The "flap-shaft" prosthesis for insensate feet with Chopart or Lisfranc amputations

BACKGROUND: The inevitable detachment of tendons and the loss of the forefoot in Chopart and Lisfranc amputations result in equinus and varus of the residual foot. In an insensate foot these deformities can lead to keratotic lesions and ulcerations. The currently available prostheses cannot safely counteract the deforming forces and the resulting complications. METHODS: A new below-knee prosthesis was developed, combining a soft socket with a rigid shaft. The mold is taken with the foot in the corrected position. After manufacturing the shaft, the lateral third of the circumference of the shaft is cut away and reattached distally with a hinge, creating a lateral flap. By closing this flap the hindfoot is gently levered from the varus position into valgus. Ten patients (seven amputations at the Chopart-level, three amputations at the Lisfranc-level) with insensate feet were fitted with this prosthesis at an average of 3 (range 1.5 to 9) months after amputation. The handling, comfort, time of daily use, mobility, correction of malposition and complications were recorded to the latest followup (average 31 months, range 24 to 37 months after amputation). RESULTS: Eight patients evaluated the handling as easy, two as difficult. No patient felt discomfort in the prosthesis. The average time of daily use was 12 hours, and all patients were able to walk. All varus deformities were corrected in the prosthesis. Sagittal alignment was kept neutral. Complications were two minor skin lesions and one small ulcer, all of which responded to conservative treatment, and one ulcer healed after debridement and lengthening of the Achilles tendon. CONCLUSIONS: The "flap-shaft" prosthesis is a valuable option for primary or secondary prosthetic fitting of Chopart-level and Lisfranc-level amputees with insensate feet and flexible equinus and varus deformity at risk for recurrent ulceration. It provided safe and sufficient correction of malpositions and enabled the patients to walk as much as their general condition permitted.

Focal adhesion kinase is a load-dependent governor of the slow contractile and oxidative muscle phenotype

Striated muscle exhibits a pronounced structural-functional plasticity in response to chronic alterations in loading. We assessed the implication of focal adhesion kinase (FAK) signalling in mechano-regulated differentiation of slow-oxidative muscle. Load-dependent consequences of FAK signal modulation were identified using a multi-level approach after electrotransfer of rat soleus muscle with FAK-expression plasmid vs. empty plasmid-transfected contralateral controls. Muscle fibre-targeted over-expression of FAK in anti-gravitational muscle for 9 days up-regulated transcript levels of gene ontologies underpinning mitochondrial metabolism and contraction in the transfected belly portion. Concomitantly, mRNA expression of the major fast-type myosin heavy chain (MHC) isoform, MHC2A, was reduced. The promotion of the slow-oxidative expression programme by FAK was abolished after co-expression of the FAK inhibitor FAK-related non-kinase (FRNK). Elevated protein content of MHC1 (+9%) and proteins of mitochondrial respiration (+165-610%) with FAK overexpression demonstrated the translation of transcript differentiation in targeted muscle fibres towards a slow-oxidative muscle phenotype. Coincidentally MHC2A protein was reduced by 50% due to protection of muscle from de-differentiation with electrotransfer. Fibre cross section in FAK-transfected muscle was elevated by 6%. The FAK-modulated muscle transcriptome was load-dependent and regulated in correspondence to tyrosine 397 phosphorylation of FAK. In the context of overload, the FAK-induced gene expression became manifest at the level of contraction by a slow transformation and the re-establishment of normal muscle force from the lowered levels with transfection. These results highlight the analytic power of a systematic somatic transgene approach by mapping a role of FAK in the dominant mechano-regulation of muscular motor performance via control of gene expression.

Lethal respiratory failure and mild primary hypothyroidism in a term girl with a de novo heterozygous mutation in the TITF1/NKX2.1 gene

CONTEXT: Thyroid transcription factor 1 (TITF1/NKX2.1) is expressed in the thyroid, lung, ventral forebrain, and pituitary. In the lung, TITF1/NKX2.1 activates the expression of genes critical for lung development and function. Titf/Nkx2.1(-/-) mice have pituitary and thyroid aplasia but also impairment of pulmonary branching. Humans with heterozygous TITF1/NKX2.1 mutations present with various combinations of primary hypothyroidism, respiratory distress, and neurological disorders. OBJECTIVE: The objective of the study was to report clinical and molecular studies of the first patient with lethal neonatal respiratory distress from a novel heterozygous TITF1/NKX2.1 mutation. Participant: This girl, the first child of healthy nonconsanguineous French-Canadian parents, was born at 41 wk. Birth weight was 3,460 g and Apgar scores were normal. Soon after birth, she developed acute respiratory failure with pulmonary hypertension. At neonatal screening on the second day of life, TSH was 31 mU/liter (N <15) and total T(4) 245 nmol/liter (N = 120-350). Despite mechanical ventilation, thyroxine, surfactant, and pulmonary vasodilators, the patient died on the 40th day. RESULTS: Histopathology revealed pulmonary tissue with low alveolar counts. The thyroid was normal. Sequencing of the patient's lymphocyte DNA revealed a novel heterozygous TITF1/NKX2.1 mutation (I207F). This mutation was not found in either parent. In vitro, the mutant TITF-1 had reduced DNA binding and transactivation capacity. CONCLUSION: This is the first reported case of a heterozygous TITF1/NKX2.1 mutation leading to neonatal death from respiratory failure. The association of severe unexplained respiratory distress in a term neonate with mild primary hypothyroidism is the clue that led to the diagnosis.

