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All the trains were lined up at the station, ready to go to work. The big black train said, 'Choo-choo.' The shiny silver train said, 'Choo-choo.' But the little red [...]

Todos los trenes estaban en la estacion, listos para empezar a trabajar. El tren grande y negro dijo:--Chucuchu. El tren plateado y brillante dijo:--Chucuchu. Pero el pequeno tren rojo dijo:--iAchus! [...]

All the trains were lined up at the station, ready to go to work. The big black train said, 'Choo-choo.' The shiny silver train said, 'Choo-choo.' But the little red [...]

Todos los trenes estaban en la estación, listos para empezar a trabajar. El tren grande y negro dijo:--Chucuchú. El tren plateado y brillante dijo:--Chucuchú. Pero el pequeño tren rojo dijo:--¡Achús! [...]

Background: Some patients with neovascular age-related macular degeneration (nAMD) respond insufficiently to anti-VEGF treatment despite maximal monthly intravitreal injections. Their short-term response between injections was investigated for extent and visual prognosis. Subjects/Methods: Monocentric retrospective observational study. 45 eyes from 41 patients with refractory nAMD (who previously received at least 12 months of anti-VEGF treatment), evaluated by optical coherence tomography (OCT) in between monthly anti-VEGF injections. The fluid profile on OCT was evaluated before, 1 week after, and 1 month after an intravitreal injection, using central retinal thickness (CRT), manual measurements, and fluid specific volumetric measurements performed by an automated algorithm based on artificial intelligence. Results: A significant improvement was found at week 1 in terms of CRT (p< 0.0001), intraretinal (IRF) (p= 0.007), subretinal fluid (SRF) (p< 0.0001), and pigment epithelium detachment (PED) volume (p< 0.0001). Volumetric fluid measures revealed a >50% reduction at week 1 for both IRF and SRF for approximately two-thirds of eyes. Poorer short-term response was associated with larger exudative fluid amounts (IRF + SRF) (p= 0.003), larger PED (p= 0.007), lower visual acuity (p= 0.004) and less anatomic changes at treatment initiation (p< 0.0001). Univariate and multivariate analysis revealed that visual outcomes 4 and 5 years later was significantly worse with weaker short-term responsiveness (p= 0.005), with the presence of atrophy (p= 0.01) and larger PED volumes (p= 0.002). Conclusions: Incomplete responders to anti-VEGF showed a significant short-term response, identifiable at 1 week after injection, with rapid recurrence at 1 month. Weaker short-term responsiveness at 1 week was associated with poorer long term visual prognosis. These patients may need adjuvant treatment to improve their prognosis.

All the trains were lined up at the station, ready to go to work. The big black train said, 'Choo-choo.' The shiny silver train said, 'Choo-choo.' But the little red [...]

Todos los trenes estaban en la estación, listos para empezar a trabajar. El tren grande y negro dijo:--Chucuchú. El tren plateado y brillante dijo:--Chucuchú. Pero el pequeño tren rojo dijo:--!Achús! [...]

•Dual-tasking contributes to self-efficacy regarding falls and community mobility.•Efficacy for community mobility directly impacts social participation.•Fall status does not differently influence contributors to social participation.

highlights the findings and application of Cochrane reviews and other evidence pertinent to the practice of physical therapy. The Cochrane Library is a respected source of reliable evidence related to health care. Cochrane systematic reviews explore the evidence for and against the effectiveness and appropriateness of interventions--medications, surgery, education, nutrition, exercise--and the evidence for and against the use of diagnostic tests for specific conditions. Cochrane reviews are designed to facilitate the decisions of clinicians, patients, and others in health care by providing a careful review and interpretation of research studies published in the scientific literature. (1) Each article in this PTJ series summarizes a Cochrane review or other scientific evidence resource on a single topic and presents clinical scenarios based on real patients to illustrate how the results of the review can be used to directly inform clinical decisions. This article focuses on an ambulatory patient with multiple sclerosis and mild to moderate impairments. Can exercise improve the quality of life for individuals like this patient with multiple sclerosis?, Individuals with multiple sclerosis (MS) experience a range of symptoms that present significant challenges to daily functioning, mobility, and family and community participation. (2,3) In addition, the physical decline and [...]

