Search

Introduction: Numerous indices for patella height measurement are described in the literature; however, there is not a universally accepted 'gold standard'. Choice of indices varies depending on personal preference and previous experience, making it difficult to compare results between studies. The aims of this study were to assess the correlation between different patella height indices and generate statistically derived formulae that can be used to predict the value of one patella height ratio when another is known., Materials and Methods: Patients with patellofemoral instability were radiologically evaluated using both X-ray and Magnetic Resonance Imaging (MRI) of the knee. Two observers measured six validated patella height indices at two separate time intervals. All measurements were aggregated together and a mean average for each patella height ratio was calculated. These results were then statistically analysed using Pearson product-moment correlation and linear regression tests., Results: Forty-four patients were included in the study. A statistically significant correlation was found between the majority of patella height ratios. On X-ray, the strongest correlation (r = 0.92, p < 0.001) and regression (R 2  = 0.85, p < 0.001) coefficients were between the Blackburne-Peel and Caton-Dechamps ratios, with the formula; CD = 0.20 + (0.95xBP). On MRI, the strongest correlation (r = - 0.84, p < 0.001) and regression (R 2  = 0.71, p < 0.001) coefficients were between the Patellophyseal index and Patellotrochlear index, with the formula; PP = 1.02-(1.10xPT)., Conclusion: The formulae produced in this study can predict the value of one patella height ratio when the results of another are known. This could facilitate systematic reviews and meta-analyses by allowing the pooling together of data from many studies., (© 2024. Crown.)

Background: Range of motion (ROM) is an important aspect of orthopaedic patient assessment. It can be measured at the knee joint by determining the knee flexion angle (KFA) a patient can achieve at extremes of flexion and extension. As with any measurement, the accuracy and reliability of the method used determine its validity. The consistency of magnetic resonance imaging (MRI) scans as compared to the current gold standard of X-ray remains unknown in terms of KFA evaluation. The aim of this study was to assess and compare the reliability of measuring KFA between X-ray and MRI scans., Methods: This study included 80 patients (94 knees) who had attended a specialist knee clinic due to varying knee pathologies and undergone both X-ray and MRI scans. Lateral and T1-weighted sagittal imaging views (respectively) were used to measure KFA by two trained observers independently at two separate time points, 8 weeks apart. The data was then statistically analysed and intra- and inter-observer reliability calculated using the intraclass correlation coefficient (ICC)., Results: The intra-observer reliability for X-ray was 0.96 (P<0.001) and that for MRI was 0.83 (P<0.001). The inter-observer reliability for X-ray was 0.99 (P<0.001) and that for MRI was 0.81 (P<0.001). All the intra-class correlation coefficients were graded as excellent in both the intra- and inter-observer reliability analysis. Overall, the mean KFA was notably higher on X-ray measurements than that on MRI scans. There was a statistically significant difference between Time 1 and Time 2 measurements (17.7° vs. 16.8°) for MRI data (P=0.022). No significant difference was found for X-ray measurements (46.4° vs. 45.6°) in this regard (P=0.182)., Conclusions: Both X-ray and MRI allow KFA to be measured with an excellent degree of reliability. However, X-ray measurements were overall superior to that of MRI mainly due to the larger field of view of the visible on-screen image which more readily identifies the anatomical landmarks required to measure KFA., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-22-2/coif). The authors have no conflicts of interest to declare., (2022 Annals of Joint. All rights reserved.)

Introduction: Many patella height indices exist in the literature. There is no single universally accepted radiological assessment for measuring patella height. The aims of this study were to determine which of the commonly used indices can most reliably measure patella height and compare the findings on both plain X-ray and magnetic resonance imaging (MRI) of the knee., Methods: This case-controlled study compared patients with recurrent patella instability (patella group) to a control group. Two observers measured six validated patella height indices on X-ray and MRI of both groups at two separate time periods. Between-group and within-group statistical analysis was undertaken of the data. The inter- and intra-observer reliability was assessed using the intraclass correlation coefficient (ICC) and the kappa measure of agreement (k)., Results: Forty-four patients comprised the patella group and 50 patients the control group. There was a significant difference of most indices between the two groups (p < 0.05). There was a significant difference of most indices between the two imaging modalities (p < 0.05). The Insall-Salvati ratio had the greatest inter-observer reliability for both X-ray and MRI (ICC = 0.79 to 0.97; p < 0.001) (k = 0.50 to 1.00; p < 0.001)., Conclusion: Patella height indices significantly differ when measured on X-ray as compared to MRI. This may infer that a different set of normative values are required for each radiological modality, which we have proposed in this study. Overall, the Insall-Salvati ratio performed best and shows a high degree of intra- and inter-observer reliability on both X-ray and MRI., (© 2021. ISS.)

