A Simplified Preoperative Radiographic Assessment for Metatarsus Adductus Associated With Hallux Valgus.

Radiographic measurements for the assessment of metatarsus adductus (MTA) have a broad range of interpretation without a consensus regarding surgical indications. The "Plumbline" (PL) radiographic assessment method helps identify MTA and determines if physical space is available to align the first metatarsal to the longitudinal foot axis without the need to realign the lesser metatarsals. Forty-five neutral weight-bearing anterior-posterior (AP) radiographs of patients scheduled for surgical intervention for isolated hallux valgus (HV) or combined MTA/HV deformities were reviewed. The cohort was grouped based on the presence of MTA using a Sgarlato's angle (SA) of 15°, with 23 patients in the HV-only group and 22 patients in the MTA group. A mean preoperative SA of 8.7° (SD: 2.1; range: 5.4-13.4) and 26.6° (SD: 5.1; range: 18.2-36) were found in the HV-only and MTA groups, respectively. Subjects with an SA ≤ 15° (N = 22) were found to have a negative PL (100%) and subjects with an SA > 15° (N = 23) displayed a positive PL (100%). The PL technique provided a simple method and clear visual reference for determining the presence of MTA in HV patients without the need to measure traditional radiographic angles.Level of Evidence: Retrospective, Level IV, Diagnostic.

The Influence of Health Equity on Patient Outcomes in Orthopaedics.

Health equity has become both a national and international health priority when addressing health disparities that influence health outcomes across all patient populations. Orthopaedic nurses play a critical role in advancing health equity among orthopaedic patients when it comes to ensuring orthopaedic patients have fair and just opportunities to achieve their best state of musculoskeletal health. For health equity to be realized by the specialty of orthopaedics and the orthopaedic patient populations being served, it is important for the orthopaedic nurse to be involved in community-based partnerships, research opportunities, and health policy initiatives that focus on the advancement of health equity for all populations.

Report of the 2018-2019 Strategic Engagement Standing Committee.

EXECUTIVE SUMMARY. Strategic engagement is critical to the success of colleges and schools of pharmacy in expanding pharmacy and public health practice, meeting programmatic needs, and fulfilling institutional missions. The AACP 2019-2020 Strategic Engagement Committee was charged with exploring faculty leadership and development as they relate to strategic engagement, considering challenges and barriers to faculty participation and identifying successes in faculty engagement and opportunities for professional development. The committee reviewed literature and examples regarding strategic engagement across academic pharmacy, with strategic engagement understood as being part of the service mission of academic institutions. The committee found faculty service is often not rewarded or recognized equally to efforts in research and education, including in promotion and tenure. The perceived low value often accorded to strategic engagement efforts, coupled with lack of time and low priority for the work, are barriers to faculty participation in strategic engagement. Service missions thrive when supported by institutional culture, faculty and alumni role models and administration priorities. The committee also found that there is no defined path to leadership in most national organizations, a limited number of leadership positions and a lack of awareness regarding these positions. However, strategic engagement with organizations can open doors and increase visibility for faculty, leading to enhanced opportunities and improved scholarship. Engagement efforts can be particularly successful when aligned with faculty interests and school and departmental priorities. Based on the committee's work, the following recommendations are provided to AACP for consideration.Recommendation #1 - AACP should create a pathway or exemplar stories of members who have become leaders within the Academy including institutional and volunteer leadership roles.Recommendation #2 - AACP should provide an organizational chart to outline the reporting structures, as well as the policy development process to help members understand how AACP works and points of entry for involvement.Recommendation #3 - AACP should develop an initiative to "groom" faculty for leadership roles including providing tools/training programs for emerging leaders within the Academy.Recommendation #4 - AACP should consider creating a community for targeted groups of faculty, eg, tenured/tenure-track and non-tenure track to address leadership development and engagement based on member interest.Recommendation #5 - AACP should establish a "service mentors" program to match current and past leaders with members interested in enhancing their involvement in the association.

Dental Public Health in Action: Understanding oral health care needs and oral health-related quality of life in vulnerable adults in Plymouth.

This paper aims to provide a snapshot analysis of the oral health status of vulnerable adults in Plymouth; and to demonstrate the extent to which oral disease impacts on their normal functioning through the implementation of the Oral Health Impact Profile (OHIP). It is acknowledged that gaining a representative sample of a transient population such as people who are homeless, or individuals affected by problematic use of drugs and/or alcohol is difficult. An opportunity was identified to collect data within the Community Engagement Team's (CET) programme of activity within the Peninsula Dental Social Enterprise. The CET works alongside local organisations to enable dental students from Peninsula School of Dentistry to undertake outreach programmes in a variety of settings. A study was designed which aimed to analyse the oral health status of vulnerable adults accessing three day-support services in Plymouth, and to understand the extent to which oral disease impacts on their normal functioning through the OHIP-14. For all impact domains, the 44 patients in this study reported a greater impact than that found in the Adult Dental Health Survey. The most commonly reported impact domains were physical pain and psychological discomfort. The sample was divided into high and low oral health-related quality of life impact groups, and those participants in the high impact group had significantly greater median D3MFT scores, i.e. higher levels of decay experience. This survey highlights how these vulnerable groups are characterised by a high prevalence of poor oral health, ill-health, deprivation and social exclusion.

