Motion of the first metatarsophalangeal joint

The analysis of motion of the first metatarsophalangeal joint in this study demonstrates the character of motion about this joint. Four instantaneous centers of rotation were calculated in the first metatarsal head that formed an arc encircling an area of increased stress patterns. The joint motion is made up of rolling, sliding, and compression. The fact that there is more than one center of motion contradicts the theory of a simple hinge joint. The joint is a dynamic acetabulum or "hammock," as described by Kelikian. That is, the first metatarsal head moves within a stable support comprised of the base of the proximal phalanx, the sesamoids, soft tissue, and muscle tendons. The nature of first metatarsophalangeal joint motion must be considered when contemplating surgical procedures of the first metatarsophalangeal joint.     

Temporal and spatial regulation of bone morphogenetic protein signaling in late lung development.

Bone morphogenetic proteins (BMPs) play important roles in early lung development. No study to date has addressed a role for BMP signaling in late lung development. We describe changes in the expression and localization of BMP receptors (Bmpr1a, Bmpr1b, and Bmpr2) and Smad (Smad1, Smad4, Smad5, and Smad8) intracellular signaling proteins during the saccular and alveolarization stages of late lung development. BMP signaling, assessed by Smad1/5 phosphorylation, nuclear translocation, and induction of id1, id2, and id3 gene expression, was evident throughout late lung development. Our data indicate that BMP signaling is active during late lung development, and points to roles for the BMP system in septal and vascular development, and in the homeostasis of the epithelial layer of large conducting airways in the mature lung.     

Voices from the past: Comparing the rapid prompting method and facilitated communication

Objective: This article briefly reviews the history and damage caused by facilitated communication (FC) and highlights the parallels between FC and the Rapid Prompting Method (RPM).

Background: FC involves a therapist (or facilitator) supporting the hand of a person with autism while a message is typed on a letter board. FC is widely acknowledged to be a pseudoscientific, unsafe, and unethical treatment for people with autism. RPM is a more recent intervention for people with autism that involves the facilitator holding and moving the letter board while the individual with autism moves their own hand. Those who espouse the perceived benefits of FC and RPM make strikingly similar claims of hidden intelligence and extraordinary communication abilities in people with autism following treatment.

Conclusion: Clients, proponents, and practitioners of RPM should demand scientific validation of RPM in order to ensure the safety of people with disabilities that are involved with RPM.     

Data from an intervention study point to a promising procedure for teaching discriminated use of a speech-generating device to children with autism spectrum disorder1

Lorah, E. R. (2016). Evaluating the iPad mini® as a speech-generating device in the acquisition of a discriminative mand repertoire for young children with autism. Focus on Autism and Other Developmental Disabilities, doi: 1088357616673624.

Source of funding and disclosure of interest: The authors did not report any financial support for this study. The authors did not report any conflicts of interest.     

Clinical practice guidelines: a tool to improve care

The American patient and consumer groups are increasing pressure on physicians and health care organizations to improve and document the quality of care that they deliver. A leading cause of inadequate care is the significant variations in medical practice that cannot be explained by patient differences, which persist through out the country. Managed care and the rise of consumer groups has forced health care providers and organization to begin analyzing how and why they deliver care to patients. The incorporation of quality improvement tools such as evidence-based practice guidelines have been shown to reduce practice variability, improving the process and outcomes of care. The correct development and implementation of these guidelines can be an effective tool to assist the practicing physician in improving the care delivered to his/her patient.