Between Equity and Empathy: Social Professions and the New Accountability

This article explores the practical and ethical implications of the ‘new accountability’ (working to procedures, targets and standards) based on interviews with British social professionals. Although similar tendencies are present in other European countries, in Britain the rule-bound nature of social work is more intense. Practitioners who regard the ‘new accountability’ positively justify their views with reference to utilitarian and rights-based arguments relating to the promotion of good outcomes, the achievement of equity, respecting the consumer rights of service users and the rights of other stakeholders to information and value for money. Those practitioners who view the new accountability requirements negatively seem to speak in a different ‘moral voice’, which can be linked to more personal and situated approaches to ethics, stressing the importance of particular relationships in context, trust, sensitivity and a sense of ‘vocation’. Both ‘voices’ are part of professional practice, but the new accountability stresses the former at the expense of the latter. For social work to play the critical role identified by Walter Lorenz, maintaining a creative balance between equity and empathy will be important.

The Impact of Western Social Workers in Romania - a Fine Line between Empowerment and Disempowerment

Ideally the social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance their well-being (IFSW 2004). The social work practice, however, often proves to be different. Social workers are always in the danger to make decisions for their clients or define problems according to their own interpretation and world view. In quite a number of cases, the consequence of such a social work practice is that the clients feel disempowered rather than empowered. This dilemma is multiplying when western social workers get involved in developing countries. The potential that intervention, with the intention to empower and liberate the people, turns into disempowerment is tremendously higher because of the differences in tradition, culture and society, on the one side and the power imbalance between the ‘West’ and the ‘Rest’ on the other side. Especially in developing countries, where the vast majority of people live in poverty, many Western social workers come with a lot of sympathy and the idea to help the poor and to change the world. An example is Romania. After the collapse of communism in 1989, Romania was an economically, politically and socially devastated country. The pictures of the orphanages shocked the western world. As a result many Non-Governmental Organisations (NGOs), churches and individuals were bringing humanitarian goods to Romania in order to alleviate the misery of the Romanian people and especially the children. Since then, important changes in all areas of life have occurred, mostly with foreign financial aid and support. At the political level, democratic institutions were established, a liberal market economy was launched and laws were adapted to western standards regarding the accession into the European Union and the NATO. The western world has left its marks also at the grassroots level in form of NGOs or social service agencies established through western grants and individuals. Above and beyond, the presence of western goods and investment in Romania is omnipresent. This reflects a newly-gained freedom and prosperity - Romania profits certainly from these changes. But this is only one side of the medal, as the effect of westernisation contradicts with the Romanian reality and overruns many deep-rooted traditions, thus the majority of people. Moreover, only a small percentage of the population has access to this western world. Western concepts, procedures or interpretations are often highly differing from the Romanian tradition, history and culture. Nevertheless, western ideas seem to dominate the transition in many areas of daily life in Romania. A closer look reveals that many changes take place due to pressure of western governments and are conditioned to financial support. The dialectic relationship between the need for foreign aid and the implementation becomes very obvious in Romania and often leads, despite the substantial benefits, to unpredictable and rather negative side-effects, at a political, social, cultural, ecological and/or economic level. This reality is a huge dilemma for all those involved, as there is a fine line between empowering and disempowering action. It is beyond the scope of this journal to discuss the dilemma posed by Western involvement at all levels; therefore this article focuses on the impact of Western social workers in Romania. The first part consists of a short introduction to social work in Romania, followed by the discussion about the dilemma posed by the structure of project of international social work and the organisation of private social service agencies. Thirdly the experiences of Romanian staff with Western social workers are presented and then discussed with regard to turning disempowering tendencies of Western social workers into empowerment.

The art to keep in touch: The ''good use'' of Lagrange multipliers

Physically-based modeling for computer animation allows to produce more realistic motions in less time without requiring the expertise of skilled animators. But, a computer animation is not only a numerical simulation based on classical mechanics since it follows a precise story-line. One common way to define aims in an animation is to add geometric constraints. There are several methods to manage these constraints within a physically-based framework. In this paper, we present an algorithm for constraints handling based on Lagrange multipliers. After few remarks on the equations of motion that we use, we present a first algorithm proposed by Platt. We show with a simple example that this method is not reliable. Our contribution consists in improving this algorithm to provide an efficient and robust method to handle simultaneous active constraints.