The notion that sensitivity to the statistical structure of the environment is pivotal to perception has recently garnered considerable attention. Here we investigated this issue in the context of hearing. Building on previous work (Sohoglu and Chait, 2016a; elife), stimuli were artificial 'soundscapes' populated by multiple (up to 14) simultaneous streams ('auditory objects') comprised of tone-pip sequences, each with a distinct frequency and pattern of amplitude modulation. Sequences were either temporally regular or random. We show that listeners' ability to detect abrupt appearance or disappearance of a stream is facilitated when scene streams were characterized by a temporally regular fluctuation pattern. The regularity of the changing stream as well as that of the background (non-changing) streams contribute independently to this effect. Remarkably, listeners benefit from regularity even when they are not consciously aware of it. These findings establish that perception of complex acoustic scenes relies on the availability of detailed representations of the regularities automatically extracted from multiple concurrent streams., (Copyright © 2020. Published by Elsevier B.V.)

Background: The WHO's Integrated Management of Childhood Illness (IMCI) has resulted in progress in addressing infant and child mortality. However, unmet needs of children continue to present a burden upon primary healthcare services. The capacity of services and quality of care offered require greater support to address these needs by extending and integrating curative and preventive care for the child with a long-term health condition and the child older than 5, not prioritised in IMCI. In response to these needs, the PACK Child intervention was developed and piloted in October 2017-February 2019 in the Western Cape Province of South Africa. We report health worker and caregiver perspectives of the existing paediatric primary care context as well as the extent to which PACK Child functions to address perceived problems within the current local healthcare system., Methods: This process evaluation involved 52 individual interviews with caregivers, 10 focus group discussions with health workers, 3 individual interviews with trainers, and 31 training observations. Interviews and focus groups explored participants' experiences of paediatric primary care, perspectives of the PACK Child intervention, and tensions with implementation in each context. Inductive thematic analysis was used to analyse verbatim interview and discussion transcripts., Results: Perspectives of caregivers and health workers suggest an institutionalised focus of paediatric primary care to treating children's symptoms as acute episodic conditions. Health workers' reports imply that this focus is perpetuated by interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics and verticalised care. Whilst these contextual conditions constrained health workers' ability to translate skills developed within PACK Child training into practice, the intervention initiated expanded care of children 0-13 years and those with long-term health conditions, enhanced professional competence, improved teamwork and referrals, streamlined triaging, and facilitated probing for psychosocial risk., Conclusion: PACK Child appears to be catalysing paediatric primary care to address the broader needs of children, including long-term health conditions and the identification of psychosocial problems. However, to maximise this requires primary care to re-orientate from risk minimisation on the day of attendance towards a view of the child beyond the day of presentation at clinics.

Background: Despite significant reductions in mortality, preventable and treatable conditions remain leading causes of death and illness in children in South Africa. The PACK Child intervention, comprising clinical decision support tool (guide), training strategy and health systems strengthening components, was developed to expand on WHO's Integrated Management of Childhood Illness programme, extending care of children under 5 years to those aged 0-13 years, those with chronic conditions needing regular follow-up, integration of curative and preventive measures and routine care of the well child. In 2017-2018, PACK Child was piloted in 10 primary healthcare facilities in the Western Cape Province. Here we report findings from an investigation into the contextual features of South African primary care that shaped how clinicians delivered the PACK Child intervention within clinical consultations., Methods: Process evaluation using linguistic ethnographic methodology which provides analytical tools for investigating human behaviour, and the shifting meaning of talk and text within context. Methods included semi-structured interviews, focus groups, ethnographic observation, audio-recorded consultations and documentary analysis. Analysis focused on how mapped contextual features structured clinician-caregiver interactions., Results: Primary healthcare facilities demonstrated an institutionalised orientation to minimising risk upheld by provincial documentation, providing curative episodic care to children presenting with acute symptoms, and preventive care including immunisations, feeding and growth monitoring, all in children 5 years or younger. Children with chronic illnesses such as asthma rarely receive routine care. These contextual features constrained the ability of clinicians to use the PACK Child guide to facilitate diagnosis of long-term conditions, elicit and manage psychosocial issues, and navigate use of the guide alongside provincial documentation., Conclusion: Our findings provide evidence that PACK Child is catalysing a transition to an approach that strikes a balance between assessing and minimising risk on the day of acute presentation and a larger remit of care for children over time. However, optimising success of the intervention requires reviewing priorities for paediatric care which will facilitate enhanced skills, knowledge and deployment of clinical staff to better address acute illnesses and long-term health conditions of children of all ages, as well as complex psychosocial issues surrounding the child.

