Meeting the challenge for foot health in rheumatic diseases

Background: National guidelines recommend that patients with rheumatic diseases should have access to podiatry services and evidence is emerging that podiatry interventions are effective in the management of foot problems in this patient group. Despite this recognition it is generally perceived that access to podiatry services appears to be varied or absent. Objectives: To identify the nature of foot health problems presenting in a rheumatology clinic and to ascertain the availability and suitability of foot care for these problems. Method: A convenience sample of 139 patients (100 female and 39 male) was recruited. An assessment of foot health, and footwear was carried out and patients completed the foot function index (FFI). Any unmet foot care needs were identified. Results: The majority of the 139 patients presented with symptomatic callus and toenail problems and over half with foot deformity. There was no clear difference between genders. There was evidence of the effects of foot pain caused by these problems but low prescription of foot orthoses and specialist footwear. Conclusion: Overall this study indicates that poor foot health and foot pain as being common in patients with rheumatic diseases. The lack of foot care could lead to reduction in mobility and in some cases serious complications. This paper recommends that a specialist and dedicated foot care service is provided for these patients

Effect of expertise on diagnosis accuracy, non-technical skills and thought processes during simulated high-fidelity anaesthetist scenarios

Background The expert performance approach can be used to examine expertise during representative field-based tasks, while collecting process-tracing measures such as think-aloud verbal reports. Collecting think-aloud verbal reports provides an insight into the cognitive mechanisms that support performance during tasks. Method We examined the thought processes and performance of anaesthetists during simulated environments. Verbal reports of thinking and the anaesthetists’ non-technical skills (ANTS) were recorded to examine cognitive processes, non-technical behaviours and diagnosis accuracy during fully immersive, high-fidelity medical scenarios. Skilled (n=6) and less skilled (n=9) anaesthetists were instructed to respond to medical scenarios experienced in theatre. Results Skilled participants demonstrated higher diagnosis accuracy and ANTS scores compared to less skilled participants. Furthermore, skilled participants engaged in deeper thinking and verbalised more evaluation, prediction and deep planning statements. Conclusions The ability to employ an effective cognitive processing strategy, more efficient non-technical behaviours and superior diagnosis is associated with superior performance in skilled participants

The effect of stimulus intensity on response time and accuracy in dynamic, temporally constrained environments

The ability to make accurate judgments and execute effective skilled movements under severe temporal constraints are fundamental to elite performance in a number of domains including sport, military combat, law enforcement, and medicine. In two experiments, we examine the effect of stimulus strength on response time and accuracy in a temporally constrained, real-world, decision-making task. Specifically, we examine the effect of low stimulus intensity (black) and high stimulus intensity (sequin) uniform designs, worn by teammates, to determine the effect of stimulus strength on the ability of soccer players to make rapid and accurate responses. In both field- and laboratory-based scenarios, professional soccer players viewed developing patterns of play and were required to make a penetrative pass to an attacking player. Significant differences in response accuracy between uniform designs were reported in laboratory- and field-based experiments. Response accuracy was significantly higher in the sequin compared with the black uniform condition. Response times only differed between uniform designs in the laboratory-based experiment. These findings extend the literature into a real-world environment and have significant implications for the design of clothing wear in a number of domains

Memory-guided force output is associated with self-reported ADHD symptoms in young adults

This is the author accepted manuscript. The final version is available from Springer Verlag via the DOI in this record.Attention-Deficit/Hyperactivity disorder (ADHD) is the most commonly diagnosed mental health disorder in childhood and persists into adulthood in up to 65% of cases. ADHD is associated with adverse outcomes such as the ability to gain and maintain employment (Kessler et al. 2009; Kupper et al. 2012), and is associated with an increased risk for substance abuse (Groenman et al. 2013; Upadhyaya 2008; Wilens et al. 1995), obesity (Albayrak et al. 2013; Cortese et al. 2008; Nazar et al. 2012; Nazar et al. 2014), workplace injuries (Breslin and Pole 2009; Hodgkins et al. 2011; Swensen et al. 2004), and traffic accidents (Barkley and Cox 2007; Barkley et al. 1993; Jerome et al. 2006a; Jerome et al. 2006b; Merkel et al. 2013). A majority of diagnosed children have motor deficits, however few studies have examined motor deficits in young adults. This study provides a novel examination of visuomotor control of grip force in young adults with and without ADHD. Participants were instructed to maintain force production over a 20-second trial with and without real-time visual feedback about their performance. The results demonstrated that when visual feedback was available, adults with ADHD produced slightly higher grip force than controls. However, when visual feedback was removed, adults with ADHD had a faster rate of decay of force, which was associated with ADHD symptom severity and trait impulsivity. These findings suggest that there may be important differences in the way that adults with ADHD integrate visual feedback during continuous motor tasks. These may account for some of the motor impairments reported in children with ADHD. These deficits could result from (1) dysfunctional sensory motor integration and/or (2) deficits in short-term visuomotor memoryThis study was supported by NIH NCATS TR000126 and NIH R01 MH084947

