographic and sport-related data, such as ability and frequency of participation, were also collected. The questionnaires were administered in several SPs in the French Alps. RESULTS: Teenagers and experienced freestylers are most frequently injured. The nature and location of injuries vary depending on the level of practice and type of feature. Few injured participants contact emergency services. CONCLUSIONS: The rate of injuries in SPs exceed that reported in prior research. Because expert and young participants expose themselves to particularly serious bodily impacts in SP, they must pay special attention to prevention.

Combining usability evaluations to highlight the chain that leads from usability flaws to usage problems and then negative outcomes.

Poor usability of health technology is thought to diminish work system performance, increase error rates and, potentially, harm patients. The present study (i) used a combination of usability evaluation methods to highlight the chain that leads from usability flaws to usage problems experienced by users and, ultimately, to negative patient outcomes, and (ii) validated this approach by studying two different discharge summary production systems. To comply with quality guidelines, the process of drafting and sending discharge summaries is increasingly being automated. However, the usability of these systems may modify their impact (or the absence thereof) in terms of production times and quality, and must therefore be evaluated. Here, we applied three successive techniques for usability evaluation (heuristic evaluation, user testing and field observation) to two discharge summary production systems (underpinned by different technologies). The systems' main usability flaws led respectively to an increase in the time need to produce a discharge summary and the risk of patient misidentification. Our results are discussed with regard to the possibility of linking the usability flaws, usage problems and the negative outcomes by successively applying three methods for evaluating usability (heuristic evaluation, user testing and in situ observations) throughout the system development life cycle.

Assessment of antigenic supplementation of bovine purified protein derivative for diagnosis of subclinical infection with Mycobacterium bovis in cattle.

Bovine tuberculosis (bTB) is usually diagnosed in vivo and ex vivo on the basis of delayed hypersensitivity reactions with a complex pool of antigens named bovine tuberculin (PPDB). The IFN-γ release assay (IGRA) for bTB is a blood-based assay that improves detection of infected cattle at early stages that escape skin testing. Improvements to IFN-γ testing with specific proteins have been performed to increase sensitivity. DosR regulon-related antigens are well known mycobacterial proteins expressed during the non-replicative phases of infection, this has been useful to improve the diagnosis of subclinical forms of TB in suspected individuals. Transcripts of DosR genes mb2054c, mb2057c, and mb2660c have been identified by our group in lymph nodes of IFN-γ test negative cattle. This led us to hypothesize that DosR-related proteins may potentiate the IFN-γ response to PPDB in animals with a false negative IFN-γ test, making evident subclinical infection. Three hundred animals were evaluated by means of IGRA and post-mortem microbiological analysis of tissue samples to validate M. bovis infection. We found that 176 out of 300 animals showed an overall increased OD in complemented IGRA with two purified protein cocktails in comparison to PPDB alone, and were scrutinized for a subclinical infection; thirty percent when PPDB was supplemented with a cocktail of four DosR antigens, and 70% when PPDB was supplemented with a cocktail of six antigens (four DosR and two RD1 antigens). Forty five animals showed a substantial IFN-γ overproduction but remained negative, and 40 animals changed the result to a positive test. Only 18 out of 176 IFN-γ high producing animals were also positive to M. bovis isolation. Fifty seven animals with no visible lesions at slaughter and with a negative IGRA test result contained M. bovis DNA in tissue samples. In conclusion, Mb1762c, Mb2054c, Mb2057c, and Mb2660c have the potential to increase sensitivity of the IFN-γ in vitro test for bTB diagnosis when supplemented to PPDB.

A retrospective review of 345 patients with lumbar TDR in two years follow-up over 10 years of practice in one Belgian clinical center : Results.

Low back pain is one of the most common symptom with high cost for the public health. When conservative treatment fails, patients are heading to surgical treatment. Instead of lumbar arthrodesis, we can offer an alternative that will keep the intervertebral mobility : Total disc replacement (TDR) by prosthesis. Many studies have published good results rate over 80%, since first implantation in 1984. Believing in keeping the mobility, we promote TDR since 2002. This retrospective study review 345 patients with two years follow-up. The outcomes show 81% of good and really good results, according to gain of improvement on VAS and ODI scores. We report 6.88% of complications for the abdominal approach and 4.57% for the device, without harmful complication. Same results are obtained in case of postdiscectomy syndrome.