Memory, on multiple timescales, is critical to our ability to discover the structure of our surroundings, and efficiently interact with the environment. We combined behavioural manipulation and modelling to investigate the dynamics of memory formation for rarely reoccurring acoustic patterns. In a series of experiments, participants detected the emergence of regularly repeating patterns within rapid tone-pip sequences. Unbeknownst to them, a few patterns reoccurred every ~3 min. All sequences consisted of the same 20 frequencies and were distinguishable only by the order of tone-pips. Despite this, reoccurring patterns were associated with a rapidly growing detection-time advantage over novel patterns. This effect was implicit, robust to interference, and persisted for 7 weeks. The results implicate an interplay between short (a few seconds) and long-term (over many minutes) integration in memory formation and demonstrate the remarkable sensitivity of the human auditory system to sporadically reoccurring structure within the acoustic environment., Competing Interests: RB, PH, MH, CB, SP, MP, MC No competing interests declared, (© 2020, Bianco et al.)

Magnetic field effects can provide a handle on steering chemical reactions and manipulating yields. The presence of a magnetic field can influence the energy levels of the active species by interacting with their spin states. Here we demonstrate the effect of a magnetic field on the electrocatalytic processes taking place on platinum-based nanoparticles in fuel cell conditions. We have identified a shift in the potentials representing hydrogen adsorption and desorption, present in all measurements recorded in the presence of a magnetic field. We argue that the changes in electrochemical behavior are a result of the interactions between the magnetic field and the unpaired spin states of hydrogen., (Copyright © 2020 Westsson, Picken and Koper.)

We report on the effect of lattice strain in three different types of core-shell electrocatalyst particles on their catalytic activity towards the oxygen reduction reaction. We decouple the changes in catalytic activity with respect to a geometrical and an energetic contribution, both of electronic origin.

Pioneering strategies like WHO's Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development., Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and declare that SP, LF, EB, CW and RC are employees of the KTU. JH is an ex-employee of the KTU. TD is an employee of the South African Medical Research Council. EB reports personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, and grants for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann La Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca. All of EB’s fees and clinical trials are for work outside the submitted work. EB is also a Member of Global Initiative for Asthma Board and Science Committee. Since August 2015, the KTU and BMJ have been engaged in a non-profit partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested, and where appropriate license PACK content. The KTU and BMJ co-fund core positions, including a PACK Global Development Director, based in the UK, and receive no profits from the partnership. This paper forms part of a Collection on PACK sponsored by the BMJ to profile the contribution of PACK across several countries towards the realisation of comprehensive primary health care as envisaged in the Declaration of Alma Ata, during its 40th anniversary. Each paper in this collection has been peer reviewed.

For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, 'A tool for every day for every patient'. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others' evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation., Competing Interests: Competing interests: JLH is an ex-employee of the KTU. TD is an employee of the South African Medical Research Council. MZ is an employee of the Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. EB reports personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, and grants for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann le Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca. All of EB’s fees and clinical trials are for work outside the submitted work. EB is also a member of Global Initiative for Asthma Board and Science Committee. Since August 2015 the KTU and BMJ have been engaged in a non-profit strategic partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested, and where appropriate license PACK content. The KTU and BMJ cofund core positions, including a PACK Global Development Director, and receive no profits from the partnership. PACK receives no funding from the pharmaceutical industry. This paper forms part of a Collection on PACK sponsored by the BMJ to profile the contribution of PACK across several countries towards the realisation of comprehensive primary healthcare as envisaged in the Declaration of Alma Ata, during its 40th anniversary.

