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We systematically reviewed prospective studies for five hand procedures to analyse postoperative follow-up time, clinical or radiographic plateau, and whether the authors provide justification for times used. Demographic data, outcomes and mean follow-up were analysed. A total of 188 articles met our inclusion criteria. The mean postoperative follow-up time among these studies were carpal tunnel release, 21 months (range 1.5–111); cubital tunnel release, 27 months (2.5–46); open reduction and internal fixation for the distal radius fracture, 24 months (3–120); thumb carpometacarpal joint arthroplasty, 64 months (8.5–228); and flexor tendon repair, 25 months (3–59). Authors provided justification for follow-up intervals in 10% of these reports. We conclude that most prospective clinical studies in hand surgery do not properly justify follow-up length. Clinically unnecessary follow-up is costly without much benefit. In prospective research, we believe justified postoperative follow-up is essential, based on expected time to detect clinical plateau, capture complications and determine the need for secondary surgery. Level of evidence: III

The Koebner phenomenon is the development of lesions in traumatized skin, often with spontaneously occurring lesions elsewhere. We report a case of a woman in her 20 s presenting with discoid lesions superimposed on tattoos that she obtained many years ago. Although a few case reports have been published describing development of lesions on red tattoos attributed to photosensitivity, or koebnerization occurring less than a month following tattoo placement, our patient demonstrates a unique delayed development of discoid lesions years after obtaining her tattoos in non-sun exposed skin. Patients with conditions associated with the Koebner phenomenon must be counseled regarding forms of preventable trauma such as tattoos, and should be made aware that the Koebner phenomenon may not only manifest immediately, but can also present many years later.

This article examines the experiential and analytical routes of the researchers-authors’ web-project titled ‘Making Home: Tai Hang’, which investigates Hong Kong home culture by accessing informants’ domestic world through different layers of interpretation via hypermedia presentation. The web-project’s [http://taihang.scm.cityu.edu.hk/#en] multilayered navigation structure—playful yet scholarly introduction, ‘tourlike’ yet distant ‘virtual’ field experiences, participants’ situated yet performative accounts of home lives, and the researchers-authors’ inductive categorizations—communicate multi-dimensional ethnographic accounts of home culture in Hong Kong. Employing media in isolation and in interaction (i.e. graphic illustrations, panorama photography, interaction of images and audio vignettes of participants’ narration and researcher-participant dialogues, and multiple micro-narratives on objects) via website’s hypermedia nature, we argue that hypermedia representation affords engaged and critical read...

Background: Pyrocarbon implants represent an increasingly popular method to treat proximal interphalangeal joint dysfunction. To this point, no association has been shown between pyrocarbon biomaterials and fibromatosis. We present a potentially serious and destructive complication associated with pyrocarbon arthroplasty. Methods: We demonstrate a clinical case involving pyrocarbon arthroplasty and subsequent fibromatosis development in an otherwise healthy 23-year-old female. To present this association, we illustrate the diagnostic workup involved in a rapidly expanding soft tissue mass of the hand and explain the appropriate treatment. Results: Pyrocarbon arthroplasty was associated with development of locally destructive fibromatosis confirmed by histopathological examination. Treatment involved wide resection with preservation of local structures. Conclusion: We describe the first association between fibromatosis and pyrocarbon biomaterial. Due to fibromatosis destructive effects, clinicians should be aware of potential complications associated with these materials and know how to accurately diagnose and treat these lesions.

Background: The clinical presentation of radial polydactyly can vary greatly. Careful planning and appreciation of the anatomic subtleties provides alternative surgical options to improve patient outcomes. Methods: We present a case of a well-formed accessory web space thumb and a hypoplastic primary thumb. Results: Rather than excising the accessory digit, we performed a spare-part, on-top-plasty reconstruction to replace the diminutive distal phalanx of the primary thumb. Conclusions: This novel case applied the principle of spare-part surgery to reconstruct a more aesthetic and functional reconstructed digit.

This article examines the genesis, usage, and meaning of the People’s Republic of China’s and the Republic of China’s U-shaped line claim in the South China Sea territorial dispute from 1946 to 1974. The Republic of China (ROC) officially created the line in 1947, which the People’s Republic of China (PRC) then adopted in 1949. Although the PRC claims sovereignty over all of the disputed islands and features, it remains silent on what specific waters the line claims. Based on ROC national archival files on the line, which remain virtually unused by scholars on the dispute, this article argues that the line was an “islands attribution” boundary until at least 1974. It claimed only the islands, features, and any adjacent waters consistent with contemporary conceptions of international maritime law. The article concludes with the present-day significance of this history and suggestions for future avenues of scholarship.

