Search

Aim: To analyse the anatomical knowledge, understanding of pathology and clinical practice perception of Plantar Fasciitis amongst Clinicians, Podiatrists and Allied Health Professionals. Materials and Methods: An online cross-sectional survey consisting of nine multiple choice questions was compiled and distributed amongst orthopaedic surgeons, radiologists, podiatrists, physiotherapists and other allied health professionals throughout the UK to ascertain the following: a) Anatomical knowledge, b) Practice setting, c) Clinical management strategies Results: There were 76 responses from Orthopaedic surgeons (28.9%), Radiologists (34.2%), Podiatrists (17.1%), Physiotherapists (14.5%), and other Allied Health Professionals (5.3%) from different settings across the UK. 56.6% chose the central band as the most affected in Plantar Fasciitis, while 43.4% picked the medial band. In the practice setting, 46.1% answered that their site of injection is central, with 47.4% injecting the medial site. Corticosteroids are the most common treatment modality for injection with 64.5% answers, while 26.3% do not use injection as a treatment. Conclusion:There is a wide variation between health professionals regarding the pathoanatomy of Plantar Fasciitis. Plantar heel pain (PHP) is a very common musculoskeletal problem with a high rate of prevalence in the community and contributes to long-term morbidity and poor quality of life. An approach involving the education and enhanced circulation of the characteristic pathoanatomic knowledge of PHP will lead to a better understanding and management of this common condition.

PurposeRural workforce shortages are a national issue. One strategy is the use of secondments from larger healthcare sites to staff rural sites on a rotational basis. The purpose of this evaluation is to explore the impact of the development, implementation of an educational, training and supervision package for junior Physiotherapists undertaking rural secondments in Northern NSW.Design/methodology/approachPre post evaluation of a training, education and supervision package to support junior Physiotherapists undertaking rural secondments across Northern NSW. A baseline survey of Physiotherapists who had undertaken a secondment in the previous 12 months defined current practice and limitations. From this a targeted education, training and supervision package was developed. Post implementation surveying for a period of 12 months was undertaken to evaluate the packages implementation.FindingsStatistically significant improvements in staff reporting they felt supported and were aware of escalation processes for patients under their care were reported. Additionally improvements were seen in staff reported access to and completing competencies relevant to their secondment.Research implicationsThese findings provide guidance in regards to junior Physiotherapists working on rural secondments and the importance of structured education, training and support mechanisms.Practical implicationsThe findings from this work support the development and implementation of structured education, training and supervision plans prior to undertaking rural secondments.Originality/valueThese findings provide evidence and support the need for structured and target training, education and supervision for staff undertaking rural secondments to ensure staff are confident to work in a rural setting.LimitationsLarger response rates for post implementation survey results may result in different outcomes being reported in comparison to pre implementation results.

There is an increasing body of work in the area of hardware defenses for software-driven security attacks. A significant challenge in developing these defenses is that the space of security vulnerabilities and exploits is large and not fully understood. This results in specific point defenses that aim to patch particular vulnerabilities. While these defenses are valuable, they are often blindsided by fresh attacks that exploit new vulnerabilities. This article aims to address this issue by suggesting ways to make future defenses more durable based on an organization of security vulnerabilities as they arise throughout the program life cycle. We classify these vulnerability sources through programming, compilation, and hardware realization, and we show how each source introduces unintended states and transitions into the implementation. Further, we show how security exploits gain control by moving the implementation to an unintended state using knowledge of these sources and how defenses work to prevent these transitions. This framework of analyzing vulnerability sources, exploits, and defenses provides insights into developing durable defenses that could defend against broader categories of exploits. We present illustrative case studies of four important attack genealogies—showing how they fit into the presented framework and how the sophistication of the exploits and defenses have evolved over time, providing us insights for the future.

