Reoperations following combat-related upper-extremity amputations.

PubMed

Tintle, Scott M; Baechler, Martin F; Nanos, George P; Forsberg, Jonathan A; Potter, Benjamin K

2012-08-15

Amputation revision rates following major upper-extremity amputations have not been previously reported in a large cohort of patients. We hypothesized that the revision rates following major upper-extremity amputation were higher than the existing literature would suggest, and that surgical treatment of complications and persistent symptoms would lead to improved outcomes. We performed a retrospective analysis of a consecutive series of ninety-six combat-wounded personnel who had sustained a total of 100 major upper-extremity amputations in Operation Iraqi Freedom and Operation Enduring Freedom. Prerevision and postrevision outcome measures, including prosthesis use and type, the presence of phantom and residual limb pain, pain medication use, and return to active military duty, were identified for all patients. All amputations resulted from high-energy trauma, with 87% occurring secondary to a blast injury. Forty-two residual limbs (42%) underwent a total of 103 repeat surgical interventions. As compared with patients with all other levels of amputation, those with a transradial amputation were 4.7 (95% confidence interval [CI]: 1.75 to 12.46) times more likely to have phantom limb pain and 2.8 (95% CI: 1.04 to 7.39) times more likely to require neuropathic pain medications. In the group of patients who underwent revision surgery, regular prosthesis use increased from 19% before the revision to 87% after it (p < 0.0001). In our cohort, revision amputation to address surgical complications and persistently symptomatic residual limbs improved the patient's overall acceptance of the prosthesis and led to outcomes equivalent to those following amputations that did not require revision.

TOTAL KNEE REPLACEMENT IN PATIENTS WITH BELOW-KNEE AMPUTATION

PubMed Central

Karam, Matthew D; Willey, Michael; Shurr, Donald G

2010-01-01

Total knee replacement (TKR) is reserved for patients with severe and disabling arthritis that is non-responsive to conservative measures. Based on existing data, total knee replacement is a safe and cost-effective treatment for alleviating pain and improving physical function in patients who do not respond to conservative therapy. Despite the large variation in health status of patients and types of prosthesis implanted, total knee replacement has proven to be a relatively low risk and successful operation. Each year in the United States surgeons perform approximately 300,000 TKR.1 Likewise, lower extremity amputation is commonly performed in the United States with an annual incidence of 110,000 per year.2 Nearly 70% of all lower extremity amputations are performed as the result of chronic vascular disease, followed by trauma (22%), congenital etiology and tumor (4% each).3 Approximately 50% of all lower extremity amputations are performed secondary to complications from Diabetes Mellitus. Norvell et al. demonstrated that patients who have previously undergone transtibial amputation and ambulate with a prosthesis are more likely to develop degenerative joint disease in the con-tralateral extremity than the ipsilateral extremity.4 Further, radiographic changes consistent with osteoporosis have been demonstrated in up to 88% of limbs that have undergone transtibial amputation.8 To our knowledge, there have been only three reported cases of total knee replacement in patients with ipsilateral transtibial amputation.5,7 The purpose of the present study is to review the existing data on total knee replacement in patients who have undergone transtibial amputation. Further we present a patient with a transtibial amputation who underwent contralateral total knee replacement. PMID:21045987

A comprehensive scoring system to evaluate patient-centred risk factors regarding lower extremity amputation.

PubMed

Miller, M S; Newgent, E W; O'Connell, S M; Broadus, C

2017-10-01

Care of the patient with a presumed life- or limb-threatening lower extremity wound poses many challenges. The mindset regarding potential outcomes of such conditions is mostly driven by the experiences and expertise of those providing the care. This mindset generally appears as two primary actions presented to the afflicted patient: attempted resolution of the problem via medical, surgical or combination treatment, with the hope of low recurrence risk, or exacerbation and amputation-amputations at a level sufficient to, at least in the mind of the surgeon, eliminate the problem. Achieving the former outcome is dependent on a number of factors associated with both patient and caregiver. If healing is achieved, the secondary goal of prevention of recurrence may be no less arduous, with failure most likely resulting in amputation. Clearly, these considerations appear to be based more on the health professionals perception, of the patient's physical and medical status rather than on patient-centred considerations. This article will review considerations and recommendations for lower extremity amputation, and the short- and long-term implications. Based on our research, there is clear need for a set of criteria against which to weigh not just the medical issues, but also definitive patient-centred issues when considering a lower extremity amputation. We offer a set of patient-centred, easily verified and recognised criteria that we believe addresses this need. The goal of the Miller-Newgent Amputation Scale (MENACE) is to provide a decision base from which to consider and evaluate all factors in determining the need for a lower extremity amputation. This involves identification of patient-centred issues, which are likely to produce satisfactory short- and long-term physical and quality-of-life outcomes if the amputation does proceed.

Measurement of absolute laser energy absorption by nano-structured targets

NASA Astrophysics Data System (ADS)

Park, Jaebum; Tommasini, R.; London, R.; Bargsten, C.; Hollinger, R.; Capeluto, M. G.; Shlyaptsev, V. N.; Rocca, J. J.

2017-10-01

Nano-structured targets have been reported to allow the realization of extreme plasma conditions using table top lasers, and have gained much interest as a platform to investigate the ultra-high energy density plasmas (>100 MJ/cm3) . One reason for these targets to achieve extreme conditions is increased laser energy absorption (LEA). The absolute LEA by nano-structured targets has been measured for the first time and compared to that by foil targets. The experimental results, including the effects of target parameters on the LEA, will be presented. This work was performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52097NA27344, and funded by LDRD (#15-ERD-054).

Ectopic banking of amputated great toe for delayed thumb reconstruction: case report.

PubMed

Valerio, Ian L; Hui-Chou, Helen G; Zelken, Jonathan; Basile, Patrick L; Ipsen, Derek; Higgins, James P

2014-07-01

Ectopic banking of amputated parts is a recognized technique for delayed replantation of an amputated part when the amputation stump will not permit immediate replantation. This is conventionally performed with the intent of transferring the injured part back to its anatomic position when the amputation stump is more appropriate for replantation. Current warfare conditions have led to a commonly encountered military trauma injury pattern of multiple extremity amputations with protected trunk and core structures. This pattern poses many challenges, including the limit or absence of donor sites for immediate or delayed flap reconstructive procedures. We describe a case in which we ectopically banked the great toe of an amputated lower extremity for delayed thumb reconstruction. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Podiatry impact on high-low amputation ratio characteristics: A 16-year retrospective study.

PubMed

Schmidt, Brian M; Wrobel, James S; Munson, Michael; Rothenberg, Gary; Holmes, Crystal M

2017-04-01

Complications from diabetes mellitus including major lower extremity amputation may have significant impact on a patient's mortality. This study determined what impact the addition of a limb salvage and diabetic foot program involving podiatry had at an academic institution over 16years by analyzing high-low amputation ratio data. The high-low amputation ratio in the diabetic population who underwent non-traumatic amputation of the lower extremity was retrospectively evaluated at an academic institution via cohort discovery of the electronic medical record and analysis of billing over 16years. We directly compared two eras, one without podiatry and one with a podiatry presence. It was found that with the addition of a podiatry program, limb salvage rates significantly increased (R 2 (without podiatry)=0.45, R 2 (with podiatry)=0.26), with a significant change in both the rate of limb salvage per year (-0.11% per year versus -0.36% per year; p<0.01) and an overall decrease in high-low amputation ratio (0.89 without podiatry to 0.60 with podiatry). Of note, approximately 40 major lower extremity amputations were avoided per year with the addition of a podiatry program (p<0.05). Our findings signify the importance of podiatric care in the diabetic population. With an established podiatry program present at an academic institution, major lower extremity amputations can be avoided and more limbs can be salvaged, thus preventing some of the moribund complications from this condition. Copyright © 2017 Elsevier B.V. All rights reserved.

Treating Intractable Post-Amputation Phantom Limb Pain with Ambulatory Continuous Peripheral Nerve Blocks

DTIC Science & Technology

2016-01-01

Upper ☐Lower Side of amputation: ☐Right ☐Left Level of original amputation (distal to…): ☐wrist/ ankle ☐elbow/knee...Right ☐Left Level of original amputation (distal to…): ☐wrist/ ankle ☐elbow/knee ☐shoulder/hip Initial Amputation Etiology...extremity: ☐Upper ☐Lower Side of amputation: ☐Right ☐Left Level of original amputation (distal to…): ☐wrist/ ankle ☐elbow/knee

Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study.

PubMed

Davis, A M; Devlin, M; Griffin, A M; Wunder, J S; Bell, R S

1999-06-01

To quantify the differences in physical disability and handicap experienced by patients with lower extremity sarcoma who required amputation for their primary tumor as compared with those treated by limb-sparing surgery. Matched case-control study. Twelve patients with amputation were matched with 24 patients treated by limb-sparing surgery on the following variables: age, gender, length of follow-up, bone versus soft-tissue tumor, anatomic site, and treatment with adjuvant chemotherapy. Patients who underwent above-knee amputation (AKA) or below-knee amputation (BKA) for primary soft-tissue or bone sarcoma, who had not developed local or systemic recurrence, and who had been followed up for at least 1 year since surgery. The Toronto Extremity Salvage Score (TESS), a measure of physical disability; the Shortform-36 (SF-36), a generic health status measure; and the Reintegration to Normal Living (RNL), a measure of handicap. Mean TESS score for the patients with amputations was 74.5 versus 85.1 for the limb-sparing patients. (p = .15). Only the physical function subscale of the SF-36 showed statistically significant differences, with means of 45 and 71.1 for the amputation versus limb-sparing groups, respectively (p = .03). The RNL for the amputation group was 84.4 versus 97 for the limb-sparing group (p = .05). Seven of the 12 patients with amputations experienced ongoing difficulty with the soft tissues overlying their stumps. There was a trend toward increased disability for those in the amputation group versus those in the limb-sparing group, with the amputation group showing significantly higher levels of handicap. These data suggest that the differences in disability between amputation and limb-sparing patients are smaller than anticipated. The differences may be more notable in measuring handicap.

High-pressure injection injuries to the upper extremity: a review of the literature.

PubMed

Hogan, Christopher J; Ruland, Robert T

2006-07-01

The purpose of this review was to identify the relative impact of injected material, location of injury, time to debridement, injection pressure, infection, and the use of adjuvant steroid medication upon the need for amputation after high-pressure injection injuries to the upper extremity. A Medline literature search extending from 1966 to December 2003 was performed, referencing the key words "high-pressure injection injury," "grease gun injury," "paint gun injury," "pressure gun injury," and "high-pressure injection." The results were limited to the English language and to reports involving human subjects. Each abstract was reviewed to confirm that the described injury had occurred in the upper extremity and that it had truly been a high-pressure injection. The reference pages from each of the papers were reviewed to identify additional reports of high-pressure injection injury. Manuscripts describing injuries resulting from hand held syringes or other low-pressure mechanisms were excluded. All of the manuscripts were analyzed to identify the clinical outcome, age, hand dominance, site of injection, substance injected, injection pressure, elapsed time to wide debridement, use of steroids, and incidence of infection. These variables were subjected to a Pearson chi test to determine their impact upon the need for amputation. Four hundred thirty-five cases of high-pressure injection injury to the upper extremity were identified. The amputation rate after these injuries was 30%. The location of the injury and the material injected contributed significantly to the need for amputation. For injections of paint, paint thinner, gasoline, oil, or jet fuel (organic solvents), the amputation risk was lower if wide surgical debridement occurred within 6 hours of injury. Steroids did not impact the amputation rate or incidence of infection. The presence of infection did not affect the incidence of amputation. The risk of amputation after high-pressure injection injury to the upper extremity is highest with organic solvent injection into the fingers. Injections into the thumb or palm result in a much lower frequency of tissue loss. Emergent surgical debridement reduces the amputation risk after injections of organic solvents. From the available data, no conclusions could be reached regarding functional outcomes, other than amputation, after high-pressure injection injury.

A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage

PubMed Central

Walker, Jay; Bhatnagar, Vibha; Richard, Erin; Sechriest, V. Franklin; Galarneau, Michael

2017-01-01

Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107). Patient medical records were analyzed for four years postinjury. After adjusting for group differences, early amputation was generally associated with a lower or similar prevalence for adverse physical and psychological diagnoses (e.g., pain, osteoarthritis, posttraumatic stress disorder) versus late amputation and/or limb salvage. By contrast, early amputation was associated with an increased likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four years postinjury, particularly in the second year. The different clinical outcomes among combat extremity injured patients treated with early amputation, late amputation, or limb salvage highlight their different healthcare requirements. These findings can inform and optimize the specific treatment pathways that address the physical and psychological healthcare needs of such patients over time. PMID:28122002

Comparing Running Specific and Traditional Prostheses During Running: Assessing Performance and Risk

DTIC Science & Technology

2016-09-01

extremity amputation (ILEA) running is limited with respect to biomechanical performance and injury risks. ILEA are able to run with both running...TERMS Kinetics, biomechanics , amputation, prosthesis, transtibial 16. SECURITY CLASSIFICATION OF: U 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES...with lower extremity amputation (ILEA) running is limited with respect to biomechanical performance and injury risks. ILEA are able to run with both

38 CFR 4.68 - Amputation rule.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Amputation rule. 4.68... DISABILITIES Disability Ratings The Musculoskeletal System § 4.68 Amputation rule. The combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were...

38 CFR 4.68 - Amputation rule.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Amputation rule. 4.68... DISABILITIES Disability Ratings The Musculoskeletal System § 4.68 Amputation rule. The combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were...

Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

PubMed

Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H

2016-08-01

Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

PubMed

Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

2015-01-01

Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. MESS is not predictive in combat related extremity injuries especially if between a score of 6-8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation.

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

PubMed Central

Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

2015-01-01

Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. Conclusion: MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation. PMID:26806974

Factors affecting perioperative mortality and wound-related complications following major lower extremity amputations.