Usability and Safety of Software Medical Devices: Need for Multidisciplinary Expertise to Apply the IEC 62366: 2007.

Software medical devices must now comply with the "ergonomics" essential requirement of the Medical Device Directive. However, the usability standard aiming to guide the manufacturers is very difficult to understand and apply. Relying on a triangulation of methods, this study aims to highlight the need to combine various expertises to be able to grasp the standard. To identify the areas of expertise on which the usability standard relies, an analytical review of this document was performed as well as an analysis of a discussion forum dedicated to it and an analysis of a case study of its application for CE marking. The results show that the IEC 62366 is a usability standard structured as a risk management one. It obviously requires Human Factors/Ergonomics expertise to be able to correctly identify and prevent risks of use errors, but it also requires risk management expertise to be able to grasp the issues of the risk analysis and master the related methods.

Analyzing Web pages visual scanpaths: between and within tasks variability.

In this paper, we propose a new method for comparing scanpaths in a bottom-up approach, and a test of the scanpath theory. To do so, we conducted a laboratory experiment in which 113 participants were invited to accomplish a set of tasks on two different websites. For each site, they had to perform two tasks that had to be repeated ounce. The data were analyzed using a procedure similar to the one used by Duchowski et al. [8]. The first step was to automatically identify, then label, AOIs with the mean-shift clustering procedure [19]. Then, scanpaths were compared two by two with a modified version of the string-edit method, which take into account the order of AOIs visualizations [2]. Our results show that scanpaths variability between tasks but within participants seems to be lower than the variability within task for a given participant. In other words participants seem to be more coherent when they perform different tasks, than when they repeat the same tasks. In addition, participants view more of the same AOI when they perform a different task on the same Web page than when they repeated the same task. These results are quite different from what predicts the scanpath theory.

Usability testing: a review of some methodological and technical aspects of the method.

The aim of this paper is to review some work conducted in the field of user testing that aims at specifying or clarifying the test procedures and at defining and developing tools to help conduct user tests. The topics that have been selected were considered relevant for evaluating applications in the field of medical and health care informatics. These topics are: the number of participants that should take part in a user test, the test procedure, remote usability evaluation, usability testing tools, and evaluating mobile applications.

Effects of the viewing context on target detection. Implications for road lighting design.

The Small Target Visibility (STV) model is the main model used to assess the quality of road lighting installations (IESNA, 2000). However, this model is based on a simple detection task in foveal vision using psychophysical data from laboratory conditions. The purpose of this study was to evaluate the impact of a complex background and apparent motion on target detection performance in mesopic vision, for three luminance contrasts, with reference to the STV scenario. To do so, participants were invited to detect standard square targets varying in terms of contrast presented in three Conditions: a uniform background, still images, and a video. Luminance levels were chosen in the mesopic domain relevant for road lighting at night. Images and video were chosen in relation to a driving task at night. The results showed that both the spatial context and the apparent motion had a negative impact on peripheral target detection performance: contrasts which are easy to detect in conditions close to the STV reference data may lead to poor performance if one adds context variables. These results give evidence that the STV model used for road lighting design based on laboratory data is limited, which strengthens previous results (Mayeur et al., 2008). The results are discussed in relation to the field factor used by practitioners to compensate for the differences between the STV reference scenario (detection of a small square target on a lit road while driving) and the STV psychophysical reference data.

Effect of task and eccentricity of the target on detection thresholds in mesopic vision: implications for road lighting.

OBJECTIVE: The aim of this work is to assess how adding a driving-related task affects the detection of objects in peripheral vision, under mesopic conditions. BACKGROUND: The main index used to assess the quality of road lighting installations refers to simple detection tasks in foveal vision, which raises methodological and practical questions. METHOD: The experimental design consisted of a three-phase experiment. In the first phase, two groups (control and experimental) performed a peripheral detection task (simple task). Based on these results an individual detection threshold was computed for each participant and eccentricity. A tracking task was performed in Phase 2 for both groups (steering a tracking target along a circuit, on a screen). In the third phase, the control group performed the same task as in Phase 2. The experimental group performed a double task, with a tracking (primary) task and a peripheral detection (secondary) task. RESULTS: The data show an effect of the tracking task and eccentricity on peripheral event detection. The tracking task caused detection performance to decrease from 84.2% to 67.5%, p < .001. CONCLUSION: The small target visibility model used in road lighting may be improved, taking into account the effects of task and eccentricity on target detection. APPLICATION: This study supports improved roadway lighting design by guiding consideration of sign eccentricity and task load.