The North American Forest Database: going beyond national-level forest resource assessment statistics.

Forests cannot be managed sustainably without reliable data to inform decisions. National Forest Inventories (NFI) tend to report national statistics, with sub-national stratification based on domestic ecological classification systems. It is becoming increasingly important to be able to report statistics on ecosystems that span international borders, as global change and globalization expand stakeholders' spheres of concern. The state of a transnational ecosystem can only be properly assessed by examining the entire ecosystem. In global forest resource assessments, it may be useful to break national statistics down by ecosystem, especially for large countries. The Inventory and Monitoring Working Group (IMWG) of the North American Forest Commission (NAFC) has begun developing a harmonized North American Forest Database (NAFD) for managing forest inventory data, enabling consistent, continental-scale forest assessment supporting ecosystem-level reporting and relational queries. The first iteration of the database contains data describing 1.9 billion ha, including 677.5 million ha of forest. Data harmonization is made challenging by the existence of definitions and methodologies tailored to suit national circumstances, emerging from each country's professional forestry development. This paper reports the methods used to synchronize three national forest inventories, starting with a small suite of variables and attributes.

AACP Special Taskforce White Paper on Diversifying Our Investment in Human Capital.

The 2015-2017 American Association of Colleges of Pharmacy (AACP) Special Taskforce on Diversifying our Investment in Human Capital was appointed for a two-year term, due to the rigors and complexities of its charges. This report serves as a white paper for academic pharmacy on diversifying our investment in human capital. The Taskforce developed and recommended a representation statement that was adapted and adopted by the AACP House of Delegates at the 2016 AACP Annual Meeting. In addition, the Taskforce developed a diversity statement for the Association that was adopted by the AACP Board of Directors in 2017. The Taskforce also provides recommendations to AACP and to academic pharmacy in this white paper.

Exploration of a new model of care in a psychiatry unit.

The model established at Orillia Soldiers Memorial Hospital involves family physicians as the most responsible physician. They act as "admission gatekeeper" for all unattached patients who are admitted to the psychiatry in-patient unit. A PubMed, EBSCO, OVID Medline, Embase, CINAHL, and Web of Science database review of the last 10 years (2006-2016) was undertaken. A satisfaction survey was undertaken. An intensive literature review found this model to be unique. The model has proved to be extremely efficient and cost-effective.

A continuous-time model of centrally coordinated motion with random switching.

This paper considers differential problems with random switching, with specific applications to the motion of cells and centrally coordinated motion. Starting with a differential-equation model of cell motion that was proposed previously, we set the relaxation time to zero and consider the simpler model that results. We prove that this model is well-posed, in the sense that it corresponds to a pure jump-type continuous-time Markov process (without explosion). We then describe the model's long-time behavior, first by specifying an attracting steady-state distribution for a projection of the model, then by examining the expected location of the cell center when the initial data is compatible with that steady-state. Under such conditions, we present a formula for the expected velocity and give a rigorous proof of that formula's validity. We conclude the paper with a comparison between these theoretical results and the results of numerical simulations.

When do we think it is Safe to Drive after Hand Surgery? - Current Practice and Legal Perspective.

Patients recovering from hand surgery frequently ask when it is safe to drive and it is unclear where the responsibility lies; the surgeon, the patient or the insurance company. An eight-question survey looking at various aspects of clinical practice was circulated to consultant and trainee plastic and orthopaedic surgeons in Ireland and the UK. Of the 89 surgeons who replied, (53%) felt the decision when to drive was the patient's compared with the insurance company (40%) and the surgeon (7%). 80% advised patients to contact their insurance company. 87% were unaware of current regulations or guidelines. National guidelines were vague and left the decision with the treating doctor. Similarly, major insurers advise patients to contact their doctor for advice. From a legal standpoint, the patient has a duty of care to other road users to be in full control of his vehicle prior to driving, regardless of any advice received.

Determining the Sufficiency of Cultural Competence Instruction in Pharmacy School Curriculum.

