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Aims: A consensus definition of fracture related infection (FRI) has been created with the aim of standardising diagnosis and eliminating heterogeneity that prevents accurate comparison between existing studies. FRI remains one of the most challenging complications in musculoskeletal trauma surgery and carries with it a significant cost burden. A review of UK finances has not been completed utilising consensus diagnostic criteria. The goal of this study was to investigate the hospital-associated healthcare cost related to the treatment of FRI within an NHS major trauma centre., Method: Through retrospective case-control analysis, 1240 patients with close fractures were identified. Of those, 21 patients with FRI were compared to 63 uninfected patients. Patients were matched based on fracture location, type of procedure and proximity in age. The costs assessed included hospitalisation, imaging, outpatient consultation, pharmaceuticals and procedure charges. Cost data was retrieved from healthcare resource group (HRG) guidelines, NHS Business Service Authority's (NBSA) prescription rates and internal costing., Results: The FRI group were found to incur a 2.51 increase in total medial healthcare cost compared to the control group (£22,058 vs £8798 [p < 0.001]), which was primarily due to increased procedural costs (£13,020 vs £6291 [p < 0.001]) and length of hospital stay (£7552 vs £2124 [p < 0.001])., Conclusion: Whilst diagnosis of FRI has a more rigorous definition following the new consensus, prevalence and cost outcomes are similar to previous studies. Given the deficiency in funding and ongoing challenges of resource allocation to the NHS, it is prudent to incorporate studies such as this into stratifying departmental budgets and quality improvement., Level of Evidence: III., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent pelvic floor disorders (PFDs) among the female population. In the military environment, being a non-commissioned member (NCM), and physically demanding occupations are factors associated with higher PFD risk. This study seeks to characterize the profile of female Canadian Armed Forces (CAF) members reporting symptoms of UI and/or POP., Methods: Present CAF members (18-65 years) responded to an online survey. Only current members were included in the analysis. Symptoms of UI and POP were collected. Multivariate logistic regressions analyzed the relationships between PFD symptoms and associated characteristics., Results: 765 active members responded to female-specific questions. The prevalence of self-reported POP and UI symptoms were 14.5% and 57.0%, respectively, with 10.6% of respondents reporting both. Advanced age (adjusted odds ratio [aOR]: 1.062, CI 1.038-1.087), a body mass index (BMI) categorized as obese (aOR: 1.909, [1.183-3.081]), parity ≥1 (e.g., aOR for 1: 2.420, [1.352-4.334]) and NCMs (aOR: 1.662, [1.144-2.414]) were factors associated with urine leakage. Parity of ≥2 (aOR: 2.351, [1.370-4.037]) compared to nulliparous and having a perception of a physically demanding job (aOR: 1.933, [1.186-3.148]) were associated with experiencing POP symptoms. Parity of ≥2 increased the odds of reporting both PFD symptoms (aOR: 5.709, [2.650-12.297])., Conclusion: Parity was associated with greater odds of experiencing symptoms of UI and POP. Higher age, higher BMI, and being an NCM were associated with more symptoms of UI, and the perception of having a physically demanding role increased the likelihood of reporting POP symptoms., (Copyright © 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Objectives: This review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception., Methods: Electronic databases PubMed, Embase, Web of Science, and Scopus were searched using 'medical tourism' AND 'assisted reproductive technology' from 1978 to 2020., Results: Predominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce., Conclusions: While patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient's safety., Clinical Practice Implications: This review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The cylindrical conflorescences of the Banksia spinulosa Sm complex have several different colour types, i.e., black, red, maroon, lemon, and yellow. It is unknown if colour variation is due to extrinsic factors, importantly soil pH. Recent morphological observations have indicated that style colour are not contiguous, so follow-up chemical and soil analysis was conducted to further characterize the colour difference with respect to putative taxa and abiotic factors. Conflorescences of all known colours were sampled from across the eastern Australian distribution of B. spinulosa, and the respective soils were sampled and analysed for pH and total nitrogen. Regression analyses of this data demonstrated that pH and nitrogen gave nil and limited predictability for style colour respectively, i.e., only the taxa with black styles demonstrated a correlation, which was to a soil with slightly higher nitrogen content (p < 0.05). Furthermore, differences of pH were more often between taxa with conflorescences of the same colour. For chemical characterisation, the coloured styles were removed from conflorescences, extracted, and analysed by liquid chromatography-mass spectrometry (HPLC-MS/MS-DAD). Ten anthocyanin and twelve flavonol monoglycosides were identified by mass spectral fragmentation patterns (MS 1 and MS 2 ) and retention times. The data demonstrates that style colour differences are caused by the concentration of anthocyanins and their specific chemistry. It remains to be determined if the differences of anthocyanin expression are caused by other abiotic factors, or if it is intrinsic to the respective taxon., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