Crazy Rich Asians (2018), a box-office hit in North America, provoked celebration particularly from Asian American commentators and actors. Shot in Singapore and Malaysia with an Asian and Asian American cast, it was a success too in Singapore itself and in territories such as Hong Kong, Taiwan and Australia but not in East Asia’s largest markets, those of China, Japan and South Korea. Focusing on the phenomenon of Crazy Rich Asians’ release, particularly its engagement with and circulation in East and Southeast Asia and its polarized reception among different Asian American and Asian communities, this article traces a series of discursive flashpoints to understand the film’s position in Asian and Asian American film culture. Arguing that the fortunes of US releases with Asian and Asian American casts reveal cosmopolitanism’s invisible borders, the article proposes a model of pan-Asian screen cosmopolitanism. This model recognizes that even globally hybrid screen texts such as Crazy Rich Asians bear cultural markers that may inhibit their appeal in territories with shared ethnic heritages but discrete social histories.

Crazy Rich Asians (2018), a box-office hit in North America, provoked celebration particularly from Asian American commentators and actors. Shot in Singapore and Malaysia with an Asian and Asian American cast, it was a success too in Singapore itself and in territories such as Hong Kong, Taiwan and Australia but not in East Asia’s largest markets, those of China, Japan and South Korea. Focusing on the phenomenon of Crazy Rich Asians’ release, particularly its engagement with and circulation in East and Southeast Asia and its polarized reception among different Asian American and Asian communities, this article traces a series of discursive flashpoints to understand the film’s position in Asian and Asian American film culture. Arguing that the fortunes of US releases with Asian and Asian American casts reveal cosmopolitanism’s invisible borders, the article proposes a model of pan-Asian screen cosmopolitanism. This model recognizes that even globally hybrid screen texts such as Crazy Rich Asians bear cultural markers that may inhibit their appeal in territories with shared ethnic heritages but discrete social histories.

Coal seam gas (CSG), or coal bed methane, developments in sedimentary basins such as the Great Artesian Basin (GAB) in Australia, have the potential to impact on aquifers overlying and underlying the target coal formations. The extent to which this may occur depends upon the degree of hydrogeological connectivity between the coal formations and the surrounding aquifers or aquifer systems, with general implications for groundwater management. In southeast Australia, one such aquifer system, the Condamine Alluvium (CA), overlies the Walloon Coal Measures (WCM), which is a formation of the GAB and also a target for CSG production. To investigate the connectivity between the two systems, multiple lines of investigation were employed involving field investigations, data gathering and analysis (including reinterpretation of geology, multivariate hydrochemistry analysis, regional water-level mapping, drilling and coring across the contact zone, multiple piezometer installations, long-term pumping tests, groundwater-level monitoring and local-scale modelling). The study found a low level of connectivity between the GAB and the overlying CA. A layer of undifferentiated basement clay (referred to as the ‘transition zone’)—a mixture of alluvial clay and weathered basement—provides an effective impediment to flow across the CA and the underlying GAB formations. Results from the study potentially have wider application across the GAB and sedimentary basins where younger alluvial sediments associated with river systems frequently overlie the erosional surface.

Introduction: Prior to ablation, predicting the site of origin (SOO) of outflow tract ventricular arrhythmia (OTVA), can inform patient consent and facilitate appropriate procedural planning. We set out to determine if OTVA variability can accurately predict SOO. Methods: Consecutive patients with a clear SOO identified at OTVA ablation had their prior 24-hour ambulatory ECGs retrospectively analysed (derivation cohort). Percentage ventricular ectopic (VE) burden, hourly VE values, episodes of trigeminy/bigeminy, and the variability in these parameters were evaluated for their ability to distinguish right from left sided SOO. Effective parameters were then prospectively tested on a validation cohort of consecutive patients undergoing their first OTVA ablation. Results: High VE variability (coefficient of variation ≥ 0.7) and the presence of any hour with < 50 VE, were found to accurately predict RVOT SOO in a derivation cohort of 40 patients. In a validation cohort of 29 patients, the correct SOO was prospectively identified in 23/29 patients (79.3%) using CoV, and 26/29 patients (89.7%) using VE < 50. Including current ECG algorithms, VE < 50 had the highest Youden Index (78), the highest positive predictive value (95.0%) and the highest negative predictive value (77.8%). Conclusion: VE variability and the presence of a single hour where VE < 50 can be used to accurately predict SOO in patients with OTVA. Accuracy of these parameters compares favourably to existing ECG algorithms.