OBJECTIVE: To assess the change in the level of cultural competency and knowledge of health disparities among students in the third year of the doctor of pharmacy (PharmD) program at the University of Florida and to explore the demographic correlates. METHODS: A cross-sectional survey was conducted in 3 consecutive academic years. Chi-square tests, analysis of variance (ANOVA), and multivariate regression were used for data analysis. RESULTS: Following the inclusion of relevant instruction, there was some increase in knowledge of health disparities and self-awareness, but no significant increase in cultural competency skills. More students reported receiving relevant instruction within the pharmacy school curriculum than outside the curriculum. CONCLUSION: Current effort to incorporate cultural competence and health disparities instruction into the pharmacy curriculum has met with some success. However, there is a need to establish standards on how much relevant training is required and further explore ways to effectively incorporate it into pharmacy education.

Influence of eye size and beam entry angle on dose to non-targeted tissues of the eye during stereotactic x-ray radiosurgery of AMD.

Age-related macular degeneration is a leading cause of vision loss for the elderly population of industrialized nations. The IRay® Radiotherapy System, developed by Oraya® Therapeutics, Inc., is a stereotactic low-voltage irradiation system designed to treat the wet form of the disease. The IRay System uses three robotically positioned 100 kVp collimated photon beams to deliver an absorbed dose of up to 24 Gy to the macula. The present study uses the Monte Carlo radiation transport code MCNPX to assess absorbed dose to six non-targeted tissues within the eye-total lens, radiosensitive tissues of the lens, optic nerve, distal tip of the central retinal artery, non-targeted portion of the retina, and the ciliary body--all as a function of eye size and beam entry angle. The ocular axial length was ranged from 20 to 28 mm in 2 mm increments, with the polar entry angle of the delivery system varied from 18° to 34° in 2° increments. The resulting data showed insignificant variations in dose for all eye sizes. Slight variations in the dose to the optic nerve and the distal tip of the central retinal artery were noted as the polar beam angle changed. An increase in non-targeted retinal dose was noted as the entry angle increased, while the dose to the lens, sensitive volume of the lens, and ciliary body decreased as the treatment polar angle increased. Polar angles of 26° or greater resulted in no portion of the sensitive volume of the lens receiving an absorbed dose of 0.5 Gy or greater. All doses to non-targeted structures reported in this study were less than accepted thresholds for post-procedure complications.

Cell speed is independent of force in a mathematical model of amoeboidal cell motion with random switching terms.

In this paper the motion of a single cell is modeled as a nucleus and multiple integrin based adhesion sites. Numerical simulations and analysis of the model indicate that when the stochastic nature of the adhesion sites is a memoryless and force independent random process, the cell speed is independent of the force these adhesion sites exert on the cell. Furthermore, understanding the dynamics of the attachment and detachment of the adhesion sites is key to predicting cell speed. We introduce a differential equation describing the cell motion and then introduce a conjecture about the expected drift of the cell, the expected average velocity relation conjecture. Using Markov chain theory, we analyze our conjecture in the context of a related (but simpler) model of cell motion, and then numerically compare the results for the simpler model and the full differential equation model. We also heuristically describe the relationship between the simplified and full models as well as provide a discussion of the biological significance of these results.

Molecular simulations of the fluctuating conformational dynamics of intrinsically disordered proteins.

Intrinsically disordered proteins (IDPs) do not possess well-defined three-dimensional structures in solution under physiological conditions. We develop all-atom, united-atom, and coarse-grained Langevin dynamics simulations for the IDP α-synuclein that include geometric, attractive hydrophobic, and screened electrostatic interactions and are calibrated to the inter-residue separations measured in recent single-molecule fluorescence energy transfer (smFRET) experiments. We find that α-synuclein is disordered, with conformational statistics that are intermediate between random walk and collapsed globule behavior. An advantage of calibrated molecular simulations over constraint methods is that physical forces act on all residues, not only on residue pairs that are monitored experimentally, and these simulations can be used to study oligomerization and aggregation of multiple α-synuclein proteins that may precede amyloid formation.

Clinical cultural competency and knowledge of health disparities among pharmacy students.

OBJECTIVE: To evaluate the level of competency and knowledge about health disparities among third-year doctor of pharmacy (PharmD) students at 2 Florida public colleges of pharmacy and to explore the demographic correlates of these variables. METHODS: A cross-sectional survey study design was used to collect data from participants. RESULTS: The students had low health-disparities knowledge and moderate skills in dealing with sociocultural issues and cross-cultural encounters. Speaking a language(s) other than English and having exposure to cultural-competency instruction were the demographic variables found to be most significantly associated with clinical cultural competency and/or knowledge of health disparities. CONCLUSIONS: Clinical cultural competency and health-disparities instruction may not be adequately incorporated into the pharmacy school curricula in the institutions studied. Relevant education and training are necessary to enhance cultural competency among pharmacy students.

Reliability of skin-type self-assessment: agreement of adolescents' repeated Fitzpatrick skin phototype classification ratings during a cohort study.