We aimed to investigate the impact of time on fine-wire (fw) electromyography (EMG) signal amplitude, and to determine whether any attenuation is confounded by task type. Twenty healthy participants were instrumented with fw and surface (s) EMG electrodes at the biceps brachii bilaterally. Participants held a weight statically with one arm and with the other arm either repeated the same task following a maximum voluntary contraction (MVC) or repeated dynamic elbow flexion/extension contractions. Each task was repeated for 30 s every five minutes over two hours. EMG amplitude was smoothed and normalized to time = 0. Stable median power frequency of the s-EMG ruled out the confounding influence of fatigue. Repeated-measures ANCOVAs determined the effect of electrode type and time (covariate) on EMG amplitude and the confounding impact of task type. During the isometric protocol, fw-EMG amplitude reduced over time (p = 0.002), while s-EMG amplitude (p = 0.895) and MPF (p > 0.05) did not change. Fw-EMG amplitude attenuated faster during the dynamic than the isometric protocol (p = 0.008) and there was evidence that the MVC preceding the isometric protocol impacted the rate of decline (p = 0.001). We conclude that systematic signal attenuation of fw-EMG occurs over time and is more pronounced during dynamic tasks., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: To describe the successes and challenges associated with developing an otolaryngology-head and neck surgery (OHNS) medical education app and website., Design: From 2010 to 2018, OHNS faculty across Canada contributed to the development of a smartphone app, LearnENT. LearnENT 1.0, was initially launched in 2012 using the Apple iOS 6 platform. The app utilized a novel user interface and interactive features to help learners develop approaches to OHNS clinical problems, review relevant anatomy, history, and physical examination skills. However, the release of iOS 7 necessitated a redesign and relaunch of LearnENT which occurred from 2015 to 2018 to produce the final version of the app, LearnENT 2.0. Through the relaunching process, the LearnENT team redesigned the app's interface, produced a web version of the app, and created a new content management system., Setting: OHNS departments across Canada., Participants: OHNS faculty members, residents, and medical students., Results: Through this approach, a sustainable, widely accessible, open access OHNS e-Learning resource was developed. Since the relaunch, the LearnENT app has 2728 user accounts and has been widely used across the globe with users in 36 countries outside of North America. LearnENT is currently the official learning app of the Canadian Society of OHNS, has been featured on several different medical education platforms and incorporated into medical school curricula at various institutions., Conclusions: The authors successfully created a novel e-Learning resource with the goal of improving OHNS medical education both nationally and internationally., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The use of hydroxychloroquine (HCQ), with or without concurrent administration of azithromycin (AZM), for treatment of COVID-19 has received considerable attention. The purpose of this study was to determine whether HCQ administration is associated with improved mortality in COVID-19 patients., Methods: We conducted a retrospective analysis of data collected during the care process for COVID-19 positive patients discharged from facilities affiliated with a large healthcare system in the United States as of April 27, 2020. Patients were categorized by treatment with HCQ (in addition to standard supportive therapy) or receipt of supportive therapy with no HCQ. Patient outcomes were evaluated for in-hospital mortality. Patient demographics and clinical characteristics were accounted for through a multivariable regression analysis., Results: A total of 1669 patients were evaluated (no HCQ, n = 696; HCQ, n = 973). When adjusting for patient characteristics, receipt of AZM, and severity of disease at admission, there was no beneficial effect of receipt of HCQ on the risk of death. In this population, there was an 81% increase in the risk of mortality among patients who received HCQ at any time during their hospital stay versus no HCQ exposure (OR: 1.81, 95% CI: 1.20-2.77, p = 0.01)., Conclusions: In this retrospective analysis, we found that there was no benefit of administration of HCQ on mortality in COVID-19 patients. These results support recent changes to clinical trials that discourage the use of HCQ in COVID-19 patients., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Trauma impacts people's coping mechanisms with their ability to function posing risks to their capacity to manage and respond appropriately to stressors, and to recover. Trauma informed care recognises the needs of survivors by focusing on system-wide design and support during recovery, minimising the risk of re-traumatisation, and maximising choice and empowerment for new adaptations and post-traumatic growth. The principles of TIC are currently not being fully utilised in burns practice, including for severe burns, with the nature, extent and impacts of trauma not being fully understood or acknowledged. Those who sustain a burn injury have an increased risk for developing psychosocial issues that can extend to the family unit, and people with pre-existing mental disorders are more likely to sustain a burns injury, experiencing extended hospitalisation and rehabilitation and being less likely to adhere to burns care. With the application of trauma-informed care within the burns setting, along with an understanding and acknowledging the link between trauma, burns injuries and mental health, health care professionals can minimise potential negative psychological impacts. Investing resources is now essential to effectively address the "trauma deficit" in the area of burns recovery., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Trauma-informed care (TIC) is a model for the relationship of care between service users and service providers that recognises the importance of trauma, past and present, on that person's experiences, vulnerabilities and recovery. Burn injuries are a complex area of healthcare where trauma and the mental health disorders associated with trauma can both precede and proceed a burns injury with complications for recovery. Incorporating a model of TIC in the assessment and treatment of burns patients will proactively work to mitigate and arrest trauma responses, mental disorders and their sequelae in this population. With reference to the existing TIC knowledge base, we propose development of a model for the TIC of burns patients divided into three stages; before, during and after initial engagement with the patient. In the before stage, TIC will require clinical-level change, organisational integration, training and time. In the during stage, five elements are identified; creating safety, screening, collaborative inclusion of the patient in the intervention and recovery planning process, psychoeducation of the patient and supporters, and the use of peer-led services. In the after stage, patients need to be proactively supported through outreach and follow-up. Implementation of a trauma-informed model of care for burns injury patients provides significant opportunities to burns services and benefits towards their patients' recovery., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Introduction: Acute scrotum is a common presentation to the pediatric emergency department, and ultrasound is frequently used to narrow the differential diagnosis. Point-of-care ultrasound (POCUS) is increasingly used by urologists and emergency physicians and could potentially be used to detect pediatric testicular torsion., Objectives: This study aimed to determine the accuracy of POCUS by pediatric emergency physicians in diagnosing testicular torsion and the agreement between point-of-care ultrasound and final diagnosis for other causes of acute scrotum., Study Design: A chart review of patients presenting to the study emergency department who received POCUS by a pediatric emergency physician, as well as radiology department ultrasound and/or surgery, was performed. Charts were reviewed for POCUS diagnoses, final diagnoses, and imaging time metrics., Results: A total of 120 patients met study criteria, with 12 cases of testicular torsion. The diagnostic accuracy of POCUS for testicular torsion is described in the summary table. For all causes of acute scrotum, point-of-care ultrasound agreed with final diagnosis in 70% (95% confidence interval [CI] 62-78%) of cases, and more experienced point-of-care ultrasound users displayed higher agreement with final diagnosis. Point-of-care ultrasound results were generated a median of 73 min (Q1 = 51, Q3 = 112) before radiology department ultrasound results., Discussion: Scrotal POCUS performed by pediatric emergency physicians appears to be an accurate tool to detect testicular torsion in children with acute scrotum and saves time compared with radiology ultrasound. The study results may not be generalizable to hospitals without a multidisciplinary POCUS system for quality assurance and image sharing. Future work on POCUS for acute scrotum should investigate its impact on patient outcomes, cost-effectiveness, and family satisfaction., Conclusion: Point-of-care ultrasound by pediatric emergency physicians is accurate for detecting testicular torsion in children with acute scrotum and could expedite diagnosis of this time-sensitive condition., (Copyright © 2019 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Research into recovery and adjustment after burn injury has indicated a link between psychopathological symptoms including traumatic stress, distress, depression and anxiety, and worse psychosocial and physical outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, and symptoms can be ongoing in certain patients for extensive periods, leading to a need for early screening in burns patients for psychological vulnerabilities. One potential factor influencing recovery from the psychological impact of burn injury is adult attachment style, specifically secure and insecure attachment, as this describes how an individual organizes their stress regulation. This cross-sectional study measured: (a) attachment style (via the Relationship Questionnaire [RQ]): (b) negative psychological symptoms (via the Depression Anxiety and Stress Scale [DASS]); and, (c) post-traumatic symptoms (via the Davidson Trauma Scale [DTS]) in a cohort of burns patients (n = 104, 51 analysed) in a severe burns unit in Australia during the acute phase of their recovery. Secure attachment style was inversely related to psychopathological symptoms. Secure participants scored significantly lower scores on the DASS (M = 17.63, SD = 17.07) compared to self-rated insecure participants [(M = 42.38, SD = 34.69), p < .01] and on the DTS (M = 14.22, SD = 15.42) compared to insecure participants [(M = 40.54, SD = 35.72), p < .01]. Similar results were found in analyses controlling for covariates of gender, age and burn severity as potential confounders. This research suggests attachment style may play an important role in psychosocial recovery from severe burn injury., (Copyright © 2019 Elsevier Ltd and ISBI. All rights reserved.)

