Tarsal tunnel syndrome: A narrative literature review

Background Tarsal tunnel syndrome is classified as a focal compressive neuropathy of the posterior tibial nerve or one of its associated branches individually or collectively. The tunnel courses deep to fascia, the flexor retinaculum and within the abductor hallucis muscle of the foot/ankle. The condition is rare and regularly under-diagnosed leading to a range of symptoms affecting the plantar margins of the foot. There are many intervention strategies for treating tarsal tunnel syndrome with limited robust evidence to guide the clinical management of this condition. The role of conservative versus surgical interventions at various stages of the disease process remains unclear, and there is a need for a structured, step-wise approach in treating patients with this syndrome based on derived empirical evidence. This narrative review attempts to scrutinize the literature to date by clarifying initial presentation, investigations and definitive treatment for the purpose of assisting future informed clinical decision and prospective research endeavours. Process The literature searches that have been incorporated in compiling a rigorous review of this condition have included: the Cochrane Neuromuscular Group's Specialized Register (Cochrane Library 2013), the databases of EMBASE, AMED, MEDLINE, CINAHL, Physiotherapy evidence database (PEDRO), Biomed Central, Science Direct and Trip Database (1972 to the present). Reference listings of located articles were also searched and scrutinized. Authors and experts within the field of lower-limb orthopaedics were contacted to discuss applicable data. Subject-specific criteria searches utilizing the following key terms were performed across all databases: tarsal tunnel syndrome, tibial neuralgia, compression neuropathy syndromes, tibial nerve impingement, tarsal tunnel neuropathy, entrapment tibial nerve, posterior tibial neuropathy. These search strategies were modified with differing databases, adopting specific sensitivity-searching tools and functions unique to each. This search strategy identified 88 journal articles of relevance for this narrative literature review. Findings This literature review has appraised the clinical significance of tarsal tunnel syndrome, whilst assessing varied management interventions (non-surgical and surgical) for the treatment of this condition in both adults and children. According to our review, there is limited high-level robust evidence to guide and refine the clinical management of tarsal tunnel syndrome. Requirements for small-scaled randomized controlled trials in groups with homogenous aetiology are needed to analyse the effectiveness of specific treatment modalities. Conclusions It is necessary that further research endeavours be pursued for the clinical understanding, assessment and treatment of tarsal tunnel syndrome. Accordingly, a structured approach to managing patients who have been correctly diagnosed with this condition should be formulated on the basis of empirical evidence where possible.

The National Road Safety Partnership Program providing a pathway for any business/organisation to create a positive road safety culture

The National Road Safety Partnership Program (NRSPP) is an industry-led collaborative network which aims to support Australian businesses in developing a positive road safety culture. It aims to help businesses to protect their employees and the public, not only during work hours, but also when their staff are ‘off-duty’. How do we engage and help an organisation minimise work-related vehicle crashes and their consequences both internally, and within the broader community? The first step is helping an organisation to understand the true cost of its road incidents. Larger organisations often wear the costs without knowing the true impact to their bottom line. All they perceive is the change in insurance or vehicle repairs. Understanding the true cost should help mobilise a business’s leadership to do more. The next step is ensuring the business undertakes an informed, structured, evidence-based pathway which will guide them around the costly pitfalls. A pathway based around the safe system approach with buy-in at the top which brings the workforce along. The final step, benchmarking, allows the organisation to measure and track its change. This symposium will explore the pathway steps for organisations using NRSPP resources to become engaged in road safety. The 'Total Cost of Risk' calculator has been developed by Zurich, tested in Europe by Nestle and modified by NRSPP for Australia. This provides the first crucial step. The next step is a structured approach through the Workplace Road Safety Guide using experts and industry to discuss the preferred safe system approach which can then link into the national Benchmarking Project. The outputs from the symposium can help frame a pathway for organisations to follow through the NRSPP website.

Discussion of “Generalized estimating equations: Notes on the choice of the working correlation matrix”

Objective To discuss generalized estimating equations as an extension of generalized linear models by commenting on the paper of Ziegler and Vens "Generalized Estimating Equations. Notes on the Choice of the Working Correlation Matrix". Methods Inviting an international group of experts to comment on this paper. Results Several perspectives have been taken by the discussants. Econometricians have established parallels to the generalized method of moments (GMM). Statisticians discussed model assumptions and the aspect of missing data Applied statisticians; commented on practical aspects in data analysis. Conclusions In general, careful modeling correlation is encouraged when considering estimation efficiency and other implications, and a comparison of choosing instruments in GMM and generalized estimating equations, (GEE) would be worthwhile. Some theoretical drawbacks of GEE need to be further addressed and require careful analysis of data This particularly applies to the situation when data are missing at random.

