Outcomes following operative and non-operative management of humeral midshaft fractures: a prospective, observational cohort study of 47 patients

Background Although the non-operative management of closed humeral midshaft fractures has been advocated for years, the increasing popularity of operative intervention has left the optimal treatment choice unclear. Objective To compare the outcomes of operative and non-operative treatment of traumatic closed humeral midshaft fractures in adult patients. Methods A multicentre prospective comparative cohort study across 20 centres was conducted. Patients with AO type 12 A2, A3 and B2 fractures were treated with a functional brace or a retrograde-inserted unreamed humeral nail. Follow-up measurements were taken at 6, 12 and 52 weeks after the injury. The primary outcome was fracture healing after 1 year. Secondary outcomes included sub-items of the Constant score, general patient satisfaction, complications and cost-effectiveness parameters. Functions of the uninjured extremity were used as reference parameters. Intention-to-treat analysis was applied with the use of t-tests, Fisher’s exact tests, Mann–Whitney U-tests and adjusted analysis of variance (ANOVA). Results Forty-seven patients were included. The patient sample consisted of 23 women and 24 men, with a mean age of 52.7 years (range 17–86 years). Of the 47 cases, 14 were treated non-operatively and 33 operatively. The follow-up rate at 1 year was 81%. After 1 year, 11 fractures (100%) healed in the non-operative group and at least 24 fractures (≥89%) healed in the operative group [1 non-union patient (4%) and no data for 2 patients (7%)]. There were no significant differences in pain, range of motion (ROM) of the shoulder and elbow, and return to work after 6 weeks, 12 weeks and 1 year. Although operatively treated patients showed significantly greater shoulder abduction strength (p = 0.036), elbow flexion strength (p = 0.021), functional hand positioning (p = 0.008) and return to recreational activities (p = 0.043) after 6 weeks, no statistically significant differences existed in any outcome measure at the 1-year follow-up. Conclusions Our findings indicate that the non-operative management of humeral midshaft fractures can be expected to have similar functional outcomes and patient satisfaction at 1 year, despite an early benefit to operative treatment. If no radiological evidence of fracture healing exists in non-operatively treated patients during early follow-up, a switch to surgical treatment results in good functional outcomes and patient satisfaction. Keywords: Humeral shaft fracture, Non-operative treatment, Functional brace, Operative treatment, Unreamed humeral nail (UHN), Prospective, Cohort study

Secondary curve behavior in Lenke Type 1C adolescent idiopathic scoliosis after thoracoscopic selective anterior thoracic fusion

Study Design. Analysis of a case series of 24 Lenke 1C adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior scoliosis correction. Objective. To report the behaviour of the compensatory lumbar curve in a group of Lenke IC AIS patients following thoracoscopic anterior scoliosis correction, and to compare the results of this study with previously published data. Summary of Background Data. Several prior studies have reported spontaneous lumbar curve correction for both anterior and posterior selective fusion in Lenke 1C/King-Moe II patients; however to our knowledge no previous studies have reported outcomes of thoracoscopic anterior correction for this curve type. Methods. All AIS patients with a curve classification of Lenke 1C and a minimum of 24 months follow-up were retrieved from a consecutive series of 190 AIS patients who underwent thoracoscopic anterior instrumented fusion. Cobb angles of the major curve, instrumented levels, compensatory lumbar curve, and T5-T12 kyphosis were recorded, as well as coronal spinal balance, T1 tilt angle and shoulder balance. All radiographic parameters were measured before surgery and at 2, 6, 12 and 24 months after surgery. Results. Twenty-four female patients with right thoracic curves had a mean thoracic Cobb angle of 53.0° before surgery, decreasing to 24.9° two years after surgery. The mean lumbar compensatory Cobb angle was 43.5° before surgery, spontaneously correcting to 25.4° two years after surgery, indicating balance between the thoracic and lumbar scoliotic curves. The lumbar correction achieved (41.8%) compares favourably to previous studies. Conclusions. Selective thoracoscopic anterior fusion allows spontaneous lumbar curve correction and achieves coronal balance of main thoracic and compensatory lumbar curves, good cosmesis and patient satisfaction. Correction and balance are maintained 24 months after surgery.