Naturopathy is the general practice of natural therapies. It emphasizes prevention, treatment, and promotion of optimal health through therapeutic modalities which encourage the self-healing process of the body. Formalized in the 19th century by the hydrotherapy and nature cure movement in Austria and Germany, naturopathy was introduced to Australia at the turn of the 20th century. It became popular since the 1970s due to social and cultural change characterized by the post-modern philosophy, as well as government policies highlighting individual responsibility and freedom of choice. Naturopathy is one of the most popular forms of complementary medicine in Australia today with naturopaths received 4.9 million consultations annually. Naturopathic consultations are sought for a variety of conditions and, in some areas, as a form of primary care, especially by middle-aged women who have a higher education level and a higher annual income. The number of Australian naturopaths was estimated to be over 4000 in 2017 and expects to grow to over 4600 by 2022, although this number is likely to be an underestimation. Australian naturopaths, as a predominantly female profession, work mainly in private clinical practice with nutritional medicine, herbal medicine, homeopathy, as well as massage therapies being the most common modalities used. There are also signs of greater integration with community pharmacies and integrative medicine clinics in major cities. The Bachelor's degree programs in Naturopathy has just become the only accredited entry-level qualification since late 2015. Currently, there are only 5 private colleges offering naturopathic education, a far cry from the 40 over in mid-2000. The profession continues to be self-regulated. There is no barrier of entry to practice and unqualified practitioners of naturopathy can potentially do harm to the public. The registration of naturopaths remains unresolved due to fragmented representation under many professional associations, disunity among the profession, and objections by certain health care lobbyists. There is a dearth of research demonstrating efficacy of the whole practice of naturopathy in Australia, which has directed the government's decision to withdraw it from private health insurance coverage from 2019. Moving forward, the whole system research of naturopathy in Australia will be in focus with the recent establishment of a practice-based research network and an international research consortium. With increasing scrutiny from evidence-based medicine, the present and future challenge to Australian naturopaths is centered on the integration of both scientific and traditional evidence to form the foundation of a person-centered, evidence-informed practice., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Aims: The purpose of this study was to investigate the relationship between pelvic floor muscle (PFM) electromyographic (EMG) activation and urogenital landmark motion measured using 2D transperineal ultrasound (US) imaging., Methods: Eight healthy, nulliparous women performed maximum voluntary PFM contractions while EMG and transperineal US images were acquired simultaneously. Changes in the levator plate length (LPL), bladder neck (BN) position and urethral position were determined by visual inspection. The relative timing of EMG onset and the onset of landmark motion, and the correlation coefficients between EMG activation and landmark motion were computed. Comparisons between the correlation coefficients and onset latencies of each landmark motion were made using one-way analysis of variance models., Results: Despite generally good reliability metrics for the onset of EMG and the onset of landmark motion, the relative timing of EMG onset and the onset of landmark motion demonstrated no systematic patterns of activation onset. That said, the overall motion of the different urogenital landmarks throughout the MVC task was highly correlated with the PFM EMG data; correlation coefficients were generally good (>0.90) and highly significant (p < .001). The correlation between PFM EMG and LPL motion was significantly better than the correlation between PFM EMG and motion of the other landmarks. The relevance of one outlier is discussed., Conclusions: The motion of all urogenital landmarks seen on US imaging is highly correlated with PFM EMG activation during maximum voluntary PFM contractions and may therefore be of value in the context of biofeedback training to infer that PFM activation has occurred. The motion of the BN, however, may require more cautious interpretation than the reduction of LPL. The timing of the onset of urogenital landmark motion on transperineal US imaging does not precede nor follow the timing of PFM activation, while the high variance of relative onset timing makes the onset of landmark motion of questionable value when training or evaluating co-ordination or motor control., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Purpose: We aimed to determine if state of bladder fullness affects pelvic floor muscle activation in healthy women without urogenital symptoms., Materials and Methods: Twenty-three nulliparous, continent female participants were recruited to participate. Women were randomized to begin the protocol with either an empty (EF) or a full (FE) bladder. Tonic and maximal voluntary pelvic floor muscle electromyographic activity were measured in three states of bladder fullness (empty, full and uncomfortably full). Electromyographic signal amplitudes were compared among bladder states using separate two-way repeated-measures analyses of variance including bladder state and test order as main effects as well as the interaction between bladder state and test order., Results: Tonic activity of the pelvic floor muscles was significantly higher in the full and uncomfortably full bladder states compared to when the bladder was empty (p<0.005). Maximum voluntary electromyographic activation was unaffected by state of bladder fullness (p=0.713)., Conclusions: Consistent with studies in which the bladder was filled through saline infusion, these results suggest that tonic activity of the PFMs is higher when the bladder is full compared to when it is empty. However once the bladder is moderately full, tonic PFM activity does not increase with increases in bladder volume., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Background: Global health experiences (GHEs) are becoming increasingly prevalent in surgical residency education. Although it may seem intuitive that participation in GHEs develops CanMEDS competencies, this has not been studied in depth in surgery. The purpose of this study is (1) to explore if and how otolaryngology-head and neck surgery (OHNS) resident participation in GHEs facilitates the development of CanMEDS competencies and (2) to develop an OHNS GHE tool to facilitate the integration of CanMEDS into GHE participation and evaluation., Methods: An online survey explored the GHEs of current and past OHNS residents in Canada. Based on the data collected and a literature review, a foundational tool was then created to (1) enable OHNS residents to structure their GHEs into CanMEDS-related learning objectives and (2) enable OHNS program directors to more effectively evaluate residents' GHEs with respect to CanMEDS competencies., Results: Participants' GHEs varied widely. These experiences often contributed informally to the development of several CanMEDS competencies. However, few residents had concrete objectives, rarely were CanMEDS roles clearly incorporated, and most residents were not formally evaluated during their experience. Residents felt they achieved greater learning when predeparture objectives and postexperience reflections were integrated into their GHEs., Conclusions: Although GHEs vary widely, they can serve as valuable forums for developing CanMEDS competencies among participating residents. Without clear objectives that adhere to the CanMEDS framework or formal assessment methods however, residents in GHEs risk becoming medical tourists. The use of an objective and evaluation tool may facilitate the creation of predeparture learning objectives, encourage self-reflection on their GHE, and better enable program directors to evaluate residents participating in GHEs., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: This study investigated the differences in airway morphology between control patients and those with obstructive sleep apnea (OSA) treated with maxillomandibular advancement (MMA) to gain better insight into the beneficial effects of MMA on airway morphology and OSA severity., Study Design: This retrospective case-control study included preoperative radiographic data gathered for all patients; postoperative radiographic data were gathered for the OSA group. Statistical analysis, including the Student t test, and simple linear regression was performed to identify differences in cephalometric and airway variables among the three groups and to associate airway morphology to disease severity., Results: Twenty-four patients (12 with OSA; 12 controls) treated at the same clinic were included in this study. Statistically significant differences versus control values were found for preoperative total airway volume, postoperative airway length, and both pre- and postoperative airway minimum cross-sectional areas. In general, the untreated OSA airway was anatomically compromised in comparison with controls, whereas the treated airway showed significant morphologic improvements, comparable with the control group values., Conclusions: MMA produces statistically significant airway improvements for OSA patients, producing airway morphology comparable with that of the controls. However, some degree of residual OSA may still exist. Therefore, factors other than static airway morphology contribute to OSA pathogenesis., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Peer support has long been recognised as an essential component of a supportive network for people facing adversity. In particular, burn survivor peer support is a valuable and credible resource available to those rehabilitating from a severe burn. The aim of this study was to explore burn survivors' experiences of providing and receiving inpatient peer support to develop an in-depth understanding of the influence during the rehabilitation journey. In 2011, twenty-one burn survivors were recruited from four severe burn units across Australia. A qualitative phenomenological methodology was used to construct themes depicting survivors' experiences. Participants were selected through purposeful sampling, and data collected through in-depth individual semi-structured interviews. Data were analysed using Colaizzi's phenomenological method of data analysis. Central to burn rehabilitation was the notion of peer support having a significant impact on burn survivors' psychosocial rehabilitation. The emergent theme 'Burn Survivor Peer Support' identified five cluster themes: (1) Encouragement, inspiration and hope (2) Reassurance (3) The Importance of Timing (4) The Same Skin (5) Appropriate Matching. These findings demonstrate that peer support assists with fostering reassurance, hope and motivation in burn rehabilitation. A national network based on a clinician led inpatient burn survivor peer support programme could provide burn survivors across Australia, and in particular remote access locations, with the benefits of peer support necessary to endure the rehabilitation journey., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

