Model Predictions that Consider Individualized Gait Patterns and Patient Mobility Level for the Use of Passive Hip-Flexion Exosuits by Persons with Unilateral Transfemoral Amputation.

The muscular remodeling that occurs during a transfemoral amputation surgery and subsequent long-term use of mechanically-passive prostheses have significant impacts on the mobility and gait pattern of the patient. At toe-off and during the subsequent swing phase, this behavior is characterized by increased hip flexion moment and power provided by the biological limb. In other patient populations (e.g., individuals with multiple sclerosis) passive tension-generating assistive elements have been shown to restore altered hip flexion mechanics at toe off. We hypothesized that an exosuit of the same basic architecture could be well applied to individuals with transfemoral amputation. In this paper, we simulate the effects of such a device for 18 patients of K2 and K3 Medicare functional classification levels. The device consists of two parallel elastic bands. Our approach considers the wrapping and geometric behavior of these elements over the residual limb in full-body patient-specific kinematic simulations of level ground walking. A nonlinear least squares problem was solved via the Levenberg-Marquardt method to find the band properties that best match (in order to offset) the intrinsic power delivery of the muscles during the swing phase. We found higher mobility patients (K3) often require a stiffer device, which leads to a greater error in the kinetic match between the biological limb and exosuit. In contrast, this method appears to be effective for K2 patients, which suggests that a different means of parameter selection or power delivery (e.g., active devices) may be necessary for higher mobility levels.

Ova-looking feminist theory: a call for consideration within health professions education and research.

The role of feminist theory in health professions education is often 'ova-looked'. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.

The Anatomical Society's Core Anatomy Syllabus for Dental Undergraduates.

The Anatomical Society has developed a series of learning outcomes in consultation with dentists, dental educators and anatomists delivering anatomical content to undergraduate dental students. A modified Delphi methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate dental programmes throughout the UK. Utilising the extensive learning outcomes from two UK Dental Schools, and neuroanatomy learning outcomes that remained outside the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students, a modified Delphi technique was utilised to develop dental anatomical learning outcomes relevant to dental graduates. The Delphi panel consisted of 62 individuals (n = 62) from a wide pool of educators associated with the majority of undergraduate dental schools in the UK, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 147 anatomical learning outcomes deemed to be applicable to all dental undergraduate programmes in the UK. The new recommended core anatomy syllabus for dental undergraduates, grouped into body regions, offers a comprehensive anatomical framework with which to scaffold clinical practice. The syllabus, presented as a set of learning outcomes, may be used in a variety of pedagogic situations, including where anatomy teaching exists within an integrated dental curriculum (both horizontally in the basic sciences part of the curriculum and vertically within the clinical years).

Interprofessional education in dentistry.

A collaborative health workforce is required to respond to the increasing demands on healthcare resources. Various national and international bodies are promoting interprofessional education (IPE) as a method to provide this collaborative health workforce. IPE is therefore becoming increasingly prominent within healthcare training and will be an essential aspect of dental education. A literature search was completed to provide this narrative review which will introduce IPE, discuss the rationale for IPE within dentistry and the challenges faced. Based on current literature, it will provide practical advice on how to implement an effective IPE learning activity within dentistry.

The Anatomical Society's core anatomy syllabus for undergraduate nursing.

The Anatomical Society has developed a series of learning outcomes in consultation with nursing educators delivering anatomical content to undergraduate (preregistration) nursing students. A Delphi panel methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate nursing programmes throughout the UK. Using the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students as a foundation, a modified Delphi technique was used to develop discipline-specific outcomes to nursing graduates. The Delphi panel consisted of 48 individuals (n = 48) with a minimum of 3 years' experience teaching anatomy to nursing students, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 64 nursing specific learning outcomes in anatomy that are applicable to all undergraduate (preregistration) programmes in the UK. The new core anatomy syllabus for Undergraduate Nursing offers a basic anatomical framework upon which nurse educators, clinical mentors and nursing students can underpin their clinical practice and knowledge. The learning outcomes presented may be used to develop anatomy teaching within an integrated nursing curriculum.

Relating professionalism and conscientiousness to develop an objective, scalar, proxy measure of professionalism in anaesthetic trainees.

