Clinical and radiographic outcomes of acetabular impaction grafting without cage reinforcement for revision hip replacement : a minimum ten-year follow-up study

Impaction bone grafting for reconstitution of bone stock in revision hip surgery has been used for nearly 30 years. We used this technique, in combination with a cemented acetabular component, in the acetabula of 304 hips in 292 patients revised for aseptic loosening between 1995 and 2001. The only additional supports used were stainless steel meshes placed against the medial wall or laterally around the acetabular rim to contain the graft. All Paprosky grades of defect were included. Clinical and radiographic outcomes were collected in surviving patients at a minimum of 10 years following the index operation. Mean follow-up was 12.4 years (SD 1.5; range 10.0-16.0). Kaplan-Meier survivorship with revision for aseptic loosening as the endpoint was 85.9% (95% CI 81.0 to 90.8%) at 13.5 years. Clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared loose radiographically.

Differential expression of VEGF ligands and receptors in prostate cancer

BACKGROUND Prostate cancer disseminates to regional lymph nodes, however the molecular mechanisms responsible for lymph node metastasis are poorly understood. The vascular endothelial growth factor (VEGF) ligand and receptor family have been implicated in the growth and spread of prostate cancer via activation of the blood vasculature and lymphatic systems. The purpose of this study was to comprehensively examine the expression pattern of VEGF ligands and receptors in the glandular epithelium, stroma, lymphatic vasculature and blood vessels in prostate cancer. METHODS The localization of VEGF-A, VEGF-C, VEGF-D, VEGF receptor (VEGFR)-1, VEGFR-2, and VEGFR-3 was examined in cancerous and adjacent benign prostate tissue from 52 subjects representing various grades of prostate cancer. RESULTS Except for VEGFR-2, extensive staining was observed for all ligands and receptors in the prostate specimens. In epithelial cells, VEGF-A and VEGFR-1 expression was higher in tumor tissue compared to benign tissue. VEGF-D and VEGFR-3 expression was significantly higher in benign tissue compared to tumor in the stroma and the endothelium of lymphatic and blood vessels. In addition, the frequency of lymphatic vessels, but not blood vessels, was lower in tumor tissue compared with benign tissue. CONCLUSIONS These results suggest that activation of VEGFR-1 by VEGF-A within the carcinoma, and activation of lymphatic endothelial cell VEGFR-3 by VEGF-D within the adjacent benign stroma may be important signaling mechanisms involved in the progression and subsequent metastatic spread of prostate cancer. Thus inhibition of these pathways may contribute to therapeutic strategies for the management of prostate cancer.

Weekly cisplatin concurrently with radiotherapy in head and neck squamous cell cancer : a retrospective analysis of a tertiary institute experience

Radiotherapy combined with three weekly 100 mg/m2 of cisplatin is the accepted standard of care in head and neck squamous cell carcinoma. However, this regimen is associated with severe toxicities with devastating effects on patients. Alternative protocols like weekly 40 mg/m2 have been used in an attempt to reduce toxicities. The main objective of the present study is to identify the dose intensities and toxicities of weekly cisplatin in patients treated in a tertiary centre over a 12 month period. Included patients had squamous cell carcinoma arising in the oral cavity, oropharynx, larynx, or hypopharynx. Patients were excluded if they had nasopharyngeal squamous cell carcinoma, distant metastasis or if they had prior treatment for head and neck cancer excluding neck dissection. During the study period, 52 patients met the inclusion criteria and their data were retrospectively obtained from the patients' database of St James hospital, Dublin. The median age of the study cohort was 54 years (range 33-73). Of the patients, 40 (76.9 %) were male and 12 (20.1 %) were female. The primary tumour sites were as follows: oral cavity and oropharynx in 38 (73 %), larynx in 10 (19 %), and hypopharynx in 4 (8 %). In total, 33 (63.5 %) patients had stage IV disease, while 19 (36.5 %) had stage III disease. Treatment was definitive in 35 (67 %) patients and adjuvant in 17 (35 %). Full-dose radiotherapy was achieved in 50 (96 %) patients. Only 22 (42.3 %) patients completed the intended six cycles of chemotherapy. Cumulative dose of 200 mg/m2 or more was reached in 37 (71 %) patients. The acute adverse effects included grades 3 and 4 mucositis, which occurred in 22 (43.3 %) and 6 patients (12 %), respectively. Grade 3 and 4 neutropenia occurred in six (11.5 %) and three (5.7 %) patients, respectively. The only other haematological toxicity was grade 3 anaemia in 20 (38.4 %) patients. There was no grade 3 or 4 renal toxicity among the study cohort, although grade 2 was observed in six (11.5 %) patients. Death occurred in one patient due to neutropenic septicaemia. In conclusion, weekly cisplatin is associated with moderate to severe toxicities and might lead to suboptimal chemotherapy delivery. More prospective clinical studies are required to determine the optimal chemoradiation regimen in head and neck squamous cell carcinoma.

