Osteoarticular Infections in Children Arnold, John C; Bradley, John S
Infectious disease clinics of North America,
09/2015, Letnik:
29, Številka:
3
Journal Article
Recenzirano
For a child with a suspected bone or joint infection, knowledge of the workup and initial therapy is important to provide quality care. Fever and pain are hallmarks of a pediatric osteoarticular ...infection, although occasionally the signs and symptoms can be more subtle. The use of C-reactive protein to diagnose and validate effective management of treatment has become standard. Multiple reports confirm the success of much shorter intravenous (IV) courses than traditionally taught. The ideal IV and oral antibiotic duration, as well as defining the markers indicating need for surgical intervention, are questions yet to be answered.
The protean career concept is a widely acknowledged contemporary career model, but conceptual and empirical analysis of the model is scarce. We provide an integrative literature review of empirical ...research and note that the research is hampered by inconsistent use of terminology and methodological limitations. First, we show that the two protean metacompetencies—adaptability and identity—have been relatively neglected as the research has evolved. Second, we describe how preexisting protean measures are limited in covering the full range of the concept. Finally, we draw on career theory to suggest four conceptual components as a basis for future model development and offer suggestions for research that tests the utility of the protean career concept in relation to other similar constructs.
Study Design Systematic review. Background Despite improvements in self-reported symptoms and perceived functional ability after total hip arthroplasty (THA) and total knee arthroplasty (TKA), it is ...unclear whether changes in objectively measured physical activity (PA) occur after surgery. Objective To determine if objectively measured PA increases after THA and TKA in adults with osteoarthritis. Methods Five electronic databases were searched from inception to March 3, 2015. All study designs objectively measuring PA before and after THA or TKA were eligible, including randomized controlled trials, cohort studies, and case-control studies. Two reviewers independently screened abstracts and full texts and extracted study demographic, PA, and clinical outcome data. Standardized mean differences (SMDs) and 95% confidence intervals were calculated for accelerometer- and pedometer-derived estimates of PA. Risk of methodological bias was assessed with Critical Appraisal Skills Programme checklists. Results Eight studies with a total of 373 participants (238 TKA, 135 THA) were included. Findings were mixed regarding improvement in objectively measured PA at 6 months after THA (SMDs, -0.20 to 1.80) and TKA (SMDs, -0.36 to 0.63). Larger improvements from 2 studies at 1 year postsurgery were generally observed after THA (SMDs, 0.39 to 0.79) and TKA (SMDs, 0.10 to 0.85). However, at 1 year, PA levels were still considerably lower than those of healthy controls (THA SMDs, -0.25 to -0.77; TKA SMDs, -1.46 to -1.80). Risk-of-bias scores ranged from 3 to 9 out of 11 (27%-82%) for cohort studies, and from 3 to 8 out of 10 (30%-80%) for case-control studies. Conclusion The best available evidence indicates negligible changes in PA at 6 months after THA or TKA, with limited evidence for larger changes at 1 year after surgery. In the 4 studies that reported control-group data, postoperative PA levels were still considerably less than those of healthy controls. Improved perioperative strategies to instill behavioral change are required to narrow the gap between patient-perceived functional improvement and the actual amount of PA undertaken after THA and TKA. Registered with PROSPERO (registration number CRD42014010155). Level of Evidence Therapy, level 2a. J Orthop Sports Phys Ther 2016;46(6):431-442. Epub 26 Apr 2016. doi:10.2519/jospt.2016.6449.
Abstract
While in recent decades historians have, to some degree, engaged with anthropological debates over the nature of ‘religion’, they have tended still to take the key term ‘belief’ somewhat for ...granted. This article suggests that we have inherited an Enlightenment legacy of thought on ‘belief’ that tends to treat it as credulity when applied to the general masses (taking Edward Gibbon as an important exemplar of that legacy). More recently, the theorist Bruno Latour has written about belief in terms of J. L. Austin’s speech-act theory, a useful theoretical move, despite the fact that Latour himself in some ways mirrors Gibbon’s perspective, particularly as it applies to the pre-modern. Using a range of examples to discuss change over time, via a case study of southern France about 1000 to 1300, this article argues that social historians may find it useful to consider these issues in terms of performative ‘belief acts’, where the contextual setting — the ‘conditions of felicity’, to use Latour’s and Austin’s phrase — are amenable to historical analysis.
Acceptor-doped barium zirconate is a promising proton-conducting oxide for various applications, for example, electrolysers, fuel cells or methane-conversion cells. Despite many experimental and ...theoretical investigations there is, however, only a limited understanding as to how to connect the complex microscopic proton motion and the macroscopic proton conductivity for the full range of acceptor levels, from diluted acceptors to concentrated solid solutions. Here we show that a combination of density functional theory calculations and kinetic Monte Carlo simulations enables this connection. At low concentrations, acceptors trap protons, which results in a decrease of the average proton mobility. With increasing concentration, however, acceptors form nanoscale percolation pathways with low proton migration energies, which leads to a strong increase of the proton mobility and conductivity. Comparing our simulated proton conductivities with experimental values for yttrium-doped barium zirconate yields excellent agreement. We then predict that ordered dopant structures would not only strongly enhance the proton conductivities, but would also enable one- or two-dimensional proton conduction in barium zirconate. Finally, we show how the properties of other dopants influence the proton conductivity.Although acceptor-doped barium zirconate is a promising conductor for electrolysers or fuel cells, our understanding of the relationship between proton motion and conductivity is limited. Our simulations now suggest a generic nanoscale percolation mechanism for high mobility in other oxides.