The occurrence of a low energy fracture of the distal radius increases the risk for another, more serious fracture, such as a proximal femoral fracture. Early mortality after a proximal femoral fracture has been widely studied, but the association between a distal radial fracture and mortality is unknown. The date of death for all Medicare beneficiaries who sustained an isolated distal radial fracture in 2007 was determined using Medicare Vital Statistics files. The adjusted mortality rate for each age–sex group was calculated and compared with published US mortality tables. Distal radial fractures were not associated with an increased mortality rate. In fact, beneficiaries had a significantly lower mortality rate after distal radial fractures than the general population. This may be related to the injured beneficiaries’ involvement in the healthcare system. Mortality rate did not vary significantly based on time from injury. Our results indicate that any mortality is unlikely to be attributable to the distal radial fracture or its treatment. Level of Evidence: III

Purpose The objective of the study was to determine the efficacy of contrast-enhanced ultrasound (CEUS) using ultrasound (US)-specific microbubbles in guiding radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Methods A retrospective analysis of 50 patients with HCC treated with CEUS guided RFA using perflutren at our institution was performed. CEUS images were first compared to B-mode US images performed at the same RFA session to determine the ability of CEUS to increase the conspicuity of lesions. A qualitative score (1 = poor, 2 = fair, 3 = excellent) was used to grade the ability to visualize the lesions. The preprocedure CEUS images were then evaluated using the most recent prior contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI). The efficacy of the treatment was evaluated with short-term follow-up imaging (median 1 month) for presence of residual or recurrent disease. Results CEUS allows at least fair visualization (score ≥2) in 78% (reader 1) and 80% (reader 2) of the lesions not visualized by B-mode US, and 50% (reader 1) and 42% (reader 2) of the lesions poorly visualized by B-mode US. Lesion appearances on CEUS are largely concordant with those on CT or MRI: 88% for reader 1, 96% for reader 2. With CEUS-guided RFA, complete response was achieved in the vast majority of the lesions at short-term follow-up: 82% for reader 1, 94% for reader 2. Conclusions CEUS increases the conspicuity and provides better characterization of hypervascular HCC that are either not seen or poorly seen on B-mode US, and CEUS provides real-time guidance of RFA with good short-term treatment responses.

Pyogenic flexor tenosynovitis (PFT) is an aggressive closed-space infection that can result in severe morbidity. Although surgical treatment of pyogenic flexor tenosynovitis has been widely described, the role of antibiotic therapy is inadequately understood. We conducted a literature review of studies reporting on acute pyogenic flexor tenosynovitis management. A total of 28 case series articles were obtained, all of which used surgical intervention with varied use of antibiotics. Inconsistencies among the studies limited summative statistical analysis. Our results showed that use of antibiotics as a component of therapy resulted in improved range of motion outcomes (54% excellent vs. 14% excellent), as did using catheter irrigation rather than open washout (71% excellent vs. 26% excellent). These studies showed benefits of early treatment of pyogenic flexor tenosynovitis and of systemic antibiotic use. As broad-spectrum antibiotics have changed the management of other infectious conditions, we must more closely evaluate consistent antibiotic use in pyogenic flexor tenosynovitis management. Level of Evidence: Therapeutic, Level III

Background Quality normative data requires a diverse sample of participants and plays an important role in the appropriate use of health outcomes. Using social media and other online resources for survey recruitment is a tempting prospect, but the effectiveness of these methods in collecting a diverse sample is unknown. The purpose of this study is to pilot test four methods of recruitment to determine their ability to produce a sample representative of the general US population. Methods This project is part of a larger study to gather normative data for the Michigan Hand Outcomes Questionnaire (MHQ). We used flyers, e-mail, Facebook, and an institution-specific clinical research recruitment Web site to direct participants to complete an online version of the MHQ. Participants also provided comorbidity and demographic information. Results The institution-specific recruitment Web site yielded the greatest number of respondents in an age distribution that mirrored the US population. Facebook was effective for recruiting young adults, and e-mail was successful for recruiting the older adults. None of the methods was successful in reaching an ethnically diverse sample. Conclusions Obtaining normative data that is truly representative of the US population is a difficult task. The use of any one recruitment method is unlikely to result in a representative sample, but a greater understanding of these methods will empower researchers to use them to target specific populations. This pilot analysis provides support for the use of Facebook and clinical research sites in addition to traditional methods of e-mail and paper flyers.

Although modern medicine and new medical technologies offer enormous potential to improve diagnosis and treatment of many diseases, mortalities from fall accidents are steadily on the rise for the elderly. Since postural stability characteristics are considered to be important in maintaining functional independence free of falls and healthy life style especially for the growing elderly population, there is an imminent need in inexpensive and portable device that can assess balance. While inertial sensors embedded in smartphone are seen as an alternative to force plate (ground truth) to unobtrusively assess postural stability in home environments, no study has yet reported the non-linear physiological information captured by smartphone affixed at pelvic region. By using recurrence quantitative analysis (RQA), this study investigates non-linear dynamical features of postural sway measured from force plate and smartphone. The resultant position vector of postural sway from the two systems was highly coherent and was used for non-linear analysis. Even though most of RQA measures collected from the projected postural sway using the smartphone were significantly different than measures collected using the force plate, deterministic characteristics of postural sway were not found significantly different. This study opens new prospects of easy clinical testing using postural variables that may be relevant for assessing fall risks at home and patient environment in future.