PubMed

Stone, Patrick A; Flaherty, Sarah K; Aburahma, Ali F; Hass, Stephen M; Jackson, J Michelle; Hayes, J David; Hofeldt, Matthew J; Hager, Casey S; Elmore, Michael S

2006-03-01

Major lower extremity amputations continue to be associated with significant morbidity and mortality, yet few recent large series have evaluated factors associated with perioperative mortality and wound complications. The purpose of this study was to examine factors affecting perioperative mortality and wound-related complications following major lower extremity amputation. A retrospective review was conducted of all adult patients who underwent nontraumatic major lower extremity amputations over a 5-year period at a single tertiary-care center in southern West Virginia. Demographic and clinical data, perioperative data, and outcomes were collected and analyzed to identify any relationship with perioperative mortality, as well as wound complications and early revisions (within 90 days) to a more proximal level. Variables were examined using chi-squared, two-tailed t-tests, and logistic regression. Three hundred eighty patients (61% male) underwent 412 major lower extremity amputations during 1999-2003. The initial level of amputation included 230 below-knee (BKA), 149 above-knee (AKA), and one hip disarticulation. Perioperative mortality was 15.5% (n = 59). From a regression model, age, albumin level, AKA, and lack of a previous coronary artery bypass graft (CABG) were independently related to mortality. Patients who did not have a previous CABG were nearly three times more likely to die than those who did (p = 0.038). Overall early wound complications were noted in 13.4% (n = 51). Four factors were independently related to experiencing a 90-day wound complication: BKA, community (rather than care facility) living, type of anesthesia, and preoperative hematocrit >30%. Major lower extremity amputation in patients with peripheral vascular disease continues to be associated with considerable perioperative morbidity and mortality. Even though the surgical procedure itself may not be challenging from a technical standpoint, underlying medical conditions put this group at high risk for perioperative death. Wound-healing problems are frequently encountered and must be minimized to facilitate early mobilization and hospital discharge.

Incidence of Pulmonary Embolus in Combat Casualties With Extremity Amputations and Fractures

DTIC Science & Technology

2011-09-01

digits/ ankles /feet) are at increased risk of developing a PE than those suffering long-bone fracture without an asso- ciated amputation. MATERIALS AND...Amputations and extremity fractures limited in level to or distal to the wrist or ankle were excluded from analysis. The primary outcome measured was...vigorous physical therapy and rehab . Immobility has been shown to be a risk factor for the development of PE, espe- cially in the trauma setting. 13

Toe amputations and ray resections.

PubMed

Pulla, R J; Kaminsky, K M

1997-10-01

Loss of a part of the lower extremity is an unfortunate complication of diabetes. Indications and general principles of amputation have been established. Distal limb salvage procedures include forefoot amputation alternatives, digital amputations, and ray resections. A variety of risks and complications are associated with these procedures. Postoperative management including prosthetic and accommodative therapy may enhance the successful outcomes of these procedures.

Use of a Temporary Shunt as a Salvage Technique for Distal Extremity Amputations Requiring Repair by Vessel Grafting during Critical Ischemia

PubMed Central

Dadaci, Mehmet; Altuntas, Zeynep

2016-01-01

Background Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours. This study also aimed to determine the total volume of blood loss when temporary shunts were used. Methods Patients who underwent distal major extremity replantation and/or revascularization with a vessel graft and who experienced ischemia for 6–8 hours between 2013 and 2014 were included in the study. A 6-Fr suction catheter was cut to 5 cm in length after the infusion of heparin, and secured with a 5-0 silk suture between the distal and the proximal ends of the artery. While bleeding continued, the bones were shortened and fixed. After the complete restoration of circulation, the arterial shunt created using the catheter was also repaired with a vein graft. Results Six patients were included in this study. The mean duration of ischemia was 7.25 hours. The mean duration of suction catheter use during limb revascularization was 7 minutes. The mean transfusion volume was 7.5 units. No losses of the extremity were observed. Conclusions This procedure should be considered in distal extremity amputations requiring repair by vessel grafting during critical ischemia. PMID:27896186

38 CFR 4.58 - Arthritis due to strain.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in... associated with the leg amputation or shortening, will be considered as service incurred, provided, however... amputation will not be granted service connection. This will generally require separate evaluation of the...

38 CFR 4.58 - Arthritis due to strain.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... With service incurred lower extremity amputation or shortening, a disabling arthritis, developing in... associated with the leg amputation or shortening, will be considered as service incurred, provided, however... amputation will not be granted service connection. This will generally require separate evaluation of the...

Landing Biomechanics in Participants With Different Static Lower Extremity Alignment Profiles

PubMed Central

Nguyen, Anh-Dung; Shultz, Sandra J.; Schmitz, Randy J.

2015-01-01

Context: Whereas static lower extremity alignment (LEA) has been identified as a risk factor for anterior cruciate ligament injury, little is known about its influence on joint motion and moments commonly associated with anterior cruciate ligament injury. Objective: To cluster participants according to combinations of LEA variables and compare these clusters in hip- and knee-joint kinematics and kinetics during the landing phase of a drop-jump task. Design: Descriptive laboratory study. Setting: Research laboratory. Patients or Other Participants: A total of 141 participants (50 men: age = 22.2 ± 2.8 years, height = 177.9 ± 9.3 cm, weight = 80.9 ± 13.3 kg; 91 women: age = 21.2 ± 2.6 years, height = 163.9 ± 6.6 cm, weight = 61.1 ± 8.7 kg). Main Outcome Measure(s): Static LEA included pelvic angle, femoral anteversion, quadriceps angle, tibiofemoral angle, genu recurvatum, tibial torsion, and navicular drop. Cluster analysis grouped participants according to their static LEA profiles, and these groups were compared on their hip- and knee-joint kinematics and external moments during the landing phase of a double-legged drop jump. Results: Three distinct clusters (C1–C3) were identified based on their static LEAs. Participants in clusters characterized with static internally rotated hip and valgus knee posture (C1) and externally rotated knee and valgus knee posture (C3) alignments demonstrated greater knee-valgus motion and smaller hip-flexion moments than the cluster with more neutral static alignment (C2). Participants in C1 also experienced greater hip internal-rotation and knee external-rotation moments than those in C2 and C3. Conclusions: Static LEA clusters that are positioned anatomically with a more rotated and valgus knee posture experienced greater dynamic valgus along with hip and knee moments during landing. Whereas static LEA contributes to differences in hip and knee rotational moments, sex may influence the differences in frontal-plane knee kinematics and sagittal-plane hip moments. PMID:25658815

Sexuality in persons with lower extremity amputations.

PubMed

Bodenheimer, C; Kerrigan, A J; Garber, S L; Monga, T N

2000-06-15

There is a paucity of information regarding sexual functioning in persons with lower extremity amputations. The purpose of this study was to describe sexual and psychological functioning and health status in persons with lower extremity amputation. Self-report surveys assessed sexual functioning (Derogatis Inventory), depression (Beck Depression Inventory, anxiety (State-Trait Anxiety Inventory), and health status (Health Status Questionnaire) in a convenience sample of 30 men with lower extremity amputations. Mean age of the participants was 57 years (range 32-79). Mean duration since amputation was 23 months (range 3-634 months). Twenty one subjects (70%) had trans-tibial and seven subjects (23%) had trans-femoral amputations. A majority of subjects were experiencing problems in several domains of sexual functioning. Fifty three percent (n = 16) of the subjects were engaged in sexual intercourse or oral sex at least once a month. Twenty seven percent (n = 8) were masturbating at least once a month. Nineteen subjects (63%) reported orgasmic problems and 67% were experiencing erectile difficulties. Despite these problems, interest in sex was high in over 90% of the subjects. There was no evidence of increased prevalence of depression or anxiety in these subjects when compared to other outpatient adult populations. Sexual problems were common in the subjects studied. Despite these problems, interest in sex remained high. Few investigations have been directed toward identifying the psychological and social factors that may contribute to these problems and more research with a larger population is needed in this area.

Prognostic factors of a satisfactory functional result in patients with unilateral amputations of the upper limb above the wrist that use an upper limb prosthesis.

PubMed

Dabaghi-Richerand, A; Haces-García, F; Capdevila-Leonori, R

2015-01-01

The purpose of this study is to determine the prognostic factors of a satisfactory functional outcome in patients using upper extremity prosthetics with a proximal third forearm stump, and above, level of amputation. All patients with longitudinal deficiencies and traumatic amputations of upper extremity with a level of amputation of proximal third forearm and above were included. A total of 49 patients with unilateral upper extremity amputations that had used the prosthetic for a minimum of 2 years were included in the protocol. The Disability arm shoulder hand (DASH) scale was used to determine a good result with a cut-off of less than 40%. The independent variables were the level of amputation, the etiology for its use, initial age of use and number of hours/day using the prosthesis. It was found that patients with a congenital etiology and those that started using the prosthetic before 6 years of age had better functional results. It was found that when adapting a patient with an upper extremity prosthetic, which has a high rejection rate of up to 49%, better functional outcomes are found in those who started using it before 6 years of age, and preferably because of a congenital etiology. It was also found that the number of hours/day strongly correlates with a favorable functional outcome. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Fluorometric prediction of successful amputation level in the ischemic limb.

PubMed

Silverman, D G; Rubin, S M; Reilly, C A; Brousseau, D A; Norton, K J; Wolf, G L

1985-01-01

The present study was undertaken to compare fluorometric documentation of fluorescein dye delivery with the standard means of determining the level at which an amputation should be performed in the dysvascular extremity. Thirty-nine patients underwent lower-extremity amputation at the level determined by the surgeon based upon physical examination, angiography, segmental pressure indices, and/or pulse volume recordings. In addition, fiberoptic fluorometry was performed preoperatively. After intravenous administration of sodium fluorescein (4-8 mg/kg), fluorometric readings were obtained by placing the fluorometer's light guide on 126 reading sites. Fluorometric findings were evaluated retrospectively, and therefore did not influence the surgeon's decision. Of the 39 amputations performed overall, only 26 healed. The accuracy of the standard criteria was lowest for the 20 below-ankle amputations, where only 12 cases healed. Alternatively, fluorometric indices separated healing from nonhealing sites in 36 of the 39 cases and in 18 of the 20 below-ankle amputations. Overall, healing sites averaged 94 percent of the fluorescence of the healthy reference area, while nonhealing sites averaged only 29 percent. We conclude that fluorometry should prove to be a valuable adjunct in the assessment of the dysvascular extremity. It uses a low dose of dye, is easy to perform, and is readily repeatable.

Evaluation of Spine Health and Spine Mechanics in Servicemembers with Traumatic Lower Extremity Amputation or Injury

DTIC Science & Technology

2015-10-01

of proximal compensations (e.g., hip-hiking) to assist with toe clearance (Michaud et al., 2000), or simply because these individuals feel more...related unilateral lower extremity amputation: a long-term survey in a prosthesis center in Iran. Journal of orthopaedic trauma 23(7), 525-530

Brachial plexus injury management through upper extremity amputation with immediate postoperative prostheses.

PubMed

Malone, J M; Leal, J M; Underwood, J; Childers, S J

1982-02-01

Management of patients with brachial plexus injuries requires a team approach so that all aspects of their care are addressed simultaneously. This report examines elective amputation and prosthetic rehabilitation in a patient with brachial plexus avulsion of the left arm. The best possibility for good prosthetic rehabilitation is the early application of prosthetic devices with intensive occupational therapy. Using this type of approach, we have achieved significant improvement in amputation rehabilitation of upper extremity amputees treated with immediate postoperative conventional electric and myoelectric prostheses.

38 CFR 3.350 - Special monthly compensation ratings.

Code of Federal Regulations, 2011 CFR

2011-07-01

... that which would be equally well served by an amputation stump at the site of election below elbow or... amputation stump with prosthesis; for example: (a) Extremely unfavorable complete ankylosis of the knee, or... the conditions which follow: Amputation is a prerequisite except for loss of use of both arms and...

Temporal trends and geographic variation of lower-extremity amputation in patients with peripheral artery disease: results from U.S. Medicare 2000-2008.

PubMed

Jones, W Schuyler; Patel, Manesh R; Dai, David; Subherwal, Sumeet; Stafford, Judith; Calhoun, Sarah; Peterson, Eric D

2012-11-20

This study sought to characterize temporal trends, patient-specific factors, and geographic variation associated with amputation in patients with lower-extremity peripheral artery disease (LE PAD) during the study period. Amputation represents the end-stage failure for those with LE PAD, and little is known about the rates and geographic variation in the use of LE amputation. By using data from the Centers for Medicare & Medicaid Services (CMS) from January 1, 2000, to December 31, 2008, we examined national patterns of LE amputation among patients age 65 years or more with PAD. Multivariable logistic regression was used to adjust regional results for other patient demographic and clinical factors. Among 2,730,742 older patients with identified PAD, the overall rate of LE amputation decreased from 7,258 per 100,000 patients with PAD to 5,790 per 100,000 (p < 0.001 for trend). Male sex, black race, diabetes mellitus, and renal disease were all independent predictors of LE amputation. The adjusted odds ratio of LE amputation per year between 2000 and 2008 was 0.95 (95% CI: 0.95-0.95, p < 0.001). From 2000 to 2008, LE amputation rates decreased significantly among patients with PAD. However, there remains significant patient and geographic variation in amputation rates across the United States. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Major amputation of lower extremity: prognostic value of positive bone biopsy cultures.

PubMed

Vaznaisiene, D; Beltrand, E; Laiskonis, A P; Yazdanpanah, Y; Migaud, H; Senneville, E

2013-02-01

To assess the correlation between culture results of section's osseous slice biopsy (SOB) and the distal infected site responsible for the amputation performed concomitantly during major amputation of lower extremity. The influence of a positive culture of SOB on the patients' outcome was also evaluated. We conducted a retrospective study of medical charts of patients who underwent SOB during major amputation of lower extremity at our institution from 2000 to 2009. Fifty-seven patients (42 males/15 females, mean age 52.16years) who undergone major limb amputation (47 below knee and ten above knee) were included. The initial medical conditions of the investigated patients were: trauma (n=32), infection (n=13), trophic disorders (n=10) and tumor (n=2). The major cause of amputation was an uncontrolled infection, accouting for 64.9% of the cases (37/57) (foot=5, ankle=8, leg=24), the remaining 20 patients had trophic disorders of lower limb. Twenty-one (36.8%) from 57 biopsies were sterile, 12 (21.1%) doubtful and 24 (42.1%) positive. Thirty-one (54.4%) patients had an antibiotic-free interval before limb amputation. Independently of the bacterial species, 69.6% of the microorganisms identified from SOB were found in the distal infected site. Patients with positive SOB had a significantly longer interval between the decision to amputate the patient and the surgical procedure (200.2 vs. 70.1days; P<0.03) and a shorter total duration of antibiotic therapy before amputation than patients with negative SOB (3.68 vs. 6.08months; P<0.03). The delay for complete healing was significantly higher in patients with a positive SOB compared with those with a negative SOB (3.57 vs. 2.48months; P<0.03). Our results suggest that the infection may extend from the distal site to the level of amputation in a large proportion of cases and that the delay with which the amputation is performed after the decision has been taken may play a role in this event. Study level IV: retrospective observationnal study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Effect of Roy's Adaptation Model-Guided Education on Coping Strategies of the Veterans with Lower Extremities Amputation: A Double-Blind Randomized Controlled Clinical Trial.

