Prospective Evaluation of Clinical and Ultrasound Findings in Ankle Disease in Juvenile Idiopathic Arthritis: Importance of Ankle Ultrasound

Objective. To prospectively compare clinical examination of the ankle structures with ultrasound (US) findings. Methods. In 42 children with juvenile idiopathic arthritis (JIA; 25 girls, 17 boys, mean age 11.3 yrs, range 2.3–22.3 yrs), a total of 61 swollen/painful ankles were assessed clinically and ultrasonographically. Accurate clinical examination of the entire ankle joint was performed, focusing especially on 3 regions — tibiotalar joint and medial and lateral tendons. Clinical and US findings were both scored 0–3 (normal-severe). Results. US demonstrated no signs of tibiotalar joint effusion in 14 out of 43 ankles considered clinically involved. For the medial tendons, US showed tenosynovitis in 13 ankles out of 31 thought to be clinically normal; and for the lateral tendons, of the 19 deemed to be clinically involved, less than 50% had involvement on US. Very poor agreement was observed comparing the clinical and US scores for the 3 regions: tibiotalar joint, kappa = 0.3; medial tendons, kappa = 0.24; lateral tendons, kappa = 0.25. With regard to other ankle structures, only 39% of the subtalar (talocalcaneal) joints considered clinically involved were deemed abnormal on US. Finally, of the 10 ankles with talonavicular US effusion, only 2 were considered clinically involved. Conclusion. Using US findings as the “gold standard,” clinical examination of the ankle in children with JIA was found to be inadequate in identifying the structures involved. US assessment prior to any glucocorticoid injection should be considered to improve the outcome. A prospective study comparing the outcome following clinical- versus US-guided ankle joint injection should be undertaken, to confirm our findings.

Memory-keeping effects and forgetfulness in the dynamics of a qubit coupled to a spin chain

Using recently proposed measures for non-Markovianity [H.-P. Breuer, E. M. Laine, and J. Piilo, Phys. Rev. Lett. 103, 210401 (2009)], we study the dynamics of a qubit coupled to a spin environment via an energy-exchange mechanism. We show the existence of a point, in the parameter space of the system, where the qubit dynamics is effectively Markovian and that such a point separates two regions with completely different dynamical behaviors. Indeed, our study demonstrates that the qubit evolution can in principle be tuned from a perfectly forgetful one to a deep non-Markovian regime where the qubit is strongly affected by the dynamical backaction of the environmental spins. By means of a theoretical quantum process tomography analysis, we provide a complete and intuitive characterization of the qubit channel.

The Battle of the Somme in Ulster memory and identity

One of the enduring illusions about Northern Ireland is that its society can be conceptualized through a binary distinction between protestant and catholic. unionist and nationalist. It is increasingly apparent that these broad domains are themselves fractured and diverse and that otherness is often conceived from within rather than without. Northern Ireland can also be viewed as a laboratory for identity formation as unionists and loyalists strive to reconcile themselves with the fundamental political changes that have followed in the wake of the Peace Process. This paper considers one aspect of the contestation of belonging that increasingly characterizes unionism. It examines the competition for the ownership of the mythology of the Battle of the Somme ( 1916), long a key event in the unionist narrative. In particular, the paper addresses the ways in which paramilitary organizations are using the Somme to legitimate their own activities but also to distance the loyalist working classes from the former hegemonic Britishness of official unionism and the sectarianism of the Orange Order. The analysis concludes that loyalist identity is being conceptualized thorough a narrative of betrayal from within and at an intensely localized scale.

The contours of memory in post-conflict societies: enacting public remembrance of the bomb in Omagh, Northern Ireland

Drawing on the theoretical insights of Paul Ricoeur this paper investigates the geographies of public remembrance in a post-conflict society. In Northern Ireland, where political divisions have found expression through acts of extreme violence over the past 30 years, questions of memory and an amnesty for forgetting have particular resonance both at the individual and societal level, and render Ricoeur’s framework particularly prescient. Since the signing of the Belfast Agreement in 1998, initiating the Peace Process through consociational structures, discovering a nomenclature and set of practices which would aid in the rapprochement of a deeply divided society has presented a complex array of issues. In this paper I examine the various practices of public remembrance of the 1998 bombing of Omagh as a means of understanding how memory-spaces evolve in a post-conflict context. In Omagh there were a variety of commemorative practices instituted and each, in turn, adopted a different contour towards achieving reconciliation with the violence and grief of the bombing. In particular the Garden of Light project is analysed as a collective monument which, with light as its metaphysical centre, invited the populace to reflect backward on the pain of the bombing while at the same time enabling the society to look forward toward a peaceful future where a politics of hope might eclipse a politics of despair.