Supermarkets and private standards : unintended consequences of the audit ritual

Recent scholarship has considered the implications of the rise of voluntary private standards in food and the role of private actors in a rapidly evolving, de-facto ‘mandatory’ sphere of governance. Standards are an important element of this globalising private sphere, but are an element that has been relatively peripheral in analyses of power in agri-food systems. Sociological thought has countered orthodox views of standards as simple tools of measurement, instead understanding their function as a governance mechanism that transforms many things, and people, during processes of standardisation. In a case study of the Australian retail supermarket duopoly and the proprietary standards required for market access this paper foregrounds retailers as standard owners and their role in third-party auditing and certification. Interview data from primary research into Australia’s food standards captures the multifaceted role supermarkets play as standard-owners, who are found to impinge on the independence of third-party certification while enforcing rigorous audit practices. We show how standard owners, in attempting to standardize the audit process, generate tensions within certification practices in a unique example of ritualism around audit. In examining standards to understand power in contemporary food governance, it is shown that retailers are drawn beyond standard-setting into certification and enforcement, that is characterized by a web of institutions and actors whose power to influence outcomes is uneven.

What knowledge do ICU nurses have with regard to the effects of noise exposure in the Intensive Care Unit?

This small-scale study was undertaken to assess what knowledge nursing staff from a General Intensive Care Unit held with regard to noise exposure. To assess knowledge a self-administered multiple-choice questionnaire was used. Rigorous peer-review insured content validity. This study produced poor results in terms of the knowledge nurses held with regard to noise related issues in particular the psychophysiological effects and current legislation concerning its safe exposure. Non-parametric testing, using Kruskal–Wallis found no significant difference between nursing grades, however, descriptive analysis demonstrated that the staff nurse grade (D and E) performed better overall. Whilst the results of this study may seem self-evident in some respects, it is the problems of exposure to excessive noise levels for both patients and hospital personnel, which are clearly not understood. The effects noise exposure has on individuals for example decreased wound healing; sleep deprivation and cardiovascular stimulation must be of concern especially in terms of patient care but more so for nursing staff especially the effects noise levels can have on cognitive task performance.

Bridging the gap in school achievement through the arts : summary report

Educational Transformations Pty Ltd was commissioned by The Song Room (TSR) to conduct a study of the impact of TSR programs in government schools in relatively disadvantaged communities in New South Wales (NSW) on indicators of student performance that have been identified in previous research as related to potential engagement in juvenile crime. Students in Grades 5 and 6 were the subjects of study. TSR is a not-for-profit organisation in receipt of grants from public and private sources that conducts free programs in the performing arts in schools where these are not currently offered. These programs are conducted by mutual agreement between TSR and participating schools. Across Australia, approximately 200 schools and 40,000 students are engaged for a minimum of six months each year. Students typically participate for approximately one hour per week in each class. Instruction is provided by a Teaching Artist (TA), contracted to TSR and working in partnership with the classroom teacher at the school of placement. TSR received a three-year grant from the Macquarie Group Foundation to investigate the efficacy of its interventions in improving social and education outcomes for children in a range of high need target group areas participating in its program...

Promoting Statistical Literacy Through Data Modelling in the Early School Years

This chapter addresses data modelling as a means of promoting statistical literacy in the early grades. Consideration is first given to the importance of increasing young children’s exposure to statistical reasoning experiences and how data modelling can be a rich means of doing so. Selected components of data modelling are then reviewed, followed by a report on some findings from the third-year of a three-year longitudinal study across grades one through three.

Fire performance of cold-formed steel wall panels and prediction of their fire resistance rating

Recent research at the Queensland University of Technology has investigated the structural and thermal behaviour of load bearing Light gauge Steel Frame (LSF) wall systems made of 1.15 mm G500 steel studs and varying plasterboard and insulation configurations (cavity and external insulation) using full scale fire tests. Suitable finite element models of LSF walls were then developed and validated by comparing with test results. In this study, the validated finite element models of LSF wall panels subject to standard fire conditions were used in a detailed parametric study to investigate the effects of important parameters such as steel grade and thickness, plasterboard screw spacing, plasterboard lateral restraint, insulation materials and load ratio on their performance under standard fire conditions. Suitable equations were proposed to predict the time–temperature profiles of LSF wall studs with eight different plasterboard-insulation configurations, and used in the finite element analyses. Finite element parametric studies produced extensive fire performance data for the LSF wall panels in the form of load ratio versus time and critical hot flange (failure) temperature curves for eight wall configurations. This data demonstrated the superior fire performance of externally insulated LSF wall panels made of different steel grades and thicknesses. It also led to the development of a set of equations to predict the important relationship between the load ratio and the critical hot flange temperature of LSF wall studs. Finally this paper proposes a simplified method to predict the fire resistance rating of LSF walls based on the two proposed set of equations for the load ratio–hot flange temperature and the time–temperature relationships.