PubMed

Farsi, Zahra; Azarmi, Somayeh

2016-04-01

Any defect in the extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy's adaptation model-guided education on coping strategies of the veterans with lower extremities amputation. In a double-blind randomized controlled clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of Veterans Clinic in Tehran, Iran were recruited using convenience method and randomly assigned to intervention and control groups in 2013-2014. Lazarus and Folkman coping strategies questionnaire was used to collect the data. After completing the questionnaires in both groups, maladaptive behaviours were determined in the intervention group and an education program based on Roy's adaptation model was implemented. After 2 months, both groups completed the questionnaires again. Data were analyzed using SPSS software. Independent T-test showed that the score of the dimensions of coping strategies did not have a statistically significant difference between the intervention and control groups in the pre-intervention stage (P>0.05). This test showed a statistically significant difference between the two groups in the post-intervention stage in terms of the scores of different dimensions of coping strategies (P>0.05), except in dimensions of social support seeking and positive appraisal (P>0.05). The findings of this research indicated that the Roy's adaptation model-guided education improved the majority of coping strategies in veterans with lower extremities amputation. It is recommended that further interventions based on Roy's adaptation model should be performed to improve the coping of the veterans with lower extremities amputation. IRCT2014081118763N1.

Determinants of lower extremity amputations: an institutional experience.

PubMed

Soomro, Nabila; Khan, Mahjabeen; Ahmed, Syed Imran; Minhas, Muhammad Ali

2013-07-01

To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient`s age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males (77.6%). Mean age in diabetic and nondiabetics being 49.6 ± 15.2 and 26.6 ± 17.9 years respectively which is significant at (p < 0.001). Socioeconomic status and educational levels were significantly associated with diabetic status (p < 0.001). Amputation was more common in non-diabetic 858 (78.6%) compared to diabetics 233 (21.4%). This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, (infections and ischaemia), initial diagnosis acute/chronic arterial insufficiency and diabetic foot.

Characterisation and Outcomes of Upper Extremity Amputations

DTIC Science & Technology

2014-06-01

military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces... Trauma Registry, the Armed Forces Health Longitudinal Technology Application, and the Physical Evaluation Board Liaison Offices were queried in order to...without associated lower extremity amputation. This cohort was cross-referenced with the Department of Defense Trauma Registry (DoDTR, Joint Base

Severe extremity amputations in surviving Palestinian civilians caused by explosives fired from drones during the Gaza War.

PubMed

Heszlein-Lossius, Hanne; Al-Borno, Yahya; Shaqoura, Samar; Skaik, Nashwa; Giil, Lasse Melvær; Gilbert, Mads

2018-02-21

During four separate Israeli military attacks on Gaza (2006, 2009, 2012, and 2014), about 4000 Palestinians were killed and more than 17 000 injured (412 killed and 1264 injured in 2006; 1383 killed and more than 5300 injured in 2009; 130 killed and 1399 injured in 2012; and 2251 killed and 11 231 injured in 2014). An unknown number of people had traumatic amputations of one or more extremities. Use of unmanned Israeli drones for surveillance and armed attacks on Gaza was evident, but exact figures on numbers of drone strikes on Gaza are not available. The aim of this study was to explore the medical consequences of strikes on Gaza with different weapons, including drones. We studied a cohort of civilians in the Gaza Strip who had one of more traumatic limb amputation during the Israeli military attacks between 2006 and 2016. The study was done at The Artificial Limb and Polio Center (ALPC) in the Gaza Strip where most patients are treated and trained after amputation. We used standardised forms and validated instruments to record date and mechanism of injury, self-assessed health, socioeconomic status, anatomical location and length of amputation, comorbidity, and the results of a detailed clinical examination. The studied cohort consisted of 254 Paletinian civilians (234 [92%] men, 20 [8%] women, and 43 [17%] children aged 18 years and younger) with traumatic amputations caused by different weapons. 216 (85%) people had amputations proximal to wrist or ankle, 131 (52%) patients had more than one major amputation or an amputation above the knee, or both, and 136 (54%) people were injured in attacks with Israeli drones, including eight (40%) of the women. The most severe amputations were caused by drone attacks (p=0·0001). Extremity injuries after drone attacks led to immediate amputation more often than with other weapons (p=0·014). Patients injured during cease-fire periods were younger than patients injured during periods of declared Israeli military operations (p=0·0001). Weapons fired on the Gaza Strip from Israeli drones caused severe injuries in surviving Palestinian civilians. Drone-fired missiles resulted in major amputations in almost all victims who had limb losses. Substantially more severe injuries were inflicted by the drone-launched explosives than by other weapons used during the Gaza War. Traumatic amputations caused by drones were often immediately complete. One limitation of our study is that it does not elucidate injury patterns in victims with fatal injuries. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

Self-Amputation in Two Non-Psychotic Patients.

PubMed

Rahmanian, Hamid; Petrou, Nikoletta A; Sarfraz, M Aamer

2015-09-01

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

Initial Experience of US Marine Corps Forward Resuscitative Surgical System during Operation Iraqi Freedom

DTIC Science & Technology

2005-01-01

lavage, and splinting. Exter- nal fixation was used when there was concurrent vascular pro- cedures or if fractures were extremely unstable...foot open fracture Completion lower extremity amputation; completion right upper amputation; external fixation right ankle 8/Iraqi child Class 3 shock...infection Comminuted mandible fracture with loss of airway (casualty 1 in Table 2) Airway control Infection of mandibular plate at echelon 5 facility

Determining Reliability of a Dual-Task Functional Mobility Protocol for Individuals With Lower Extremity Amputation.

PubMed

Hunter, Susan W; Frengopoulos, Courtney; Holmes, Jeff; Viana, Ricardo; Payne, Michael W

2018-04-01

To determine the relative and absolute reliability of a dual-task functional mobility assessment. Cross-sectional study. Academic rehabilitation hospital. Individuals (N=60) with lower extremity amputation attending an outpatient amputee clinic (mean age, 58.21±12.59y; 18, 80% male) who were stratified into 3 groups: (1) transtibial amputation of vascular etiology (n=20); (2) transtibial amputation of nonvascular etiology (n=20); and (3) transfemoral or bilateral amputation of any etiology (n=20). Not applicable. Time to complete the L Test measured functional mobility under single- and dual-task conditions. The addition of a cognitive task (serial subtractions by 3's) created dual-task conditions. Single-task performance on the cognitive task was also reported. Intraclass correlation coefficients (ICCs) measured relative reliability; SEM and minimal detectable change with a 95% confidence interval (MDC 95 ) measured absolute reliability. Bland-Altman plots measured agreement between assessments. Relative reliability results were excellent for all 3 groups. Values for the dual-task L Test for those with transtibial amputation of vascular etiology (n=20; mean age, 60.36±7.84y; 19, 90% men) were ICC=.98 (95% confidence interval [CI], .94-.99), SEM=1.36 seconds, and MDC 95 =3.76 seconds; for those with transtibial amputation of nonvascular etiology (n=20; mean age, 55.85±14.08y; 17, 85% men), values were ICC=.93 (95% CI, .80-.98), SEM=1.34 seconds, and MDC 95 =3.71 seconds; and for those with transfemoral or bilateral amputation (n=20; mean age, 58.21±14.88y; 13, 65% men), values were ICC=.998 (95% CI, .996-.999), SEM=1.03 seconds, and MDC 95 =2.85 seconds. Bland-Altman plots indicated that assessments did not vary systematically for each group. This dual-task assessment protocol achieved approved levels of relative reliability values for the 3 groups tested. This protocol may be used clinically or in research settings to assess the interaction between cognition and functional mobility in the population with lower extremity amputation. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary team work and continuous prospective audit.

PubMed

Krishnan, Singhan; Nash, Fiona; Baker, Neil; Fowler, Duncan; Rayman, Gerry

2008-01-01

To assess changes in diabetic lower-extremity amputation rates in a defined relatively static population over an 11-year period following the introduction of a multidisciplinary foot team. All diabetic patients with foot problems admitted to Ipswich Hospital, a large district general hospital, were identified by twice-weekly surveillance of all relevant in-patient areas and outcomes including amputations recorded. The incidence of major amputations fell 62%, from 7.4 to 2.8 per 100,000 of the general population. Total amputation rates also decreased (40.3%) but to a lesser extent due to a small increase in minor amputations. Expressed as incidence per 10,000 people with diabetes, total amputations fell 70%, from 53.2 to 16.0, and major amputations fell 82%, from 36.4 to 6.7. Significant reductions in total and major amputation rates occurred over the 11-year period following improvements in foot care services including multidisciplinary team work.

Risk Factors for Thirty-Day Readmissions After Lower Extremity Amputation in Patients With Vascular Disease.

PubMed

Vogel, Todd R; Smith, Jamie B; Kruse, Robin L

2018-05-29

Understanding risk factors associated with readmission after lower extremity amputation may indicate targets for reducing readmission. This study evaluated factors associated with all-cause 30-day readmission after lower extremity amputation procedures. Retrospective cohort study. Inpatient. A total of 2480 patients who had lower extremity amputations between 2008 and 2014 were selected from national electronic medical record database, Cerner Health Facts. Univariate analysis of demographics, diagnoses, postoperative medications, and laboratory results were examined. Multivariate logistic regression models were used to identify characteristics independently associated with readmission overall and by amputation location-above the knee (AKA) or below the knee (BKA). Readmission within 30 days of discharge. More than one half of patients (1403, 57%) underwent BKA and 1077 (43%) underwent AKA. Readmission within 30 days was 22% (24.1% BKA versus 19.4% AKA, P = .005). In multivariable logistic regression, factors associated with 30-day readmission after any amputation included BKA (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.15-1.74, P = .001), hypertension (OR 1.70, 95% CI 1.33-2.16), surgical-site infections (OR 1.44, 95% CI 1.02-2.04), heart failure (OR 1.39, 95% CI 1.10-1.75), discharge to a skilled nursing facility (OR 1.88, 95% CI 1.41-2.51), and emergency/urgent procedures (OR 1.32, 95% CI 1.04-1.67). At readmission, 13.3% of patients with a BKA required an AKA revision, and 21.3% had a diagnosis of surgical-site infection. Risk factors for readmission after any amputation included cardiac comorbidities, associated postoperative medications, and discharge to a skilled nursing facility. The finding that acute arterial embolism or thrombosis and a BKA during the index admission was highly associated with readmission, combined with the high rates of 30-day conversion to an AKA when readmitted, suggests these patients more often develop stump complications or may be undertreated during the initial hospitalization. III. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

General outcomes and risk factors for minor and major amputations in Brazil.

PubMed

Leite, Jose O; Costa, Leandro O; Fonseca, Walter M; Souza, Debora U; Goncalves, Barbara C; Gomes, Gabriela B; Cruz, Lucas A; Nister, Nilder; Navarro, Tulio P; Bath, Jonathan; Dardik, Alan

2018-06-01

Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.

A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees.

PubMed

Allami, Mostafa; Mousavi, Batool; Masoumi, Mehdi; Modirian, Ehsan; Shojaei, Hadi; Mirsalimi, Fatemeh; Hosseini, Maryam; Pirouzi, Pirouz

2016-01-01

Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation. The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees (206 amputations) from the Iran-Iraq war were evaluated, and a detailed questionnaire was also administered. The most common level of amputation was the finger or wrist level (108, 52.4 %). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis (65, 31.6 %), rotator cuff injury (24, 11.7 %), bicipital tendonitis (69, 33.5 %), shoulder drop (42, 20.4 %) and muscle atrophy (19, 9.2 %). Peripheral nerve disorders included carpal tunnel syndrome in 13 (6.3 %) and unilateral brachial plexus injury in 1 (1 %). Fifty-three (51.5 %) were diagnosed with facet joint syndrome at the level of the cervical spine (the most frequent site). Using a prosthesis was reported by 65 (63.1 %), both left and right sides. The back was the most common site of pain (71.8 %). The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

Common Factors and Outcome in Late Upper Extremity Amputations After Military Injury

DTIC Science & Technology

2014-04-01

documentation, if this pain was solely phan- tom limb pain or a different type of neuropathic pain. Only 1 (14%) had a chronic infection . Table 1... Infection 1 14% Malunion 1 14% Nonunion 1 14% Krueger et al J Orthop Trauma Volume 28, Number 4, April 2014 228 | www.jorthotrauma.com 2013... infections to be the most common reasons why those with lower extrem- ities underwent late amputations. Tintle et al5 also found infec- tion and wound

A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma.

PubMed

Ginsberg, Jill P; Rai, Shesh N; Carlson, Claire A; Meadows, Anna T; Hinds, Pamela S; Spearing, Elena M; Zhang, Lijun; Callaway, Lulie; Neel, Michael D; Rao, Bhaskar N; Marchese, Victoria G

2007-12-01

Comparison of functional mobility and quality of life is performed in patients with lower-extremity bone sarcoma following either amputation, limb-sparing surgery, or rotationplasty with four different types of outcome measures: (1) an objective functional mobility measure that requires patients to physically perform specific tasks, functional mobility assessment (FMA); (2) a clinician administered tool, Musculoskeletal Tumor Society Scale (MSTS); (3) a patient questionnaire, Toronto Extremity Salvage Scale (TESS); and (4) a health-related quality of life (HRQL) measure, Short Form-36 version 2 (SF-36v.2). This is a prospective multi-site study including 91 patients with lower-extremity bone sarcoma following amputation, limb-sparing surgery, or rotationplasty. One of three physical therapists administered the quality of life measure (SF-36v.2) as well as a battery of functional measures (FMA, MSTS, and TESS). Differences between patients who had amputation, limb-sparing surgery, or rotationplasty were consistently demonstrated by the FMA. Patients with limb sparing femur surgery performed better than those patients with an above the knee amputation but similarly to a small number of rotationplasty patients. Several of the more conventional self-report measures were shown to not have the discriminative capabilities of the FMA in these cohorts. In adolescents with lower-extremity bone sarcoma, it may be advantageous to consider the use of a combination of outcome measures, including the FMA, for objective functional mobility assessment along with the TESS for a subjective measure of disability and the SF-36v.2 for a quality-of-life measure. 2007 Wiley-Liss, Inc

Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb.