Water-based exercise for patients with chronic arm lymphedema : a randomized controlled pilot trial

Objective: To evaluate the feasibility and effect of a water-based exercise (WBE) program on lymphedema status and shoulder range of motion (ROM) among women with breast cancer related lymphedema. Design: Single-blinded, randomized controlled pilot trial. Twenty-nine eligible breast cancer survivors (median 10 years after surgery) with arm lymphedema (median 21% inter limb difference) were included and randomized into intervention (n= 15) or control (n=14). Twenty-five participants completed the study. The intervention was at least twice weekly WBE for 8 weeks; supervised initially but performed independently during the study period. Outcomes of interest were feasibility as measured by retention and adherence, lymphedema status as measured by optoelectronic perometry, bioimpedance spectroscopy and tissue dielectric constant, and shoulder range of motion (ROM) as measured by goniometer. Results: Four participants were not measured at post-intervention and were not included in the analysis (retention). Four participants in the intervention group did not perform the minimum WBE criteria set (adherence). No effect was found on lymphedema status. Compared to the control group, median ROM change for flexion was 6 (1-10) degrees (p<0.001) and 6 (0-15.5) degrees (p=0,07) for external rotation. Clinically relevant increase in the intervention group was found for 36% in flexion (p≤0.05) and (57%) in external rotation (p≤0.05) compared to controls. Conclusions: This study shows WBE is feasible for breast cancer survivors with arm lymphedema and that shoulder ROM can be improved years after cancer treatment has been completed.

Intratherapist reliability in the rating of scapula posture in multiple planes of reference

Background: Evaluation of scapular posture is a fundamental component in the clinical evaluation of the upper quadrant. This study examined the intrarater reliability of scapular posture ratings. Methods: A test-retest reliability investigation was undertaken with one week between assessment sessions. At each session physical therapists conducted visual assessments of scapula posture (relative to the thorax) in five different scapula postural planes (plane of scapula, sagittal plane, transverse plane, horizontal plane, and vertical plane). These five plane ratings were performed for four different scapular posture perturbating conditions (rest, isometric shoulder; flexion, abduction, and external rotation). Results. A total of 100 complete scapular posture ratings (50 left, 50 right) were undertaken at each assessment. The observed agreement between the test and retest postural plane ratings ranged from 59% to 87%; 16 of the 20 plane-condition combinations exceeded 75% observed agreement. Kappa (and prevalence adjusted bias adjusted kappa) values were inconsistent across the postural planes and perturbating conditions. Conclusions: This investigation generally revealed fair to moderate intrarater reliability in the rating of scapular posture by visual inspection. However, enough disagreement between assessments was present to warrant caution when interpreting perceived changes in scapula position between longitudinal assessments using visual inspection alone.

Use of condition-specific patient-reported outcome measures in clinical trials among patients with wrist osteoarthritis : a systematic review

Background. This paper aimed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer-reviewed evidence supporting their reliability, validity, and responsiveness to change. Methods. A systematic review of randomised controlled trials among people with wrist osteoarthritis was undertaken. Studies reporting reliability, validity, or responsiveness were identified using a systematic reverse citation trail audit procedure. Psychometric properties of the instruments were examined against predefined criteria and summarised. Results. Thirteen clinical trials met inclusion criteria. The most common patient-reported outcome was the disabilities of the arm, shoulder, and hand questionnaire (DASH). The DASH, the Michigan Hand Outcomes Questionnaire (MHQ), the Patient Evaluation Measure (PEM), and the Patient-Reported Wrist Evaluation (PRWE) had evidence supporting their reliability, validity, and responsiveness. A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis Hand Index as another suitable instrument that had favourable reliability, validity, and responsiveness. Conclusions. The DASH, MHQ, and AUSCAN Osteoarthritis Hand Index instruments were supported by the most favourable empirical evidence for validity, reliability, and responsiveness. The PEM and PRWE also had favourable empirical evidence reported for these elements. Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted.