There are no direct recordings of obturator internus muscle activity in humans because of difficult access for electromyography (EMG) electrodes. Functions attributed to this muscle are based on speculation and include hip external rotation/abduction, and a role in stabilization as an "adjustable ligament" of the hip. Here we present (1) a technique to insert intramuscular EMG electrodes into obturator internus plus (2) the results of an investigation of obturator internus activity relative to that of nearby hip muscles during voluntary hip efforts in two hip positions and a weight-bearing task. Fine-wire electrodes were inserted with ultrasound guidance into obturator internus, gluteus maximus, piriformis and quadratus femoris in ten participants. Participants performed ramped and maximal isometric hip efforts (open kinetic chain) into flexion/extension, abduction/adduction, and internal/external rotation, and hip rotation to end range in standing. Analysis of the relationship between activity of the obturator internus and the other hip muscles provided evidence of limited contamination of the recordings with crosstalk. Obturator internus EMG amplitude was greatest during hip extension, then external rotation then abduction, with minimal to no activation in other directions. Obturator internus EMG was more commonly the first muscle active during abduction and external rotation than other muscles. This study describes a viable and valid technique to record obturator internus EMG and provides the first evidence of its activation during simple functions. The observation of specificity of activation to certain force directions questions the hypothesis of a general role in hip stabilisation regardless of force direction., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Although studies have explored the 'lived experience' of burn survivors, little is known about their experiences encountered during rehabilitation. A descriptive phenomenological study was conducted to gain an in-depth insight into burn survivors' experiences' of acknowledgement and acceptance of their injury and the challenges experienced during their rehabilitation journey. A descriptive phenomenological methodology was used to construct themes depicting how burn survivors endeavoured to acknowledge and accept their injury and subsequent altered body image. Twenty men and one woman up to eight years after-burn within Australia were selected through purposeful sampling, and data were collected through in-depth individual interviews conducted in 2011 (N = 21). Interviews were analysed using Colaizzi's method of data analysis. The emergent theme acknowledgement identified four cluster themes that represented how burn survivors came to terms with their injury and an altered body image: (1) reasoning (2) humour (3) the challenge of acceptance (4) self-awareness. Coming to terms with a severe burn is a challenging experience. Reasoning and humour are strategies utilised by burn survivors that facilitate with acknowledgement and acceptance. Understanding these concepts through the burn survivors' perspective will, potentially, facilitate a better understanding of how to best provide for this cohort of patients., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey., (Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.)