PubMed

Baril, Donald T; Goodney, Philip P; Robinson, William P; Nolan, Brian W; Stone, David H; Li, YouFu; Cronenwett, Jack L; Schanzer, Andres

2012-08-01

To date, history of a contralateral amputation as a potential predictor of outcomes after lower extremity bypass (LEB) for critical limb ischemia (CLI) has not been studied. We sought to determine if a prior contralateral lower extremity amputation predicts worse outcomes in patients undergoing LEB in the remaining intact limb. A retrospective analysis of all patients undergoing infrainguinal LEB for CLI between 2003 and 2010 within hospitals comprising the Vascular Study Group of New England was performed. Patients were stratified according to whether or not they had previously undergone a contralateral major or minor amputation before LEB. Primary end points included major amputation and graft occlusion at 1 year postoperatively. Secondary end points included in-hospital major adverse events, discharge status, and mortality at 1 year. Of 2636 LEB procedures, 228 (8.6%) were performed in the setting of a prior contralateral amputation. Patients with a prior amputation compared to those without were younger (66.5 vs 68.7; P = .034), more like to have congestive heart failure (CHF; 25% vs 16%; P = .002), hypertension (94% vs 85%; P = .015), renal insufficiency (26% vs 14%; P = .0002), and hemodialysis-dependent renal failure (14% vs 6%; P = .0002). They were also more likely to be nursing home residents (8.0% vs 3.6%; P = .036), less likely to ambulate without assistance (41% vs 80%; P < .0002), and more likely to have had a prior ipsilateral bypass (20% vs 12%; P = .0005). These patients experience increased in-hospital major adverse events, including myocardial infarction (MI; 8.9% vs 4.2%; P = .002), CHF (6.1% vs 3.4%; P = .044), deterioration in renal function (9.0% vs 4.7%; P = .006), and respiratory complications (4.2% vs 2.3%; P = .034). They were less likely to be discharged home (52% vs 72%; P < .0001) and less likely to be ambulatory on discharge (25% vs 55%; P < .0001). Although patients with a prior contralateral amputation experienced increased rates of graft occlusion (38% vs 17%; P < .0001) and major amputation (16% vs 7%; P < .0001) at 1 year, there was not a significant difference in mortality (16% vs 10%; P = .160). On multivariable analysis, prior contralateral amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06-2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39-2.68; P < .0001) at 1 year. Patients with prior contralateral amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of perioperative adverse events, increased rates of 1-year graft occlusion, and decreased rates of limb salvage, when compared with patients who have not undergone a contralateral amputation. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Prior contralateral amputation predicts worse outcomes for lower extremity bypasses performed in the intact limb

PubMed Central

Baril, Donald T.; Goodney, Philip P.; Robinson, William P.; Nolan, Brian W.; Stone, David H.; Li, YouFu; Cronenwett, Jack L.; Schanzer, Andres

2013-01-01

Introduction To date, history of a contralateral amputation as a potential predictor of outcomes after lower extremity bypass (LEB) for critical limb ischemia (CLI) has not been studied. We sought to determine if a prior contralateral lower extremity amputation predicts worse outcomes in patients undergoing LEB in the remaining intact limb. Methods A retrospective analysis of all patients undergoing infrainguinal LEB for CLI between 2003 and 2010 within hospitals comprising the Vascular Study Group of New England was performed. Patients were stratified according to whether or not they had previously undergone a contralateral major or minor amputation before LEB. Primary end points included major amputation and graft occlusion at 1 year postoperatively. Secondary end points included in-hospital major adverse events, discharge status, and mortality at 1 year. Results Of 2636 LEB procedures, 228 (8.6%) were performed in the setting of a prior contralateral amputation. Patients with a prior amputation compared to those without were younger (66.5 vs 68.7; P = .034), more like to have congestive heart failure (CHF; 25% vs 16%; P = .002), hypertension (94% vs 85%; P = .015), renal insufficiency (26% vs 14%; P = .0002), and hemodialysis-dependent renal failure (14% vs 6%; P = .0002). They were also more likely to be nursing home residents (8.0% vs 3.6%; P = .036), less likely to ambulate without assistance (41% vs 80%; P < .0002), and more likely to have had a prior ipsilateral bypass (20% vs 12%; P = .0005). These patients experience increased in-hospital major adverse events, including myocardial infarction (MI; 8.9% vs 4.2%; P = .002), CHF (6.1% vs 3.4%; P = .044), deterioration in renal function (9.0% vs 4.7%; P = .006), and respiratory complications (4.2% vs 2.3%; P = .034). They were less likely to be discharged home (52% vs 72%; P < .0001) and less likely to be ambulatory on discharge (25% vs 55%; P < .0001). Although patients with a prior contralateral amputation experienced increased rates of graft occlusion (38% vs 17%; P < .0001) and major amputation (16% vs 7%; P < .0001) at 1 year, there was not a significant difference in mortality (16% vs 10%; P = .160). On multivariable analysis, prior contralateral amputation was an independent predictor of both major amputation (odds ratio, 1.73; confidence interval, 1.06–2.83; P = .027) and graft occlusion (odds ratio, 1.93; confidence interval, 1.39–2.68; P < .0001) at 1 year. Conclusions Patients with prior contralateral amputations who present with CLI in the intact limb represent a high-risk population, even among patients with advanced peripheral arterial disease. When considering LEB in this setting, both physicians and patients should expect increased rates of perioperative adverse events, increased rates of 1-year graft occlusion, and decreased rates of limb salvage, when compared with patients who have not undergone a contralateral amputation. PMID:22480762

Impact of Prehospital Medical Evacuation (MEDEVAC) Transport Time on Combat Mortality in Patients with Non-Compressible Torso Injury and Traumatic Amputations

DTIC Science & Technology

2018-12-28

MED EV AC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations Sb. GRANT NUMBER Sc. PROGRAM...increased morbidity and mortality. Limited data exists on the influence of transport time on patient outcomes with specific injury types. The...treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI). Methods: We

Preservation of lower extremity amputation length using muscle perforator free flaps.

PubMed

Hallock, G G

2008-06-01

Coverage of any lower extremity amputation stump must be durable to resist external forces, well contoured, and thin enough for proper shoewear or prothesis fitting. Preservation of bone length to maximise the ability to ambulate is also of paramount importance. If local soft tissues are inadequate to fulfil these prerequisites, consideration of a microsurgical tissue transfer is a reasonable option, especially to cover bone or save a major joint. Muscle perforator free flaps, as shown in this series of eight patients using four different donor sites, are a versatile alternative for the necessary soft tissue augmentation. Multiple choices are available and often even from the involved lower extremity to minimise further morbidity. The vascular pedicles of this genré of flaps are relatively exceedingly long and of respectable calibre to facilitate reaching an appropriate recipient site. They can be sensate if desired. Of course, muscle function is by definition preserved. Complications are minimal and usually related to the reason for the amputation in the first place.

[Body integrity identity disorder, relief after amputation].

PubMed

Blom, R M; Braam, A W; de Boer-Kreeft, N; Sonnen, M P A M

2014-01-01

Body integrity identity disorder (BIID) is a rare condition in which a person, for no apparent physical reason, is tormented by the experience that a body-part, such as a limb, does not really belong to the body. Patients experience an intense desire for the limb to be amputated (a 'desire' formerly referred to as 'apotemnophilia'). We report on a 58-year-old male patient with BIID who froze one of his legs so that he could amputate it himself. A surgeon ultimately intervened and amputated the leg professionally. The patient was extremely relieved and was still experiencing relief at a follow-up three years later.

Early Identification of Molecular Predictors of Heterotopic Ossification Following Extremity Blast Injury with a Biomarker Assay

DTIC Science & Technology

2016-10-01

incidence is reported between 57-63% in patients that sustain a poly -trauma blast injury [1,2]. Complications related to HO in residual limbs...following blast amputation include pain , overlying skin and muscle breakdown, poor fitting and functioning of prosthetic limbs, reoperation for amputation

Evaluation of Mangled Extremity Severity Score (MESS) as a predictor of lower limb amputation in children with trauma.

PubMed

Behdad, Saba; Rafiei, Mohammad Hadi; Taheri, Hadi; Behdad, Samin; Mohammadzadeh, Mahdi; Kiani, Gelare; Hosseinpour, Mehrdad

2012-12-01

Management of the severely injured lower limb in children remains a challenge despite advances in surgical techniques. Models that predict the risk of lower limb trauma patients are designed to provide an estimation of the probability of limb salvage. In this study, we validate Mangled Extremity Syndrome Index (Mangled Extremity Severity Score [MESS]) by measurement of its discrimination in children. From September 2009 to 2010, we collected the hospital records of all children who presented with lower extremity long bone open fractures. The inclusion criteria were I grade, II B, III C open fractures, severe injury to three of four organ systems, and severe injury to two of four organ systems with minor injury to two of four systems that require surgical interventions. Severity of limb injury was measured using MESS. Patients were followed up for 1 year. The discrimination of MESS model in differentiating of outcome in patients was assessed by calculating the area under the receiver operator characteristic plot. We evaluated 200 children referred consecutively to our center. The mean MESS in the amputation group was 7.5 ± 1.59 versus 6.4 ± 2.02 in the limb salvage group (p = 0.04). Amputation rate was 7.5% (n = 15). Percentages of skeletal/soft-tissue injury was different between groups (p = 0.0001). Children in the amputation group showed more tissue injury compared with limb salvage group. The best clinical discriminator power was calculated as MESS ≥ 6.5 (sensitivity = 73%, specificity = 54%). We assumed that patients with a high risk of amputation can be identified early, and specific measures can be implemented immediately by using MESS with threshold of 6.5. Georg Thieme Verlag KG Stuttgart · New York.

Classification systems for lower extremity amputation prediction in subjects with active diabetic foot ulcer: a systematic review and meta-analysis.

PubMed

Monteiro-Soares, M; Martins-Mendes, D; Vaz-Carneiro, A; Sampaio, S; Dinis-Ribeiro, M

2014-10-01

We systematically review the available systems used to classify diabetic foot ulcers in order to synthesize their methodological qualitative issues and accuracy to predict lower extremity amputation, as this may represent a critical point in these patients' care. Two investigators searched, in EBSCO, ISI, PubMed and SCOPUS databases, and independently selected studies published until May 2013 and reporting prognostic accuracy and/or reliability of specific systems for patients with diabetic foot ulcer in order to predict lower extremity amputation. We included 25 studies reporting a prevalence of lower extremity amputation between 6% and 78%. Eight different diabetic foot ulcer descriptions and seven prognostic stratification classification systems were addressed with a variable (1-9) number of factors included, specially peripheral arterial disease (n = 12) or infection at the ulcer site (n = 10) or ulcer depth (n = 10). The Meggitt-Wagner, S(AD)SAD and Texas University Classification systems were the most extensively validated, whereas ten classifications were derived or validated only once. Reliability was reported in a single study, and accuracy measures were reported in five studies with another eight allowing their calculation. Pooled accuracy ranged from 0.65 (for gangrene) to 0.74 (for infection). There are numerous classification systems for diabetic foot ulcer outcome prediction, but only few studies evaluated their reliability or external validity. Studies rarely validated several systems simultaneously and only a few reported accuracy measures. Further studies assessing reliability and accuracy of the available systems and their composing variables are needed. Copyright © 2014 John Wiley & Sons, Ltd.

Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study.

PubMed

Patterson, Brendan M; Agel, Julie; Swiontkowski, Marc F; Mackenzie, Ellen J; Bosse, Michael J

2007-10-01

The purpose of this study is to report the clinical and functional results of a cohort of patients with knee dislocations associated with vascular injury. Patients with knee dislocation and associated vascular injury were prospectively assessed for outcome of severe lower extremity trauma during 2 years. The Sickness Impact Profile was used to assess the functional recovery of the patient. Surgeon and therapist assessments documented clinical metrics and treatment, including salvage or amputation, neurologic recovery, knee stability, and knee motion. Eighteen patients sustained a knee dislocation and an associated popliteal artery injury. Seven patients were found to have an additional vascular injury. All patients underwent repair of the vascular injury. At the time of final follow-up, 14 knees were successfully salvaged and four required amputation (1 below knee amputation, 2 through knee amputation, and 1 above knee amputation). Eighteen patients had at least a popliteal injury and underwent repair of the vascular injury. The patients with a limb-threatening knee dislocation that was successfully reconstructed had Sickness Impact Profile scores of 20.12 at 3 months, 13.18 at 6 months, 12.08 at 1 year, and 7.0 at 2 years after injury. Patients who sustain a limb-threatening knee dislocation have a moderate to high level of disability 2 years after injury. Nearly one in five patients who present to a Level I trauma center with a dysvascular limb associated with a knee dislocation will require amputation. Prolonged warm ischemia time was associated with a high rate of amputation. Patients who sustain vascular injuries associated with a knee dislocation need immediate transport to a trauma hospital, rapid assessment and diagnosis at presentation, and revascularization. Patients with these injuries can be effectively treated without angiography before surgery.

Complete major amputation of the upper extremity: Early results and initial treatment algorithm.

PubMed

Märdian, Sven; Krapohl, Björn D; Roffeis, Jana; Disch, Alexander C; Schaser, Klaus-Dieter; Schwabe, Philipp

2015-03-01

Traumatic major amputations of the upper extremity are devastating injuries. These injuries have a profound impact on patient's quality of life and pose a burden on social economy. The aims of the current study were to report about the initial management of isolated traumatic major upper limb amputation from the time of admission to definitive soft tissue closure and to establish a distinct initial management algorithm. We recorded data concerning the initial management of the patient and the amputated body part in the emergency department (ED) (time from admission to the operation, Injury Severity Score [ISS], cold ischemia time from injury to ED, and total cold ischemia time). The duration, amount of surgical procedures, the time to definitive soft tissue coverage, and the choice of flap were part of the documentation. All intraoperative and postoperative complications were recorded. All patients were successfully replanted (time from injury to ED, 59 ± 4 minutes; ISS16; time from admission to operating room 57 ± 10 minutes; total cold ischemia time 203 ± 20 minutes; total number of procedures 7.3 ± 2.5); definitive soft tissue coverage could be achieved 23 ± 14 days after injury. Two thromboembolic complications occurred, which could be treated by embolectomy during revision surgery, and we saw one early infection, which could be successfully managed by serial debridements in our series. The management of complete major amputations of the upper extremity should be reserved for large trauma centers with enough resources concerning technical, structural, and personnel infrastructure to meet the demands of surgical reconstruction as well as the postoperative care. Following a distinct treatment algorithm is mandatory to increase the rate of successful major replantations, thus laying the foundation for promising secondary functional reconstructive efforts. Therapeutic study, level V.

Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population.

PubMed

Baril, Donald T; Ghosh, Kaushik; Rosen, Allison B

2014-09-01

Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population. This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates. Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend < .001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend < .001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend < .001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend < .001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend < .001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend < .001); however, 1-year amputation-free survival remained unchanged. Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population

PubMed Central

Baril, Donald T.; Ghosh, Kaushik; Rosen, Allison B.

2015-01-01

Objective Acute lower extremity ischemia (ALI) is a common vascular surgery emergency associated with high rates of morbidity and mortality. The purpose of this study was to assess contemporary trends in the incidence of ALI, the methods of treatment, and the associated mortality and amputation rates in the U.S. Medicare population. Methods This was an observational study using Medicare claims data between 1998 and 2009. Outcomes examined included trends in the incidence of ALI; trends in interventions for ALI; and trends in amputation, mortality, and amputation-free survival rates. Results Between 1998 and 2009, the incidence of hospitalization for ALI decreased from 45.7 per 100,000 to 26.0 per 100,000 (P for trend < .001). The percentage of patients undergoing surgical intervention decreased from 57.1% to 51.6% (P for trend < .001), whereas the percentage of patients undergoing endovascular interventions increased from 15.0% to 33.1% (P for trend < .001). In-hospital mortality rates decreased from 12.0% to 9.0% (P for trend < .001), whereas 1-year mortality rates remained stable at 41.0% and 42.5% (P for trend not significant). In-hospital amputation rates remained stable at 8.1% and 6.4% (P for trend not significant), whereas 1-year amputation rates decreased from 14.8% to 11.0% (P for trend < .001). In-hospital amputation-free survival after hospitalization for ALI increased from 81.2% to 85.4% (P for trend < .001); however, 1-year amputation-free survival remained unchanged. Conclusions Between 1998 and 2009, the incidence of ALI among the U.S. Medicare population declined significantly, and the percentage of patients treated with endovascular techniques markedly increased. During this time, 1-year amputation rates declined. Furthermore, although in-hospital mortality rates declined after presentation with ALI, 1-year mortality rates remained unchanged. PMID:24768362

Relationship between amputation and risk factors in individuals with diabetes mellitus: A study with Brazilian patients.

PubMed

Mantovani, Alessandra M; Fregonesi, Cristina E P T; Palma, Mariana R; Ribeiro, Fernanda E; Fernandes, Rômulo A; Christofaro, Diego G D

Individuals with diabetes develop lower extremity amputation for several reasons. Investigations into pathways to the development of complications are important both for treatment and prevention. To evaluate the relationship between amputation and risk factors in people with diabetes mellitus. All participants included in this study (n=165) were recruited from the Diabetic Foot Program, developed in a Brazilian University, over seven years (2007-2014) and all information for this study was extracted from their clinical records. The prevalence of amputation in patients with diabetes with four risk factors was up to 20% higher when compared to those with only one risk factor. The main predictive risk factors for amputation in this population were the presence of an ulcer and smoking. The risk factors for amputation can be predicted for people with diabetes mellitus and, in the present study, the main factors were the presence of an ulcer and the smoking habit. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Management of the multiple limb amputee.

PubMed

Davidson, J H; Jones, L E; Cornet, J; Cittarelli, T

2002-09-10

Multiple limb amputations involving at least one upper extremity are very uncommon. The amputation of both an upper and lower limb is even more uncommon. Due to the rarity of these amputations therapists are uncertain regarding the most appropriate treatment methods. While the majority of the protocols used for single limb amputations are appropriate for these multiple limb amputees, there are differences. Loss of multiple limbs creates a problem of overheating for the individual. Loss of an arm and leg results in difficulty donning the prostheses and difficulty using crutches and parallel bars during mobilization. A review is given of 16 multiple limb amputees seen in our rehabilitation centre in the last 15 years. Return to work was seen in one third and was not related to the number of the amputations. A higher proportion of these multiple limb amputations occur through alcoholism or attempted suicide behaviour than occurs with either single upper limb amputations or lower limb amputations. This existing behaviour can create a management problem for the rehabilitation team during rehabilitation. Guidelines as to appropriate prosthetic and preprosthetic care are provided to assist the practitioner who has the acute and long term care of these patients. All multiple limb amputees should be referred to a specialized rehabilitation centre to discuss prosthetic options and long term rehabilitation requirements. This paper does not discuss bilateral lower limb amputations when not combined with an upper limb amputation.

Dismounted Complex Blast Injury.

PubMed

Andersen, Romney C; Fleming, Mark; Forsberg, Jonathan A; Gordon, Wade T; Nanos, George P; Charlton, Michael T; Ficke, James R

2012-01-01

The severe Dismounted Complex Blast Injury (DCBI) is characterized by high-energy injuries to the bilateral lower extremities (usually proximal transfemoral amputations) and/or upper extremity (usually involving the non-dominant side), in addition to open pelvic injuries, genitourinary, and abdominal trauma. Initial resuscitation and multidisciplinary surgical management appear to be the keys to survival. Definitive treatment follows general principals of open wound management and includes decontamination through aggressive and frequent debridement, hemorrhage control, viable tissue preservation, and appropriate timing of wound closure. These devastating injuries are associated with paradoxically favorable survival rates, but associated injuries and higher amputation levels lead to more difficult reconstructive challenges.

Late Embryogenesis Abundant (LEA) proteins in legumes

PubMed Central

Battaglia, Marina; Covarrubias, Alejandra A.

2013-01-01

Plants are exposed to different external conditions that affect growth, development, and productivity. Water deficit is one of these adverse conditions caused by drought, salinity, and extreme temperatures. Plants have developed different responses to prevent, ameliorate or repair the damage inflicted by these stressful environments. One of these responses is the activation of a set of genes encoding a group of hydrophilic proteins that typically accumulate to high levels during seed dehydration, at the last stage of embryogenesis, hence named Late Embryogenesis Abundant (LEA) proteins. LEA proteins also accumulate in response to water limitation in vegetative tissues, and have been classified in seven groups based on their amino acid sequence similarity and on the presence of distinctive conserved motifs. These proteins are widely distributed in the plant kingdom, from ferns to angiosperms, suggesting a relevant role in the plant response to this unfavorable environmental condition. In this review, we analyzed the LEA proteins from those legumes whose complete genomes have been sequenced such as Phaseolus vulgaris, Glycine max, Medicago truncatula, Lotus japonicus, Cajanus cajan, and Cicer arietinum. Considering their distinctive motifs, LEA proteins from the different groups were identified, and their sequence analysis allowed the recognition of novel legume specific motifs. Moreover, we compile their transcript accumulation patterns based on publicly available data. In spite of the limited information on these proteins in legumes, the analysis and data compiled here confirm the high correlation between their accumulation and water deficit, reinforcing their functional relevance under this detrimental conditions. PMID:23805145

[Study of bone mass with dual energy x-ray absorptiometry in a population of 99 lower limb amputees].

PubMed

Leclercq, M M; Bonidan, O; Haaby, E; Pierrejean, C; Sengler, J

2003-02-01

Osteopenia in lower extremity amputation is described with an increased risk of fracture and it seems to be interesting to study bone mass in a population of 99 amputees of limb. We studied the bone mass with Dual Energy Xray Absorptiometry in patients with limb amputation, above and under knee and who have been treated in the rehabilitation department of Mulhouse's hospital and more specifically the percentage of the difference of the mesure between amputed and non amputed side and the influence on this mesure of several factors like sexe; age; diabetes mellitus; delay of amputation; aetiology and use of prosthesis. For all the population, we find lower values of BMD (Bone mineral density) for femoral neck -10.4% +/- 12.2 (P < 0,001) and trochanter -14.9% +/- 14.5 (P < 0,001) between amputated and non amputated side, and also comparing with normal population -19.9% +/- 18.8 (P < 0,001) for femoral neck and -8.8% +/- 22 (P < 0,001) for trochanter.There is no influence of sexe, age, and time since amputation on BMD. The study of sub-groupes shows that the loss of bone mass is depending on traumatic amputation, the level of amputation (above knee) and when prothetis doesn't fit. Arteritis or diabetis are not pejoratif factors. This work confirms the mechanical factors as an important parameter of bone loss in the limb amputation.

Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.

PubMed

Budiman-Mak, Elly; Epstein, Noam; Brennan, Meghan; Stuck, Rodney; Guihan, Marylou; Huo, Zhiping; Emanuele, Nicholas; Sohn, Min-Woong

2016-04-01

Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations. This is a nested case-control study of a cohort of patients with diabetes aged<60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability. The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR=1.44, 95% CI=1.00-2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3=2.62, 95% CI=1.85-3.72; OR for Quartile 4=2.50, 95% CI=1.74-3.59) higher risk of major amputation (P for trend<0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease. This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Targeted Muscle Reinnervation for Transradial Amputation: Description of Operative Technique.

PubMed

Morgan, Emily N; Kyle Potter, Benjamin; Souza, Jason M; Tintle, Scott M; Nanos, George P

2016-12-01

Targeted muscle reinnervation (TMR) is a revolutionary surgical technique that, together with advances in upper extremity prostheses and advanced neuromuscular pattern recognition, allows intuitive and coordinated control in multiple planes of motion for shoulder disarticulation and transhumeral amputees. TMR also may provide improvement in neuroma-related pain and may represent an opportunity for sensory reinnervation as advances in prostheses and haptic feedback progress. Although most commonly utilized following shoulder disarticulation and transhumeral amputations, TMR techniques also represent an exciting opportunity for improvement in integrated prosthesis control and neuroma-related pain improvement in patients with transradial amputations. As there are no detailed descriptions of this technique in the literature to date, we provide our surgical technique for TMR in transradial amputations.

Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol.

PubMed

van Netten, Jaap J; Baba, Mendel; Lazzarini, Peter A

2017-05-18

Diabetic foot disease is associated with major morbidity, mortality, costs, and reduction of a person's quality of life. Investigating the epidemiology of diabetic foot disease is the backbone of diabetic foot research and clinical practice, yet the full burden of diabetic foot disease in Australia is unknown. This study aims to describe the protocol for a systematic review of the epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia. The systematic review will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. PubMed and EMBASE will be searched for publications in any language and without restrictions to date. Two independent investigators will screen publications for eligibility, with publications reporting Australian population-based incidence or prevalence of diabetic foot disease or diabetes-related lower-extremity amputation to be included. Additionally, a forward literature search will be performed in Google Scholar, and a grey literature search will be performed to identify government publications. Quality assessment will be performed using customised checklists. The summary statistic used for each study will be an incidence or prevalence proportion of diabetic foot disease or diabetes-related lower-extremity amputation. The standard error for each proportion will be calculated. A meta-analysis will be performed when three or more publications of adequate quality, reporting on similar outcomes and in similar populations, are identified. The results of this systematic review can be used to adequately inform stakeholders in the field of diabetic foot disease on the extent of the problem in incidence and prevalence of diabetic foot disease in Australia, and to help guide appropriate use of resources to reduce the burden of this disease. PROSPERO CRD42016050740.

Perioperative and rehabilitation outcome after lower-limb amputation in elderly Chinese patients in Hong Kong.

PubMed

Leung, H B; Wong, W C; Wu, F C J; Guerin, J S

2004-06-01

Major amputation of the lower limb is considered the last resort when limb salvage is impossible. The aim of this study is to determine the morbidity, mortality, and rehabilitation outcome of patients that underwent a lower-limb amputation. A retrospective cohort study was conducted among 100 elderly patients who underwent a total of 120 lower-limb amputations in a regional hospital in Hong Kong from 1996 to 2001. The mean age of the amputees was 77.9 years; 58 were female. 95% of the amputations were performed because of infection with or without vascular compromise; 55 transfemoral and 60 transtibial amputations contributed 96% of the case mix. Some 43% of patients experienced early complications and 12% required re-amputation. The early (30-day) mortality rate was 15%. Only 55% of the amputees survived after 4 years. A 44% return-home rate was achieved. However, only 11% of the amputees could walk without help from other people. Although prostheses were issued to 42% of the survivors, compliance was only 53%; 24% of the survivors lost their remaining leg within 2 years. The outcome of major lower-extremity amputation remains poor. Efforts should be made to retain these limbs. When it is proven impossible, one should strive to preserve the knee joint whenever feasible.

Lower extremity amputation rates in people with diabetes as an indicator of health systems performance. A critical appraisal of the data collection 2000-2011 by the Organization for Economic Cooperation and Development (OECD).

PubMed

Carinci, F; Massi Benedetti, M; Klazinga, N S; Uccioli, L

2016-10-01

Critical appraisal of secondary data made available by the OECD for the time frame 2000-2011. Comparison of trends and variation of amputations in people with diabetes across OECD countries. Generalized estimating equations to test the statistical significance of the annual change adjusting for major potential confounders. A total of 26 OECD countries contributed to the OECD data collection for at least 1 year in the reference time frame, showing a decline in rates of over 40 %, from a mean of 13.2 (median 9.4, range 5.1-28.1) to 7.8 amputations per 100,000 in the general population (9.9, 1.0-18.4). The multivariate model showed an average decrease equal to -0.27 per 100,000 per year (p = 0.015), adjusted by structural characteristics of health systems, showing lower amputation rates for health systems financed by public taxation (-4.55 per 100,000 compared to insurance based, p = 0.002) and non-ICD coding mechanisms (-7.04 per 100,000 compared to ICD-derived, p = 0.001). Twelve-year decrease was stronger among insurance-based financing systems (tax based: -0.16 per 100,000, p = 0.064; insurance based: -0.36 per 100,000; p = 0.046). In OECD countries, amputation rates in diabetes continuously decreased over 12 years. Still, in 2011, one amputation every 7 min could be directly attributed to diabetes. Although interesting, these results should be taken with extreme caution, until common definitions are improved and data quality issues, e.g., a different ability in capturing diabetes diagnoses, are fully resolved.