A lightweight biometric signature scheme for user authentication over networks

We introduce a lightweight biometric solution for user authentication over networks using online handwritten signatures. The algorithm proposed is based on a modified Hausdorff distance and has favorable characteristics such as low computational cost and minimal training requirements. Furthermore, we investigate an information theoretic model for capacity and performance analysis for biometric authentication which brings additional theoretical insights to the problem. A fully functional proof-of-concept prototype that relies on commonly available off-the-shelf hardware is developed as a client-server system that supports Web services. Initial experimental results show that the algorithm performs well despite its low computational requirements and is resilient against over-the-shoulder attacks.

Assessment of the molecular structure of the borate mineral sakhaite Ca12Mg4(BO3)7(CO3)4Cl(OH)2·H2O using vibrational spectroscopy

The structure of the borate mineral sakhaite Ca12Mg4(BO3)7(CO3)4Cl(OH)2·H2O, a borate–carbonate of calcium and magnesium has been assessed using vibrational spectroscopy. Assignment of bands is undertaken by comparison with the data from other published results. Intense Raman band at 1134 cm−1 with a shoulder at 1123 cm−1 is assigned to the symmetric stretching mode. The Raman spectrum displays bands at 1479, 1524 and 1560 cm−1 which are assigned to the antisymmetric stretching vibrations. The observation of multiple carbonate stretching bands supports the concept that the carbonate units are non-equivalent. The Raman band at 968 cm−1 with a shoulder at 950 cm−1 is assigned to the symmetric stretching mode of trigonal boron. Raman bands at 627 and 651 cm−1 are assigned to the out-of-plane bending modes of trigonal and tetrahedral boron. Raman spectroscopy coupled with infrared spectroscopy enables the molecular structure of the mineral sakhaite to be assessed.

A basis for inquiry into policy considerations for increasing the application of biophilic urbanism

Urban design that harnesses natural features (such as green roofs and green walls) to improve design outcomes is gaining significant interest, particularly as there is growing evidence of links between human health and wellbeing, and contact with nature. The use of such natural features can provide many significant benefits, such as reduced urban heat island effects, reduced peak energy demand for building cooling, enhanced stormwater attenuation and management, and reduced air pollution and greenhouse gas emissions. The principle of harnessing natural features as functional design elements, particularly in buildings, is becoming known as ‘biophilic urbanism’. Given the potential for global application and benefits for cities from biophilic urbanism, and the growing number of successful examples of this, it is timely to develop enabling policies that help overcome current barriers to implementation. This paper describes a basis for inquiry into policy considerations related to increasing the application of biophilic urbanism. The paper draws on research undertaken as part of the Sustainable Built Environment National Research Centre (SBEnrc) In Australia in partnership with the Western Australian Department of Finance, Parsons Brinckerhoff, Green Roofs Australasia, and Townsville City Council (CitySolar Program). The paper discusses the emergence of a qualitative, mixed-method approach that combines an extensive literature review, stakeholder workshops and interviews, and a detailed study of leading case studies. It highlights the importance of experiential and contextual learnings to inform biophilic urbanism and provides a structure to distil such learnings to benefit other applications.

Adaptive teachers embracing new ways of learning with robotics in Chinese schools

