Reliability of Achilles Tendon Resting Angle and Calf Circumference measurement techniques

BackgroundThe resting angle of the ankle joint may be altered following apparently successful management of Achilles tendon rupture. The reliability of the Achilles Tendon Resting Angle and Calf Circumference measurements was determined.MethodsThree test–retest measurements for reliability assessment were performed on 16 healthy subjects: 10 males and 6 females.ResultsThe mean left Achilles Tendon Resting Angle was mean 50.1° (range [26–61]), ICC 0.92 (CI [0.83–0.97]), SEM 2.4°. The mean right Achilles tendon resting angle was mean 49.9° (range [26–60]), ICC 0.91 (CI [0.80–0.96]), SEM 2.6°. The mean left calf circumference was mean 38.5 cm (range [33.3–44.2]), ICC 0.97 (CI [0.94–0.98]), SEM 0.6 cm, and the mean right calf circumference was mean 38.4 cm (range [33.3–43.6]), ICC 0.97 (CI [0.94–0.99]), SEM 0.5 cm.ConclusionsThe Achilles Tendon Resting Angle and Calf Circumference at 15 cm from the antero-medial joint line had excellent test–retest reliability. These are simple, quick and inexpensive measurements, which have the potential to correlate with tendon elongation and functional outcome. The Achilles tendon resting angle may be used as a guide to tendon length during intra-operative repair and rehabilitation     

A retrospective study on non-drug related poisoning in the community among children from south India

Objectives: This retrospective study was performed to determine the incidence, demographic distribution, types and outcomes across various non-drug related poisonings among children attending a tertiary care center in south India.

Methods: All children from 0-16 years who presented to the Paediatric Emergency Department, Christian Medical College, Vellore with non-drug related poisoning from October 2004 to September 2013 were included.

Results: Out of the total 997 cases of poisoning, 629 (63.1%) cases were contributed by chemicals and plants: mainly hydrocarbons (kerosene) 309 (49.1%); organophosphates 72 (11.5%); corrosive acids and alkalis 57 (9.1%); insecticides 51 (8.1%); and plant poisons 20 (3.2%). Males (62.79%) and children < 5 years (77.42%) were mostly affected. Although many children developed complications requiring intensive care unit admissions, the total mortality was only 9 (1.4%). The incidence of poisoning showed a decreasing trend over the last 4 years.

Conclusion: This study for the first time gives an elaborative insight on non-drug related pediatric poisoning from a tertiary care center in south India for almost a decade.     

The association between relationship markers of sexual orientation and suicide: Denmark, 1990–2001

Objective  

Minority sexual orientation has been repeatedly linked to elevated rates of suicide attempts. Whether this translates into greater risk for suicide mortality is unclear. We investigated sexual orientation-related differences in suicide mortality in Denmark during the initial 12-year period following legalization of same-sex registered domestic partnerships (RDPs).     

A Bill of Rights for Hospitalized Older Adults

Acute-care hospitals have few structures, programs, or staff prepared to address the special needs of older adults. To address this issue, the Hartford Institute for Geriatric Nursing [including the Nurses Improving Care for Hospitalized Elders (NICHE) program] and the Coalition of Geriatric Nursing Organizations proposed language for a Bill of Rights for Hospitalized Older Adults. The Bill of Rights moves from general value statements to the specific knowledge, skills, and actions necessary to provide quality of care to older adults. The authors describe the development and testing of the Bill of Rights and suggest steps for its adoption and dissemination.     

Changes in the Geriatric Care Environment Associated with NICHE (Nurses Improving Care for HealthSystem Elders)

The aging of the U.S. population has profound implications for acute care nursing practice. NICHE (Nurses Improving Care for HealthSystem Elders) is the only national nursing program that addresses the needs of the hospitalized older adult. This secondary analysis examines the influence of the NICHE program on nurse perceptions of the geriatric nursing practice environment and quality of geriatric care, as well as geriatric nursing knowledge in a sample comprising 8 acute care hospitals in the United States that administered the Geriatric Institutional Assessment Profile before and after NICHE implementation. Results were compared in a sample of 821 and 942 direct care nurses, respectively. Controlling for hospital and nurse characteristics, both nurse perceptions of the geriatric nursing practice environment (P < .0001) and quality of geriatric care (P =.0004) increased, but not geriatric nursing knowledge (P =.1462), following NICHE implementation. NICHE tools and principles can exert an important influence over the care provided to older adult patients by increasing the organizational support for geriatric nursing.     

Combinations of cyclophilin inhibitor NIM811 with hepatitis C Virus NS3-4A Protease or NS5B polymerase inhibitors enhance antiviral activity and suppress the emergence of resistance

Chronic hepatitis C virus (HCV) infection remains a major global health burden while current interferon-based therapy is suboptimal. Efforts to develop more effective antiviral agents mainly focus on two viral targets: NS3-4A protease and NS5B polymerase. However, resistant mutants against these viral specific inhibitors emerge quickly both in vitro and in patients, particularly in the case of monotherapy. An alternative and complementary strategy is to target host factors such as cyclophilins that are also essential for viral replication. Future HCV therapies will most likely be combinations of multiple drugs of different mechanisms to maximize antiviral activity and to suppress the emergence of resistance. Here, the effects of combining a host cyclophilin inhibitor NIM811 with other viral specific inhibitors were investigated in vitro using HCV replicon. All of the combinations led to more pronounced antiviral effects than any single agent, with no significant increase of cytotoxicity. Moreover, the combination of NIM811 with a nucleoside (NM107) or a non-nucleoside (thiophene-2-carboxylic acid) polymerase inhibitor was synergistic, while the combination with a protease inhibitor (BILN2061) was additive. Resistant clones were selected in vitro with these inhibitors. Interestingly, it was much more difficult to develop resistance against NIM811 than viral specific inhibitors. No cross-resistance was observed among these inhibitors. Most notably, NIM811 was highly effective in blocking the emergence of resistance when used in combination with viral protease or polymerase inhibitors. Taken together, these results illustrate the significant advantages of combining inhibitors targeting both viral and host factors as key components of future HCV therapies.