Study Question: Do women with ITALIC! BRCA1 or ITALIC! BRCA2 mutations have reduced ovarian reserve, as measured by circulating anti-Müllerian hormone (AMH) concentration?, Summary Answer: Women with a germline mutation in ITALIC! BRCA1 have reduced ovarian reserve as measured by AMH., What Is Known Already: The DNA repair enzymes encoded by ITALIC! BRCA1 and ITALIC! BRCA2 are implicated in reproductive aging. Circulating AMH is a biomarker of ovarian reserve and hence reproductive lifespan., Study Design, Size, Duration: This was a cross-sectional study of AMH concentrations of 693 women at the time of enrolment into the Kathleen Cuningham Foundation Consortium for research in the Familial Breast Cancer (kConFab) cohort study (recruitment from 19 August 1997 until 18 September 2012). AMH was measured on stored plasma samples between November 2014 and January 2015 using an electrochemiluminescence immunoassay platform., Participants/materials, Setting, Methods: Eligible women were from families segregating ITALIC! BRCA1 or ITALIC! BRCA2 mutations and had known mutation status. Participants were aged 25-45 years, had no personal history of cancer, retained both ovaries and were not pregnant or breastfeeding at the time of plasma storage. Circulating AMH was measured for 172 carriers and 216 non-carriers from families carrying ITALIC! BRCA1 mutations, and 147 carriers and 158 non-carriers from families carrying ITALIC! BRCA2 mutations. Associations between plasma AMH concentration and carrier status were tested by linear regression, adjusted for age at plasma storage, oral contraceptive use, body mass index and cigarette smoking., Main Results and the Role of Chance: Mean AMH concentration was negatively associated with age ( ITALIC! P < 0.001). Mutation carriers were younger at blood draw than non-carriers ( ITALIC! P ≤ 0.031). ITALIC! BRCA1 mutation carriers had, on average, 25% (95% CI: 5%-41%, ITALIC! P = 0.02) lower AMH concentrations than non-carriers and were more likely to have AMH concentrations in the lowest quartile for age (OR 1.84, 95% CI: 1.11-303, ITALIC! P = 0.02). There was no evidence of an association between AMH concentration and ITALIC! BRCA2 mutation status ( ITALIC! P = 0.94)., Limitations, Reasons for Caution: AMH does not directly measure the primordial follicle pool. The clinical implications of the lower AMH concentrations seen in ITALIC! BRCA1 mutation carriers cannot be assessed by this study design., Wider Implications of the Findings: Women with a germline mutation in ITALIC! BRCA1 may have reduced ovarian reserve. This is consistent with other smaller studies in the literature and has potential implications for fertility and reproductive lifespan., Study Funding/competing Interests: kConFab is supported by a grant from the Australian National Breast Cancer Foundation, and previously by the National Health and Medical Research Council (NHMRC), the Queensland Cancer Fund, the Cancer Councils of New South Wales, Victoria, Tasmania and South Australia, and the Cancer Foundation of Western Australia. K.A.P. is an Australian National Breast Cancer Foundation Practitioner Fellow. J.L.H. is a NHMRC Senior Principal Research Fellow. M.H. is a NHMRC Practitioner Fellow. R.A.A. reports personal fees from Roche Diagnostics & Beckman Coulter outside the submitted work and C.S. reports other earnings from Melbourne IVF outside the submitted work. The remaining authors have nothing to declare and no conflicts of interest., (© The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.)

In this work a new electrochemical sensor based on an Ag-doped zeolite-expanded graphite-epoxy composite electrode (AgZEGE) was evaluated as a novel alternative for the simultaneous quantitative determination of nitrate and nitrite in aqueous solutions. Cyclic voltammetry was used to characterize the electrochemical behavior of the electrode in the presence of individual or mixtures of nitrate and nitrite anions in 0.1M Na(2)SO(4) supporting electrolyte. Linear dependences of current versus nitrate and nitrite concentrations were obtained for the concentration ranges of 1-10mM for nitrate and 0.1-1mM for nitrite using cyclic voltammetry (CV), chronoamperometry (CA), and multiple-pulsed amperometry (MPA) procedures. The comparative assessment of the electrochemical behavior of the individual anions and mixtures of anions on this modified electrode allowed determining the working conditions for the simultaneous detection of the nitrite and nitrate anions. Applying MPA allowed enhancement of the sensitivity for direct and indirect nitrate detection and also for nitrite detection. The proposed sensor was applied in tap water samples spiked with known nitrate and nitrite concentrations and the results were in agreement with those obtained by a comparative spectrophotometric method. This work demonstrates that using multiple-pulse amperometry with the Ag-doped zeolite-expanded graphite-epoxy composite electrode provides a real opportunity for the simultaneous detection of nitrite and nitrate in aqueous solutions., (Copyright © 2010 Elsevier B.V. All rights reserved.)