Hand injuries affect our ability to manipulate objects, and existing tools are useful in determining if patients have difficulty performing tasks. The Jebsen–Taylor Hand Function Test (JTT), is a widely used test for functional motor assessment that reflects activities of daily living. But current tools, including the JTT, do not measure compensatory behavior. This study aimed to investigate the use of a low cost motion capture system to evaluate compensatory behavior of Rheumatoid Arthritis (RA) patents during a JTT assessment. Youth and Older control groups were used as a basis for comparison of RA patient performance. Results of the JTT itself illustrated how RA patient can perform some tasks more quickly than control groups. However, the JTT only evaluates completion times of each task, not how the participant performed the activity. Including Range of Motion measurements during this JTT assessment indicated that there are significant differences in the Range of Motion of RA patients in comparison to both young and older control groups. For example, hand displacement results for the RA participants were significantly greater than those of the older control. This demonstrates that the integration of motion capture analysis with the JTT gives a more comprehensive assessment of hand function.

Abstract Myopericytoma is a rare type of soft tissue tumor with perivascular myoid differentiation. Although the pathology characteristics of myopericytomas are well described in literature, the clinical characteristics of these tumors have received less attention. We report on a 44-year-old female who developed a myopericytoma in her right distal forearm. The patient presented with a painless solid mass that had been slowly increasing in size for approximately 5 years. Unlike typical myopericytoma in the extremity growing as a subcutaneous nodule, the tumor enveloped the distal ulna. This case suggests a different growth pattern for myopericytoma. Myopericytoma is a rare soft tissue tumor originating from perivascular myoid cells, which has only been recognized as a distinct condition in the past 15 years (Granter et al. Am J Surg Pathol. 22 (5):513–25, 1998). Most of these tumors present as a painless, slow-growing subcutaneous nodule. They have typically been described by pathologists who concentrate on the pathological features rather than the clinical characteristics of these tumors (Granter et al. Am J Surg Pathol. 22 (5):513–25, 1998; Dray et al. J Clin Pathol. 59 (1):67–73, 2006; Mentzel et al. Am J Surg Pathol. 30 (1):104–113 2006). We report a case of myopericytoma with an unusual growth pattern involving the distal forearm to highlight the clinicopathologic features of this tumor.

Melanin plays a role in determining human skin color of a person, and a large amount of melanin makes the skin color look darkened. The proper amount of melanin formation protects our skin from UV radiation, but excessive melanin production causes hyperpigmentation and leads to freckles, melasma, and lentigo. In this study, we investigated the inhibitory effect of hydroxyectoine on melanogenesis and its mechanism in B16F10 cells. Melanin content and cellular tyrosinase activity were determined. The expression of microphthalmia-associated transcription factor (MITF), and the activities of tyrosinase and other melanogenesis-related enzymes, such as tyrosinase-related protein 1 (TRP-1) and tyrosinase-related protein 2, were also examined. Hydroxyectoine treatment significantly inhibited melanin production and intracellular tyrosinase activity in a dose-dependent manner. Western blot analysis showed that hydroxyectoine also reduced the expressions of tyrosinase and TRP-1. In addition, hydroxyectoine significantly reduced the expression of MITF, a major regulator of melanin production, and inhibited the phosphorylation of p38, c-Jun N-terminal kinase, and activated the protein kinase B. The results demonstrated that hydroxyectoine inhibits the expression of MITF through the inhibition or activation of melanin-related signaling pathways and downregulates melanogenesis by inhibiting melanogenic enzyme expression and tyrosinase activity. Hydroxyectoine has potential value in functional cosmetics applications, such as whitening.

PurposeThe purpose of this study was to conduct a systematic review of outcomes of fingertip revision amputation for fingertip amputation injuries in the English-language literature to provide best evidence of functional outcomes.MethodA MEDLINE literature search was performed to identify studies that met the following criteria: (1) reported primary data; (2) included at least five cases of primary revision amputation treatment following digit amputation injury; (3) reported finger or thumb amputation at or distal to the distal interphalangeal (DIP) joint or interphalangeal (IP) joint, respectively; (4) presented at least one of the following outcomes: static two-point discrimination (2PD), cold intolerance, arc of motion (AOM) of metacarpophalangeal (MCP) joints, proximal interphalangeal joints (PIP), DIP joints, or return-to-work time.ResultsThirty-eight studies met the inclusion criteria. Twenty-seven studies reported 2PD, 20 studies reported cold intolerance, eight studies reported AOM, and 18 studies reported return-to-work time after revision amputation of fingertip injuries. The mean 2PD was 5.6 mm. On average, 24 % of patients experienced cold intolerance. AOM at the PIP joint was reported in four studies and averaged 94°. DIP joint AOM was presented in four studies and averaged 66°. Thumb MCP and IP joint AOM was presented in three and four studies, respectively. Mean thumb MCP joint AOM was 54° and that of the IP joint was 71°. The mean return-to-work time was 47 days.ConclusionsOn average, fingertip revision amputation can achieve almost normal sensibility and satisfactory motion and patients can expect to return to work on average approximately 7 weeks after surgery.