BACKGROUND: The concept of professionalism is complex and subjective and relies on expert judgements. Currently, there are no existing objective measures of professionalism in anaesthesia. However, it is possible that at least some elements of professionalism may be indicated by objective measures. A number of studies have suggested that conscientiousness as a trait is a significant contributor to professionalism. METHODS: A 'Conscientiousness Index' (CI) was developed by collation of routinely collected data from tasks expected to be carried out by anaesthetic trainees such as punctual submission of holiday and 'not-on-call' requests, attendance at audit meetings, timely submission of completed appraisal documentation and sickness/absence notifications. The CI consists of a sum of points deducted from a baseline of 50 for non-completion of these objective and measurable behaviours related to conscientiousness. This was correlated with consultants' formal and informal subjective measures of professionalism in those trainees. Informal, subjective measures of professionalism consisted of a 'Professionalism Index' (PI). The PI consisted of a score developed from consultants' expert, subjective views of professionalism for those trainees. Formal, subjective measures of professionalism consisted of a score derived from comments made by consultants in College Tutor feedback forms on their views on the professionalism of those trainees (College Tutor feedback; CT). The PI and CT scores were correlated against the CI using a Pearson or Spearman correlation coefficient. RESULTS: There was a negative, but not statistically significant, relationship between the CI and formal, subjective measures of professionalism; CT scores (r = -0.341, p = 0.06), but no correlation between CI and consultants informal views of trainees' professionalism; the PI scores (r s = -0.059, p = 0.759). CONCLUSIONS: This may be due the 'failure to fail' phenomenon due to the high stakes nature of raising concerns of professionalism in postgraduate healthcare professionals or may be that the precision of the tool may be insufficient to distinguish between trainees who generally show highly professional behaviour. Future development of the tool may need to include more of the sub-facets of conscientiousness. Independently of a relationship with the construct of professionalism, a measure of conscientiousness might be of interest to future employers.

Anatomical Society core regional anatomy syllabus for undergraduate medicine: the Delphi process.

A modified Delphi method was employed to seek consensus when revising the UK and Ireland's core syllabus for regional anatomy in undergraduate medicine. A Delphi panel was constructed involving 'expert' (individuals with at least 5 years' experience in teaching medical students anatomy at the level required for graduation). The panel (n = 39) was selected and nominated by members of Council and/or the Education Committee of the Anatomical Society and included a range of specialists including surgeons, radiologists and anatomists. The experts were asked in two stages to 'accept', 'reject' or 'modify' (first stage only) each learning outcome. A third stage, which was not part of the Delphi method, then allowed the original authors of the syllabus to make changes either to correct any anatomical errors or to make minor syntax changes. From the original syllabus of 182 learning outcomes, removing the neuroanatomy component (163), 23 learning outcomes (15%) remained unchanged, seven learning outcomes were removed and two new learning outcomes added. The remaining 133 learning outcomes were modified. All learning outcomes on the new core syllabus achieved over 90% acceptance by the panel.

The Anatomical Society core regional anatomy syllabus for undergraduate medicine.

The Anatomical Society's core syllabus for anatomy (2003 and later refined in 2007) set out a series of learning outcomes that an individual medical student should achieve on graduation. The core syllabus, with 182 learning outcomes grouped in body regions, referenced in the General Medical Council's Teaching Tomorrow's Doctors, was open to criticism on the grounds that the learning outcomes were generated by a relatively small group of anatomists, albeit some of whom were clinically qualified. We have therefore used a modified Delphi technique to seek a wider consensus. A Delphi panel was constructed involving 'experts' (n = 39). The revised core syllabus of 156 learning outcomes presented here is applicable to all medical programmes and may be used by curriculum planners, teachers and students alike in addressing the perennial question: 'What do I need to know ?'

Rupture of an abdominal aortic aneurysm post EVAR: a rare presentation of retroperitoneal liposarcoma.

Endoleak is the classical cause of rupture of aneurysms previously treated by endovascular means. We report a rare case of a retroperitoneal liposarcoma (LIS) invading an abdominal aortic aneurysm (AAA), previously treated by endovascular repair (EVAR), causing rupture. Furthermore, a brief discussion of the diagnostic challenges posed by retroperitoneal tumors is presented with a closing note on their management.

Endovascular repair of aorto-bi-iliac aneurysm.

Iliac bifurcated devices (IBDs) are used in the endovascular treatment of aorto-iliac and common iliac artery aneurysms to preserve the flow to at least one internal iliac artery thereby decreasing the risk of pelvic ischemic complications. We report the use of IBDs in preserving both the internal iliac arteries.

[A child with apnoea]. / Et barn med apnoe.

This is a case report of a girl, from the age 73 days to 5 years and 173 days , who during sleep had 127 episodes of apnoea (lasting 20-55 seconds) accompanied by colour shifts. In her first year of life she had 21 episodes of apnoea, in the second 21, in the third 36, in the fourth 22, in the fifth year 7, and during the first 6 months of the sixth year there were 2 episodes of apnoea. An explanation was never found in spite of investigations aiming at cardiopulmonary, neurological or metabolic disease. The staff never verified episodes of apnoea during admittances to hospital wards. The episodes were merely observed by the mother, the father and the grandmother, but the circumstances were persuasive. In addition to episodes of apnoea she had symptoms of dysfunction of the autonomous nervous system, i.e. facial colour shift and sweating without apnoea or exercise. She had frequent attacks of abdominal colic until aged two and a half years. It has not been possible to give a clear-cut diagnosis. It is hypothesized that she suffers from a mild form of a disease entity covering a wide spectrum from Ondine's curse (Congenital central hypoventilation syndrome) to remittent Apparent life-threatening events (ALTEs) and Sudden infant death syndrome (SIDS).

Reliability and sensitivity to change of the OMERACT rheumatoid arthritis magnetic resonance imaging score in a multireader, longitudinal setting.