In July 2010, China announced the “National Plan for Medium and Long-term Education Reform and Development(2010-2020)” (PRC 2010). The Plan calls for an education system that: • promotes an integrated development which harnesses everyone’s talent; • combines learning and thinking; unifies knowledge and practice; • allows teachers to teach according to individuals’ needs; and • reforms education quality evaluation and personnel evaluation systems focusing on performance including character, knowledge, ability and other factors. This paper discusses the design and implementation of a Professional Learning Program (PLP) undertaken by 432 primary, middle and high school teachers in China. The aim of this initiative was to develop adaptive expertise in using technology that facilitated innovative science and technology teaching and learning as envisaged by the Chinese Ministry of Education’s (2010-2020) education reforms. Key principles derived from literature about professional learning and scaffolding of learning informed the design of the PLP. The analysis of data revealed that the participants had made substantial progress towards the development of adaptive expertise. This was manifested not only by advances in the participants’ repertoires of Subject Matter Knowledge and Pedagogical Content Knowledge but also in changes to their levels of confidence and identities as teachers. It was found that through time the participants had coalesced into a professional learning community that readily engaged in the sharing, peer review, reuse and adaption, and collaborative design of innovative science and technology learning and assessment activities.

Usability and security of gaze-based graphical grid passwords

We present and analyze several gaze-based graphical password schemes based on recall and cued-recall of grid points; eye-trackers are used to record user's gazes, which can prevent shoulder-surfing and may be suitable for users with disabilities. Our 22-subject study observes that success rate and entry time for the grid-based schemes we consider are comparable to other gaze-based graphical password schemes. We propose the first password security metrics suitable for analysis of graphical grid passwords and provide an in-depth security analysis of user-generated passwords from our study, observing that, on several metrics, user-generated graphical grid passwords are substantially weaker than uniformly random passwords, despite our attempts at designing schemes to improve quality of user-generated passwords.

A vibrational spectroscopic study of the so-called ‘healing’ mineral papagoite CaCuAlSi2O6(OH)3

Papagoite is a silicate mineral named after an American Indian tribe and was used as a healing mineral. Papagoite CaCuAlSi2O6(OH)3 is a hydroxy mixed anion compound with both silicate and hydroxyl anions in the formula. The structural characterization of the mineral papagoite remains incomplete. Papagoite is a four-membered ring silicate with Cu2+ in square planar coordination. The intense sharp Raman band at 1053 cm−1 is assigned to the ν1 (A 1g) symmetric stretching vibration of the SiO4 units. The splitting of the ν3 vibrational mode offers support to the concept that the SiO4 tetrahedron in papagoite is strongly distorted. A very intense Raman band observed at 630 cm−1 with a shoulder at 644 cm−1 is assigned to the ν4 vibrational modes. Intense Raman bands at 419 and 460 cm−1 are attributed to the ν2 bending modes. Intense Raman bands at 3545 and 3573 cm−1 are assigned to the stretching vibrations of the OH units. Low-intensity Raman bands at 3368 and 3453 cm−1 are assigned to water stretching modes. It is suggested that the formula of papagoite is more likely to be CaCuAlSi2O6(OH)3 · xH2O. Hence, vibrational spectroscopy has been used to characterize the molecular structure of papagoite.

Social signal processing for pain monitoring using a hidden conditional random field

utomatic pain monitoring has the potential to greatly improve patient diagnosis and outcomes by providing a continuous objective measure. One of the most promising methods is to do this via automatically detecting facial expressions. However, current approaches have failed due to their inability to: 1) integrate the rigid and non-rigid head motion into a single feature representation, and 2) incorporate the salient temporal patterns into the classification stage. In this paper, we tackle the first problem by developing a “histogram of facial action units” representation using Active Appearance Model (AAM) face features, and then utilize a Hidden Conditional Random Field (HCRF) to overcome the second issue. We show that both of these methods improve the performance on the task of pain detection in sequence level compared to current state-of-the-art-methods on the UNBC-McMaster Shoulder Pain Archive.