The function of air jet smoke prevention system is blowing air from the lineal vent installed on either sides or single side of the wall to prevent the smoke spread from fire sites. The system has the advantages for using in the hospitals, nursing homes, or underground tunnels which have a large number of weaker evacuees that may cause trouble by fire door or smoke curtain and other smoke devices. The corridors are designed to connect emergency exit and stairs as an evacuate route in most buildings. Therefore, stopping the hot smoke from corridor to stairs becomes an important fire safety design. The corridors may have various widths in existing buildings. Thus, three different size (2 m, 4 m, and 6 m) corridor widths are examined experimentally in this study. Referring to the test data, the air jet smoke prevention system applied in 2 m and 4 m width corridors are able to create a smoke-free area during the fire tests. Under the design supply air volume, air jet smoke prevention system fails to protect the 6 m width corridor.

Pierre-Auguste Renoir was one of the most influential painters in art history, but few people know that he suffered from debilitating rheumatoid arthritis. Despite his arthritis, he was able to maintain an incredible level of precision and efficiency with his painting. More importantly, he remained positive and did not let his condition affect his passion for painting or take away from the beauty that he saw in the world around him. Renoir applied a wide variety of coping mechanisms and used his ingenuity to come up with different ways to continue painting even as his arthritis weakened him. Renoir's long battle with rheumatoid arthritis serves as an inspiration to patients who experience the pain and limited mobility associated with this disease, encouraging them to persevere and to develop coping mechanisms that prevent the effects of their impairment from disabling them.

Background: In 1962, Bertil Stener first described the anatomy and treatment of the displaced ulnar collateral ligament of the metacarpophalangeal joint, later called the Stener lesion. Since Stener’s publication, treatment algorithms for ulnar collateral ligament rupture have aided in preoperative diagnosis, yet the best diagnostic method to assess ligament displacement remains largely undefined. Methods: An extensive literature search was performed to explore the treatment evolution of the Stener lesion and explore how technical development has influenced Stener lesion diagnosis. We also sought to illuminate the life and work of Bertil Stener. Results: Studies evaluating the use of magnetic resonance imaging (MRI) and ultrasound (US) technology have suggested that these modalities have improved Stener lesion diagnosis. Conclusion: Despite the utility of developing MRI and US technology, consensus for one superior diagnostic tool for Stener lesions does not currently exist.

Heat generated during implant osteotomy might lead to osteonecrosis and delayed bone repair, thus resulting in impaired early osseointegration and fixation of bone-anchoring devices. In this study, we proposed to overcome heat-induced injury to bone by fabricating core-shell polymeric biodegradable microspheres encapsulating a mitogenic factor, platelet-derived growth factor (PDGF), and a differentiation factor, simvastatin, in a simultaneous or sequential release profile. Microspheres encapsulating bovine serum albumin (BSA), PDGF, simvastatin, PDGF-in-core with simvastatin-in-shell, and simvastatin-in-core with PDGF-in-shell were delivered to fill standardized osteotomy sites on edentulous ridges of rat maxillae under irrigated or non-irrigated conditions. In the absence of irrigation, significant reduction of cell viability and increase in inflammation and sequestrum formation without evidence of osteogenesis were observed. Both PDGF and simvastatin deliveries facilitated cell viability and reduced osteonecrosis. Localized osteogenesis was seen under simvastatin treatment, while generalized but primitive osteogenesis was noted in PDGF-treated osteotomy sites. In addition, sequential PDGF-simvastatin delivery further augmented osteogenesis and promoted bone maturation. The results suggested that sequential PDGF-simvastatin delivery was an effective modality to prevent heat-induced complications and facilitate bone apposition after implant osteotomy, potentially favoring the early fixation of bone-anchoring devices and oral implant osseointegration.

Background The usefulness of peer review has been expressed as a method to improve the quality of published work. However, there has been a lack of systematic reviews to date to highlight the essential themes of the peer-review process. Methods We performed a search of the English language literature published prior to October 2011 using PubMed to identify articles regarding peer review. Inclusion and exclusion criteria were developed a priori. Data were extracted and then analyzed for the prevalence of peer-review themes contained within the literature. Results Of the 941 articles found during our original literature search, 37 were selected for review. The majority were commentary/editorial articles. The themes in our search included the structure and process of the peer-review system, the criteria for papers, ethics, and the different forms of the peer-review process. Conclusions The criteria for submission will vary, but our systematic review provides a comprehensive overview of what reviewers expect from authors. Our systematic review also highlighted ethical considerations for both authors and reviewers during the peer-review process. Although the topic of peer review is expansive and its process may vary from journal to journal, the understanding of the themes outlined in this paper will help authors recognize how to write a more successful paper. Also, more research must be carried out to establish the efficacy of the different styles of peer review, and it would be presumptuous to draw conclusions until further research is established.