Primary axillary clearance (ANC) is currently performed based on cytology from abnormal appearing node(s) without considering extent of involvement. We assessed correlation between nodal burden and nodal appearance. 439 invasive breast cancer cases underwent axillary ultrasound (AUSS) with nodal scoring [UN2-normal (n = 293), UN3-indeterminate (n = 84), UN4-suspicious (n = 29), and UN5-replaced (n = 34)]. Fine needle aspiration cytology (FNAC) of all UN3, UN4 & UN5 nodes was performed. 64 cases had nodal metastases identified pre-operatively, proceeding to primary ANC. 375 cases underwent sentinel lymph node biopsy (SLNB), 64 of whom were found to have nodal metastases. Likelihood of metastases and nodal burden was related to AUSS score. >50% of malignant UN4 & UN5 scored nodes had ≥4 metastases compared to 19% of UN3 nodes. Most UN3 nodes are either not involved or have low metastatic burden which may be better served by SLNB alone. Redefining our FNAC nodal threshold could potentially avoid additional ANC morbidity and reduce pre-operative workload., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The purpose of this study was to determine whether a differential suction electrode (DSE) probe is less prone to recording crosstalk from the hip adductors or external rotators than the Femiscan™ probe when recording electromyography (EMG) data from the pelvic floor muscles (PFMs). Twenty nulliparous, continent women performed hip adduction and hip external rotation contractions at 25%, 50% and 100% of maximal voluntary effort both while keeping their PFMs relaxed and while contracting their PFMs as strongly as possible. All tasks were performed while DSEs were adhered to the vaginal wall at the level of the pubococcygeus group bilaterally, and also with the Femiscan™ probe in situ. The order of the probes was randomized. For each task, the peak smoothed PFM EMG amplitude was compared between hip forces and probes using a two-way repeated measures analysis of variance (ANOVA) including the interaction between contraction level and probe (α = 0.05). There was a significant contraction level by probe interaction for each task. In most cases the Femiscan™ probe recorded significantly higher PFM EMG activity during hip adduction and external rotation tasks at 25% and 50% MVC compared to what it recorded when the hip musculature remained relaxed, whereas the DSE probe did not. As such, the DSE probe appears to be less susceptible to crosstalk from the hip adductors and external rotators than the Femiscan™ probe at these hip muscle contraction levels. Both probes recorded significantly higher EMG activity when maximal contractions of the hip adductors and external rotators were performed therefore, no conclusion can be made regarding whether the activity recorded from the PFMs during maximal hip adduction and external rotation is the result of crosstalk or co-activation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Vaginal probes may induce changes in pelvic floor muscle (PFM) recruitment by the very presence of the probes. Fine-wire electrodes allow us to detect muscle activation parameters without altering the natural position and shape of the PFMs. The purpose of this study was to determine whether PFM activation is altered by changes in sensory feedback, muscle length or tissue position caused by two different vaginal probes used to record surface electromyography (EMG). Twelve continent women (30.1 ± 5.4 years), performed PFM maximal voluntary contractions (MVCs) in supine while fine-wire EMG was recorded bilaterally from the PFMs under three conditions: (a) without any probe inserted into the vagina, (b) while a Femiscan™ probe was in situ, and (c) while a Periform™ vaginal probe was in situ. The reliability of the fine wire EMG data was assessed using intra-class correlation coefficients (ICCs) and coefficients of variation (CV). A repeated measures analysis of variance (ANOVA) model was used to determine if there were differences in EMG amplitude recorded when the different vaginal probes were in situ. For each condition the between-trial reliability was excellent, ICC((3,1)) = 0.93-0.96, (p < 0.001) and CV = 11.2-21.8%. There were no differences in peak EMG amplitude recorded during the MVCs across the three conditions (no probe 63.4 ± 48.4 μV, Femiscan™ 55.3 ± 42.4 μV, Periform™ 59.4 ± 42.2 μV, p = 0.178). These results suggest that women produce consistent MVCs over multiple contractions, and that PFM muscle activation is not affected by different probes inserted into the vagina., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: The purpose of this study was to determine whether sensorimotor abnormalities are detectable in asymptomatic individuals deemed at risk of developing carpal tunnel syndrome (CTS) METHODS: Seventeen individuals deemed at risk of developing CTS and 16 asymptomatic individuals deemed to be at minimal risk of developing CTS participated. Nerve conduction velocity, two-point discrimination ability, pressure acuity, Purdue Pegboard Test performance and tracking error and tracking variance on a manual tracking task performed at two different speeds were measured in all participants and compared between the groups., Results: None of the measures of nerve conduction, sensory perception, or Purdue Pegboard task performance were different between the groups. The error in the manual tracking tasks was significantly different between the groups, where the at-risk group demonstrated more error than the control group., Conclusion: These results suggest that manual tracking tasks may be useful in the identification of those individuals at risk of developing CTS before they develop any measurable sensorimotor impairment., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Introduction: We aimed to determine the effectiveness of five isometric exercises at maximally activating the lower trapezius muscle in healthy subjects., Methods: Surface electromyography data were recorded from the upper, middle, and lower fibers of the trapezius muscle bilaterally while 18 healthy subjects performed five different exercises: Latissimus Pull-down, Prone Row, Prone V-Raise, Posterior Fly and Modified Prone Cobra. The peak activation was determined from the rectified and smoothed data to determine which exercise generated the highest amount of lower trapezius activity, and to determine which exercise best resulted in activation of the lower fibers of trapezius while minimizing activation of the upper and middle fibers of trapezius., Results: Males and females demonstrated different patterns of lower trapezius recruitment and therefore the data were analyzed separately for each sex. For the males, the Prone Row exercise (2.84 ± 1.67 mV), the Posterior Fly (2.23 ± 1.00 mV) and the Modified Prone Cobra (2.26 ± 1.19 mV) exercises generated the highest EMG activity in the lower trapezius muscle. For the females, the Modified Prone Cobra (2.40 ± 1.32 mV) and the Prone Row (2.37 ± 1.14 mV) exercises generated higher activation than the Latissimus Pull Down (1.04 ± 0.56 mV), the Posterior Fly (1.62 ± 1.044 mV) and the Prone V-Raise (1.32 ± 1.07 mV). In both sexes, the Modified Prone Cobra, the Prone Row and the Latissimus Pull Down outperformed the other exercises in terms of maximizing lower trapezius activation while minimizing activation of the upper and middle fibers of trapezius. The Modified Prone Cobra showed lower relative activation of the upper trapezius muscle than did the Prone Row exercise., Conclusion: The Modified Prone Cobra and Prone Row exercises are the most effective exercises for targeted strengthening of the lower trapezius muscle in both sexes. The Modified Prone Cobra is somewhat better than the Prone Row due to the low activation of the upper trapezius muscle during this exercise. The Modified Prone Cobra exercise should therefore be considered as a manual muscle test position and as a strengthening exercise for the lower trapezius muscle fibers., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Unlabelled: Recruitment patterns of the superficial and deep abdominal muscles have been well documented in the general population, but not in a group of individuals with a chronic cough, such as individuals with cystic fibrosis (CF), which may alter the recruitment patterns between the abdominal muscles. Therefore the two objectives of this study were (1) to identify whether recruitment of the superficial and deep abdominal muscles during abdominal hollowing (AH) and unilateral leg load (ULL) tasks differed between individuals with CF and a non-CF control group (C); and (2) to compare the muscle activity between the superficial and deep abdominal muscles across these tasks., Methods: Twenty-eight participants (14 with CF and 14 controls) performed (i) AH in supine at three target pressures of a pressure biofeedback unit (PBU) and (ii) a right-sided ULL. Surface electromyography (EMG) of the abdominal muscles was recorded and the amplitude of the signal was normalized to a maximum value (% max)., Results: A 3-way repeated measures ANOVA showed a muscle × task interaction during the AH, but no between group differences. Bonferonni post hoc tests on pooled data showed the deep abdominal muscles to be significantly more active than the superficial muscles. A 2-way repeated measure ANOVA indicated no group differences during the ULL., Discussion: The results of this study demonstrate that adults with stable CF do not recruit their abdominal muscles differently from healthy control subjects during the AH and the ULL tasks. This suggests that coughing is not a risk factor for developing abdominal muscles imbalances in adults with cystic fibrosis., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study was undertaken to determine the effect of changing standing lumbopelvic posture on pelvic floor muscle (PFM) activation amplitude and timing and the resultant vaginal manometry values recorded during static and dynamic tasks. Sixteen nulliparous, continent women between the ages of 22 and 41 years performed five tasks (quiet standing, maximal effort cough, Valsalva manoeuvre, maximum voluntary contraction (MVC) of the PFMs, and a load-catching task) in three different standing postures (normal lumbopelvic posture, hyperlordosis and hypolordosis). Electromyographic (EMG) data were recorded from the PFMs bilaterally using a Periform™ vaginal probe coupled to Delsys™ Bagnoli-8 EMG amplifiers. In separate trials, vaginal manometry was obtained using a Peritron™ perineometer. Lumbopelvic angle was recorded simultaneously with EMG and vaginal manometry using an Optotrak™ 3D motion analysis system to ensure that subjects maintained the required posture throughout the three trials of each task. All data were filtered using a moving 100 ms RMS window and peak values were determined for each trial and task. Repeated-measures analyses of variance were performed on the peak PFM EMG, intra-vaginal pressure amplitudes, and lumbopelvic angles as well as activation onset data for the cough and load-catching tasks. There was significantly higher resting PFM activity in all postures in standing as compared to supine, and in the standing position, there was higher resting PFM activity in the hypo-lordotic posture as compared to the normal and hyperlordotic postures. During the MVC, cough, Valsalva, and load-catching tasks, subjects generated significantly more PFM EMG activity when in their habitual posture than when in hyper- or hypo-lordotic postures. Conversely, higher peak vaginal manometry values were generated in the hypo-lordotic posture for all tasks in all cases. These results clearly indicate that changes in lumbopelvic posture influence both the contractility of the PFMs and the amount of vaginal pressure generated during static postures and during dynamic tasks. Lumbopelvic posture does not, however, appear to have a significant effect on the timing of PFM activation during coughing or load-catching tasks., (Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.)