Inspired by Concord's newly consecrated Sleepy Hollow Cemetery, Herman Melville's “The Apple-Tree Table; or, Original Spiritual Manifestations” (1856) undercuts spirituality with materiality in a gothic parody that is both a literal parody of the “Sleepy Hollow” genre and an ironic parody of both Thoreau and Hawthorne.

Oor Mad History and Survivors History Group are community history projects formed by people diagnosed with psychiatric conditions investigating the history of collective action by patients. This chapter sets their scholarship in context by bringing some of their arguments into dialogue with debates concerning how to investigate histories in which patient voices, experiences and perspectives are foregrounded. There are often tensions between the avowed aims of these community history projects to ‘regain control of the past’ and to ‘make survivor history accessible to all who are interested in or studying mental health’. By bringing these debates from academic and survivors history into conversation, some of the challenges, tensions and opportunities of pursuing further work on the history of collective action by patients are revealed.

To maintain the control-flow integrity of today’s machines, code pointers must be protected. Exploits forge and manipulate code pointers to execute arbitrary, malicious code on a host machine. A corrupted code pointer can effectively redirect program execution to attacker-injected code or existing code gadgets, giving attackers the necessary foothold to circumvent system protections. To combat this class of exploits, we employ a Displaced and Dilated Address Space (DDAS), which uses a novel address space inflation mechanism to obfuscate code pointers, code locations, and the relative distance between code objects. By leveraging runtime re-randomization and custom hardware, we are able to achieve a high-entropy control-flow defense with performance overheads well below 5% and similarly low power and silicon area overheads. With DDAS in force, attackers come up against 63 bits of entropy when forging absolute addresses and 18 to 55 bits of entropy for relative addresses, depending on the distance to the desired code gadget. Moreover, an incorrectly forged code address will result in a security exception with a probability greater than 99.996%. Using hardware-based address obfuscation, we provide significantly higher entropy at lower performance overheads than previous software techniques, and our re-randomization mechanism offers additional protections against possible pointer disclosures.

Aims: To investigate the utility of adenosine administration to test the durability of cavotricuspid isthmus (CTI) block after radiofrequency (RF) catheter ablation for typical atrial flutter. Methods: Adenosine 10mg was administered by bolus injection through a femoral sheath at 5 minutes after apparent completion of CTI ablation in consecutive patients, and its effect on CTI conduction was recorded. Conduction in both directions across the CTI was tested repeatedly until 20 minutes after the last energy delivery. Results: Among 132 patients treated with a Blazer 10mm (n=126) or 8mm (n=6) ablation catheter, bidirectional block of the CTI was achieved in all cases. Adenosine administration was followed by a transient recurrence of conduction in 3 cases (2.3%); in all of these, a persistent recurrence of CTI conduction was observed within the waiting period. Persistent recurrence of CTI conduction occurred within the waiting period in 3 patients (2.3%) whose adenosine test had been negative. In all cases, further RF delivery achieved CTI block that persisted to the end of a 20-minute waiting period. During 38 months of follow-up, 131 patients (99.2%) remained free of clinical recurrence of typical flutter. Conclusion: Administration of adenosine 10mg at 5 minutes after RF delivery reveals latent conduction in the CTI in some but not all cases that are revealed by a 20-minute wait. At this dosage and at this time-point, adenosine testing is not an adequate substitute for a waiting period.