The phosphate mineral arrojadite-(KFe) and its spectroscopic characterization

The arrojadite-(KFe) mineral has been analyzed using a combination of scanning electron microscopy and a combination of Raman and infrared spectroscopy. The origin of the mineral is Rapid Creek sedimentary phosphatic iron formation, northern Yukon. The formula of the mineral was determined as K2.06Na2Ca0.89Na3.23(Fe7.82Mg4.40Mn0.78)Σ13.00Al1.44(PO4)10.85(PO3OH0.23)(OH)2. The complexity of the mineral formula is reflected in the spectroscopy. Raman bands at 975, 991 and 1005 cm−1 with shoulder bands at 951 and 1024 cm−1 are assigned to the View the MathML source ν1 symmetric stretching modes. The Raman bands at 1024, 1066, 1092, 1123, 1148 and 1187 cm−1 are assigned to the View the MathML source ν3 antisymmetric stretching modes. A series of Raman bands observed at 540, 548, 557, 583, 604, 615 and 638 cm−1 are attributed to the ν4 out of plane bending modes of the PO4 and H2PO4 units. The ν2 PO4 and H2PO4 bending modes are observed at 403, 424, 449, 463, 479 and 513 cm−1. Hydroxyl and water stretching bands are readily observed. Vibrational spectroscopy enables new information about the complex phosphate mineral arrojadite-(KFe) to be obtained.

A vibrational spectroscopic study of the phosphate mineral cyrilovite Na(Fe3+)3(PO4)2(OH)4·2(H2O) and in comparison with wardite

Vibrational spectroscopy enables subtle details of the molecular structure of cyrilovite to be determined. Single crystals of a pure phase from a Brazilian pegmatite were used. Cyrilovite is the Fe3+ member of the wardite group. The infrared and Raman spectroscopy were applied to compare the structure of cyrilovite with that of wardite. The Raman spectrum of cyrilovite in the 800–1400 cm−1 spectral range shows two intense bands at 992 and 1055 cm−1 assigned to the ν1View the MathML source symmetric stretching vibrations. A series of low intensity bands at 1105, 1136, 1177 and 1184 cm−1 are assigned to the ν3View the MathML source antisymmetric stretching modes. The infrared spectrum of cyrilovite in the 500–1300 cm−1 shows much greater complexity than the Raman spectrum. Strong infrared bands are found at 970 and 1007 cm−1 and are attributed to the ν1View the MathML source symmetric stretching mode. Raman bands are observed at 612 and 631 cm−1 and are assigned to the ν4 out of plane bending modes of the View the MathML source unit. In the 2600–3800 cm−1 spectral range, intense Raman bands for cyrilovite are found at 3328 and 3452 cm−1 with a broad shoulder at 3194 cm−1 and are assigned to OH stretching vibrations. Sharp infrared bands are observed at 3485 and 3538 cm−1. Raman spectroscopy complimented with infrared spectroscopy has enabled the structure of cyrilovite to be ascertained and compared with that of wardite.

Infrared and Raman spectroscopic characterization of the carbonate mineral weloganite – Sr3Na2Zr(CO3)6·3H2O and in comparison with selected carbonates

The mineral weloganite Na2Sr3Zr(CO3)6·3H2O has been studied by using vibrational spectroscopy and a comparison is made with the spectra of weloganite with other carbonate minerals. Weloganite is member of the mckelveyite group that includes donnayite-(Y) and mckelveyite-(Y). The Raman spectrum of weloganite is characterized by an intense band at 1082 cm−1 with shoulder bands at 1061 and 1073 cm−1, attributed to the View the MathML source symmetric stretching vibration. The observation of three symmetric stretching vibrations is very unusual. The position of View the MathML source symmetric stretching vibration varies with mineral composition. The Raman bands at 1350, 1371, 1385, 1417, 1526, 1546, and 1563 cm−1 are assigned to the ν3 (CO3)2− antisymmetric stretching mode. The observation of additional Raman bands for the ν3 modes for weloganite is significant in that it shows distortion of the carbonate anion in the mineral structure. The Raman band observed at 870 cm−1 is assigned to the (CO3)2− ν2 bending mode. Raman bands observed for weloganite at 679, 682, 696, 728, 736, 749, and 762 cm−1 are assigned to the (CO3)2− ν4 bending modes. A comparison of the vibrational spectra is made with that of the rare earth carbonates decrespignyite, bastnasite, hydroxybastnasite, parisite, and northupite.