'Sink or swim': An evaluation of the clinical characteristics of individuals with high bone mass

Summary High bone mineral density on routine dual energy X-ray absorptiometry (DXA) may indicate an underlying skeletal dysplasia. Two hundred fifty-eight individuals with unexplained high bone mass (HBM), 236 relatives (41% with HBM) and 58 spouses were studied. Cases could not float, had mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (BMI). HBM cases may harbour an underlying genetic disorder. Introduction High bone mineral density is a sporadic incidental finding on routine DXA scanning of apparently asymptomatic individuals. Such individuals may have an underlying skeletal dysplasia, as seen in LRP5 mutations. We aimed to characterize unexplained HBM and determine the potential for an underlying skeletal dysplasia. Methods Two hundred fifty-eight individuals with unexplained HBM (defined as L1 Z-score ≥ +3.2 plus total hip Z-score ≥ +1.2, or total hip Z-score ≥ +3.2) were recruited from 15 UK centres, by screening 335,115 DXA scans. Unexplained HBM affected 0.181% of DXA scans. Next 236 relatives were recruited of whom 94 (41%) had HBM (defined as L1 Z-score + total hip Z-score ≥ +3.2). Fifty-eight spouses were also recruited together with the unaffected relatives as controls. Phenotypes of cases and controls, obtained from clinical assessment, were compared using random-effects linear and logistic regression models, clustered by family, adjusted for confounders, including age and sex. Results Individuals with unexplained HBM had an excess of sinking when swimming (7.11 [3.65, 13.84], p < 0.001; adjusted odds ratio with 95% confidence interval shown), mandible enlargement (4.16 [2.34, 7.39], p < 0.001), extra bone at tendon/ligament insertions (2.07 [1.13, 3.78], p = 0.018) and broad frame (3.55 [2.12, 5.95], p < 0.001). HBM cases also had a larger shoe size (mean difference 0.4 [0.1, 0.7] UK sizes, p = 0.009) and increased BMI (mean difference 2.2 [1.3, 3.1] kg/m 2, p < 0.001). Conclusion Individuals with unexplained HBM have an excess of clinical characteristics associated with skeletal dysplasia and their relatives are commonly affected, suggesting many may harbour an underlying genetic disorder affecting bone mass.

Effects of PTPN22 C1858T polymorphism on susceptibility and clinical characteristics of British Caucasian rheumatoid arthritis patients

Objectives. To confirm the association of a functional single-nucleotide polymorphism (SNP), C1858T (rs2476601), in the PTPN22 gene of British Caucasian rheumatoid arthritis (RA) patients and to evaluate its influence on the RA phenotype. Methods. A total of 686 RA patients and 566 healthy volunteers, all of British Caucasian origin, were genotyped for C1858T polymorphism by PCR-restriction fragment length polymorphism assay. Data were analysed using SPSS software and the χ 2 test as applicable. Results. The PTPN22 1858T risk allele was more prevalent in the RA patients (13.9%) compared with the healthy controls (10.3%) (P = 0.008, odds ratio 1.4, 95% confidence interval 1.09-1.79). The association of the T allele was restricted to those with rheumatoid factor (RF)-positive disease (n = 524, 76.4%) (P = 0.004, odds ratio 1.5, 95% confidence interval 1.1-1.9). We found no association between PTPN22 and the presence of the HLA-DRB1 shared epitope or clinical characteristics. Conclusions. We confirmed the previously reported association of PTPN22 with RF-positive RA, which was independent from the HLA-DRB1 genotype.

Characteristics of on-road driving by persons with central vision loss: Learning to drive with a bioptic telescope

There is limited research on the driving performance and safety of bioptic drivers and even less regarding the driving skills that are most challenging for those learning to drive with bioptic telescopes. This research consisted of case studies of five trainee bioptic drivers whose driving skills were compared with those of a group of licensed bioptic drivers (n = 23) while they drove along city, suburban, and controlled-access highways in an instrumented dual-brake vehicle. A certified driver rehabilitation specialist was positioned in the front passenger seat to monitor safety and two backseat evaluators independently rated driving using a standardized scoring system. Other aspects of performance were assessed through vehicle instrumentation and video recordings. Results demonstrate that while sign recognition, lane keeping, steering steadiness, gap judgments and speed choices were significantly worse in trainees, some driving behaviors and skills, including pedestrian detection and traffic light recognition were not significantly different to those of the licensed drivers. These data provide useful insights into the skill challenges encountered by a small sample of trainee bioptic drivers which, while not generalizable because of the small sample size, provide valuable insights beyond that of previous studies and can be used as a basis to guide training strategies.