Introduction: This study compared the patterns of pelvic floor muscle (PFM) activity during coughing between women with stress urinary incontinence (SUI) and continent women, using surface electromyography (EMG) and posterior vaginal wall (PVW) pressure., Methods: Twenty-four women participated: eight continent, eight with mild SUI and eight with severe SUI. Volunteers performed three maximum coughs in supine and standing. Maximum PFM EMG and PVW pressure amplitudes and the timing of the EMG peak relative to the PVW pressure peak were determined. Ensemble average PVW pressure versus EMG curves were created., Results: There were no significant differences among the groups in the maximum EMG or PVW pressure amplitudes. The EMG and PVW pressure peaked simultaneously in both positions in the continent group. In the mild SUI group, the EMG and PVW pressure peaked simultaneously in supine, but the EMG peaked before the PVW pressure in standing. In the severe SUI group, the EMG peaked before the PVW pressure in both positions. The shapes of the PVW pressure versus EMG curves were similar among the groups and positions, however the SUI groups displayed higher EMG-intercepts than the continent women., Conclusion: These findings suggest that urine leakage during coughing in women with SUI may be related to delays in force generation rather than PFM weakness., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

Background: Depression is associated with an increased risk of cardiovascular disease (CVD). Although the mechanism is uncertain, prothrombotic and inflammatory factors may play a role., Objectives: As platelets play a key role in CVD, we determined first, whether depressed individuals had more activated platelets than non-depressed individuals and second, whether treatment of depression reduced platelet activation levels., Patients/methods: We recruited 108 depressed outpatients and 45 control subjects all without a history of CVD. After psychological assessment, the depressed patients were offered treatment with medication and/or psychotherapy. Flow cytometric markers of platelet activation and level of depression were assessed at baseline and at 4 weeks and 6 months after treatment., Results: Depression was associated with increased platelet activation with a higher number of circulating CD62p (0.76x10(9) L(-1) vs. 0.46, P=0.019) and CD63 (P=0.05) positive platelets compared with controls. Patients with depression also had more circulating platelet-leukocyte aggregates than controls (P<0.001). There was a positive correlation between the severity of depression and the level of platelet activation. Platelets from depressed patients were also hyperreactive to adenosine 5 -diphosphate (ADP) stimulation with increased CD62p and CD63 exposure (P=0.003 and 0.019, respectively). Six months of treatment resulted in a reduced number of circulating CD62p and CD63 positive platelets (29.84% and 53.38% decrease) and a 20.9% reduction in CD63 exposure after ADP activation., Conclusions: Depression is associated with increased in vivo platelet activation and resolution of depression using psychotherapy and/or medication reduces platelet activation. These findings provide insights into the link between depression and cardiovascular risk.

