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Unlabelled: For patients with refractory retrocalcaneal bursitis (Haglund's syndrome), the most effective surgical approach has not been defined. We asked whether patients undergoing the tendon-splitting approach and the lateral approach would have comparably effective relief of pain for both types of calcaneal ostectomies. We retrospectively reviewed 30 patients (31 feet) who underwent the tendon-splitting approach and compared their results with 32 previous patients (35 feet) who had a lateral incision. Minimum followup was 12 months (mean, 16 months; range, 12-23 months) for the tendon-splitting group and 15 months (mean, 51 months; range, 15-109 months) for the lateral group. The mean American Orthopaedic Foot and Ankle Society score improved from 43 points preoperatively to 81 points (range, 8-100 points) postoperatively in the tendon-splitting group and from 54 points to 86 points (range, 55-100 points) in the lateral group. The mean physical component score of the Short Form-36, version 2, at followup was 52 (range, 22-61) in the tendon-splitting group and 49 (range, 34-63) in the lateral group. The median return to normal function was 4.1 months (range, 3-13 months) in the tendon-splitting group and 6.4 months (range, 4-20 months) in the lateral group. Both approaches to calcaneal ostectomy provided symptomatic pain relief. However, patients in the tendon-splitting group returned to normal function quicker than patients in the lateral group.Level Of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Radiographic assessment of the patella after total knee arthroplasty is typically performed with use of static, unloaded views that may not reproduce the in vivo patellofemoral kinematics. The purpose of the present study was to evaluate and validate the reliability and reproducibility of a weight-bearing radiographic assessment of the patellofemoral joint in patients who have undergone total knee arthroplasty.Methods: Radiographs were made for 100 knees in sixty-nine patients who had undergone total knee arthroplasty. Radiographic assessment of the patellofemoral joint was performed with use of both the standard Merchant axial view and a modification of that view. The Merchant axial view was modified by positioning the standing patient in the semi-squatted position with the knees in 45 degrees of flexion. The relationship between the x-ray source, the angle of incidence on the joint, and the cassette position was kept unchanged from the original view. The standing position and consequent muscle involvement were the only differences.Results: Compared with the standard Merchant axial view, the weight-bearing axial view showed a number of patellofemoral tracking changes. Specifically, lateral tilt and subluxation of the patella were significantly reduced; the rate of exposed, uncovered patellar bone contact with the femoral trochlea was significantly increased; and radiographic evidence of maltracking was more closely correlated with clinical symptoms.Conclusions: An axial weight-bearing radiographic view with the patient in the semi-squatting position was developed to reproduce patellofemoral joint loading. This view demonstrates that the position of the patella, as seen on the standard unloaded Merchant view, changes during squatting. Utilization of this axial weight-bearing view to evaluate total knee arthroplasty may provide additional information over standard radiographic views. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine the relationship between demographic and clinical characteristics of cardiac surgery patients with postoperative length of stay (PLOS) greater than 7 days and determine the demographic, social, and clinical predictors of the need for transitional cardiac rehabilitation (TCR) after cardiac surgery. DATA SOURCES: A retrospective review of characteristics, clinical indices, caregiver availability, and patient status (whether living alone) was completed for 304 patients undergoing cardiac surgery over 24 consecutive months. Univariate analyses and multivariable logistic regression models were used to evaluate risk factor characteristics for PLOS greater than 7 days and to predict discharge disposition to TCR or home. CONCLUSIONS: Older patients, those with preoperative comorbidities, and those without a caregiver at home experience delays in functional recovery and discharge and are more likely to need TCR services. IMPLICATIONS FOR PRACTICE: Our findings support the addition of functional recovery and social support risk items to the preoperative cardiac surgery risk assessment. [ABSTRACT FROM AUTHOR]

This paper explores the experiences of three young people with emotional and behavioral challenges and their families as they entered, participated in, and completed a community-based system of care. Using a case narrative approach, the characteristics and experiences of the children and families who successfully completed the Dawn Project system of care are described. For each of the three narratives, the young person's parent or caregiver, teacher, and service coordinator were interviewed and a review of available records was conducted. Several themes appear to be related to successful completion of the system of care, including active and ongoing involvement of the family and collaboration of team members, a collective commitment to follow through on developed plans, an emphasis on child and family strengths, and concerted efforts to keep the young people at home and their services in the community. [ABSTRACT FROM AUTHOR]

Systems of care represent a fundamental departure from traditional service provision by espousing genuine family-centered, culturally competent philosophies and blending the funding streams of multiple payers (e.g., education, mental health, child welfare). In Marion County, Indiana, local leaders created a system of care based on these principles called the Dawn Project. Currently, a comprehensive, multidisciplinary evaluation is being implemented to evaluate the program. Preliminary findings from initial evaluation efforts suggest that for youth in the project, there is significant clinical improvement during the first year of receiving services, a reduction in the use of more restrictive settings, and a decrease in recidivism among those who successfully complete the program. [ABSTRACT FROM AUTHOR]

In this paper, we study the long-time dynamics of a Timoshenko system modeling vibrations of beams with non-linear localized damping mechanisms acting on both displacement and angular rotation and subjected to non-linear source terms. Using recent quasi-stability methods, we prove the existence of smooth finite dimensional global attractor, which is characterized as unstable manifold of the set of stationary solutions. Moreover, the existence of exponential attractors is shown. These aspects were not previously considered for the Timoshenko system with localized damping. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is common in patients with COPD, but its prevalence and progression are not well characterized. Concerns have been raised over the possible deleterious effect of long-term therapy with inhaled corticosteroids (ICSs) on bone density in this population. Here, we investigated the long-term effects of therapy with fluticasone propionate (FP) alone, salmeterol (SAL) alone, and a SAL/FP combination (SFC) on bone mineral density (BMD) and bone fractures in patients with moderate-to-severe COPD in the TOwards a Revolution in COPD Health (TORCH) study.Methods: A randomized, double-blind, parallel-group, placebo-controlled study conducted at 88 US centers involving 658 patients (a subset of 6,184 international subjects in TORCH). Therapy with placebo, SAL (50 microg), FP (500 microg), or SFC (SAL 50 microg/FP 500 microg) twice daily was administered for 3 years. Baseline and yearly measurements of BMD at the hip and lumbar spine were performed. The incidence of traumatic and nontraumatic bone fractures was recorded.Results: At baseline, 18% of men and 30% of women had osteoporosis, and 42% of men and 41% of women had osteopenia based on BMD assessments. Forty-three percent of subjects completed all testing. The changes in BMD at the hip and lumbar spine over 3 years were small. No significant differences were observed between treatment arms (adjusted mean percent change from baseline at hip was -3.1% for placebo, -1.7% for SAL, -2.9% for FP, and -3.2% for SFC therapy, respectively; while, the corresponding changes for the lumbar spine were 0, 1.5%, -0.3%, and -0.3% for placebo, respectively, SAL, FP, and SFC therapy). The incidence of fractures was low and was similar for all treatments (5.1% to 6.3%).Conclusions: Osteoporosis is highly prevalent in patients with COPD, irrespective of gender. In the TORCH study, no significant effect on BMD was detected for ICS therapy compared with placebo.Trial Registration: ClinicalTrials.gov Identifier: NTC00268216. [ABSTRACT FROM AUTHOR]