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Tendon is an intricately organized connective tissue that efficiently transfers muscle force to the bony skeleton. Its structure, function, and physiology reflect the extreme, ...repetitive mechanical stresses that tendon tissues bear. These mechanical demands also lie beneath high clinical rates of tendon disorders, and present daunting challenges for clinical treatment of these ailments. This article aims to provide perspective on the most urgent frontiers of tendon research and therapeutic development. We start by broadly introducing essential elements of current understanding about tendon structure, function, physiology, damage, and repair. We then introduce and describe a novel paradigm explaining tendon disease progression from initial accumulation of damage in the tendon core to eventual vascular recruitment from the surrounding synovial tissues. We conclude with a perspective on the important role that biomaterials will play in translating research discoveries to the patient.
Tendon and ligament problems represent the most frequent musculoskeletal complaints for which patients seek medical attention. Current therapeutic options for addressing tendon disorders are often ineffective, and the need for improved understanding of tendon physiology is urgent. This perspective article summarizes essential elements of our current knowledge on tendon structure, function, physiology, damage, and repair. It also describes a novel framework to understand tendon physiology and pathophysiology that may be useful in pushing the field forward.
A hip fracture causes bleeding, pain and immobility, and initiates inflammatory, hypercoagulable, catabolic and stress states. Accelerated surgery may improve outcomes by reducing the duration of ...these states and immobility. We undertook a pilot trial to determine the feasibility of a trial comparing accelerated care (i.e., rapid medical clearance and surgery) and standard care among patients with a hip fracture.
Patients aged 45 years or older who, during weekday, daytime working hours, received a diagnosis of a hip fracture requiring surgery were randomly assigned to receive accelerated or standard care. Our feasibility outcomes included the proportion of eligible patients randomly assigned, completeness of follow-up and timelines of accelerated surgery. The main clinical outcome, assessed by data collectors and adjudicators who were unaware of study group allocations, was a major perioperative complication (i.e., a composite of death, preoperative myocardial infarction, myocardial injury after noncardiac surgery, pulmonary embolism, pneumonia, stroke, and life-threatening or major bleeding) within 30 days of randomization.
Of patients eligible for inclusion, 80% consented and were randomly assigned to groups (30 to accelerated care and 30 to standard care) at 2 centres in Canada and 1 centre in India. All patients completed 30-day follow-up. The median time from diagnosis to surgery was 6.0 hours in the accelerated care group and 24.2 hours in the standard care group (p < 0.001). A major perioperative complication occurred in 9 (30%) of the patients in the accelerated care group and 14 (47%) of the patients in the standard care group (hazard ratio 0.60, 95% confidence interval 0.26-1.39).
These results show the feasibility of a trial comparing accelerated and standard care among patients with hip fracture and support a definitive trial.
ClinicalTrials.gov, no. NCT01344343.
This special section builds on recent scholarship on territory and borders to call for attention to the ways that bodies are central in their constitution. Through a wide range of case studies from ...the delivery room to Tahrir Square, the six contributors find territory and borders in unlikely places, and reveal new lines of inquiry through their explorations of the ways that bodies both are marked by territory and borders and take an active role in their making. The contributors bring together recent work on territory with literatures from a divergent set of literatures, including feminist geopolitics, queer theory and actor network theory, to build a case for an embodied and material understanding of the intersections of bodies, territory and borders. We argue that territory is made, in part, through bodies – an intimate geopolitics. Bodies challenge and subvert state control of territory, become vulnerable to violence due to state bordering practices, and experience and produce smaller-scale forms of territory in the refugee camp or hospital. Borders can limit our epistemological vision or expand it. Seeking to expand embodied nationalism and build on scholarship on globalisation that cuts across scale, we approach the body as an active, territorial agent in processes of border and territory-making. Here, territory becomes a versatile, but grounded and material, focal point, allowing for the embodied experiences of border-crossers, but also for other racialised, gendered and sexualised bodies as they give birth or seek to build neighbourhoods.
Injury prevention plays a key role in keeping children safe, but emerging research suggests that imposing too many restrictions on children's outdoor risky play hinders their development. We explore ...the relationship between child development, play, and conceptions of risk taking with the aim of informing child injury prevention. Generational trends indicate children's diminishing engagement in outdoor play is influenced by parental and societal concerns. We outline the importance of play as a necessary ingredient for healthy child development and review the evidence for arguments supporting the need for outdoor risky play, including: (1) children have a natural propensity towards risky play; and, (2) keeping children safe involves letting them take and manage risks. Literature from many disciplines supports the notion that safety efforts should be balanced with opportunities for child development through outdoor risky play. New avenues for investigation and action are emerging seeking optimal strategies for keeping children "as safe as necessary," not "as safe as possible." This paradigm shift represents a potential for epistemological growth as well as cross-disciplinary collaboration to foster optimal child development while preserving children's safety.
The UK government is considering reforms to the legal process for resolving clinical negligence claims after concluding that making care safer will not be enough to curb the burgeoning costs of ...compensation. The working group, which includes the Department of Health, the Ministry of Justice, and NHS Resolution, was set up after reports from the National Audit Office (NAO) and the Public Accounts Committee (PAC) demanded a coordinated strategy across government to tackle the problem. The NAO report said that while the quality and safety of healthcare had improved or remained stable, the number of negligence claims had continued to rise.
In all constitutional systems, there is a reticence in sanctioning criminally any injury caused by fault to a person, without taking into account certain aspects really justifying the penology’s ...intervention – a severe injury of the victim’s body, a case where there are broken prudence norms enacted precisely for avoiding the bodily injury by fault of a person.
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