The relative levels of pelvic floor muscle (PFM) activation and pressure generated by maximum voluntary PFM contractions were investigated in healthy continent women. The normal sequence of abdominal and PFM activation was determined. Fifteen women performed single and repeated maximum voluntary PFM contractions in supine, sitting and standing. PFM electromyographic (EMG) signals and associated intra-vaginal pressure data were recorded simultaneously. Surface EMG data were recorded from rectus abdominus (RA), external obliques (EO), internal obliques (IO) and transversus abdominus (TA). Abdominal and PFM EMG and intra-vaginal pressure amplitudes generated during voluntary PFM contractions were not different among the positions. Muscle activation sequence differed by position. In supine, EO activation preceded all other muscles by 27 ms (p = 0.043). In sitting, all of the muscles were activated simultaneously. In standing, RA and EO were activated 11 and 17 ms, respectively, prior to the PFMs and TA and IO were activated 10 and 12 ms, respectively, after the PFMs (p<<0.001). The results suggest that women are able to perform equally strong PFM contractions in supine, sitting and standing, however the pattern of abdominal and PFM activation varies by position. These differences may be related to position-dependent urine leakage in women with stress incontinence.

Background: In small studies, investigators have described oral features and their sequelae in primary Sjögren syndrome (PSS), but they have not provided a full picture of the aspects and implications of oral involvement. The authors describe what is, to their knowledge, the first large-scale evaluation to do so. In addition, they report data regarding utilization and cost of dental care among patients with PSS., Methods: The authors surveyed patients with primary Sjögren syndrome as identified by their physicians (PhysR-PSS), patient-members of the Sjögren's Syndrome Foundation (SSF-PSS) and control subjects who did not have PSS. They made comparisons between the three groups., Results: Subjects were 277 patients with PhysR-PSS, 1,225 patients with SSF-PSS and 606 control subjects. More than 96 percent of those in the patient groups experienced oral problems. An oral complaint was the initial symptom in more than one-half of the patients. Xerostomia-associated signs and symptoms were common and severe, as evidenced by scores on an inventory of sicca symptoms. These patients' rate of dental care utilization was high, and the care was costly., Conclusions: Oral and dental disease in PSS is extensive and persistent and represents a significant burden of illness., Clinical Implications: Oral symptoms and signs are common in patients with PSS. Early recognition of the significance of these findings by oral specialists could accelerate diagnosis and minimize oral morbidities.

Stress urinary incontinence (SUI) constitutes a large-scale public health concern. The integrated continence system (ICS) developed by the authors is an evidence-based model that demonstrates how urinary incontinence is maintained through the interaction of three structural systems (intrinsic urethral closure, urethral support and lumbopelvic stability) and three modifiable factors (motor control, musculoskeletal and behavioural). The purpose of the ICS is first, to demonstrate the important role that manual physiotherapists can play in the treatment of SUI and second, to guide clinical practice decisions in order to improve clinical outcomes among women with SUI.

The purpose of this study was to determine (i) if decomposition-based quantitative electromyography (DQEMG) could detect changes in motor unit potential (MUP) morphology and motor unit (MU) firing pattern statistics associated with muscle fatigue, (ii) if any detected changes are correlated with surface electromyographic (SEMG) signs of fatigue, and (iii) if significant fatigue-dependent changes are repeatable within individuals. Mean MU firing rates and the morphology of MUPs detected using needle and surface electrodes during constant-torque isometric contractions held until exhaustion were investigated in the brachioradialis (BR) muscle in 10 healthy volunteers (mean age=28.6 yr, SD+/-3.9). Time dependant changes were investigated using an analysis of variance with normalized time as a main effect. Partial correlation coefficients were computed using a repeated measures analysis of covariance to determine if changes in MU firing rates, needle-detected MUPs and surface-detected MUPs (SMUPs) were related to changes in SEMG signal amplitude and frequency parameters. Intraclass correlation coefficients (ICCs) were used to determine the within-subject repeatability of changes in MU firing rates, and MUP and SMUP parameters. Significant decreases in mean MU firing rates were found along with significant increases in various duration and area related parameters in both MUPs and SMUPs across the fatiguing contraction. The SEMG signal demonstrated the expected changes with fatigue: an increase in amplitude and a decrease in frequency content. SEMG amplitude was significantly positively correlated with SMUP peak-to-peak voltage (r=0.85, p<0.05), and SMUP area (r=0.86, p<0.05). Mean power frequency was significantly negatively correlated with SMUP negative peak duration (r=-0.74, p<0.05). The significant time-dependent changes were reliably observed (ICCs were 0.94 for MUP peak to peak amplitude, 0.97 for MUP area and 0.95 for MUP area to amplitude ratio, 0.95 for SMUP peak-to-peak voltage, 0.83 for SMUP area, 0.99 for SMUP negative peak amplitude and 0.88 for SMUP negative peak area). The decreases in mean MU firing rates measured along with the increases in amplitude, duration and area parameters of MUPs and SMUPs and their partial correlation with SEMG amplitude during submaximal fatiguing contractions of the BR, suggest that recruitment is a main cause of increased SEMG amplitude parameters with fatigue. We conclude that DQEMG can be effectively and reliably used to detect changes in physiological characteristics of MUs that accompany fatigue.

In clinical practice, postural correction is a common treatment approach for individuals with neck and shoulder pain. As chronic static muscle use is thought to be associated with the onset of some neck and shoulder pain syndromes, it is important to understand the impact a postural correction program might have on muscle activation amplitudes in the neck and shoulder regions. Normalized surface electromyographic data were recorded from the levator scapulae, upper trapezius, supraspinatus, posterior deltoid, masseter, rhomboid major, cervical erector spinae, and sternocleidomastoid muscles of the dominant side of each of eighteen healthy subjects. Subjects performed five repetitions of each of four seated typing postures (habitual, corrected, head-forward and slouched) and four standing postures (habitual, corrected, and head-forward and slouched). Repeated-measures analysis of variance models (alpha=0.05) revealed that in sitting postural correction tended to decreased the level of muscle activation required in all muscles studied during seated computer work, however this finding was not statistically significant. Corrected posture in sitting did, however produce a statistically significant reduction in muscle activity compared to forward head posture. Corrected posture in standing required more muscle activity than habitual or forward head posture in the majority of cervicobrachial and jaw muscles, suggesting that a graduated approach to postural correction exercises might be required in order to train the muscles to appropriately withstand the requirements of the task. A surprising finding was that muscle activity levels and postural changes had the largest impact on the masseter muscle, which demonstrated activation levels in the order of 20% maximum voluntary electrical activation.