The phosphoinositide 3-kinase/Akt pathway is essential for the retinoic acid-induced differentiation of F9 cells.

Retinoic acid (RA) induces cell growth arrest and differentiation through two families of nuclear receptors, the RARs and the RXRs. The phosphoinositide 3-kinase (PI3K)/Akt pathway also plays key roles in these processes, that is, cell cycle progression, cell differentiation and cell survival. We report that, in mouse embryocarcinoma cells (F9 cells), RA induces an early activation of PI3K and Akt via an increase in the expression of the p85alpha regulatory subunit. This effect is followed by an inhibition of Akt. Both effects require the integrity of the RA pathway as they are not observed in RA-resistant RARgamma null cells. We propose a model through which RA induces a biphasic regulation of Akt with an activation participating to the differentiation process, followed by an inhibition, which has been correlated to the RA-induced growth arrest.

TFIIH interacts with the retinoic acid receptor gamma and phosphorylates its AF-1-activating domain through cdk7.

Retinoic acid receptor gamma (RARgamma) is phosphorylated in COS-1 cells at two conserved serine residues located in the N-terminal region (serines 77 and 79 in RARgamma1 and serines 66 and 68 in RARgamma2) that contains the activation function AF-1. These serines are phosphorylated in vitro by cdk7, a cyclin-dependent kinase associated to cyclin H and MAT1 in the CAK complex (cdk7.cyclin H. MAT1), that is found either free or as a component of the transcription/DNA repair factor TFIIH. RARgamma is more efficiently phosphorylated by TFIIH than by CAK and interacts not only with cdk7 but also with several additional subunits of TFIIH. RARgamma phosphorylation and interaction with TFIIH occur in a ligand-independent manner. Our data demonstrate also that phosphorylation of the AF-1 function modulates RARgamma transcriptional activity in a response gene-dependent manner.

Inhibitory and stimulatory effects of somatostatin on two human pancreatic cancer cell lines: a primary role for tyrosine phosphatase SHP-1.

Somatostatin (SS-14) and its structural analogue SMS 201-995 (SMS) are recognized as physiological inhibitors of multiple organs and tissue functions through specific membrane receptors (sst1-sst5). The effects of SS-14 and SMS in the growth control of the pancreatic cancer cell lines MIA PaCa-2 and PANC-1 were investigated to identify and clarify the intracellular events involved. In PANC-1 cells, SS-14 and SMS caused inhibition of their basal growth, and that stimulated by epidermal growth factor, with a maximal effect at 0.1-1 microM. To understand the inhibitory mechanisms, we investigated the effects of SS-14 and SMS on phosphotyrosine phosphatase (PTPase) activity and, more specifically, that of tyrosine phosphatase SHP-1 (PTP1C). SS-14 and SMS caused significant increases in total cellular PTPase activity, and particularly SHP-1, with maximal activation within 1 min. Inhibition of membrane tyrosine kinase and p42 MAP kinase activities was also observed, in response to SS-14 and SMS. In MIA PaCa-2 cells, SS-14 and SMS were associated with a positive growth response at 1-10 nM, after 4 days of culture in serum-free medium. Total cellular PTPase activity was slightly increased, but SHP-1 activity could not be detected; its absence in this cell line was confirmed by Western blot. Membrane tyrosine kinase activities were significantly increased by SS-14 and SMS at concentrations needed for maximal growth. p44/p42, which are constitutively active in this cell line, and p38 activities were not affected by somatostatin. In conclusion, somatostatin can exert different effects on human pancreatic cancer cell growth, depending upon the presence or absence of SHP-1. This enzyme can play a key role in the control of cell proliferation, and its cellular presence may determine the therapeutic potential of somatostatin in the control of cancer cell growth.

Drug leads from the Kallawaya herbalists of Bolivia. 1. Background, rationale, protocol and anti-HIV activity.