CARMA1 is a novel regulator of T-ALL disease and leukemic cell migration to the CNS

No abstract available

Amygdala responses to fearful and happy facial expressions under conditions of binocular suppression

The human amygdala plays a crucial role in processing affective information conveyed by sensory stimuli. Facial expressions of fear and anger, which both signal potential threat to an observer, result in significant increases in amygdala activity, even when the faces are unattended or presented briefly and masked. It has been suggested that afferent signals from the retina travel to the amygdala via separate cortical and subcortical pathways, with the subcortical pathway underlying unconscious processing. Here we exploited the phenomenon of binocular rivalry to induce complete suppression of affective face stimuli presented to one eye. Twelve participants viewed brief, rivalrous visual displays in which a fearful, happy, or neutral face was presented to one eye while a house was presented simultaneously to the other. We used functional magnetic resonance imaging to study activation in the amygdala and extrastriate visual areas for consciously perceived versus suppressed face and house stimuli. Activation within the fusiform and parahippocampal gyri increased significantly for perceived versus suppressed faces and houses, respectively. Amygdala activation increased bilaterally in response to fearful versus neutral faces, regardless of whether the face was perceived consciously or suppressed because of binocular rivalry. Amygdala activity also increased significantly for happy versus neutral faces, but only when the face was suppressed. This activation pattern suggests that the amygdala has a limited capacity to differentiate between specific facial expressions when it must rely on information received via a subcortical route. We suggest that this limited capacity reflects a tradeoff between specificity and speed of processing

Horizontal gene transfer converts non-toxigenic Clostridium difficile strains into toxin producers.

Clostridium difficile is a major nosocomial pathogen and the main causative agent of antibiotic-associated diarrhoea. The organism produces two potent toxins, A and B, which are its major virulence factors. These are chromosomally encoded on a region termed the pathogenicity locus (PaLoc), which also contains regulatory genes, and is absent in non-toxigenic strains. Here we show that the PaLoc can be transferred from the toxin-producing strain, 630Δerm, to three non-toxigenic strains of different ribotypes. One of the transconjugants is shown by cytotoxicity assay to produce toxin B at a similar level to the donor strain, demonstrating that a toxigenic C. difficile strain is capable of converting a non-toxigenic strain to a toxin producer by horizontal gene transfer. This has implications for the treatment of C. difficile infections, as non-toxigenic strains are being tested as treatments in clinical trials

'Choosing shoes': a preliminary study into the challenges facing clinicians in assessing footwear for rheumatoid patients

Background: Footwear has been accepted as a therapeutic intervention for the foot affected by rheumatoid arthritis (RA). Evidence relating to the objective assessment of footwear in patients with RA is limited. The aims of this study were to identify current footwear styles, footwear characteristics, and factors that influence footwear choice experienced by patients with RA. Methods: Eighty patients with RA were recruited from rheumatology clinics during the summer months. Clinical characteristics, global function, and foot impairment and disability measures were recorded. Current footwear, footwear characteristics and the factors associated with choice of footwear were identified. Suitability of footwear was recorded using pre-determined criteria for assessing footwear type, based on a previous study of foot pain. Results: The patients had longstanding RA with moderate-to severe disability and impairment. The foot and ankle assessment demonstrated a low-arch profile with both forefoot and rearfoot structural deformities. Over 50% of shoes worn by patients were opentype footwear. More than 70% of patients’ footwear was defined as being poor. Poor footwear characteristics such as heel rigidity and sole hardness were observed. Patients reported comfort (17%) and fit (14%) as important factors in choosing their own footwear. Only five percent (5%) of patients wore therapeutic footwear. Conclusions: The majority of patients with RA wear footwear that has been previously described as poor. Future work needs to aim to define and justify the specific features of footwear that may be of benefit to foot health for people with RA