Background. The Balance Evaluation Systems Test (BESTest) and Mini-BESTest are clinical examinations of balance impairment, but the tests are lengthy and the Mini-BESTest is theoretically inconsistent with the BESTest. Objective. The purpose of this study was to generate an alternative version of the BESTest that is valid, reliable, time efficient, and founded upon the same theoretical underpinnings as the original test. Design. This was a cross-sectional study. Methods. Three raters evaluated 20 people with and without a neurological diagnosis. Test items with the highest item-section correlations defined the new Brief-BESTest. The validity of the BESTest, the Mini-BESTest, and the new BriefBESTest to identify people with or without a neurological diagnosis was compared. Interrater reliability of the test versions was evaluated by intraclass correlation coefficients. Validity was further investigated by determining the ability of each version of the examination to identify the fall status of a second cohort of 26 people with and without multiple sclerosis. Results. Items of hip abductor strength, functional reach, one-leg stance, lateral push-and-release, standing on foam with eyes closed, and the Timed 'Up & Go' Test defined the Brief-BESTest. Intraclass correlation coefficients for all examination versions were greater than .98. The accuracy of identifying people from the first cohort with or without a neurological diagnosis was 78% for the BESTest versus 72% for the Mini-BESTest or Brief-BESTest. The sensitivity to fallers from the second cohort was 100% for the Brief-BESTest, 71% for the Mini-BESTest, and 86% for the BESTest, and all versions exhibited specificity of 95% to 100% to identify nonfallers. Limitations. Further testing is needed to improve the generalizability of findings. Conclusions. Although preliminary, the Brief-BESTest demonstrated reliability comparable to that of the Mini-BESTest and potentially superior sensitivity while requiring half the items of the Mini-BESTest and representing all theoretically based sections of the original BESTest., Injuries resulting from falls contribute to decreased health status and increased mortality, particularly for individuals of advanced age or with chronic disease. (1) In addition, falls are linked to a [...]

OBJECTIVE--The purpose of this study was to determine the effect of monochromatic infrared energy (MIRE) on plantar sensation in subjects with diabetic peripheral neuropathy. RESEARCH DESIGN AND METHODS--In this randomized, [...]

Un cancer est associé au diagnostic de dermatomyosite (DM) dans 10 à 25 % des cas et est pour les myopathies inflammatoires idiopathiques la principale cause de mortalité. Il existe cependant peu de données sur les facteurs pronostiques de la dermatomyosite associée au cancer, en particulier l’impact des traitements immunosuppresseurs. De plus, le caractère paranéoplasique suggère une évolution conjointe avec celle du cancer, qui a également été peu évaluée dans la DM. L’objectif de cette étude est d’évaluer la possible évolution parallèle du cancer et de la dermatomyosite, ainsi que d’identifier les facteurs associés à la mortalité et à rémission de la DM.

Modern government systems acquisition processes can be improved by applying the concepts of total quality management in said processes. Cost plus contract administration is inherently defective due to the incentives provided for cost reduction. As a result, quality is significantly affected. In implementing quality management principles in acquisition processes, managers should include value as an important part of quality.

The capital femoral epiphysis is the head of the femur (thigh bone) at the hip joint. Until growth is completed the epiphysis is separated from the shaft of the femur by the cartilaginous growth plate. A slipped capital femoral epiphysis occurs when there is a disruption through this plate. This condition results in dysfunction of hip movements and may lead to the development of osteoarthrosis. Treatment is aimed at avoiding osteoarthrosis by preventing further displacement; this may be carried out by fixing the epiphysis in place. There is controversy over the extent of femur reshaping after surgery and its effect on restoration of hip function. A study was undertaken to analyze the relationship of remodeling to the patient's subsequent walking ability. Forty-five patients were involved in this study, the average age for the 31 boys was 13.5 and for the 14 girls was 12.3. The weight-to-height ratio was greater than 50th percentile for 44 of the 45 children, with 18 children being in the 90th percentile. Two-year follow-up was obtained on 39 patients (87 percent). The largest amount of hip motion (86 percent of final motion) returned within six months of surgery. X-ray and computed tomographic scans showed minimum change in the relationship of the head and shaft of the femur. Motion returned with minimum bony remodeling. During the follow-up period 18 patients (40 percent) developed slipped epiphysis of the opposite leg. No factors predicting this were able to be found. Two patients had major complications and these patients still have pain. (Consumer Summary produced by Reliance Medical Information, Inc.)