Effect of decellularization on the load-bearing characteristics of articular cartilage matrix

The application of decellularized extracellular matrices to aid tissue regeneration in reconstructive surgery and regenerative medicine has been promising. Several decellularization protocols for removing cellular materials from natural tissues such as heart valves are currently in use. This paper evaluates the feasibility of potential extension of this methodology relative to the desirable properties of load bearing joint tissues such as stiffness, porosity and ability to recover adequately after deformation to facilitate physiological function. Two decellularization protocols, namely: Trypsin and Triton X-100 were evaluated against their effects on bovine articular cartilage, using biomechanical, biochemical and microstructural techniques. These analyses revealed that decellularization with trypsin resulted in severe loss of mechanical stiffness including deleterious collapse of the collagen architecture which in turn significantly compromised the porosity of the construct. In contrast, triton X-100 detergent treatment yielded samples that retain mechanical stiffness relative to that of the normal intact cartilage sample, but the resulting construct contained ruminant cellular constituents. We conclude that both of these common decellularization protocols are inadequate for producing constructs that can serve as effective replacement and scaffolds to regenerate articular joint tissue.

Covitality constructs as predictors of psychological well-being and depression for secondary school students'

This study was an examination of the strength of relations among covitality, and its underlying constructs of belief in self, emotional competence, belief in others, and engaged living, and two outcome variables; subjective well-being and depression. Participants included 361 Australian secondary school students (75 males and 286 females) who completed a series of online questionnaires related to positive psychological well-being in adolescents. The results from the first standard multiple regression analysis indicated that higher levels of belief in self, belief in others, and engaged living were significant predictors of increased subjective well-being. The results from the second standard multiple regression showed that higher levels of belief in self, belief in others, and engaged living were significant predictors of decreased feelings of depression. In both standard multiple regression models, the combined effect of the traits that comprise covitality was greater than the effect of each individual positive psychological trait.

Positive psychological strengths and school engagement in primary school children

A sizeable body of research has investigated the impact of specific character strengths or traits on significant outcomes. Some recent research is beginning to consider the effects of groups of strengths, combined as a higher order variable, and termed covitality. This study investigated the combined influence of four positive character traits: gratitude, optimism, zest and persistence, upon school engagement, within a sample of 112 Australian primary school students. The combined effect of these four traits, in defining covitality as a higher or second order factor within a path analysis, was found to predict relatively higher levels of school engagement and pro-social behaviour.

Prevalence and characteristics of road traffic injuries among young drivers in Oman, 2009-2011

Objectives Studies from different parts of the world have indicated that the impact of road traffic incidents disproportionally affects young adults. Few known studies have been forthcoming from Arabian Gulf countries. Within Oman, a high proportion of the population is under the age of 20. Coupled with the drastic increase of motorization in recent years there is a need to understand the state of road safety among young people in Oman. The current research aimed to explore the prevalence and characteristics of road traffic injuries among young drivers aged 17-25 years. Methods Crash data from 2009-2011 was extracted from the Directorate General of Traffic, Royal Oman Police (ROP) database in Oman. The data was analyzed to explore the impact of road crashes on young people (17-25 years), the characteristics of young driver crashes and how these differ from older drivers and to identify key predictors of fatalities in young driver crashes. Results Overall, young people were over-represented in injuries and fatalities within the sample time period. While it is true that many young people in crashes were driving at the time, it was also evident that young people were often a victim in a crash caused by someone else. Thus, to reduce the impact of road crashes on young people, there is a need to generally address road safety within Oman. When young drivers were involved in crashes they were predominantly male. The types of crashes these drivers have can be broadly attributed to risk taking and inexperience. Speeding and night time driving were the key risk factors for fatalities. Conclusion The results highlight the need to address young driver safety in Oman. From these findings, the introduction of a graduated driver licensing system with night time driving restrictions could significantly improve young driver safety.