In this paper, a modified expanded graphite composite electrode based on natural zeolitic volcanic tuff modified with silver (EG-Ag-Z-Epoxy) was developed. Cyclic voltammetry measurements revealed a reasonably fast electron transfer and a good stability of the electrode in 0.1 M NaOH supporting electrolyte. This modified electrode exhibited moderate electrocatalytic effect towards urea oxidation, allowing its determination in aqueous solution. The linear dependence of the current versus urea concentration was reached using square-wave voltammetry in the concentrations range of urea between 0.2 to 1.4 mM, with a relatively low limit of detection of 0.05 mM. A moderate enhancement of electroanalytical sensitivity for the determination of urea at EG-Ag-Z-Epoxy electrode was reached by applying a chemical preconcentration step prior to voltammetric/amperometric quantification.

Electrodes based on carbon, i.e., expanded graphite (20%, wt.)-epoxy composite(20EG-Epoxy) and expanded graphite (20%, wt.)-polystyrene composite (20EG-PS) havebeen prepared, characterized using scanning electron microscopy (SEM) and cyclicvoltammetry (CV), and tested as anodic sensors. The electrodes exhibited good mechanicalresistance and low electrical resistances. Scan rate dependent cyclic voltammetry responsesat 20EG-Epoxy and 20EG-PS composite electrodes, which were exemplified for thiourea(TU), a toxic sulphur organic compound selected as testing target analyte in 0.1 M Na₂SO₄ supporting electrolyte, were investigated. The obtained voltammetric data were inaccordance with those for a random array of microelectrodes. The voltammetric andchronoamperometric detection results of TU in tap water samples, without a supplementaryaddition of supporting electrolyte, at 20EG-Epoxy electrode proved its use for directanalysis of environmental samples.

Introduction: The Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab) is a multidisciplinary, collaborative framework for the investigation of familial breast cancer. Based in Australia, the primary aim of kConFab is to facilitate high-quality research by amassing a large and comprehensive resource of epidemiological and clinical data with biospecimens from individuals at high risk of breast and/or ovarian cancer, and from their close relatives., Methods: Epidemiological, family history and lifestyle data, as well as biospecimens, are collected from multiple-case breast cancer families ascertained through family cancer clinics in Australia and New Zealand. We used the Tyrer-Cuzick algorithms to assess the prospective risk of breast cancer in women in the kConFab cohort who were unaffected with breast cancer at the time of enrolment in the study., Results: Of kConFab's first 822 families, 518 families had multiple cases of female breast cancer alone, 239 had cases of female breast and ovarian cancer, 37 had cases of female and male breast cancer, and 14 had both ovarian cancer as well as male and female breast cancer. Data are currently held for 11,422 people and germline DNAs for 7,389. Among the 812 families with at least one germline sample collected, the mean number of germline DNA samples collected per family is nine. Of the 747 families that have undergone some form of mutation screening, 229 (31%) carry a pathogenic or splice-site mutation in BRCA1 or BRCA2. Germline DNAs and data are stored from 773 proven carriers of BRCA1 or BRCA1 mutations. kConFab's fresh tissue bank includes 253 specimens of breast or ovarian tissue--both normal and malignant--including 126 from carriers of BRCA1 or BRCA2 mutations., Conclusion: These kConFab resources are available to researchers anywhere in the world, who may apply to kConFab for biospecimens and data for use in ethically approved, peer-reviewed projects. A high calculated risk from the Tyrer-Cuzick algorithms correlated closely with the subsequent occurrence of breast cancer in BRCA1 and BRCA2 mutation positive families, but this was less evident in families in which no pathogenic BRCA1 or BRCA2 mutation has been detected.

Serial plasma samples from 1006 patients with breast cancer revealed: (i) no correlation of p53 autoantibody status with disease status at the time of sample collection, or with menopausal status at time of primary diagnosis of breast cancer; (ii) 155 out of 1006 (15%) of patients were positive for p53 autoantibodies, and these patients tended to have a persistent autoantibody status throughout follow up, irrespective of disease behaviour; and (iii) where a negative autoantibody status was found at primary diagnosis of breast cancer, this negative status persisted throughout follow up, irrespective of later disease behaviour. We conclude that screening for p53 autoantibody status is not informative on residual tumour activity nor on therapeutic responsiveness.