OBJECTIVE: To assess the intra- and interreader reliability and the sensitivity to change of the Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) system on digital images of the wrist joints of patients with early or established rheumatoid arthritis (RA). METHODS: Ten sets of baseline and 1-year followup MR images of the wrists of patients with progressive changes on conventional hand radiographs were scored independently by 4 readers on 2 consecutive days, preceded by reader training and calibration. The MR images were acquired and scored according to the recommendations from the OMERACT MRI group. The intra- and interreader agreement (evaluated by intraclass correlation coefficients [ICCs]) and the sensitivity to change (evaluated by the smallest detectable difference [SDD]) were determined for scores of synovitis, erosion, and bone marrow edema status and for change scores. RESULTS: Intrareader ICCs were generally very high, both for status scores (median baseline and followup 0.89 and 0.90 for synovitis, 0.91 and 0.90 for erosion, and 0.90 and 0.98 for edema) and for change scores (median 0.80 for synovitis, 0.96 for erosion, and 0.97 for edema). The SDDs were generally low, suggesting a high potential to detect changes. Interreader single-measure ICCs were high for status scores (mean baseline and followup 0.69 and 0.78 for synovitis, 0.83 and 0.73 for erosion, and 0.79 and 0.95 for edema) and for change scores (mean 0.74 for synovitis, 0.67 for erosion, and 0.95 for edema). The average-measure ICCs were > or =0.94 for all components of both the status scores and change scores. CONCLUSION: The RAMRIS showed very good intrareader reliability, good interreader reliability, and a high level of sensitivity to change. The results suggest that the RAMRIS may be a suitable system for use in monitoring joint inflammation and destruction in RA.

Potential for drug interactions involving cytochrome P450 in patients attending palliative day care centres: a multicentre audit.

AIM: To determine the potential for drug interactions involving cytochrome P450 (CYP) in patients receiving palliative day care. METHODS: Drugs used by patients attending four specialist palliative day care centres were reviewed to identify combinations that could result in a pharmacokinetic interaction via any of the five main human forms of CYP. RESULTS: Of 160 patients, 145 (91%) were prescribed at least one drug that was a substrate, inhibitor or inducer of one of the five main CYP isoforms. Twenty-four drug combinations, involving 34 patients, could have given rise to a clinically important interaction. CONCLUSIONS: Prescribers should be aware that in this group of patients, one in five are at risk of a clinically important CYP-mediated drug interaction.

Study of the in vitro cytotoxic potential of natural and synthetic coumarin derivatives using human normal and neoplastic skin cell lines.

A selection of natural and synthetic coumarin compounds, including the hydroxylated and nitrated derivatives, were assessed for their cytotoxic potential using the microculture 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay for cellular viability. For the first time this study utilized both human skin malignant melanocytes (SK-MEL-31) and normal human skin fibroblastic cells (HS613.SK), allowing identification of those coumarin derivatives that are selectively toxic. Coumarin was found to exhibit comparatively low toxicity in both cell types, while 7-hydroxycoumarin (7-OHC) and coumarin had similar activity in SK-MEL-31 cells. The entire series of hydroxylated coumarins were considerably more toxic in HS613.SK than in SK-MEL-31 cells. Novel synthetic nitrated coumarins, 6-nitro-7-hydroxycoumarin (6-NO2-7-OHC) and 3,6,8-nitro-7-hydroxycoumarin (3,6,8-NO2-7-OHC), were shown to be significantly more toxic to SK-MEL-31 than HS613.SK cells. In the malignant melanocyte skin cell line (SK-MEL-31) the cytotoxic effects of these nitro-derivatives were shown to be dose and time dependent. Therefore, the cytotoxic potential of coumarins appears to be highly dependent on the nature and position of the functional group. In addition, nitration of 7-OHC produced compounds that were cytotoxic to malignant melanocytes, suggesting that these nitro-derivatives may have a chemotherapeutic role in the future.

[Physical examination and palpation findings of mammary glands and indications of udder health in goat milk]. / Adspektorische und palpatorische Befunde an der Milchdrüse und Indikatoren für Eutergesundheit in der Milch bei Ziegen.

In dairy goats there is less evidence for relationships between udder form traits, results of physical udder examinations and mastitis indicators in the milk than in dairy cows. In 413 goats (predominantly Weisse Deutsche Edelziege and Bunte Deutsche Edelziege) from five herds (free from C.A.E.) repeated investigations of 2537 udder halves and fore milk samples were carried out in order to compare udder traits with findings in the milk. Less than 20% positive bacteriological findings and a low incidence of clinical mastitis testified a good clinical udder health status of the herds. Small teat-floor distances, loose hanging of the udders and bottle-shaped teats, findings which tended to become more frequent as lactation and lactation numbers progressed, indurative alterations of the mammary tissues and the teats tended to be connected with higher milk cell counts (> 1 million/microliter), more polymorphonuclear milk cells (> 40%), higher electrical milk conductivity (> 6.8 mS/cm) and lower milk lactose content (< 4.6%). A similar effect had a bad state of foot trimming. It is proposed to include the studied udder traits into herd health programs and breeding schemes for goats.