Characteristics of road factors in multi and single vehicle motorcycle crashes in Queensland

Motorcyclists were involved in 6.4% of all police-reported crashes and 12.5% of all fatal crashes in Queensland during 2004-2011. Of these crashes, 43% were single-vehicle (SV) and 57% were multi-vehicle (MV). The overall reduction in motorcycle crashes in this period masked different trends: single-vehicle crashes increased while MV motorcycle crashes decreased. However, little research has been undertaken to understand the similarities and differences between SV and MV motorcycle crashes in Queensland and the factors underlying these diverging trends. The descriptive analyses and regression model developed here confirm international research findings regarding the greater role of road infrastructure factors in SV crashes. In particular, road geometric factors such as horizontal and vertical alignment and road surface factors such as sealed/unsealed and wet/dry were more important in SV than MV crashes.

MEG Adaptation resolves the spatiotemporal characteristics of face-sensitive brain responses

An unresolved goal in face perception is to identify brain areas involved in face processing and simultaneously understand the timing of their involvement. Currently, high spatial resolution imaging techniques identify the fusiform gyrus as subserving processing of invariant face features relating to identity. High temporal resolution imaging techniques localize an early latency evoked component—the N/M170—as having a major generator in the fusiform region; however, this evoked component is not believed to be associated with the processing of identity. To resolve this, we used novel magnetoencephalographic beamformer analyses to localize cortical regions in humans spatially with trial-by-trial activity that differentiated faces and objects and to interrogate their functional sensitivity by analyzing the effects of stimulus repetition. This demonstrated a temporal sequence of processing that provides category-level and then item-level invariance. The right fusiform gyrus showed adaptation to faces (not objects) at ∼150 ms after stimulus onset regardless of face identity; however, at the later latency of ∼200–300 ms, this area showed greater adaptation to repeated identity faces than to novel identities. This is consistent with an involvement of the fusiform region in both early and midlatency face-processing operations, with only the latter showing sensitivity to invariant face features relating to identity.

A pilot study in different unstable designs on the biomechanical effect of gait characteristics

The purpose of this study was to compare kinematics and kinetics during walking for healthy subjects using unstable shoes with different designs. Ten subjects participated in this study, and foot biomechanical data during walking were quantified using motion analysis system and a force plate. Data were collected for unstable shoes condition after accommodation period of one week. With soft material added in the heel region, the peak impact force was effectively reduced when compared among similar shapes. In addition, the soft material added in the rocker bottom showed more to be in dorsiflexed position during the initial stance. The shoe with three rocker curves design reduced the contact area in the heel strike, which may result in increasing human body forward speed. Further studies shall be carried out after adapting to long periods of wearing unstable shoes.

Phantom limb pain: A nursing perspective

Phantom limb pain (PLP) is a neuropathic pain condition occurring after amputation of a limb. PLP affects amputees’ quality of life and results in loss of productivity and psychological distress. The origin of pain from a non-existing limb creates a challenging situation for both patients and nurses. It is imperative to provide patients and nurses with the knowledge that PLP is a real phenomenon that requires care and treatment. This knowledge will lead to reduced problems for patients by allowing them to talk about PLP and ask for help when needed. Understanding of this phenomenon will enable nurses to appreciate the unique features of this form of neuropathic pain and apply appropriate techniques to promote effective pain management. Performing accurate and frequent assessments to understand the unique characteristics of PLP, displaying a non-judgemental attitude towards patients and teaching throughout the peri-operative process are significant nursing interventions.

Workplace belongingness, psychological distress and resilience in emergency service workers

- Objective Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel whilst controlling for more routinely examined factors. - Method Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10 (Kessler & Mroczek, 1994), Brief Resilience Scale (Smith et al., 2008) and Psychological Sense of Organisational Membership (Cockshaw & Shochet, 2010) scale. - Results Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. - Conclusions Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organisations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events.