La survenue d’ulcérations cutanées dans le cadre d’une vasculopathie thrombosante est une manifestation exceptionnelle dans les rectocolites hémorragiques (RCH). Nous rapportons ici deux cas.

Matsusaka N, Yokoyama S, Tsurusaki T, et al (School of Allied Medical Sciences, Nagasaki University; Department of Rehabilitation, Nagasaki University Hospital, Nagasaki, Japan), Am J Sports Med. 2001;29:25-30. The purpose [...]

This paper describes the process of consolidation of irregular T15 tool steel powder by atmospheric pressure. The sintering kinetics is studied over a range of times between 0.5 and 8 hours at 1250 °C. The results indicated that increasing of sintering time decreases the porosity rate and increases the hardness. When the material is near full density, then grain growth starts and the hardness decreases as a consequence. Glass penetration into the powder is a peculiar phenomenon to the CAP process. The thickness of penetration is time dependent but does not exceed 2 mm at 1250 °C. The relationship between microstructure and properties of the sintered powder was illustrated.

•High-intensity training is a safe and feasible modality for people with MS.•Adults with MS may achieve walking improvements through high-intensity training.•Evidence of high-intensity training on balance outcomes remains inconclusive.•Inconsistent dosing of high-intensity training hinders optimal prescription in MS.

We thank Dr. Burke (1) for his thoughtful comments and critical review of our research study (2). In responding to his comments, we have addressed each of his stated concerns [...]

* CLINICAL QUESTION How can I differentiate septic arthritis from transient synovitis of the hip in children? * BOTTOM LINE To distinguish septic arthritis from transient synovitis of the hip [...]

Gilbert A, ed. London, England, NW1 OAE, Martin Dunitz Ltd, 2001, hardcover, 343 pp, illus, ISBN: 1-84184015-7, $125. A French physician edited this book, and all chapters contain a bibliography [...]

Individuals with multiple sclerosis (MS) experience a clinical course that is highly variable with daily fluctuations in symptoms significantly affecting functional ability and quality of life. Yet, understanding how MS symptoms co-vary and associate with physical and psychological health is unclear.

This letter provides a clarification regarding the scoring method for the Mini-BESTest used in our previous publication (1) that compared the Mini-BESTest with the Brief-BESTest. King and Horak (2) recently [...]

•Mobility and cognitive impairments associated with multiple sclerosis seriously impact fall risk.•Assessing if individuals with MS have difficulties dual tasking enhances fall risk prediction.•Accurate prediction of fall risk based on self-reported difficulty of dual tasking is beneficial for early identification and timely intervention for adults with MS.

Fractures of multiple metatarsals in the pediatric population are uncommon; however, indications for surgical treatment have not been delineated. The aim of this study was to review multiple metatarsal fractures to help refine surgical indications. A total of 98 patients had multiple metatarsal fractures; displacement greater than 10% shaft width (displaced) was encountered in 33 (34.0%) patients. Fifteen patients had displacement of more than 75% shaft width of one metatarsal. Patients older than 14 years of age were more likely to have surgery for their injury (52.6%) than those younger than 14 years of age (3.7%) (P<0.0001). Younger patients and those with less than 75% displacement should be considered for nonoperative care. Levels of Evidence: Level IV.

