Validity and reliability of hallux valgus angle measured on digital photographs

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: To investigate the reliability and concurrent validity of photographic measurements of hallux valgus angle compared to radiographs as the criterion standard. BACKGROUND: Clinical assessment of hallux valgus involves measuring alignment between the first toe and metatarsal on weight-bearing radiographs or visually grading the severity of deformity with categorical scales. Digital photographs offer a noninvasive method of measuring deformity on an exact scale; however, the validity of this technique has not previously been established. METHODS: Thirty-eight subjects (30 female, 8 male) were examined (76 feet, 54 with hallux valgus). Computer software was used to measure hallux valgus angle from digital records of bilateral weight-bearing dorsoplantar foot radiographs and photographs. One examiner measured 76 feet on 2 occasions 2 weeks apart, and a second examiner measured 40 feet on a single occasion. Reliability was investigated by intraclass correlation coefficients and validity by 95% limits of agreement. The Pearson correlation coefficient was also calculated. RESULTS: Intrarater and interrater reliability were very high (intraclass correlation coefficients greater than 0.96) and 95% limits of agreement between photographic and radiographic measurements were acceptable. Measurements from photographs and radiographs were also highly correlated (Pearson r = 0.96). CONCLUSIONS: Digital photographic measurements of hallux valgus angle are reliable and have acceptable validity compared to weight-bearing radiographs. This method provides a convenient and precise tool in assessment of hallux valgus, while avoiding the cost and radiation exposure associated with radiographs.

Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis

BACKGROUND: The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes. OBJECTIVE: The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD. DESIGN: Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD. RESULTS: Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups. CONCLUSION: This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials.

Democracy, Crime and Justice. Annals of the American Academy of Political and Social Sciences

As a growing number of nations embark on a path to democracy, criminologists have become increasingly interested and engaged in the challenges, concerns, and questions connecting democracy with both crime and criminal justice. Rising levels of violence and street crime, white collar crime and corruption both in countries where democracy is securely in place and where it is struggling, have fuelled a deepening skepticism as to the capacity of democracy to deliver on its promise of security and justice for all citizens. What role does crime and criminal justice play in the future of democracy and for democratic political development on a global level? The editors of this special volume of The Annals realized the importance of collecting research from a broad spectrum of countries and covering a range of problems that affect citizens, politicians, and criminal justice officials. The articles here represent a solid balance between mature democracies like the U.S. and U.K. as well as emerging democracies around the globe – specifically in Latin America, Africa and Eastern Europe. They are based on large and small cross-national samples, regional comparisons, and case studies. Each contribution addresses a seminal question for the future of democratic political development across the globe. What is the role of criminal justice in the process of building democracy and instilling confidence in its institutions? Is there a role for unions in democratizing police forces? What is the impact of widespread disenfranchisement of felons on democratic citizenship and the life of democratic institutions? Under what circumstances do mature democracies adopt punitive sentencing regimes? Addressing sensitive topics such as relations between police and the Muslim communities of Western Europe in the wake of terrorist attacks, this volume also sheds light on the effects of terrorism on mature democracies under increasing pressure to provide security for their citizens. By taking a broad vantage point, this collection of research delves into complex topics such as the relationship between the process of democratization and violent crime waves; the impact of rising crime rates on newly established as well as secure democracies; how crime may endanger the transition to democracy; and how existing practices of criminal justice in mature democracies affect their core values and institutions. The collection of these insightful articles not only begins to fill a gap in criminological research but also addresses issues of critical interest to political scientists as well as other social and behavioral scientists and scholars. Taking a fresh approach to the intersection of crime, criminal justice, and democracy, this volume of The Annals is a must-read for criminologists and political scientists and provides a solid foundation for further interdisciplinary research.

Helping understand nutritional gaps in the elderly (HUNGER) : a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients

BACKGROUND: Malnutrition, and poor intake during hospitalisation, are common in older medical patients. Better understanding of patient-specific factors associated with poor intake may inform nutritional interventions. AIMS: To measure the proportion of older medical patients with inadequate nutritional intake, and identify patient-related factors associated with this outcome. METHODS: Prospective cohort study enrolling consecutive consenting medical inpatients aged 65 years or older. Primary outcome was energy intake less than resting energy expenditure estimated using weight-based equations. Energy intake was calculated for a single day using direct observation of plate waste. Explanatory variables included age, gender, number of co-morbidities, number of medications, diagnosis, usual residence, nutritional status, functional and cognitive impairment, depressive symptoms, poor appetite, poor dentition, and dysphagia. RESULTS: Of 134 participants (mean age 80 years, 51% female), only 41% met estimated resting energy requirements. Mean energy intake was 1220 kcal/day (SD 440), or 18.1 kcal/kg/day. Factors associated with inadequate energy intake in multivariate analysis were poor appetite, higher BMI, diagnosis of infection or cancer, delirium and need for assistance with feeding. CONCLUSIONS: Inadequate nutritional intake is common, and patient factors contributing to poor intake need to be considered in nutritional interventions.

The red mist? red shirts, success and team sports

Baron von Richthofen (the Red Baron) arguably the most famous fighter pilot of all time painted his plane the vividest of red hues, making it visible and identifiable at great distance, showing an aggressive pronouncement of dominance to other pilots. Can colour affect aggression and performance and if so is it observable within team sports? This study explores the effect of red on sporting performances within a team sports arena, through empirical analysis of match results from the Australian Rugby League spanning a period of 30 years. Both the descriptive analysis and the multivariate analysis report a positive relationship. Nevertheless, more evidence is required to better understand whether teams in red do enjoy greater success controlling explicitly in a multivariate analysis for many factors that simultaneously affect performance.

Malnutrition and falls risk in community-dwelling older adults

Background and Aims: Falls and fall-related injuries result in reduced functioning, loss of independence, premature nursing home admissions and mortality. Malnutrition is associated with falls in the acute setting, but little is known about malnutrition and falls risk in the community. The aim of this study was to assess the association between malnutrition risk, falls risk and falls over a one-year period in community-dwelling older adults. Methods: Two hundred and fifty four subjects >65 years of age were recruited to participate in a study in order to identify risk factors for falls. Malnutrition risk was determined using the Mini Nutritional Assessment–Short Form. Results: 28.6% had experienced a fall and according to the Mini Nutritional Assessment-Short Form 3.9% (n=10) of subjects were at risk of malnutrition. There were no associations between malnutrition risk, the risk of falls, nor actual falls in healthy older adults in the community setting. Conclusions: There was a low prevalence of malnutrition risk in this sample of community-dwelling older adults and no association between nutritional risk and falls. Screening as part of a falls prevention program should focus on the risk of developing malnutrition as this is associated with falls.