Objective This review systematically examines the literature regarding mentor-mentee relationships in surgery. Background The usefulness of mentorship in surgical training has been expressed in many articles. However, to date, there has been no systematic review on mentoring surgical trainees. This surgical environment is different from other areas of medicine and requires young surgeons to learn skills not readily available from textbooks. Instead, mentors are a valuable mode of transferring this knowledge to the next generation of surgeons. Thus, mentorship is a worthy area of research and attention. Methods We identified all articles discussing mentorship in surgery between January 1985 and August 2010 using PubMed and ISI Web of Knowledge. Predetermined exclusion and inclusion criteria were used to screen articles by title, abstract, and full text in sequence. We extracted the relevant data, and then analyzed the prevalence of major surgical mentoring themes in the literature. Results Of the 1,091 unique articles found during our original literature search, 38 were selected for review. The majority (68%) were commentary/editorial articles. The most discussed themes include the desirable qualities of a surgical mentor, the structure of mentor-mentee relationships, and advice for overcoming barriers to mentoring. Much less discussed themes include the desirable traits in a mentee and the appreciation of generational and cultural differences in mentorship. Conclusions Several barriers to effective surgical mentoring were identified, such as time constraints and a lack of female mentors. By focusing on the positive traits found in this review, for example, developing formal programs to alleviate time constraints, these barriers can be overcome and effective mentor-mentee relationships can be built. Many articles draw attention to the dying art of mentorship in surgical training programs, and currently, the literature on mentorship in surgery is somewhat scarce. These concerns should serve as motivation to revive mentorship in surgery education and to expand the literature regarding underexplored themes and overcoming the current barriers. Although mentorship may not always take on a structured form, it should not be treated casually because proper mentorship is the foundation for training quality surgeons.

Participation in everyday occupations influences people's health and well-being. To enable individuals to do the activities they want and need to do is the main concern of occupational therapy practice. Many daily occupations are universal, but they also depend on culture. The development of the Activity Card Sort in eight countries has offered the opportunity to describe occupations across cultures. In the developmental process of culturally relevant versions of the Activity Card Sort by occupational therapists in each country, the instrument versions included samples of older adults ( N = 468). These data are used in the current description with the aim of identifying central activities across cultures and central activities for Asian and Western cultures. Te n activities were identified as being central across cultures (i.e., more than half of the older adults in all eight countries performed them). They were the following: shopping in a store, doing grocery shopping, doing dishes, doing laundry, reading books or magazines, sitting and thinking, watching television, listening to radio or music, visiting with friends and relatives, and talking on the telephone. Further, 16 additional activities central to Asian culture and 18 activities central to Western culture were identified. The identification of central activities deepens knowledge of activities with cultural significance. This knowledge is needed in clinical practice and multicultural research. This description provides a starting point for further exploration of everyday occupations among older adults.

BackgroundToe-to-thumb transfer is an established procedure for reconstruction of traumatic thumb amputations. The four types of toe-to-thumb transfers are the second toe, the great toe, the wrap-around great toe and the trimmed great toe transfers. The purpose of this study is to conduct a systematic review of the literature to compare outcomes amongst different methods of toe-to-thumb transfers.MethodsA literature search using ‘toe-to-thumb transfer’ combined with ‘thumb injury’ and ‘thumb reconstruction’ as keywords and limited to humans and the English language identified 633 studies. Studies were included in the review if they: (1) present primary data, (2) report three or more toe-to-thumb transfers for isolated complete traumatic thumb amputation between the metacarpophalangeal joint and the interphalangeal joint (both excluded) and (3) present functional outcome data.ResultsTwenty-five studies representing 450 toe-to-thumb transfers met the inclusion criteria. They included 101 second toe transfers, 196 great toe transfers, 122 wrap-around transfers and 31 trimmed toe transfers. The mean survival rate was 96.4%. No statistically significant differences could be detected between the four transfers with regards to survival, arc of motion, total active motion, grip and pinch strength and static two-point discrimination.ConclusionsAll four types of toe transfer procedures have predictably high survival rates and good patient satisfaction scores. The current data are inadequate to make any comments with regards to donor site morbidity. Till such data are available, an evidence-based recommendation for the superiority of a specific type of toe-to-thumb transfer cannot be made.