The use of animation to promote student learning about the importance of mental well-being for tertiary study success

It is now widely acknowledged that student mental well-being is a critical factor in the tertiary student learning experience and is important to student learning success. The issue of student mental well-being also has implications for effective student transition out of university and into the world of work. It is therefore vital that intentional strategies are adopted by universities both within the formal curriculum, and outside it, to promote student well-being and to work proactively and preventatively to avoid a decline in student psychological well-being. This paper describes how the Queensland University of Technology Law School is using animation to teach students about the importance for their learning success of the protection of their mental well-being. Mayer and Moreno (2002) define an animation as an external representation with three main characteristics: (1) it is a pictorial representation, (2) it depicts apparent movement, and (3) it consists of objects that are artificially created through drawing or some other modelling technique. Research into the effectiveness of animation as a tool for tertiary student learning engagement is relatively new and growing field of enquiry. Nash argues, for example, that animations provide a “rich, immersive environment [that] encourages action and interactivity, which overcome an often dehumanizing learning management system approach” (Nash, 2009, 25). Nicholas states that contemporary millennial students in universities today, have been immersed in animated multimedia since their birth and in fact need multimedia to learn and communicate effectively (2008). However, it has also been established, for example through the work of Lowe (2003, 2004, 2008) that animations can place additional perceptual, attentional, and cognitive demands on students that they are not always equipped to cope with. There are many different genres of animation. The dominant style of animation used in the university learning environment is expository animation. This approach is a useful tool for visualising dynamic processes and is used to support student understanding of subjects and themes that might otherwise be perceived as theoretically difficult and disengaging. It is also a form of animation that can be constructed to avoid any potential negative impact on cognitive load that the animated genre might have. However, the nature of expository animation has limitations for engaging students, and can present as clinical and static. For this reason, the project applied Kombartzky, Ploetzner, Schlag, and Metz’s (2010) cognitive strategy for effective student learning from expository animation, and developed a hybrid form of animation that takes advantage of the best elements of expository animation techniques along with more engaging short narrative techniques. First, the paper examines the existing literature on the use of animation in tertiary educational contexts. Second, the paper describes how animation was used at QUT Law School to teach students about the issue of mental well-being and its importance to their learning success. Finally, the paper analyses the potential of the use of animation, and of the cognitive strategy and animation approach trialled in the project, as a teaching tool for the promotion of student learning about the importance of mental well-being.

Cyclic plastic deformation characteristics of subgrade under moving train wheel load

Cyclic plastic deformation of subgrade and other engineered layers is generally not taken into account in the design of railway bridge transition zones, although the plastic deformation is the governing factor of frequent track deterioration. Actual stress behavior of fine grained subgrade/embankment layers under train traffic is, however, difficult to replicate using the conventional laboratory test apparatus and techniques. A new type of torsional simple shear apparatus, known as multi-ring shear apparatus, was therefore developed to evaluate the actual stress state and the corresponding cyclic plastic deformation characteristics of subgrade materials under moving wheel load conditions. Multi-ring shear test results has been validated using a theoretical model test results; the capability of the multi-ring shear apparatus for replicating the cyclic plastic deformation characteristics of subgrade under moving train wheel load conditions is thus established. This paper describes the effects of principal stress rotation (PSR) of the subgrade materials to the cyclic plastic deformation in a railroad and impacts of testing methods in evaluating the influence of principal stress rotation to the track deterioration of rail track.

Sleep-related crash characteristics: Implications for applying a fatigue definition to crash reports

Sleep-related (SR) crashes are an endemic problem the world over. However, police officers report difficulties in identifying sleepiness as a crash contributing factor. One approach to improving the sensitivity of SR crash identification is by applying a proxy definition post hoc to crash reports. To identify the prominent characteristics of SR crashes and highlight the influence of proxy definitions, ten years of Queensland (Australia) police reports of crashes occurring in ≥100 km/h speed zones were analysed. In Queensland, two approaches are routinely taken to identifying SR crashes. First, attending police officers identify crash causal factors; one possible option is ‘fatigue/fell asleep’. Second, a proxy definition is applied to all crash reports. Those meeting the definition are considered SR and added to the police-reported SR crashes. Of the 65,204 vehicle operators involved in crashes 3449 were police-reported as SR. Analyses of these data found that male drivers aged 16–24 years within the first two years of unsupervised driving were most likely to have a SR crash. Collision with a stationary object was more likely in SR than in not-SR crashes. Using the proxy definition 9739 (14.9%) crashes were classified as SR. Using the proxy definition removes the findings that SR crashes are more likely to involve males and be of high severity. Additionally, proxy defined SR crashes are no less likely at intersections than not-SR crashes. When interpreting crash data it is important to understand the implications of SR identification because strategies aimed at reducing the road toll are informed by such data. Without the correct interpretation, funding could be misdirected. Improving sleepiness identification should be a priority in terms of both improvement to police and proxy reporting.