Age and gender differences in objectively measured physical activity in youth

Purpose The purpose of this study was to evaluate age and gender differences in objectively measured physical activity (PA) in a population-based sample of students in grades 1–12. Methods Participants (185 male, 190 female) wore a CSA 7164 accelerometer for 7 consecutive days. To examine age-related trends, students were grouped as follows: grades 1–3 (N = 90), grades 4–6 (N = 91), grades 7–9 (N = 96), and grades 10–12 (N = 92). Bouts of PA and minutes spent in moderate-to-vigorous PA (MVPA) and vigorous PA (VPA) were examined. Results Daily MVPA and VPA exhibited a significant inverse relationship with grade level, with the largest differences occurring between grades 1–3 and 4–6. Boys were more active than girls; however, for overall PA, the magnitudes of the gender differences were modest. Participation in continuous 20-min bouts of PA was low to nonexistent. Conclusion Our results support the notion that PA declines rapidly during childhood and adolescence and that accelerometers are feasible alternatives to self-report methods in moderately sized population-level surveillance studies.

Evaluating a model of parental influence on youth physical activity

Objective To test a conceptual model linking parental physical activity orientations, parental support for physical activity, and children's self-efficacy perceptions with physical activity participation. Participants and setting The sample consisted of 380 students in grades 7 through 12 (mean age, 14.0±1.6 years) and their parents. Data collection took place during the fall of 1996. Main outcome measures Parents completed a questionnaire assessing their physical activity habits, enjoyment of physical activity, beliefs regarding the importance of physical activity, and supportive behaviors for their child's physical activity. Students completed a 46-item inventory assessing physical activity during the previous 7 days and a 5-item physical activity self-efficacy scale. The model was tested via observed variable path analysis using structural equation modeling techniques (AMOS 4.0). Results An initial model, in which parent physical activity orientations predicted child physical activity via parental support and child self-efficacy, did not provide an acceptable fit to the data. Inclusion of a direct path from parental support to child physical activity and deletion of a nonsignificant path from parental physical activity to child physical activity significantly improved model fit. Standardized path coefficients for the revised model ranged from 0.17 to 0.24, and all were significant at the p<0.0001 level. Conclusions Parental support was an important correlate of youth physical activity, acting directly or indirectly through its influence on self-efficacy. Physical activity interventions targeted at youth should include and evaluate the efficacy of individual-level and community-level strategies to increase parents’ capacity to provide instrumental and motivational support for their children's physical activity.

Physical activity patterns of inner-city elementary schoolchildren

Purpose This study aimed to objectively measure the physical activity (PA) characteristics of a racially and ethnically diverse sample of inner-city elementary schoolchildren and to examine the influence of sex, race/ethnicity, grade level, and weight status on PA. Methods A total of 470 students in grades 4-6 from six inner-city schools in Philadelphia wore an ActiGraph GT3X+ accelerometer (Actigraph, Pensacola, FL) for up to 7 d. The resultant data were uploaded to a customized Visual Basic EXCEL macro to determine the time spent in sedentary (SED), light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA). Results On average, students accumulated 48 min of MVPA daily. Expressed as a percentage of monitoring time, students were sedentary for 63% of the time, in LPA 31% of the time, and in MVPA 6% of the time. Across all race/ethnicity and grade level groups, boys exhibited significantly higher levels of MVPA than girls did; fifth-grade boys exhibited significantly lower MVPA levels than fourth-and sixth-grade boys did, and sixth-grade girls exhibited significantly lower MVPA levels than fourth-and fifth-grade girls did. Hispanic children exhibited lower levels of MVPA than children from other racial/ethnic groups did, and overweight and obese children exhibited significantly lower MVPA levels than children in the healthy weight range did. Across the entire sample, only 24.3% met the current public health guidelines for PA. Physical inactivity was significantly greater among females, Hispanics, and overweight and obese students. Conclusions Fewer than one in four inner-city schoolchildren accumulated the recommended 60 min of MVPA daily. These findings highlight the need for effective and sustainable programs to promote PA in inner-city youth.

Using objective physical activity measures with youth : How many days of monitoring are needed?