BackgroundPrevious research documents suboptimal preoperative or postoperative care for patients undergoing surgery. However, few existing quality measures directly address the fundamental element of surgical care: intra-operative care processes. This study sought to develop quality measures for intraoperative, preoperative, and postoperative care for carpal tunnel surgery, a common operation in the USA.MethodsWe applied a variation of the well-established RAND/UCLA Appropriateness Method. Adherence to measures developed using this method has been associated with improved patient outcomes in several studies. Hand surgeons and quality measurement experts developed draft measures using guidelines and literature. Subsequently, in a two-round modified-Delphi process, a multidisciplinary panel of 11 national experts in carpal tunnel syndrome (including six surgeons) reviewed structured summaries of the evidence and rated the measures for validity (association with improved patient outcomes) and feasibility (ability to be assessed using medical records).ResultsOf 25 draft measures, panelists judged 22 (88%) to be valid and feasible. Nine intraoperative measures addressed the location and extent of surgical dissection, release after wrist trauma, endoscopic release, and four procedures sometimes performed during carpal tunnel surgery. Eleven measures covered preoperative and postoperative evaluation and management.ConclusionsWe have developed several measures that experts, including surgeons, believe to reflect the quality of care processes occurring during carpal tunnel surgery and be assessable using medical records. Although quality measures like these cannot assess a surgeon's skill in handling the instruments, they can assess many important aspects of intraoperative care. Intraoperative measures should be developed for other procedures.

We investigated how older Hong Kong people perceive the application of telecommunication technologies in products that could enhance their safety at home. The telecare devices in the present study were: (1) the Personal Emergency Link Service (PELS), a 24-hour personal emergency link service; (2) a home-based non-intrusive motion monitoring system; and (3) a wearable vital signs monitoring system. Data were collected from a convenience sample of 368 elderly persons aged 65 years or above from 15 District Elderly Community Centres in Hong Kong, through a structured questionnaire administered during face-to-face interviews by trained interviewers. All three telecare devices were generally perceived as useful by the elderly participants: the PELS by 96% of them, the home-based non-intrusive monitoring system by 91% and the wearable vital signs monitoring system by 84%. However, although many respondents were positive about the function and usefulness of these devices, they stated that they would not personally use them. Technological innovations need to be perceived by the elderly as relevant to their everyday lives.

Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.

The multitier healthcare system of the USA has several major flaws. High costs and uncertain quality of care indicate that this system is no longer practical. Several improvement initiatives, such as the Oregon Health Plan, Leapfrog, Lean Manufacturing, and Pay-for-Performance have been implemented into the current system. All of these quality improvement models are being experimented in a limited fashion and do not address the biggest problem in the US healthcare, inequality of care. There is now increasing support for a universal health coverage model as an ethically sound and just way to decrease health disparities in the USA. The current quality initiatives as well as an adoption of universal coverage appear to be the best way to improve quality of care, reduce cost, and increase equality in healthcare. These initiatives may have considerable effects on the practice of hand surgery in the near future, and thus, it is important for the field of hand surgery to become more engaged in advocacy and public policy arena. The purpose of this paper is to examine the current problems in the US healthcare system and to evaluate potential solutions that will enhance quality while simultaneously curbing the unchecked increase in healthcare expenditure.

Leiomyoma is most commonly found in the uterus and lower extremities of middle-aged women. Leiomyoma is uncommonly reported in the hand and is extremely uncommon in children. We present three cases of leiomyoma of the hand, including one case in the hand of a 10-year-old boy.

A hand blast injury case causing a large through-and-through composite tissue loss is presented. This injury resulted in a dorsal and a palmar hand defect with segmental bone loss. Soft tissue coverage of both dorsal and palmar wounds was achieved by two separate pedicle flaps with pedicles closely arising from the femoral artery: a superficial inferior epigastric artery (SIEA) flap and a groin flap. Simultaneously, a large iliac corticocancellous bone graft was harvested from the same incision to be used for the wrist fusion procedure. This approach uses two separate pedicled flaps with robust independent blood supply to cover simultaneously a dorsal and a volar hand wound. A large through-and-through hand defect can be reconstructed readily with this approach, and it is associated with much less perioperative morbidity compared to free composite tissue transfer options. The dissection of both the groin flap and the SIEA flap is straightforward and can be easily performed by a single surgeon. The combined use of these two flaps allows stable coverage of sizable dorsal and palmar wounds of the hand.

Background International volunteering missions are becoming an important focus of plastic surgeons in the United States. The purpose of this paper is to describe the teaching of pediatric hand surgery in Vietnam to share the lessons learned from this project. Methods Two medical education trips were conducted to the no. 1 Children's Hospital in Ho Chi Minh city (Saigon) to teach pediatric hand and burn reconstructive surgery to the surgeons and therapists. This is the main referral children's hospital for the country, and pediatric hand surgery expertise is not available. Results Structured education programs were conducted over two trips to introduce congenital hand surgery and burn reconstructive procedures using flap techniques. The education programs included lectures and surgical demonstrations of selected procedures. Their proficiency was verified by supervised conduct of these operations. Conclusions A well-conceived medical education program can introduce complex surgical discipline to a country. Through two trips, the surgeons at this referral center will have the capability to take care of many children requiring reconstructive hand surgery.