Two novel heat-soluble protein families abundantly expressed in an anhydrobiotic tardigrade.

PubMed

Yamaguchi, Ayami; Tanaka, Sae; Yamaguchi, Shiho; Kuwahara, Hirokazu; Takamura, Chizuko; Imajoh-Ohmi, Shinobu; Horikawa, Daiki D; Toyoda, Atsushi; Katayama, Toshiaki; Arakawa, Kazuharu; Fujiyama, Asao; Kubo, Takeo; Kunieda, Takekazu

2012-01-01

Tardigrades are able to tolerate almost complete dehydration by reversibly switching to an ametabolic state. This ability is called anhydrobiosis. In the anhydrobiotic state, tardigrades can withstand various extreme environments including space, but their molecular basis remains largely unknown. Late embryogenesis abundant (LEA) proteins are heat-soluble proteins and can prevent protein-aggregation in dehydrated conditions in other anhydrobiotic organisms, but their relevance to tardigrade anhydrobiosis is not clarified. In this study, we focused on the heat-soluble property characteristic of LEA proteins and conducted heat-soluble proteomics using an anhydrobiotic tardigrade. Our heat-soluble proteomics identified five abundant heat-soluble proteins. All of them showed no sequence similarity with LEA proteins and formed two novel protein families with distinct subcellular localizations. We named them Cytoplasmic Abundant Heat Soluble (CAHS) and Secretory Abundant Heat Soluble (SAHS) protein families, according to their localization. Both protein families were conserved among tardigrades, but not found in other phyla. Although CAHS protein was intrinsically unstructured and SAHS protein was rich in β-structure in the hydrated condition, proteins in both families changed their conformation to an α-helical structure in water-deficient conditions as LEA proteins do. Two conserved repeats of 19-mer motifs in CAHS proteins were capable to form amphiphilic stripes in α-helices, suggesting their roles as molecular shield in water-deficient condition, though charge distribution pattern in α-helices were different between CAHS and LEA proteins. Tardigrades might have evolved novel protein families with a heat-soluble property and this study revealed a novel repertoire of major heat-soluble proteins in these anhydrobiotic animals.

Amputation: Not a failure for severe lower extremity combat injury.

PubMed

van Dongen, Thijs T C F; Huizinga, Eelco P; de Kruijff, Loes G M; van der Krans, Arie C; Hoogendoorn, Jochem M; Leenen, Luke P H; Hoencamp, Rigo

2017-02-01

The use of improvised explosive devices is a frequent method of insurgents to inflict harm on deployed military personnel. Consequently, lower extremity injuries make up the majority of combat related trauma. The wounding pattern of an explosion is not often encountered in a civilian population and can lead to substantial disability. It is therefore important to study the impact of these lower extremity injuries and their treatment (limb salvage versus amputation) on functional outcome and quality of life. All Dutch repatriated service members receiving treatment for wounds on the lower extremity sustained in the Afghan theater between august 2005 and August 2014, were invited to participate in this observational cohort study. We conducted a survey regarding their physical and mental health using the Short Form health survey 36, EuroQoL 6 dimensions and Lower Extremity Functional Scale questionnaires. Results were collated in a specifically designed electronic database combined with epidemiology and hospital statistics gathered from the archive of the Central Military Hospital. Statistical analyses were performed to identify differences between combat and non-combat related injuries and between limb salvage treatment and amputation. In comparison with non-battle injury patients, battle casualties were significantly younger of age, sustained more severe injuries, needed more frequent operations and clinical rehabilitation. Their long-term outcome scores in areas concerning well-being, social and cognitive functioning, were significantly lower. Regarding treatment, amputees experienced higher physical well-being and less pain compared to those treated with limb salvage surgery. Sustaining a combat injury to the lower extremity can lead to partial or permanent dysfunction. However, wounded service members, amputees included, are able to achieve high levels of activity and participation in society, proving a remarkable resilience. These long-term results demonstrate that amputation is not a failure for casualty and surgeon, and strengthen a life before limb (damage control surgery) mindset in the initial phase. For future research, we recommend the use of adequate coding and injury scoring systems to predict outcome and give insight in the attributes that are supportive for the resilience that is needed to cope with a serious battle injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

Roy's Adaptation Model-Guided Education and Promoting the Adaptation of Veterans With Lower Extremities Amputation.

PubMed

Azarmi, Somayeh; Farsi, Zahra

2015-10-01

Any defect in extremities of the body can affect different life aspects. The purpose of this study was to investigate the effect of Roy's adaptation model-guided education on promoting the adaptation of veterans with lower extremities amputation. In a randomized clinical trial, 60 veterans with lower extremities amputation referring to Kowsar Orthotics and Prosthetics Center of veterans clinic in Tehran, Iran, were recruited with convenience method and were randomly assigned to intervention and control groups during 2013 - 2014. For data collection, Roy's adaptation model questionnaire was used. After completing the questionnaires in both groups, maladaptive behaviors were determined in the intervention group and an education program based on Roy's adaptation model was implemented. After two months, both groups completed the questionnaires again. Data was analyzed with SPSS software. Independent t-test showed statistically significant differences between the two groups in the post-test stage in terms of the total score of adaptation (P = 0.001) as well as physiologic (P = 0.0001) and role function modes (P = 0.004). The total score of adaptation (139.43 ± 5.45 to 127.54 ± 14.55, P = 0.006) as well as the scores of physiologic (60.26 ± 5.45 to 53.73 ± 7.79, P = 0.001) and role function (20.30 ± 2.42 to 18.13 ± 3.18, P = 0.01) modes in the intervention group significantly increased, whereas the scores of self-concept (42.10 ± 4.71 to 39.40 ± 5.67, P = 0.21) and interdependence (16.76 ± 2.22 to 16.30 ± 2.57, P = 0.44) modes in the two stages did not have a significant difference. Findings of this research indicated that the Roy's adaptation model-guided education promoted the adaptation level of physiologic and role function modes in veterans with lower extremities amputation. However, this intervention could not promote adaptation in self-concept and interdependence modes. More intervention is advised based on Roy's adaptation model for improving the adaptation of veterans with lower extremities.

Common foot problems in diabetic foot clinic.

PubMed

Tantisiriwat, Natthiya; Janchai, Siriporn

2008-07-01

To study common foot problems presented in diabetic foot clinic. A retrospectively review of out patient department records and diabetic foot evaluation forms of patients who visited the diabetic foot clinic at King Chulalongkorn Memorial Hospital between 2004 and 2006. Of all diabetic patients, 70 men and 80 women with the average age of 63.8 years were included in this study. About 32% of all reported cases had lower extremity amputation in which the toe was the most common level. Foot problems were evaluated and categorized in four aspects, dermatological, neurological, musculoskeletal, and vascular, which were 67.30%, 79.3%, 74.0%, and 39.3% respectively. More than half of the patients had skin dryness, nail problem and callus formation. Fifty six percent had the abnormal plantar pressure area, which was presented as callus. The great toe was the most common site of callus formation, which was correlated with gait cycle. The current ulcer was 18.8%, which was presented mostly at heel and great toe. Three-fourth of the patients (75.3%) had lost protective sensation, measured by the 5.07 monofilament testing. The most common problem found in musculoskeletal system was limited motion of the joint (44.0%). Claw toe or hammer toe were reported as 32.0% whereas the other deformities were bunnion (12.0%), charcot joint (6.0%) and flat feet (5.3%). The authors classified patients based on category risk to further lower extremity amputation into four groups. Forty-seven percent had highest risk for having further amputation because they had lost protective sensation from monofilament testing, previous current ulcer, or history of amputation. Only half of the patients had previous foot care education. Multidisciplinary diabetic foot care including patient education (proper foot care and footwear), early detection, effective management of foot problems, and scheduled follow-up must be emphasized to prevent diabetes-related lower extremities amputation.

Brachial artery protected by wrapped latissimus dorsi muscle flap in high voltage electrical injury

PubMed Central

Gencel, E.; Eser, C.; Kokacya, O.; Kesiktas, E.; Yavuz, M.

2016-01-01

Summary High voltage electrical injury can disrupt the vascular system and lead to extremity amputations. It is important to protect main vessels from progressive burn necrosis in order to salvage a limb. The brachial artery should be totally isolated from the burned area by a muscle flap to prevent vessel disruption. In this study, we report the use of a wrap-around latissimus dorsi muscle flap to protect a skeletonized brachial artery in a high voltage electrical injury in order to salvage the upper extremity and restore function. The flap wrapped around the exposed brachial artery segment and luminal status of the artery was assessed using magnetic resonance angiography. No vascular intervention was required. The flap survived completely with good elbow function. Extremity amputation was not encountered. This method using a latissimus dorsi flap allows the surgeon to protect the main upper extremity artery and reconstruct arm defects, which contributes to restoring arm function in high voltage electrical injury. PMID:28149236

Brachial artery protected by wrapped latissimus dorsi muscle flap in high voltage electrical injury.

PubMed

Gencel, E; Eser, C; Kokacya, O; Kesiktas, E; Yavuz, M

2016-06-30

High voltage electrical injury can disrupt the vascular system and lead to extremity amputations. It is important to protect main vessels from progressive burn necrosis in order to salvage a limb. The brachial artery should be totally isolated from the burned area by a muscle flap to prevent vessel disruption. In this study, we report the use of a wrap-around latissimus dorsi muscle flap to protect a skeletonized brachial artery in a high voltage electrical injury in order to salvage the upper extremity and restore function. The flap wrapped around the exposed brachial artery segment and luminal status of the artery was assessed using magnetic resonance angiography. No vascular intervention was required. The flap survived completely with good elbow function. Extremity amputation was not encountered. This method using a latissimus dorsi flap allows the surgeon to protect the main upper extremity artery and reconstruct arm defects, which contributes to restoring arm function in high voltage electrical injury.

Functional Outcomes of Persons Undergoing Dysvascular Lower Extremity Amputations

PubMed Central

Sauter, Carley N.; Pezzin, Liliana E.; Dillingham, Timothy R.

2012-01-01

Objective To examine the effect of post-acute rehabilitation setting on functional outcomes among patients undergoing major lower extremity dysvascular amputations. Design A population-based, prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization following amputation and at six-month following the acute care discharge were analyzed using multivariate models and instrumental variable techniques. Results A total of 297 patients were analyzed based on post-acute care rehabilitation setting: acute inpatient rehabilitation (IRF), skilled nursing facility (SNF) or home. The majority (43.4%) received care in IRF, 32% in SNF, and 24.6% at home. On SF-36 subscales, significantly improved outcomes were observed for patients receiving post-acute care at an IRF relative to those cared for at a SNF in physical function (PF), role physical (RF) and physical component score (PCS). Patients receiving post-acute care in IRFs also experienced better RF and PCS outcomes compared to those discharged directly home. In addition, patients receiving post-acute care at an IRF were significantly more likely to score in the top quartile for general health in IRF compared to SNF or home, and less likely to score in the lowest quartile for PF, RF and PCS in IRF compared to SNF. Lower ADL impairment was observed in IRF compared to SNF. Conclusions Among this large and diverse cohort of patients undergoing major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services at an IRF yielded improved functional outcomes six months after amputation relative to care received at SNFs or home. PMID:23291599

Upper extremity sensory feedback therapy in chronic cerebrovascular accident patients with impaired expressive aphasia and auditory comprehension.

PubMed

Balliet, R; Levy, B; Blood, K M

1986-05-01

Electromyographic (EMG) sensory feedback therapy (SFT) was used in the neuromuscular retraining of the nonfunctional upper extremity in five chronic left cerebrovascular accident (CVA) patients with impaired expressive and auditory comprehension. Speech diagnoses included global, moderate-to-severe Broca, and Wernicke aphasias. These patients had experienced increased despondency associated with previous therapy failures and often had indicated that they wished to have their involved extremity amputated, so that it would no longer be in the way. In this study, specific behavioral training strategies to increase patient involvement were used, including: general relaxation, modified SFT instruction, and home exercises, which were supported by family and/or friends. After an average of 50 therapy sessions, all patients were successfully retrained to use their right upper extremity at the gross-assist level. This resulted in feelings of increased self-esteem to the extent that amputation was no longer requested. It is concluded that EMG SFT can be beneficial in the neuromuscular reeducation of paretic upper extremity muscles of CVA patients with expressive aphasia and (impaired) auditory comprehension.

The Effect of Social Integration on Outcomes after Major Lower Extremity Amputation

PubMed Central

Hawkins, Alexander T.; Pallangyo, Anthony J.; Herman, Ayesiga M.; Schaumeier, Maria J.; Smith, Ann D.; Hevelone, Nathanael D.; Crandell, David M.; Nguyen, Louis

2016-01-01

Objective Major lower extremity amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. Methods From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form (Craig Handicap Assessment and Reporting Technique (CHART). Systemic social support was assessed by comparing a US and Tanzanian population. Walking function was measured using the 6MWT and quality of life (QoL) was measured using the EQ-5D. Results 102 major lower extremity amputees were recruited. 63 patients were enrolled in the US with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs. slow walk 23% vs. fast walk 10%; P=.01) and those with high social integration were more likely to be fast walkers (no walk 10% vs. slow walk 59% vs. fast walk 74%; P=.01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing quality of life scores in a multivariable analysis (β .002; SE .0008; P = .02). In comparing the US population with the Tanzanian cohort (39 subjects), there were no significant differences between functional or quality of life outcomes in the systemic social support analysis. Conclusions In the US population, increased social integration is associated with both improved function and quality of life outcomes among major lower extremity amputees. Systemic social support, as measured by comparing the US population with a Tanzanian population, was not associated with improved function or quality of life outcomes. In the US, steps should be taken to identify and aid amputees with poor social integration. PMID:26474508

Twenty-one-year experience with land mine injuries.