Sensory systems and spatial memory in the fruit bat Rousettus aegyptiacus

The megachiropteran fruit bat Rousettus aegyptiacus is able to orient and navigate using both vision and echolocation. These two sensory systems have different environmental constraints however, echolocation being relatively short range when compared with vision. Despite this difference, an experiment testing their memory of a perch location demonstrates that once the location of a perch is learned R. aegyptiacus is not influenced by the movement of local landmark cues in the vicinity of the perch under either light or dark conditions. Thus despite the differing constraints of vision and echolocation, this suggests a place is remembered as a location in space and not by associations with landmarks in the vicinity. A decrease in initial performance when the task was repeated in the dark suggested the possibility that a memory of a location learned using vision does not generalize to echolocation.

Task prioritization in aging: effects of sensory information on concurrent posture and memory performance

In older adults, cognitive resources play a key role in maintaining postural stability. In the present study, we evaluated whether increasing postural instability using sway referencing induces changes in resource allocation in dual-task performance leading older adults to prioritize the more age-salient posture task over a cognitive task. Young and older adults participated in the study which comprised two sessions. In the first session, three posture tasks (stable, sway reference visual, sway reference somatosensory) and a working memory task (n-back) were examined. In the second session, single- and dual-task performance of posture and memory were assessed. Postural stability improved with session. Participants were more unstable in the sway reference conditions, and pronounced age differences were observed in the somatosensory sway reference condition. In dual-task performance on the stable surface, older adults showed an almost 40% increase in instability compared to single-task. However, in the sway reference somatosensory condition, stability was the same in single- and dual-task performance, whereas pronounced (15%) costs emerged for cognition. These results show that during dual-tasking while standing on a stable surface, older adults have the flexibility to allow an increase in instability to accommodate cognitive task performance. However, when instability increases by means of compromising somatosensory information, levels of postural control are kept similar in single- and dual-task, by utilizing resources otherwise allocated to the cognitive task. This evidence emphasizes the flexible nature of resource allocation, developed over the life-span to compensate for age-related decline in sensorimotor and cognitive processing.

Working Memory and Postural Control: Adult Age Differences in Potential for Improvement, Task Priority, and Dual Tasking

We investigate dynamic posture control and working memory (NBack) retest practice in young and older adults, focusing on older adults' potential for improvement in the component tasks but more importantly in dual-task performance. Participants performed the 2 tasks in 11 sessions under single- and dual-task conditions. Posture improvement was observed with retest practice for both groups. Increase in cognitive load after initial practice led to greater dual-task costs in both tasks in older adults and higher costs in memory in young adults. With continued practice, costs were reduced by both groups; however, the 2 groups focused improvement on different tasks: Older adults focused on posture but young adults on cognition. These results emphasize older adults' potential for improvement in dual-task performance and their flexibility to utilize the practice gains in posture to optimize cognitive performance.

Establishing a minimum dataset for prospective registration of systematic reviews: an international consultation

Background: In response to growing recognition of the value of prospective registration of systematic review protocols, we planned to develop a web-based open access international register. In order for the register to fulfil its aims of reducing unplanned duplication, reducing publication bias, and providing greater transparency, it was important to ensure the appropriate data were collected. We therefore undertook a consultation process with experts in the field to identify a minimum dataset for registration. Methods and Findings: A two-round electronic modified Delphi survey design was used. The international panel surveyed included experts from areas relevant to systematic review including commissioners, clinical and academic researchers, methodologists, statisticians, information specialists, journal editors and users of systematic reviews. Direct invitations to participate were sent out to 315 people in the first round and 322 in the second round. Responses to an open invitation to participate were collected separately. There were 194 (143 invited and 51 open) respondents with a 100% completion rate in the first round and 209 (169 invited and 40 open) respondents with a 91% completion rate in the second round. In the second round, 113 (54%) of the participants reported having previously taken part in the first round. Participants were asked to indicate whether a series of potential items should be designated as optional or required registration items, or should not be included in the register. After the second round, a 70% or greater agreement was reached on the designation of 30 of 36 items. Conclusions: The results of the Delphi exercise have established a dataset of 22 required items for the prospective registration of systematic reviews, and 18 optional items. The dataset captures the key attributes of review design as well as the administrative details necessary for registration.