Purpose The purpose of this study was to establish the minimal number of days of monitoring required for accelerometers to assess usual physical activity in children. Methods A total of 381 students (189 M, 192 F) wore a CSA 7164 uniaxial accelerometer for seven consecutive days. To examine age-related trends students were grouped as follows: Group I: grades 1-3 (N = 92); Group II: grades 4-6 (N = 98); Group III: grades 7-9 (N = 97); Group IV: grades 10-12 (N = 94). Average daily time spent in moderate-to-vigorous physical activity (MVPA) was calculated from minute-by-minute activity counts using the regression equation developed by Freedson et al. (1997). Results Compared with adolescents in grades 7 to 12, children in grades 1 to 6 exhibited less day-to-day variability in MVPA behavior. Spearman-Brown analysts indicated that between 4 and 5 d of monitoring would be necessary to a achieve a reliability of 0.80 in children, and between 8 and 9 d of monitoring would be necessary to achieve a reliability of 0.80 in adolescents. Within all grade levels, the 7-d monitoring protocol produced acceptable estimates of daily participation in MVPA (R = 0.76 (0.71-0.81) to 0.87 (0.84-0.90)). Compared with weekdays, children exhibited significantly higher levels of MVPA on weekends, whereas adolescents exhibited significantly lower levels of MVPA on weekends. Principal components analysis revealed two distinct time components for MVPA during the day for children (early morning, rest of the day), and three distinct time components for MVPA during the day for adolescents (morning, afternoon, early evening). Conclusions These results indicate that a 7-d monitoring protocol provides reliable estimates of usual physical activity behavior in children and adolescents and accounts for potentially important differences in weekend versus weekday activity behavior as well as differences in activity patterns within a given day.

Physical activity levels among children attending after-school programs

Purpose To describe the physical activity (PA) levels of children attending after-school programs, 2) examine PA levels in specific after-school sessions and activity contexts, and 3) evaluate after-school PA differences in groups defined by sex and weight status. Methods One hundred forty-seven students in grades 3-6 (mean age: 10.1 +/- 0.7, 54.4% male, 16.5% overweight (OW), 22.8% at-risk for OW) from seven after-school programs in the midwestern United States wore Actigraph GT1M accelerometers for the duration of their attendance to the program. PA was objectively assessed on six occasions during an academic year (three fall and three spring). Stored activity counts were uploaded to a customized data-reduction program to determine minutes of sedentary (SED), light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) physical activity. Time spent in each intensity category was calculated for the duration of program attendance, as well as specific after-school sessions (e.g., free play, snack time). Results On average, participants exhibited 42.6 min of SED, 40.8 min of LPA, 13.4 min of MPA, and 5.3 min of VPA. The average accumulation of MVPA was 20.3 min. Boys exhibited higher levels of MPA, VPA, and MVPA, and lower levels of SED and LPA, than girls. OW and at-risk-for-OW students exhibited significantly less VPA than nonoverweight students, but similar levels of LPA, MPA, and MVPA. MVPA levels were significantly higher during free-play activity sessions than during organized or structured activity sessions. Conclusion After-school programs seem to be an important contributor to the PA of attending children. Nevertheless, ample room for improvement exists by making better use of existing time devoted to physical activity.

Agreement between student-reported and proxy-reported physical activity questionnaires

Parents and 531 students (46% males, 78% white) completed equivalent questionnaires. Agreement between student and parent responses to questions about hypothesized physical activity (PA) correlates was assessed. Relationships between hypothesized correlates and an objective measure of student's moderate-to-vigorous physical activity (MVPA) in a subset of 177 students were also investigated. Agreement between student and parent ranged from r = .34 to .64 for PA correlates. Spearman correlations between MVPA and PA correlates ranged from –.04 to .21 for student report and –.14 to .32 for parent report, and there were no statistical differences for 8 out of 9 correlations between parent and student. Parents can provide useful data on PA correlates for students in Grades 7–12.

Compliance with physical activity guidelines : prevalence in a population of children and youth

PURPOSE To use objective monitoring of physical activity to determine the percentages of children and youth in a population that met physical activity guidelines. METHODS A total of 375 students in grades 1–12 wore an accelerometer (CSA 7164) for seven consecutive days. Bouts of continuous activity and accumulation of minutes spent in physical activity at various intensities were calculated to determine how many students met three physical activity guidelines. RESULTS Over 90% of students met Healthy People 2010, Objective 22.6 and nearly 70% met the United Kingdom Expert Consensus Group guideline, both of which recommend daily accumulation of moderate physical activity. Less than 3% met Healthy People 2010, Objective 22.7, which calls for bouts of continuous vigorous physical activity. For the United Kingdom Expert Consensus Group guideline, compliance decreased markedly with age, but gender differences were not statistically significant. CONCLUSIONS Prevalence estimates for compliance with national physical activity guidelines varied markedly for the three guidelines examined. Objective monitoring of physical activity in youth appears to be feasible and may provide more accurate prevalence rates than self-report measures.