PubMed

Adams, D B; Schwab, C W

1988-01-01

Land mines produce devastating injuries which are usually fatal. In Guantanamo Bay, there have been no survivors from close range, functioning antipersonnel mines of the M-16 series. All 15 antipersonnel mine fatalities suffered extremity amputation. Seven of the 15 patients suffered immediately fatal head, neck, or truncal injuries (Type I injury). The three patients who underwent hospital resuscitation had extremity amputation but were spared major head, neck, or truncal injury. It is in this group of injured that potentially salvageable patients can be identified; for them aggressive rescue and resuscitation must be performed. Those with Type II injuries are the highest priority in any triage plan. In a mass casualty or combat casualty scenario, Type II patients, in particular those with high bilateral above-the-knee amputations, may be reassigned to an expectant treatment category so as to allow the main focus on more salvageable patients. The prehospital management plan emphasizes rapid assessment and triage of patients, use of tourniquets to control extremity hemorrhage, supplemental oxygen or endotracheal intubation if possible, neck immobilization, use of the extremity section of the pneumatic antishock garment if applicable, and rapid transport to a hospital. Hospital management of these patients emphasizes aggressive resuscitation, early endotracheal intubation, and rapid volume replacement with simultaneous balanced salt solution and blood. Operative debridement with broad-spectrum antibiotic coverage and tetanus prophylaxis is performed; wounds are managed in an open fashion and frequently examined at subsequent dates in the operating room.

The first case of Horn Kolb Syndrome in Turkey, diagnosed prenatally at the 23(rd) week of a pregnancy: A very rare and unusual case far from the original geography.

PubMed

Temur, Ismail; Ulker, Kahraman; Volkan, Islim; Karaca, Mehmet; Ersoz, Mustafa; Gul, Abdulaziz; Adiguzel, Esat

2012-01-01

The aim of this report was to evaluate and announce the first documented appearance of Horn Kolb syndrome in Turkey. Acheiropodia (Horn Kolb Syndrome) is the bilateral congenital amputation of the distal parts of the 4 extremities. It is an autosomal recessive developmental disorder. The characteristic features are amputation of the upper and lower extremities with aplasia of the hands and feet. The disorder affects only the extremities without other systemic manifestations. In this report, we present the first known case of Horn Kolb syndrome in Turkey, along with the diagnostic features. Severe dysmorphic skeletal anomalies should be excluded as soon as the earlier gestational weeks in every pregnancy by visualizing all 4 limbs of the fetus in routine prenatal ultrasound screening.

[Replantation at lower leg level].

PubMed

Daigeler, A; Fansa, H; Westphal, T; Schneider, W

2003-11-01

Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. We report five cases of orthotopic and two of heterotopic lower limb replantations. Functional outcome concerning sensibility, mobility, pain, and aesthetic result were assessed clinically and using a questionnaire. Functional outcome and patient satisfaction were good. The psychological situation of the patients as well as mobility and stability of the replanted limbs were satisfying. Heterotopically replanted patients found the replanted legs superior to the prostheses. We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.

Fluid collections in amputations are not indicative or predictive of infection.

PubMed

Polfer, Elizabeth M; Hoyt, Benjamin W; Senchak, Lien T; Murphey, Mark D; Forsberg, Jonathan A; Potter, Benjamin K

2014-10-01

In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present? We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, enhancement, complexity (simple versus loculated), surrounding edema, skin changes, tract formation, presence of air, and changes within the bone itself). The presence of a fluid collection on imaging was analyzed to determine whether it was associated with infection. We further analyzed clinical parameters, objective physical examination findings at the extremity, and characteristics of the fluid collection to determine if there were other parameters associated with infection. Over half (55%) of the limbs demonstrated fluid collection in the early postoperative period and the prevalence decreased in the late group (11%; p = 0.001). There was no association between the presence of a fluid collection and infection. However, there was an association between objective clinical signs at the extremity (erythema and/or drainage) and infection (p < 0.001) in our primary study cohort. Fluid collections are common in combat-related amputations in the immediate postoperative period and become smaller and less frequent over time. In the absence of extremity erythema and wound drainage, imaging of a residual limb to evaluate for the presence of a fluid collection appears to be of little clinical use.

Simulating lifetime outcomes associated with complications for people with type 1 diabetes.

PubMed

Lung, Tom W C; Clarke, Philip M; Hayes, Alison J; Stevens, Richard J; Farmer, Andrew

2013-06-01

The aim of this study was to develop a discrete-time simulation model for people with type 1 diabetes mellitus, to estimate and compare mean life expectancy and quality-adjusted life-years (QALYs) over a lifetime between intensive and conventional blood glucose treatment groups. We synthesized evidence on type 1 diabetes patients using several published sources. The simulation model was based on 13 equations to estimate risks of events and mortality. Cardiovascular disease (CVD) risk was obtained from results of the DCCT (diabetes control and complications trial). Mortality post-CVD event was based on a study using linked administrative data on people with diabetes from Western Australia. Information on incidence of renal disease and the progression to CVD was obtained from studies in Finland and Italy. Lower-extremity amputation (LEA) risk was based on the type 1 diabetes Swedish inpatient registry, and the risk of blindness was obtained from results of a German-based study. Where diabetes-specific data were unavailable, information from other populations was used. We examine the degree and source of parameter uncertainty and illustrate an application of the model in estimating lifetime outcomes of using intensive and conventional treatments for blood glucose control. From 15 years of age, male and female patients had an estimated life expectancy of 47.2 (95 % CI 35.2-59.2) and 52.7 (95 % CI 41.7-63.6) years in the intensive treatment group. The model produced estimates of the lifetime benefits of intensive treatment for blood glucose from the DCCT of 4.0 (95 % CI 1.2-6.8) QALYs for women and 4.6 (95 % CI 2.7-6.9) QALYs for men. Absolute risk per 1,000 person-years for fatal CVD events was simulated to be 1.37 and 2.51 in intensive and conventional treatment groups, respectively. The model incorporates diabetic complications risk data from a type 1 diabetes population and synthesizes other type 1-specific data to estimate long-term outcomes of CVD, end-stage renal disease, LEA and risk of blindness, along with life expectancy and QALYs. External validation was carried out using life expectancy and absolute risk for fatal CVD events. Because of the flexible and transparent nature of the model, it has many potential future applications.

Comparison of bone-anchored prostheses and socket prostheses for patients with a lower extremity amputation: a systematic review.

PubMed

Leijendekkers, Ruud A; van Hinte, Gerben; Frölke, Jan Paul; van de Meent, Hendrik; Nijhuis-van der Sanden, Maria W G; Staal, J Bart

2017-06-01

This study aimed to provide an overview of a) the used measurement instruments in studies evaluating effects on quality of life (QoL), function, activity and participation level in patients with a lower extremity amputation using bone-anchored prostheses compared to socket prostheses and b) the effects themselves. A systematic literature search was conducted in MEDLINE, Cochrane, EMBASE, CINAHL and Web of Science. Included studies compared QoL, function, activity and/or participation level in patients with bone-anchored or socket prostheses. A best-evidence synthesis was performed. Out of 226 studies, five cohort and two cross-sectional studies were eligible for inclusion, all had methodological shortcomings. These studies used 10 different measurement instruments and two separate questions to assess outcome. Bone-anchored prostheses were associated with better condition-specific QoL and better outcomes on several of the physical QoL subscales, outcomes on the physical bodily pain subscale were inconclusive. Outcomes on function and activity level increased, no change was found at participation level. The level of evidence was limited. There is a need for a standard set of instruments. There was limited evidence that bone-anchored prostheses resulted in higher QoL, function and activity levels than socket prostheses, in patients with socket-related problems. Implications for Rehabilitation Use of bone-anchored prostheses in combination with intensive outpatient rehabilitation may improve QoL, function and activity level compared with socket prosthesis use in patients with a transfemoral amputation and socket-related problems. All clinicians and researchers involved with bone-anchored prostheses should use and publish data on QoL, function, activity and participation level. There needs to be an agreement on a standard set of instruments so that interventions for patients with a lower extremity amputation are assessed consistently.

Development of novel 3D-printed robotic prosthetic for transradial amputees.

PubMed

Gretsch, Kendall F; Lather, Henry D; Peddada, Kranti V; Deeken, Corey R; Wall, Lindley B; Goldfarb, Charles A

2016-06-01

Upper extremity myoelectric prostheses are expensive. The Robohand demonstrated that three-dimensional printing reduces the cost of a prosthetic extremity. The goal of this project was to develop a novel, inexpensive three-dimensional printed prosthesis to address limitations of the Robohand. The prosthesis was designed for patients with transradial limb amputation. It is shoulder-controlled and externally powered with an anthropomorphic terminal device. The user can open and close all five fingers, and move the thumb independently. The estimated cost is US$300. After testing on a patient with a traumatic transradial amputation, several advantages were noted. The independent thumb movement facilitated object grasp, the device weighed less than most externally powered prostheses, and the size was easily scalable. Limitations of the new prosthetic include low grip strength and decreased durability compared to passive prosthetics. Most children with a transradial congenital or traumatic amputation do not use a prosthetic. A three-dimensional printed shoulder-controlled robotic prosthesis provides a cost effective, easily sized and highly functional option which has been previously unavailable. © The International Society for Prosthetics and Orthotics 2015.

The effects of altering initial ground contact in the running gait of an individual with transtibial amputation.

PubMed

Waetjen, Linda; Parker, Matthew; Wilken, Jason M

2012-09-01

High rates of osteoarthritis of the knee joint of the intact limb in persons with amputation have raised concern about the long-term consequence of running. The purpose of this intervention was to determine if loading of the knee on the intact limb of a person with transtibial amputation during running could be decreased by changing the intact limb initial ground contact from rear foot to forefoot strike. This study compared kinematic, kinetic and temporal-spatial data collected while a 27-year-old male, who sustained a traumatic unilateral transtibial amputation of the left lower extremity, ran using a forefoot ground contact and again while using a heel first ground contact. Changing initial ground contact from rear foot strike to forefoot strike resulted in decreases in vertical ground reaction forces at impact, peak knee moments in stance, peak knee powers, and improved symmetry in step length. This case suggests forefoot initial contact of the intact limb may minimize loading of the knee on the intact limb in individuals with transtibial amputation.

Predictive Ability of the SVS WIfI Classification System Following Infrapopliteal Endovascular Interventions for CLI

PubMed Central

Darling, Jeremy D.; McCallum, John C.; Soden, Peter A.; Meng, Yifan; Wyers, Mark C.; Hamdan, Allen D.; Verhagen, Hence H.J.; Schermerhorn, Marc L.

2016-01-01

OBJECTIVES The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee has composed a new threatened lower extremity classification system that reflects the three major factors that impact amputation risk and clinical management: wound, ischemia, and foot infection (WIfI). Our goal was to evaluate the predictive ability of this scale following any infrapopliteal endovascular intervention for critical limb ischemia (CLI). METHODS From 2004 to 2014, a single institution, retrospective chart review was performed at the Beth Israel Deaconess Medical Center for all patients undergoing an infrapopliteal angioplasty for CLI. Throughout these years, 673 limbs underwent an infrapopliteal endovascular intervention for tissue loss (77%), rest pain (13%), stenosis of a previously treated vessel (5%), acute limb ischemia (3%), or claudication (2%). Limbs missing a grade in any WIfI component were excluded. Limbs were stratified into clinical stages 1 to 4 based on the SVS WIfI classification for 1-year amputation risk, as well as a novel WIfI composite score from 0 to 9. Outcomes included patient functional capacity, living status, wound healing, major amputation, major adverse limb events (MALE), RAS events (reintervention, major amputation, or stenosis [>3.5x step-up by duplex]), amputation-free survival (AFS), and mortality. Predictors were identified using Kaplan-Meier survival estimates and Cox regression models. RESULTS Of the 596 limbs with CLI, 551 were classified in all three WIfI domains on a scale of 0 (least severe) to 3 (most severe). Of these 551, 84% were treated for tissue loss and 16% for rest pain. A Cox regression model illustrated that an increase in clinical stage increases the rate of major amputation (Hazard Ratio (HR), 1.6; 95% Confidence Interval [CI], 1.1–2.3). Separate regression models showed that a one-unit increase in the WIfI composite score is associated with a decrease in wound healing (1.2 [1.1–1.4]) and an increase in the rate of RAS events (1.2 [1.1–1.4]) and major amputations (1.4 [1.2–1.8]). CONCLUSIONS This study supports the ability of the SVS WIfI classification system to predict 1-year amputation, RAS events, and wound healing in patients with CLI undergoing endovascular infrapopliteal revascularization procedures. PMID:27380993

34 CFR 300.705 - Subgrants to LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... under § 300.704 to LEAs (including public charter schools that operate as LEAs) in the State that have... LEAs, including public charter schools that operate as LEAs, even if the LEA is not serving any... LEAs based on the relative numbers of children with disabilities ages 3 through 21, or ages 6 through...

34 CFR 300.705 - Subgrants to LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... under § 300.704 to LEAs (including public charter schools that operate as LEAs) in the State that have... LEAs, including public charter schools that operate as LEAs, even if the LEA is not serving any... LEAs based on the relative numbers of children with disabilities ages 3 through 21, or ages 6 through...

34 CFR 300.705 - Subgrants to LEAs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... under § 300.704 to LEAs (including public charter schools that operate as LEAs) in the State that have... LEAs, including public charter schools that operate as LEAs, even if the LEA is not serving any... LEAs based on the relative numbers of children with disabilities ages 3 through 21, or ages 6 through...

34 CFR 300.705 - Subgrants to LEAs.

Code of Federal Regulations, 2014 CFR

2014-07-01

... under § 300.704 to LEAs (including public charter schools that operate as LEAs) in the State that have... LEAs, including public charter schools that operate as LEAs, even if the LEA is not serving any... LEAs based on the relative numbers of children with disabilities ages 3 through 21, or ages 6 through...

34 CFR 300.705 - Subgrants to LEAs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... under § 300.704 to LEAs (including public charter schools that operate as LEAs) in the State that have... LEAs, including public charter schools that operate as LEAs, even if the LEA is not serving any... LEAs based on the relative numbers of children with disabilities ages 3 through 21, or ages 6 through...

[Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients].