Aqueous, organic and alcoholic extracts of over 100 samples of 60 species of Kallawaya medicinal herbs representing 30 plant families were assayed to compare their toxicity and ability to protect MT-2 T-lymphoblastoid cells from the cytopathic effect of human immunodeficiency virus (HIV). The results are reported as a therapeutic index (TI) which was > 25 for eighteen species, including seven > 50 and one > 100. The anti-HIV activity resided primarily in the aqueous rather than in the organic extracts and was concentrated in plants used in ethnomedicine to treat lung and liver diseases.

PIP: Plants are a rich source of anti-viral substances. The National Cancer Institute therefore annually screens about 1500 species from Africa, Southeast Asia, and South and Central America, but not Bolivia, for anti-HIV activity. Several unique compounds with anti-HIV activity have emerged from the program. The Kallawaya Indians of Bolivia follow a medical tradition from the Tiahuanaco (400-1145), Mollo (1145-1435), Inca (1438-1532), Spanish (1532-1825), and Bolivian Republic (from 1825) which is only recently starting to be reported. They use approximately 900 of the more than 2000 medicinal plants found across Bolivia. Aqueous, organic, and alcoholic extracts of more than 100 samples of 60 species of Kallawaya medicinal herbs representing 30 plant families were assayed to compare their toxicity and ability to protect MT-2 T-lymphoblastoid cells from the cytopathic effects of HIV. The therapeutic index (TI) of sampled species is defined as the ratio of anti-HIV activity to toxic concentration. A TI of greater than 25 was chosen as the prerequisite for future bioassay-directed isolation of the active components as leads for potential new anti-HIV drugs. TI was greater than 25 for 18 species, including seven greater than 50 and one greater than 100. The anti-HIV activity resided mainly in the aqueous extracts and was concentrated in plants used in ethnomedicine to treat lung and liver diseases.

Cross cultural communication of tetanus vaccinations in Bolivia.

Although neonatal tetanus (NNT) is common in developing countries, many people are unaware of its causes and prevention. A study analyzed cultural beliefs and practices to understand how people in three cultural areas in Bolivia (Aymara, Quechua and Tupi-Guarani) think about NNT and tetanus toxoid (TT) immunizations. In all three cultural areas NNT is perceived within a magical and biological framework that involves alternative healing systems and healers. Tetanus immunization programs could be more successful if tetanus were a clearly marked target for the Aymara, Quechua and Tupi-Guarani people, and vaccinators were sensitive to their cultural perceptions. Health workers need to communicate cross-culturally the relationship of TT vaccinations to how members of these ethnic groups perceive NNT.

Collaboration of doctors and nurses with ethnomedical practitioners.

PIP: In Bolivia, workshops serve as a means for biomedical practitioners and Aymara and Quechua ethnomedical practitioners from the Andes to share information about illnesses. The traditional practitioners demonstrate and biomedical personnel participate in curing rituals. Joint therapy sessions and development of joint strategies to improve health are included. Participants list the names, symptoms, causes, and treatments of diarrhea in a column for ethnomedicine and another for biomedicine. Biomedical and ethnomedical practitioners work together to persuade indigenous peoples to overcome their fear of and resistance to vaccination. One way to achieve this is by having people examine unsterilized knives under the microscope to see the tetanus toxoid. Physicians tend not to respect midwives and traditional birth attendants (TBAs). Biomedical trainers are not trained in and/or undervalue ethnomedicine, and can introduce midwives and TBAs to unhealthy practices. For example, they insist on scissors to cut the umbilical cord, but scissors are hard to sterilize, resulting in increased rates of neonatal tetanus. Women trained in medical anthropology, cross-cultural communication, and public health are the best trainers of TBAs and midwives. Supervision is needed to integrate TBAs and midwives into health programs and to improve their skills. Herbalism and ritual healing are more popular than the rural health care delivery system. Integrated clinics attract more clients than standard clinics. Recommended guidelines on collaboration revolve around recognition and respect of traditional healers, rewards for biomedical and ethnomedical personnel who collaborate, and issuance of health cards so both sets of practitioners can view patients' medical histories.^ieng

Community health workers in Bolivia: adapting to traditional roles in the Andean community.

Community health workers (CHW) constitute an outreach program where community members become involved in their health concerns and elect someone to be trained and administer primary health care. A major problem is that CHWs do not fit into leadership roles of either modern or traditional medicine. CHWs of Oruro, Bolivia, are discussed to examine the success of this program in which CHWs adapted to political, economic, and cultural patterns of Andean communities.