We have reviewed imaging findings of 32 female patients with a proven haematological malignancy in the breast and axilla presenting to two breast units over a 13-year period. Nineteen patients had screen-detected lesions, and 13 presented to symptomatic services. The most common histological diagnosis was of non-Hodgkins lymphoma. Of the 12 patients who presented with disease in the breast, six (all with primary breast lymphoma) presented with a well-defined mass on mammography. The range of radiological appearances is, however, highly variable.

Aims: To identify the number of women with breast implants in the Newcastle Breast Screening Programme, it's additional workload and compare the number of screen detected cancers in the implant and non-implant group., Methods: Retrospective 9 year review of all women with cosmetic breast augmentation who have joined the National Breast Screening Programme in Newcastle., Results: The percentage of total screened attendances involving implants has increased from 61 (0.10%) in 1990-93 to 97 (0.14%) in 1993-96 and 135 (0.23%) in 1996-99. Despite this increasing workload, no additional resources have yet been required in the Breast Screening Unit.1209 cancers (0.57%) were found in the screened population, and there were no screen detected cancers in the implant group, and there was no significant difference between the groups., Conclusions: As the number of younger women receiving breast implants continues to rise, when they become eligible for the National Health Service Breast Screening Programme (NHSBSP), departments should be aware that additional personnel and finance will be needed.

Quantitative measures derived from raw myoelectric signal (MES) data must be normalized to allow for comparisons both within and between subjects. The most common method of normalization involves dividing the root mean square (RMS) amplitude of the MES recorded during a given activity by the RMS of the MES elicited during a maximal voluntary isometric contraction (MVIC) of that particular muscle. The objective of this study was to use surface-recorded MES amplitude to determine the combination of electrode site, test position, head posture, and smoothing window that elicits the highest and most reliable MES amplitudes during an MVIC of the upper trapezius (UT) muscle. Ten volunteers had surface electrodes positioned at five sites on the UT of their dominant side. Three trials of each of three MVIC test positions were performed both with the head in neutral and rotated 45 degrees to the contralateral side. A repeated-measures ANOVA was used for statistical hypothesis testing. Coefficients of variation were used to quantify the between-factor variability introduced in each case. In addition, the data were re-analyzed using moving windows of 100 to 500 ms in length, and an ANOVA was used to determine the effect of window length on both the amplitude and variability of the estimates of maximum voluntary activation (MVE). Head position had no significant effect on RMS amplitude of the MVIC in any of the test positions. There was a significant electrode site by test position interaction effect. Bonferroni post-hoc analyses were performed on this interaction by fixing test position and testing electrode site, revealing that Sites 1 (2 cm lateral to the midpoint between C7 spinous process and the posterolateral border of the acromion) and 4 (2 cm posterior to Site 1) recorded significantly higher RMS values for all test positions, and were not significantly different from each other. Fixing electrode site, the test position analysis revealed that abduction of the humerus, and abduction with external rotation of the humerus produced significantly higher RMS values than shoulder elevation at both Sites 1 and 4, and that abduction produced a significantly higher RMS amplitude than abduction in external rotation at Site 1. The results confirmed that Sites 1 and 4 consistently produced the highest MES amplitudes for all movements. Pure abduction consistently elicited maximal RMS values; however there is concern regarding supraspinatus cross talk during this movement. Site 1 was found to produce the most reliable data. A moving window of 100 ms was found to generate MVE estimates that were significantly higher than windows ranging from 200 ms to 500 ms in length. There was no effect of window length on the reliability of the MVEs. Based on this study, it was concluded that abduction or abduction with the arms in lateral rotation should be used as normalization contraction positions for the upper trapezius muscle. During this movement, Site 1 data smoothed with a moving window of 100 ms produces the highest amplitude MVE data but window lengths greater than 200 ms produce more stable estimates in terms of being able to compare studies in which moving windows are used to compute RMS.

A follow-up of 3143 women from four screening centres, who were assessed after screening mammography, showed that 371 had breast cancer diagnosed at that assessment and 62 developed a breast cancer in the following 6 years. Of these, 32 were judged to be false-negatives at assessment, with 23 of the 32 at the site originally suspected. The results show that the assessment process is not infallible and that the scale of the problem only becomes clear when an exhaustive search is made for missed cancers.

Aims: To review our institution's practice of treatment of a mammographically detected population of ductal carcinoma in situ (DCIS) patients and to determine the outcome., Methods: Between April 1989 and March 1994, 304 women with median age 59 years (range 51-65) with DCIS detected on screening mammogram, were treated in the Newcastle General and Royal Victoria Infirmary Hospitals, Newcastle-upon-Tyne, UK. More than half of the women (n=176, 57.8%) decided to have mastectomy. Other treatment options were wide local excision (WLE) with radiotherapy (n=97, 32%) and WLE alone (n=31, 10.2%). All except five received adjuvant hormone treatment., Results: Predominant DCIS was comedo in 122 (42%), followed by cribriform in 87 (30%) and micropapillary in 44 (15%) cases. Grade I was found to be commonest grade (54%) followed by grade II (27%) and grade III (11%). With a median follow-up of 88 months, there were six (2%) recurrences, all of which were in women who were given breast conservation treatment, WLE with radiotherapy (n=1, 1%) and without radiotherapy (n=5, 16.6%). Mastectomy in this series was not associated with any recurrence at all. In three cases the recurrence was invasive, one of who also had distant metastasis., Conclusions: The findings of this study suggest that in women with DCIS suitable for breast conservation, WLE when combined with radiotherapy is associated with a very low recurrence rate., (Copyright Harcourt Publishers Limited.)