This study examines the movement by global financial institutions (such as private equity and sovereign wealth funds) to make significant investments in farmland and food, instead of traditional assets of shares, or bonds, or real estate – using the case of Tanzania as the area for study. This movement was reinforced by the failure of these assets during the Global Financial Crisis of 2008, and the increase in prices for food and farmland. Utilizing Marxian concepts of political economy, this study analyses the place of Tanzania farmland in the global links to financialization.In Tanzania agricultural land use is dominated by small-scale farming, a sector of the economy which is linked with poverty and malnutrition. After the GFC there was an upsurge of interest in Tanzania farmland by foreign investors, as seen in quantitative data and from qualitative information provided by key informants of this research project. The quantitative data showed a high level of foreign investor interest, but only recorded low levels of realized investments. Many foreign investors were interested in growing crops for biofuels, however implementation of these schemes proved unrewarding and ultimately unsuccessful.Despite the national government promoting the role of foreign investment in Tanzania agriculture, at local level there are legal and governance issues that slow implementation of new farming projects. For example, for proposed new investors, village assemblies and councils intervened to limit the size of farmland available, while potential investors might be offered smaller parcels of land scattered over a wide area (and across village council boundaries) adding to the difficulty of implementing large-scale projects.The intervention of local government and the use of the legal system to prevent or to modify foreign investors’ plans for large scale acquisition of farmland may be factors that are unique to Tanzania, in comparison with other African countries that have been subject to takeovers of farmland. Historical factors, such as the “village socialism” of Tanzania’s founding father Julius Nyerere, have provided a foundation for local action and democratic methods of dealing with change. A program for the replacement of customary property titles to “western” style private titling of land commenced in Tanzania in 2003, but lost momentum when international funding for the surveying procedure ceased. Ideals of grassroots democracy mediated by international Non-Government Organizations and local Community Service Organizations are an important factor in Tanzania when local villagers consult and decide on large scale land investments by foreigners. And there are issues of (mis)governance and corruption associated with doing business in Tanzania, inhibiting the investment process.For two large foreign farms visited in Kilombero Valley – the key research site for this thesis, there are some fifteen thousand outgrowers producing rice and sugar. Farmland lost by unsuccessful outgrowers is usually purchased by larger growers, indicative of social differentiation and capitalist modes of accumulation. Workers come from many parts of Tanzania searching for employment in the Kilombero Valley, as outgrowers, or labourers, or in the informal sector.Given the difficulties confronting foreign investors in farmland in Tanzania outlined above, this study did not find widespread examples of large-scale agricultural projects by global finance companies in the country. Some anecdotal evidence suggests involvement by foreign private equity companies in the food processing sector of Tanzania. Further research is warranted in this sector to examine the extent of financialization in this part of the agrifood industry. There may be a disconnection between financialization of farmland as opposed to financialization in the food processing sector. In Tanzania, barriers to new entrants in large scale farming (described above) could result in higher levels of investment in food processing and manufacturing.Although financialization has been a substantial force in the restructuring of farming and food production throughout the world, the findings of this study indicate that this has not been the case in Tanzania - which is important for three reasons. The findings from Tanzania imply that the factors affecting agriculture in developing countries are not the same as those for the developed world; small-scale farming is the main means of agriculture in Tanzania. Secondly, the example of Tanzania shows that local farmers can influence the course of global finance, using current government structures together with support from international NGOs and local CSOs. Thirdly, as the global population continues to grow, there is a need for more accurate information concerning the factors determining world food supply. In Tanzania, projects for the modernization of agriculture have mostly come from government aid schemes from abroad – rather than from global finance.

The addition of adjuvant agents to intrathecal and epidural anaesthetic techniques is well established, in particular opioids and clonidine. These adjuvants are utilized to improve the quality of anaesthesia and analgesia. Several other adjuvants have been studied but ongoing concerns surrounding safety and efficacy may limit their use in clinical practice. Epinephrine has for many years been administered in combination with local anaesthetic, although more recently a diverse range of adjuvants have been added to peripheral nerve block solutions, again with the aim of prolonging surgical anaesthesia. The evidence to support or refute the benefit of these agents is increasing, as is our understanding of which agents have demonstrable efficacy and safety at clinically appropriate doses. Clinicians must be aware that many adjuvants are not licensed for central neuraxial or perineural use and should be aware of the risks, in particular of neurotoxicity and unwanted side effects.