It is pertinent for occupational therapists to measure the changing patterns of activity engagement of older adults who might have undergone the process of aging, institutionalization, and illness. The Activity Card Sort was developed to measure the level of activity engagement in the main areas of occupational performance. This study examined the reliability, internal consistency, and construct validity of the Hong Kong version of the Activity Card Sort. Using expert panel reviews, 65 activities were identified as culturally appropriate for inclusion in the Hong Kong version. Sixty geriatric clients who had experienced a stroke participated in the evaluation. Results showed that the Hong Kong version of the Activity Card Sort was able to discriminate between clients with different levels of functioning ( t = −14.24; p = .00), and was positively associated with the Comprehensive Quality of Life Scale ( r = 0.86; p = .00). Excellent test—retest reliability ( r = 0.98) and internal consistency ( r = 0.89) were demonstrated. The findings suggest the Hong Kong version of the Activity Card Sort is a reliable and valid instrument to use with the Hong Kong Chinese elderly population.

This prospective before-and-after observational study investigated the effect of upper airway anaesthesia on dynamic airflow. Six consenting ASA 1 adults, all authors of this study, underwent a series of Spirometric measurements before and after topical anaesthesia of the upper airway using lignocaine. Peak inspiratory flow rate, forced inspiratory flow between 25% and 75% of the maximum inhaled volume, forced expiratory volume at 1 second, and forced vital capacity in the supine and sitting positions were measured. The measured inspiratory parameters were significantly reduced after lignocaine topical anaesthesia of the upper airway. Expiratory flow parameters were not affected. We conclude that topical anaesthesia of the upper airway leads to dynamic inspiratory airflow limitation.

An integrated design method for a high-precision/speed servomechanism including interactions of mechanical and electrical subsystems is proposed in this article. On the basis of the multiobjective optimization method, a non-linear optimal design procedure of the mechanical subsystem is performed simultaneously through the design process of the electrical subsystem satisfying the desired performance. Mechanical and electrical constraints have been formulated according to design requirements. Both mechanical and electrical parameters are considered as design variables. Validity of the integrated design problem is verified on the different application areas. Parametric studies of the design variables have also been conducted in this article. Case studies show that the integrated design method for an x-y positioning system satisfies the desired high-precision/speed performance.

Thermal deformations of ball screws directly affect the positioning errors of machine tools. In order to calibrate the thermal deformations of ball screws, an accurate estimation of the whole temperature field of the screws is required. However, it is extremely inefficient and almost impossible to acquire the whole temperature distribution by measuring the temperatures of every point. Therefore, a temperature estimator, which can estimate the whole temperature field from temperatures of just a few points, is required. In this paper, one-dimensional heat transfer problems are formulated under concepts of modal analysis and state-space design. Then an observer is designed to estimate the intensity of a heat source and the whole temperature field in real time. The reliability of the estimator is confirmed through comparisons between solutions from the proposed method and those of exact solutions. The proposed method is applied to the estimation of the intensity of the heat source and the temperature distribution of a ball screw system. It is confirmed that the proposed method estimates the whole temperature distribution of a ball screw system well without noise and time delay.

This paper proposes a developmental procedure of a real-time thermal error compensator for a high-speed machine tool (HSMT). A vertical-type HSMT having a slant column with lightweight moving slides is used to investigate thermal characteristics. Since spindle speed is very fast in the HSMT, a large amount of thermal drift error occurs within a few minutes of operation. Owing to tooling problems of the high-speed spindle, axial offset errors also appear on the machined surfaces. If-then rules and thermal mode approaches are applied to remove defects of the machined surfaces. An infinite impulse response filter is used to compensate for surface roughness of the machine surface. A personal-computer-based error compensation scheme has been developed for the real-time thermal error compensation. Compensation interval of the developed compensator is selected to satisfy correction requirement of thermal errors of the HSMT. Experimental results confirm the validity of the developed compensator and show that the accuracy of machined surface is dramatically improved.

This study examines the activities engaged in by nursing home residents with dementia and their states of well-being. Dementia Care Mapping was used to record the activities engaged in by, and the well-being of, 43 participants during a 6-hour period. The average age of the group was 81 years and length of stay at the nursing home was 27 months. Fourteen percent of participants had received a Clinical Dementia Rating (CDR) score of 1 (mild level of cognitive impairment), 35% had a CDR score of 2 (moderate impairment), and 51% had a CDR score of 3 (severe impairment). Results indicated that the three CDR groups engaged differently in activities. The CDR1 group participated significantly more in therapeutic/leisure activities and activities of daily living than did the CDR2 group ( p < .001 and p < .05) and CDR3 group ( p < .001). Conversely, the CDR3 group engaged in significantly more passive activities than did the CDR1 group ( p < .001), and had fewer social interactions and displayed more negative behavior than the other two groups ( p < .05). Moreover, their well-being was significantly worse than that of the other two groups (p < .001). A majority of participants (82%) demonstrated poor to very poor well-being. Because better well-being was associated with positive and enjoyable engagement in activities (τ = +0.67, p < .001), the low level of activity participation demonstrated by low-functioning individuals with dementia needs to be addressed. Moreover, further studies are indicated to explore the possible factors influencing their limited activity participation.