ASEAN and ADB implementing new approaches to building road safety capacity

Following the Association of Southeast Asian Nations (ASEAN) senior transport officials meeting in May 2011, the Secretariat requested the Asian Development Bank (ADB) to provide assistance to improve road safety in ASEAN. In response, ADB, funded by the Japan Fund for Poverty Reduction, has begun an innovative approach to capacity building that has already been adapted and replicated in other sub-regions. This paper will discuss the model central to the project. The Road Safety Capacity Building for ASEAN Project commenced in May 2013. Each country has appointed a National Focal Point (NFP) to identify and coordinate information. A team of International Experts were appointed to develop materials and present a comprehensive train the trainer program focused on five key areas. Thirty eight senior Government officers from across ASEAN attended a two week program at ADB headquarters in Manila and will arrange and deliver specific training and associated activities to other colleagues within their country. ADB has appointed a National Consultant to work in partnership with the trainees on a range of activities including development of “pipeline project proposals” for funding consideration investors and donors. As part of the project, a draft ASEAN Regional Road Safety Strategy document has been prepared and consultation will further refine its directions and contents. The project will reach its conclusion in 2015 and a follow up phase three project is being considered.

Co-designing social marketing programs

Most alcohol education programs are designed by experts, with the target audience largely excluded from this process. Theoretically, application of co-creation which comprises co-design and co- production offers an opportunity to better orient programs to meet audience needs and wants and thereby enhance program outcomes. To date, research focus has centred on value co-creation with content co-design receiving limited research attention. The current study seeks to understand how young people would design an intervention and continues by contrasting an audience designed program with the earlier implemented expert designed program.

The SAGE Handbook of Early Childhood Research

Recent decades have seen an upsurge of research with and about young children, their families and communities. The Handbook of Early Childhood Research will provide a landmark overview of the field of early childhood research and will set an agenda for early childhood research into the future. It includes 31 chapters provided by internationally recognized experts in early childhood research. The team of international contributors apply their expertise to conceptual and methodological issues in research and to relevant fields of practice and policy. The Handbook recognizes the main contexts of early childhood research: home and family contexts; out-of-home contexts such as services for young children and their families; and broader societal contexts of that evoke risk for young children.

Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons' audit tool

Background Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the Australasian College of Podiatric Surgeons (ACPS), the ACPS audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. Methods Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the Royal Australasian College of Surgeons (RACS). Based on the Delphi survey findings the ACPS online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. Results The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. The Delphi process established consensus on audit variables to be captured, including the modified RACS generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. Conclusions Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the ACPS audit tool supported the ACPS submission to the Medical Services Advisory Committee to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.

Development and Simulation of a Variable Rate Controller for an Air search and Air Sampling Unmanned Aerial System

This report describes the development and simulation of a variable rate controller for a 6-degree of freedom nonlinear model. The variable rate simulation model represents an off the shelf autopilot. Flight experiment involves risks and can be expensive. Therefore a dynamic model to understand the performance characteristics of the UAS in mission simulation before actual flight test or to obtain parameters needed for the flight is important. The control and guidance is implemented in Simulink. The report tests the use of the model for air search and air sampling path planning. A GUI in which a set of mission scenarios, in which two experts (mission expert, i.e. air sampling or air search and an UAV expert) interact, is presented showing the benefits of the method.

Overcoming the challenges of building heritage projects: Improvements to time, scope and cost performance

This research was undertaken to encompass and identify challenges and impact factors that affect the successful outcomes of heritage building projects, especially those related to finding major causes of delays and cost overruns across projects in all Australian states. This project determined and analysed the causes of such delays and programme issues emanating from the planning and execution phases, whilst also analysing the requirements for management of multiple stakeholder relationships and the influence of unforeseen technical factors. The research proposes "call for action" guidance and was validated by experienced experts in heritage building projects in Australia. The proposed guidance is designed to ensure that realistic cost targets and delivery timeframes are set in future heritage projects, and necessary interventions made at appropriate project stages to ensure decisions are made that will help to prevent overtime and cost overuns.

Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

Background/Aim There is a 70% higher age-adjusted incidence of heart failure (HF) amongst Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths than non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community healthcare to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim©) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. Methods This study was conducted in two phases and utilised a mixed methods approach (qualitative and quantitative). Phase 1 of this study used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. A HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. Results - Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this and of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. - Phase 2: Five Aboriginal participants, mean age 61.6 ± 10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0 ± 6.7% to 58.0 ± 9.7%, a 20.8% increase and results of the self-care index indicated that the biggest change was in patient confidence for self-care with a 95% increase in confidence score (46.7 ± 16.0 to 91.1 ± 11.5). Changes in management and maintenance scores varied between9275 patients. Conclusion By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

Innovations in Knowledge and Learning for Competitive Higher Education in Asia and the Pacific

Competitive advantage in a knowledge economy is dependent on the ability to innovate and create new knowledge products and services, and to find innovative applications for them. Higher education institutions in Asia and the Pacific, modelled on industrial age thinking that demands excellence in routinized capacities, lack the ability to innovate and create new knowledge enterprises. The transition to a knowledge economy is affecting the purpose, content, pedagogy, and methodologies of higher education. Nontraditional stakeholders such as professional bodies, industry experts, think tanks, research institutes, and field experts/practitioners are now involved not only in planning but in providing higher education services. The traditional model of “knowledge versus skills” is no longer relevant. Higher education programs must consider lived experiences, contextual knowledge, and indigenous knowledge.

Intellectual Property Chapter in Part 18: Intellectual Property and Communications

This chapter addresses the areas more commonly found in everyday practice (NB circuit layouts and plant breeder's rights are not covered). Importantly, IP law has become very specialised, and as such one for which practitioners will need expertise or access to relevant experts in order to properly provide advice. The following therefore is an overview only of relevant issues.

Demand for, and impediments to, the disclosure of information about climate change-related corporate governance practices

Based on a survey of climate change experts in different stakeholder groups and interviews with corporate climate change managers, this study provides insights into the gap between what information stakeholders expect, and what Australian corporations disclose. This paper focuses on annual reports and sustainability reports with specific reference to the disclosure of climate change-related corporate governance practices. The findings culminate in the governance practises. Interview results indicate that the low levels of disclosures made by Australian companies may be due to a number of factors. A lack of proactive stakeholder engagement and an apparent preoccupation with financial performance and advancing shareholders interest, coupled with a failure by managers to accept accountability, seems to go a long way to explaining low levels of disclosure.

Methodology for developing competency standards for dietitians in Australia

Competency standards document the knowledge, skills, and attitudes required for competent performance. This study develops competency standards for dietitians in order to substantiate an approach to competency standard development. Focus groups explored the current and emerging purpose, role, and function of the profession, which were used to draft competency standards. Consensus was then sought using two rounds of a Delphi survey. Seven focus groups were conducted with 28 participants (15 employers/practitioners, 5 academics, 8 new graduates). Eighty-two of 110 invited experts participated in round one and 67 experts completed round two. Four major functions of dietitians were identified: being a professional, influencing the health of individuals, groups, communities, and populations through evidence-based nutrition practice, and working collaboratively in teams. Overall there was a high level of consensus on the standards: 93% achieved agreement by participants in round one and all revised standards achieved consensus on round 2. The methodology provides a framework for other professions wishing to embark on competency standard review or development.

Twitter as a medium for professional networking

This study aims to explore the use of Twitter for professional purposes. The researcher discovered that Twitter is widely perceived as an information ground in online spaces. Information grounds are social settings where information, people, and places come together to create an information flow within a physical environment. Twitter provides a sense of place as well as a sense of belonging that enables IT professionals to use Twitter for professional development. The data for this study were collected using online observations and interviews. The online observations helped the researcher to distinguish the ‘information behaviours’ (the objective and observable actions) of the participants. The interviews were used to understand the way IT professionals use Twitter for professional purposes through their own individual perspectives. The data were analysed using a constructive grounded theory. The findings show that building professional networking is extremely important to IT professionals; rather than the information-seeking and information-sharing aspects of Twitter. Building professional networking in microblogging has a significant influence on an individual’s professional development. The results also demonstrate that IT professionals are more likely to exploit their weak-ties rather than their strong-ties on Twitter. In short, these users experience Twitter as a real place or ‘information grounds’ where they meet and socialise with experts.