BACKGROUND: The Fitzpatrick Skin Phototype Classification (FSPC) is the most commonly used measure of skin type. In questionnaire-based surveys, self-rated FSPC is often used as a measure of respondents' skin type. OBJECTIVE: The objective of this analysis was to assess test-retest reliability of the self-rated FSPC within a 12-month cohort study that examined the psychological sequelae of acne. METHODS: Participants were students aged 14-17 years in four Australian secondary schools; two-government system schools and two private schools. The primary outcomes were a number of psychological measures. The FSPC was assessed by a single concise questionnaire item. Test-retest agreement (as measured by quadratic weighted kappa) of participants' self-rated FSPC at three time-points (baseline, 6 and 12 months) was calculated. RESULTS: Of the 244 participating students, 209 students (86%) completed all three rounds of data collection. A further 26 students (11%) completed two rounds. Quadratic weighted kappa for Rounds 1 and 2 was 0.757 (95% CI 0.663-0.831). For Rounds 2 and 3 it was 0.805 (95% CI 0.659-0.893). Between Rounds 1 and 3 it was 0.767 (95% CI 0.698-0.832). This represents good-to-very-good agreement. Skin type was retained as an independent variable in 8 of the 16 regression models built to explain psychological outcomes in this study. CONCLUSION: Skin type appears to be a significant factor in psychological morbidity in acne. The FSPC is a reliable method for assessing skin phenotype, even when elicited via a concise questionnaire item suitable for assessing skin type as a potential confounder in studies of other outcome factors.

Clinical benefits and cost-effectiveness of allogeneic red-blood-cell transfusion in severe symptomatic anaemia.

BACKGROUND: It is well known that blood transfusion is life-saving, but also that it carries a serious risk of transmitting viral infections. Introduction of new methods of testing for transmissible diseases, blood banking and dispatch regulations has considerably increased the cost of blood products. However, the clinical benefits and cost-effectiveness of allogeneic red-blood-cell (ARBC) transfusion remain assumed yet undetermined. We assessed the clinical benefits and cost-effectiveness of ARBC transfusion in severe anaemia. METHODS: This was a multicenter observational study comparing Jehovah's Witness (JW) patients with matched ARBC-transfused patients. Inclusion criteria were age ≥15 years and severe anaemia (haemoglobin ≤ 80 g/l). Two JW patients with palliative care cancer and five JW patients with haemoglobin (Hb) concentration between 70·1 and 80 g/l, mild symptoms of anaemia and Auckland Anaemia Mortality Risk Score of 0-3 were excluded. RESULTS: The entry criteria were met by 103 JW patients and the same number of patients treated with ARBC transfusion. ARBC transfusion reduced mortality by 94%, shock by 88%, gastrointestinal bleeding by 81%, infective complications by 81%, cardiac arrhythmia by 96%, angina by 86%, ischaemic myocardial injury by 81%, acute/acute on chronic renal failure by 66%, neurologic complications by 92%, delirium by 76%, depression by 91% and syncopal episodes by 95%. The incremental cost-effectiveness ratio of ARBC transfusion was 2011 US$22 515 for death prevented. CONCLUSION: ARBC transfusion in anaemic patients is clinically beneficial and cost-effective.

Potential effect of the World Health Organization's 2011-2015 global leprosy strategy on the prevalence of grade 2 disability: a trend analysis.

OBJECTIVE: To assess different countries' chances of attaining the 2011-2015 global leprosy target set by the World Health Organization (WHO) and to assess the strategy's effect on the prevalence of grade 2 disability (G2D). METHODS: Trends in G2D rate were analysed for Brazil, China, India and Thailand and figures were compared with the WHO target: a 35% decrease by 2015 relative to the 2010 baseline. To estimate the prevalence of G2D in 2015 and 2035 for each country three assumptions were made: (i) maintenance of the current trend; (ii) attainment of the WHO target, and (iii) reduction of G2D by 50% every 5 years relative to 2010. FINDINGS: Since 1995, the G2D rate has decreased every 5 years in Brazil, China, India and Thailand by 12.7% (95% confidence interval, CI: 6.6-18.3), 7.7% (95% CI: 1.1-12.8), 53.7% (95% CI: 38.1-65.4) and 35.9% (95% CI: 23.4-46.3), respectively. New cases with G2D detected after 2010 will contribute 15% (Brazil), 3% (China), 2.5% (India) and 4% (Thailand) to the total prevalence of G2D in 2015. If no policies are changed, between 2015 and 2035, the prevalence of G2D will decrease by more than half in China, India and Thailand, and by 16% in Brazil. CONCLUSION: The implications of attaining the WHO target are different for each country and using indicators other than G2D prevalence will help monitor progress. The strategy will not immediately reduce the prevalence of G2D, but if it is applied consistently over the next 25 years, its long-term effect can be substantial.