The Effects of Living in Segregated vs. Mixed Areas in Northern Ireland: A Simultaneous Analysis of Contact and Threat Effects in the Context of Micro-Level Neighbourhoods

This study examines the consequences of living in segregated and mixed neighbourhoods on ingroup bias and offensive action tendencies, taking into consideration the role of intergroup experiences and perceived threat. Using adult data from a cross-sectional survey in Belfast, Northern Ireland, we tested a model that examined the relationship between living in segregated (N = 396) and mixed (N = 562) neighbourhoods and positive contact, exposure to violence, perceived threat and outgroup orientations. Our results show that living in mixed neighbourhoods was associated with lower ingroup bias and reduced offensive action tendencies. These effects were partially mediated by positive contact. However, our analysis also shows that respondents living in mixed neighbourhoods report higher exposure to political violence and higher perceived threat to physical safety. These findings demonstrate the importance of examining both social experience and threat perceptions when testing the relationship between social environment and prejudice.

Observations of the northern seasonal polar cap on Mars: I. Spring sublimation activity and processes

Spring sublimation of the seasonal CO2 northern polar cap is a dynamic process in the current Mars climate. Phenomena include dark fans of dune material propelled out onto the seasonal ice layer, polygonal cracks in the seasonal ice, sand flow down slipfaces, and outbreaks of gas and sand around the dune margins. These phenomena are concentrated on the north polar erg that encircles the northern residual polar cap. The Mars Reconnaissance Orbiter has been in orbit for three Mars years, allowing us to observe three northern spring seasons. Activity is consistent with and well described by the Kieffer model of basal sublimation of the seasonal layer of ice applied originally in the southern hemisphere. Three typical weak spots have been identified on the dunes for escape of gas sublimed from the bottom of the seasonal ice layer: the crest of the dune, the interface of the dune with the interdune substrate, and through polygonal cracks in the ice. Pressurized gas flows through these vents and carries out material entrained from the dune. Furrows in the dunes channel gas to outbreak points and may be the northern equivalent of southern radially-organized channels ("araneiform" terrain), albeit not permanent. Properties of the seasonal CO2 ice layer are derived from timing of seasonal events such as when final sublimation occurs. Modification of dune morphology shows that landscape evolution is occurring on Mars today, driven by seasonal activity associated with sublimation of the seasonal CO2 polar cap.

Observations of the northern seasonal polar cap on Mars II: HiRISE photometric analysis of evolution of northern polar dunes in spring

We present an overview of our analyses of HiRISE observations of spring evolution of selected dune areas of the north polar erg. The north polar erg is covered annually by seasonal volatile ice layer, a mixture of CO2 and H2O with mineral dust contamination. In spring, this layer sublimes creating visually enigmatic phenomena, e.g. dark and bright fan-shaped deposits, dark–bright–dark bandings, dark down-slope streaks, and seasonal polygonal cracks. Similar phenomena in southern polar areas are believed to be related to the specific process of solid-state greenhouse effect. In the north, it is currently unclear if the solid-state greenhouse effect is able to explain all the observed phenomena especially because the increased influence of H2O on the time scales of this process has not yet been quantified. HiRISE observations of our selected locations show that the ground exhibits a temporal behaviour similar to the one observed in the southern polar areas: a brightening phase starting close to the spring equinox with a subsequent darkening towards summer solstice. The resolution of HiRISE enabled us to study dunes and substrate individually and even distinguish between different developments on windward and slip face sides of single dunes. Differences in the seasonal evolution between steep slip faces and flatter substrate and windward sides of dunes have been identified and compared to CRISM data of CO2 and H2O distributions on dunes. We also observe small scale dark blotches that appear in early observations and tend to sustain a low reflectivity throughout the spring. These blotches can be regarded as the analogue of dark fan deposits in southern polar areas, leading us to the conclusion that both martian polar areas follow similar spring evolutions.

Observations of the northern seasonal polar cap on Mars III: CRISM/HiRISE observations of spring sublimation

We analyze a series of targeted CRISM and HiRISE observations of seven regions of interest at high latitudes in the Northern polar regions of Mars. These data allow us to investigate the temporal evolution of the composition of the seasonal ice cap during spring, with a special emphasis on peculiar phenomena occurring in the dune fields and in the vicinity of the scarps of the North Polar Layered Deposits (NPLDs). The strength of the spectral signature of CO2 ice continuously decreases during spring whereas the one of H2O ice first shows a strong increase until Ls = 50°. This evolution is consistent with a scenario previously established from analysis of OMEGA data, in which a thin layer of pure H2O ice progressively develops at the surface of the volatile layer. During early spring (Ls < 10°), widespread jet activity is observed by HiRISE while strong spectral signatures of CO2 ice are detected by CRISM. Later, around Ls = 20-40°, activity concentrates at the dune fields where CRISM also detects a spectral enrichment in CO2 ice, consistent with "Kieffer's model" (Kieffer, H.H. [2007]. J. Geophys. Res. 112, E08005. doi:10.1029/2006JE002816) for jet activity. Effects of wind are prominent across the dune fields and seem to strongly influence the sublimation of the volatile layer. Strong winds blowing down the scarps could also be responsible for the significant spatial and temporal variability of the surface ice composition observed close to the NPLD.