A bursa is a small sac that lies between two bony joint surfaces and lubricates them, thus reducing friction during movement. One such bursa lies below the patellar (kneecap) ligament, which is attached to the tibia (lower leg bone). This area does not communicate with the knee joint. Infection of the infrapatellar bursa is rare and results in the knee being held rigidly in extension (straight). Two cases of infrapatellar bursa infection are described; the symptoms resemble those of a knee infection, but fluid from the knee is sterile (free from bacteria). The first case involved a 16-year-old boy who had pain and swelling of the knee, and fever for less than a day. Septic (infected) arthritis of the knee was suspected; joint fluid was obtained for laboratory analysis, but was found to be free of bacteria. However, the infrapatellar bursal fluid contained pus and was positive for streptococcal bacteria. The bursa was drained, cut back, and penicillin was administered to the patient, who recovered with full knee function. The second patient was a 13-year-old boy who had pain and swelling of the knee, and fever for three days. Initial tests suggested a bone infection, for which he was treated, but his symptoms persisted. The infrapatellar bursa was then drained and found to be infected. The infection had spread to the upper region of the tibia. The patient recovered successfully after further antibiotic therapy. These cases suggest that patient preference for maintaining the knee in full extension, rather than flexion (which is common in cases of septic arthritis), is indicative of infrapatellar bursa infection. The authors advise prompt aspiration and drainage of the bursa, and recommend that the adjacent bone be inspected for signs of infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fractures of the fifth metatarsal bone are common and surgery is uncommon. The “Jones” fracture is known to be in a watershed region that often leads to compromised healing, however, a “true Jones” fracture can be difficult to determine, and its impact on healing in pediatric patients is not well described. The purpose of this study was to retrospectively assess patterns of fifth metatarsal fracture that led to surgical fixation in an attempt to predict the likelihood for surgery in these injuries.

I've been weightlifting for 1 1/2 years, seven days a week, two hours a day. I want to thank you for your awesome magazine and for your story on Mike [...]

Modified Dunn osteotomy has gained popularity over the past decade in the treatment of moderate to severe adolescent slipped capital femoral epiphysis. The purpose of this study was to retrospectively evaluate a consecutive series of adolescent slipped capital femoral epiphysis patients treated with the modified Dunn procedure at a single institution. We analyze the indications for the procedure as well as the complications after surgical treatment.

Treatment of idiopathic clubfoot has shifted towards Ponseti technique, but previously surgical management was standard. Outcomes of surgery have varied, with many authors reporting discouraging results. Our purpose was to evaluate a single surgeon’s series of children with idiopathic clubfoot treated with a la carte posteromedial and lateral releases using the Pediatric Outcomes Data Collection Instrument (PODCI) with a minimum of 2-year follow-up.

The diagnosis and management of vascular anomalies of the extremities can be challenging as these disorders are uncommon and may clinically overlap. The aim of this paper is to describe the clinical, radiologic, and histopathologic features of fibro-adipose vascular anomaly (FAVA), a previously unrecognized disorder of the limb.

Patients with idiopathic clubfoot are considered at increased risk for having developmental dysplasia of the hips (DDH). However, the studies showing this association have been relatively small. Many clinicians who treat idiopathic clubfoot routinely screen the hips of these patients with ultrasound or radiograph due to the concerns of increased risk of DDH. We evaluated a large clubfoot population to determine the risk of DDH and compare this to a population of children without clubfoot. We also evaluated if the clubfoot patients found to have DDH would have been discovered by standard DDH screening.

Increasing community practice that facilitates physical activity for people with multiple sclerosis (MS) is critical to improve health outcomes and enhance quality of life in this population.

This paper discusses the need for competent systems engineers, the differences between nine current ways of assessing competencies (competency models) and the difficulty of comparing the competency models due to the different ways each model groups the competencies. The paper then introduces a competency model maturity framework (CMMF) for benchmarking competency models of systems engineers. The paper benchmarks the nine models using the CMMF and a surprising finding was an error of omission in all nine models. The paper shows that the CMMF can also be used as the basis for developing an original model for a specific organization in a specific time and place and concludes with suggestions for future research. ©2012 Wiley Periodicals, Inc. Syst Eng 15

Understanding how health beliefs intersect with physical activity in people with multiple sclerosis (MS) is an important step in developing effective activity promotion programs.