Purpose - Employability concerns the extent to which people possess the skills and other attributes to find and stay in work of the kind they want. It is thought by many to be a key goal for ...individuals to aim for in managing their careers, and for organisations to foster in workforces. The purpose of this paper is to report on the development of a self-report measure of individuals' perceived employability. It also seeks to examine its construct validity and correlates.Design methodology approach - Based on the analysis of relevant literature, this study developed 16 items which were intended collectively to reflect employability within and outside the person's current organisation, based on his or her personal and occupational attributes. This study administered these items by questionnaire to 200 human resources professionals in the UK, along with established measures of career success and professional commitment, as well as questions reflecting demographic variables.Findings - This article retained 11 of the 16 items for assessing self-perceived employability. Concludes that self-perceived employability can usefully be thought of as either a unitary construct, or one with two related components - internal (to the organisation) and external employability. The measure very successfully distinguished employability from professional commitment, and fairly successfully from career success. Only slight variations in employability could be attributed to demographic characteristics.Research limitations implications - This research has begun to address the gap in the literature for a brief yet psychometrically adequate measure of self-perceived individual employability.Practical implications - This author believes that the scale can be applied to other occupational groups, in organisational consultancy, and in individual career development. It can be used either as one scale or two, depending on the purpose of the investigation.Originality value - Concludes that this research represents a psychometrically adequate contribution in an under-researched field, and will lead to future research with other occupational samples, and in other settings.
Highlights • Multi-segment foot kinematics were compared between older and young adults. • Older adults displayed calcaneus kinematics indicative of a less propulsive gait. • The midfoot and ...metatarsus were less mobile in the older adults. • Age-related differences in foot kinematics exist independent of walking speed.
Obesity and musculoskeletal pain are strongly related, but there is emerging evidence that body fat, not body weight, may be a better indicator of risk. There is, therefore, a need to determine if ...body fat is associated with musculoskeletal pain as it may improve management strategies. The aim of this systematic review was to investigate the association between body fat and musculoskeletal pain.
Seven electronic databases were searched from inception to 8th January 2018. Cross-sectional and longitudinal studies investigating the association between measures of body fat and musculoskeletal pain were included. All included articles were assessed for methodological rigour using the Epidemiology Appraisal Instrument. Standardised mean differences (SMDs) and effect estimates were pooled for meta-analysis.
A total of 10,221 citations were identified through the database searching, which after abstract and full-text review, yielded 28 unique articles. Fourteen studies were included in the meta-analyses, which found significant cross-sectional associations between total body fat mass and widespread pain (SMD 0.49, 95% CI 0.37-0.61, p < 0.001). Individuals with low-back pain and knee pain had a higher body fat percentage than asymptomatic controls (SMD 0.34, 95% CI 0.17-0.52, p < 0.001 and SMD 0.18, 95% CI 0.05-0.32, p = 0.009, respectively). Fat mass index was significantly, albeit weakly, associated with foot pain (SMD 0.05, 95% CI 0.03-0.06, p < 0.001). Longitudinal studies (n = 8) were unsuitable for meta-analysis, but were largely indicative of elevated body fat increasing the risk of incident and worsening joint pain. There was conflicting evidence for an association between body fat percentage and incident low-back pain (3 studies, follow-up 4-20 years). Increasing knee pain (1 study) and incident foot pain (2 studies) were positively associated with body fat percentage and fat mass index. The percentage of items in the EAI graded as 'yes' for each study ranged from 23 to 85%, indicating variable methodological quality of the included studies.
This systematic review and meta-analysis identified positive cross-sectional associations between increased body fat and widespread and single-site joint pain in the low-back, knee and foot. Longitudinal studies suggest elevated body fat may infer increased risk of incident and worsening joint pain, although further high-quality studies are required.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Foot orthoses and insoles are prescribed to runners, however their impact on running economy and performance is uncertain. The aim of this systematic review and meta-analysis was to determine the ...effect of foot orthoses and insoles on running economy and performance in distance runners. Seven electronic databases were searched from inception until June 2018. Eligible studies investigated the effect of foot orthoses or insoles on running economy (using indirect calorimetry) or running performance. Standardised mean differences (SMDs) were computed and meta-analyses were conducted using random effects models. Methodological quality was assessed using the Quality Index. Nine studies met the criteria and were included: five studies investigated the effect of foot orthoses on running economy and four investigated insoles. Foot orthoses were associated with small negative effects on running economy compared to no orthoses (SMD 0.42 95% CI 0.17,0.72 p = 0.007). Shock absorbing insoles were also associated with negative effects on running economy, but an imprecise estimate (SMD 0.26 95% CI −0.33,0.84 p = 0.83). Quality Index scores ranged from 4 to 15 out of 17. Foot orthoses and shock absorbing insoles may adversely affect running economy in distance runners. Future research should consider their potential effects on running performance.
Abstract
This engagement with Christopher Tomlins’s
In the Matter of Nat Turner
(2020) focuses on a key methodological issue faced by the author, namely how one reads and positions the “authentic ...voice” of a past subaltern subject, known to us only through a hostile written source. This challenge is well-known to social historians of the European middle ages, and this essay suggests various ways in which Tomlins’s monograph contributes to existing debate, regarding both method and how one culturally situates and interprets the voice(s) thus identified, particularly with regard to the politics of apocalypticism.
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