An overview of the current state of outcome measurement after hand surgery is presented. The paper focuses on the development, application and strengths and weaknesses of subjective assessment techniques. It also reviews the existing questionnaires and suggests recommendations for use in research or clinical practice.

This study describes a prediction model for the impact vibration of raised access floors by a Finite Element Method (FEM) numerical analysis. The residual ratio of the natural frequency of the peak wave is 1.3% and the residual ratio of the maximum vibration acceleration is 0.8%, which indicates the accuracy in application of the numerical model. With the validated numerical model, this study evaluates the influence on the vibration of various construction parameters. It is shown that the panel material, bracing, and panel thickness may reduce the impact vibration.

The variation in the heat output of panel radiators obtained by altering the emissivity of the wall behind them has been examined. This work was conducted through experiments and Computational Fluid Dynamics (CFD). The results indicate that the presence of a high emissivity (black, such as the usual painted or wallpapered) surface to the wall increases the mass flow rate and air velocity behind the heat source compared to a reflective material. This is due to the radiation heat transfer to the wall creating an additional convecting surface behind the radiator. The results imply that the heat transfer rate can be increased by 20% through the use of a black instead of a reflective wall. The work concentrated on the air-gap behind the radiator, so these results will not be directly applicable to a normal radiator. An extrapolation indicates that the output of single bank (plate) radiator will be increased by 10% and a double radiator by 5%. Wall surface temperature results indicate that a reflective wall does indeed decrease the heat loss through the wall. The trend shown in the data obtained from the CFD analysis agreed well with the experimental results. The flow and temperature plots obtained from the CFD work help to explain the heat exchange and fluid flow processes that take place between the radiator and the wall. This understanding should lead the engineer to a better consideration of radiator placement and design.

The influencing factors of floor impact sound, are characteristics such as the impact source, floor vibration reaction, and sound radiation. In this article, computerised simulation is utilised to explore the influencing factors of floor impact vibration, including slab with beam, floor thickness, compression strength of concrete, etc. Based on the finite element method (FEM), which is frequently used by structure designers in Taiwan, this research establishes an effective convenient method of predicting the impact vibration characteristics of slabs with various boundary conditions. By means of the computerised simulation and measurements in the field, the validity of the research methods is confirmed. Then, how the floor impact characteristics is influenced by various factors is investigated with different computerised models. It is shown that the floor vibration will be decreased by increasing floor thickness, and also by changing the position and the numbers of the beam. However, the vibration insulation of the floor is not improved significantly when the compression strength of concrete is increased.

Research into the older adult sibling relationship has only recently recognized and attempted to account for differential feelings of closeness between siblings throughout their lives. Sixty-one participants, aged fifty-four and older with at least two siblings, were interviewed concerning the degree of closeness they felt towards their siblings. Participants in this investigation were able to differentiate levels of closeness felt toward their siblings and account for these differences. Family systems theory serves as a guide for these accounts.

We report our experience in the anaesthetic management of five patients undergoing three-stage thoracoscopic oesophagectomy. One patient required conversion to open thoracotomy because of extensive pleural adhesions. The other four patients, aged between 68 and 78, were all chronic smokers with mid-oesophageal squamous cell carcinoma. The duration of thoracoscopic surgery (and obligatory one-lung ventilation) ranged from 2.5 to 4 hours with total surgical time ranging from 7.5 to 9.5 hours. Anaesthetic considerations included the use of one-lung ventilation to provide surgical access, the cardiorespiratory effects of capnothorax, difficulties in assessing surgical blood loss during thoracoscopic dissection, crowding in the operating room with limitation of access to the patient and the risk of intraoperative dislodgement of the endobronchial tube. Postoperative pulmonary complications were not decreased in our patients despite the avoidance of thoracotomy. The thoracoscopic technique might contribute to pulmonary complications because of prolonged thoracoscopic dissection and unintentional pulmonary injuries. The concept of minimally invasive surgery needs further evaluation when the technique is applied in extensive procedures such as oesophagectomy.

The purpose of this study was to develop an experimental model of pulmonary metastases using VX-2 tumor, and to describe sequential radiologic and pathologic findings with special attention to the interstitial changes around the metastatic nodules. Through ear veins of 25 rabbits, VX-2 tumor cell suspension was injected with 0.8-mm scalp needles. Chest radiographs were taken every other day after tumor injection. The rabbits were sacrificed at scheduled times from 3 to 30 days after tumor injection. The inflated and fixed lungs were examined with visual inspection, low-kV radiography, high resolution CT (HRCT), microradiography of the sliced lung and with histopathologic studies. Hematogeneous pulmonary metastases occurred in 24 of 25 rabbits. In addition to the metastatic nodules, perinodular and peribronchovascular infiltrations were seen on low-kV radiography, HRCT, microradiography and histologic studies.