PubMed

Lehnhardt, M; Hirche, C; Daigeler, A; Goertz, O; Ring, A; Hirsch, T; Drücke, D; Hauser, J; Steinau, H U

2012-02-01

Soft tissue sarcomas (STS) are a rare entity with reduced prognosis due to their aggressive biology. For an optimal treatment of STS identification of independent prognostic factors is crucial in order to reduce tumor-related mortality and recurrence rates. The surgical oncological concept includes wide excisions with resection safety margins >1 cm which enables acceptable functional results and reduced rates of amputation of the lower extremities. In contrast, individual anatomy of the upper extremities, in particular of the hand, leads to an intentional reduction of resection margins in order to preserve the extremity and its function with the main intention of tumor-free resection margins. In this study, the oncological safety and outcome as well as functional results were validated by a retrospective analysis of survival rate, recurrence rate and potential prognostic factors. A total of 160 patients who had been treated for STS of the upper extremities were retrospectively included. Independent prognostic factors were analyzed (primary versus recurrent tumor, tumor size, resection status, grade of malignancy, additional therapy, localization in the upper extremity). Kaplan-Meier analyses for survival rate and local control were calculated. Further outcome measures were functional results validated by the DASH score and rate of amputation. In 130 patients (81%) wide tumor excision (R0) was performed and in 19 patients (12%) an amputation was necessary. The 5-year overall survival rate was 70% and the 5-year survival rate in primary tumors was 81% whereas in recurrences 55% relapsed locally. The 10-year overall survival rate was 45% and the 5-year recurrence rate was 18% for primary STS and 43% for recurrent STS. Variance analysis revealed primary versus recurrent tumor, tumor size, resection status and grade of malignancy as independent prognostic factors. Analysis of functional results showed a median DASH score of 37 (0-100; 0=contralateral extremity). The 5-year survival and local recurrence rates are comparable to STS wide resections with safety margins >1 cm for the lower extremities and the trunk. Analysis of prognostic factors revealed resection status and the tumor-free resection margins to be the main goals in STS resection of upper extremity.

Endothelin-1 Expression Associated with Lipid Peroxidation and Nuclear Factor-κB Activation in Type 2 Diabetes Mellitus Patients with Angiopathy and Limb Amputation.

PubMed

Kuo, Yur-Ren; Chien, Ching-Ming; Kuo, Ming-Jen; Wang, Feng-Sheng; Huang, Eng-Yen; Wang, Ching-Jen

2016-01-01

It is unclear whether diabetic angiopathy is related to oxidative stress-associated endothelial dysfunction. The authors investigated whether alteration of endothelin-1 and lipid peroxide production and activation of nuclear factor-κB expression were involved in lower limb amputation in type 2 diabetes mellitus patients. A total of 135 subjects including 51 type 2 diabetes mellitus patients with major lower extremity amputations and 36 diabetes mellitus patients without limb and vascular complication and 48 normal controls were recruited for this study. The authors measured the plasma soluble endothelin-1 concentrations by a sandwich enzyme immunoassay, and measured oxidative stress as determined by the lipid peroxide byproduct malondialdehyde. Histologic staining and nuclear factor-κB activation determined by electrophoretic mobility shift assay of the amputated vessels were examined. Histologic staining revealed that severe arteriosclerosis with atheroma formation in the amputated diabetic arteries was significantly prominent compared with normal controls. Soluble endothelin-1 concentrations and malondialdehyde levels were increased significantly in diabetic amputation patients compared with other groups (p < 0.001). The nuclear factor-κB binding activity in amputated diabetic stump vessels was more prominent compared with healthy vessels without diabetes mellitus. There was a positive correlation between endothelin-1 and malondialdehyde in patients with diabetic amputation (r = 0.46, p = 0.001). These results suggest that elevation of endothelin-1 and lipid peroxide levels is involved in the pathogenesis of diabetic foot amputation. An increase of lipid peroxide and endothelin-1 associated with nuclear factor-κB activation plays an important role in the development of diabetic angiopathies.

Extremity amputation: how to face challenging problems in a precarious environment.

PubMed

Rigal, Sylvain

2012-10-01

Indications for amputation in natural disasters are not the same compared to our daily practice. They must be determined by those with great surgical experience and good knowledge of military or disaster surgical doctrine. Unfortunately, nowadays few surgeons have this experience. In fact, some volunteer surgeons may be interested in providing care for civilian victims of war or disaster in developing countries. However, there are significant differences between the type and the management of cases seen in this context versus those seen at home. The problems of amputations cannot be solved schematically. Amputation will depend on several factors: the form of warfare or disaster, the conditions for surgery, the skill of the surgical team and the experience of the surgeon, and the length or duration of the mission. Here is a schematic showing the three main situations: civilian practice, war practice and disaster context. These three different situations require different strategies for treating the wounded and for making amputation decisions. In the case of a natural disaster, there are many wounded civilians, they arrive at the medical facility late and there is usually only one surgeon and a single, limited medical facility to provide all treatment. He must make quick, wise choices, economising limited blood supplies and the use of surgical procedures. The decision to proceed with limb salvage or amputation for patients with severely injured limbs will be a source of continued debate. Amputation, radical and irreversible intervention, is a frequent and essential procedure in the disaster context and one of the standard means to successful treatment of limb wounds. We propose to reflect on the following questions: why to amputate, how to perform amputation under these conditions and how to pass on a doctrine to the voluntary surgeons who lack experience in a disaster context.

Update and validation of the Society for Vascular Surgery wound, ischemia, and foot infection threatened limb classification system.

PubMed

Mills, Joseph L

2014-03-01

The diagnosis of critical limb ischemia, first defined in 1982, was intended to delineate a patient cohort with a threatened limb and at risk for amputation due to severe peripheral arterial disease. The influence of diabetes and its associated neuropathy on the pathogenesis-threatened limb was an excluded comorbidity, despite its known contribution to amputation risk. The Fontaine and Rutherford classifications of limb ischemia severity have also been used to predict amputation risk and the likelihood of tissue healing. The dramatic increase in the prevalence of diabetes mellitus and the expanding techniques of arterial revascularization has prompted modification of peripheral arterial disease classification schemes to improve outcomes analysis for patients with threatened limbs. The diabetic patient with foot ulceration and infection is at risk for limb loss, with abnormal arterial perfusion as only one determinant of outcome. The wound extent and severity of infection also impact the likelihood of limb loss. To better predict amputation risk, the Society for Vascular Surgery Lower Extremity Guidelines Committee developed a classification of the threatened lower extremity that reflects these important clinical considerations. Risk stratification is based on three major factors that impact amputation risk and clinical management: wound, ischemia, and foot infection. This classification scheme is relevant to the patient with critical limb ischemia because many are also diabetic. Implementation of the wound, ischemia, and foot infection classification system in critical limb ischemia patients is recommended and should assist the clinician in more meaningful analysis of outcomes for various forms of wound and arterial revascularizations procedures required in this challenging, patient population. Copyright © 2014 Elsevier Inc. All rights reserved.

Body integrity identity disorder (BIID)--is the amputation of healthy limbs ethically justified?

PubMed

Müller, Sabine

2009-01-01

The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image.

Late Embryogenesis Abundant (LEA) Constitutes a Large and Diverse Family of Proteins Involved in Development and Abiotic Stress Responses in Sweet Orange (Citrus sinensis L. Osb.)

PubMed Central

Pedrosa, Andresa Muniz; Martins, Cristina de Paula Santos; Gonçalves, Luana Pereira; Costa, Marcio Gilberto Cardoso

2015-01-01

Late Embryogenesis Abundant (LEA) proteins are an ubiquitous group of polypeptides that were first described to accumulate during plant seed dehydration, at the later stages of embryogenesis. Since then they have also been recorded in vegetative plant tissues experiencing water limitation and in anhydrobiotic bacteria and invertebrates and, thereby, correlated with the acquisition of desiccation tolerance. This study provides the first comprehensive study about the LEA gene family in sweet orange (Citrus sinensis L. Osb.), the most important and widely grown fruit crop around the world. A surprisingly high number (72) of genes encoding C. sinensis LEAs (CsLEAs) were identified and classified into seven groups (LEA_1, LEA_2, LEA_3 and LEA_4, LEA_5, DEHYDRIN and SMP) based on their predicted amino acid sequences and also on their phylogenetic relationships with the complete set of Arabidopsis thaliana LEA proteins (AtLEAs). Approximately 60% of the CsLEAs identified in this study belongs to the unusual LEA_2 group of more hydrophobic LEA proteins, while the other LEA groups contained a relatively small number of members typically hydrophilic. A correlation between gene structure and motif composition was observed within each LEA group. Investigation of their chromosomal localizations revealed that the CsLEAs were non-randomly distributed across all nine chromosomes and that 33% of all CsLEAs are segmentally or tandemly duplicated genes. Analysis of the upstream sequences required for transcription revealed the presence of various stress-responsive cis-acting regulatory elements in the promoter regions of CsLEAs, including ABRE, DRE/CRT, MYBS and LTRE. Expression analysis using both RNA-seq data and quantitative real-time RT-PCR (qPCR) revealed that the CsLEA genes are widely expressed in various tissues, and that many genes containing the ABRE promoter sequence are induced by drought, salt and PEG. These results provide a useful reference for further exploration of the CsLEAs functions and applications on crop improvement. PMID:26700652

Late Embryogenesis Abundant (LEA) Constitutes a Large and Diverse Family of Proteins Involved in Development and Abiotic Stress Responses in Sweet Orange (Citrus sinensis L. Osb.).

PubMed

Pedrosa, Andresa Muniz; Martins, Cristina de Paula Santos; Gonçalves, Luana Pereira; Costa, Marcio Gilberto Cardoso

2015-01-01

Late Embryogenesis Abundant (LEA) proteins are an ubiquitous group of polypeptides that were first described to accumulate during plant seed dehydration, at the later stages of embryogenesis. Since then they have also been recorded in vegetative plant tissues experiencing water limitation and in anhydrobiotic bacteria and invertebrates and, thereby, correlated with the acquisition of desiccation tolerance. This study provides the first comprehensive study about the LEA gene family in sweet orange (Citrus sinensis L. Osb.), the most important and widely grown fruit crop around the world. A surprisingly high number (72) of genes encoding C. sinensis LEAs (CsLEAs) were identified and classified into seven groups (LEA_1, LEA_2, LEA_3 and LEA_4, LEA_5, DEHYDRIN and SMP) based on their predicted amino acid sequences and also on their phylogenetic relationships with the complete set of Arabidopsis thaliana LEA proteins (AtLEAs). Approximately 60% of the CsLEAs identified in this study belongs to the unusual LEA_2 group of more hydrophobic LEA proteins, while the other LEA groups contained a relatively small number of members typically hydrophilic. A correlation between gene structure and motif composition was observed within each LEA group. Investigation of their chromosomal localizations revealed that the CsLEAs were non-randomly distributed across all nine chromosomes and that 33% of all CsLEAs are segmentally or tandemly duplicated genes. Analysis of the upstream sequences required for transcription revealed the presence of various stress-responsive cis-acting regulatory elements in the promoter regions of CsLEAs, including ABRE, DRE/CRT, MYBS and LTRE. Expression analysis using both RNA-seq data and quantitative real-time RT-PCR (qPCR) revealed that the CsLEA genes are widely expressed in various tissues, and that many genes containing the ABRE promoter sequence are induced by drought, salt and PEG. These results provide a useful reference for further exploration of the CsLEAs functions and applications on crop improvement.

Locomotor adaptability in persons with unilateral transtibial amputation.

PubMed

Darter, Benjamin J; Bastian, Amy J; Wolf, Erik J; Husson, Elizabeth M; Labrecque, Bethany A; Hendershot, Brad D

2017-01-01

Locomotor adaptation enables walkers to modify strategies when faced with challenging walking conditions. While a variety of neurological injuries can impair locomotor adaptability, the effect of a lower extremity amputation on adaptability is poorly understood. Determine if locomotor adaptability is impaired in persons with unilateral transtibial amputation (TTA). The locomotor adaptability of 10 persons with a TTA and 8 persons without an amputation was tested while walking on a split-belt treadmill with the parallel belts running at the same (tied) or different (split) speeds. In the split condition, participants walked for 15 minutes with the respective belts moving at 0.5 m/s and 1.5 m/s. Temporal spatial symmetry measures were used to evaluate reactive accommodations to the perturbation, and the adaptive/de-adaptive response. Persons with TTA and the reference group of persons without amputation both demonstrated highly symmetric walking at baseline. During the split adaptation and tied post-adaptation walking both groups responded with the expected reactive accommodations. Likewise, adaptive and de-adaptive responses were observed. The magnitude and rate of change in the adaptive and de-adaptive responses were similar for persons with TTA and those without an amputation. Furthermore, adaptability was no different based on belt assignment for the prosthetic limb during split adaptation walking. Reactive changes and locomotor adaptation in response to a challenging and novel walking condition were similar in persons with TTA to those without an amputation. Results suggest persons with TTA have the capacity to modify locomotor strategies to meet the demands of most walking conditions despite challenges imposed by an amputation and use of a prosthetic limb.

Early Identification of Molecular Predictors of Heterotopic Ossification Following Extremity Blast Injury with a Biomarker Assay

DTIC Science & Technology

2015-10-01

extremity war-time wounds; specifically, its incidence is reported as high as 57% in patients that sustain a poly -trauma blast injury [1]. Complications...related to HO in residual limbs following blast amputation include pain , overlying skin and muscle breakdown, poor fitting and functioning of prosthetic

Amputation and Prosthetics

MedlinePlus

... Extremity Prosthetics Find a hand surgeon near you. Videos Figures Figure 1: Thumb Prosthesis - not attached Figure ... or "in." Also, avoid using media types like "video," "article," and "picture." Tip 4: Your results can ...

Outcomes of labor epidural analgesia among women aged over 40: A single-institution retrospective study.

PubMed

Okazaki, Atsuko; Fukushima, Risa; Nagashima, Sayuri; Mazda, Yusuke; Tamura, Kazumi; Terui, Katsuo; Tanaka, Motoshi

2016-12-01

The purpose of this study was to investigate the effects of labor epidural analgesia (LEA) on maternal and neonatal outcomes among parturients aged 40 years or older. We retrospectively reviewed medical records of all laboring, singleton and cephalic deliveries at ≥36 weeks' gestation at the Saitama Medical Center from April 2003 to September 2012. Women aged ≥40 years who received LEA (≥40 with LEA group) were compared with women aged ≥40 years who delivered without LEA (≥40 without LEA group) and women <40 years who received LEA (<40 with LEA group). Extracted outcomes included mode of delivery, oxytocin augmentation, duration of labor, amount of estimated blood loss, umbilical artery pH, Apgar scores, and neonatal intensive care unit admission. This study included 4441 women. There were 74 women in the ≥40 with LEA group, 369 in the ≥40 without LEA group, and 601 in the <40 with LEA group. The maternal outcomes of emergency cesarean delivery rate (9.5%, 12.5%, 9.0%), instrumental delivery rate (33.8%, 10.3%, 28.3%), duration of labor (521 min, 321 min, 565 min), and estimated blood loss (524 g, 351 g, 412 g) were reported for the ≥40 with LEA, ≥40 without LEA, and <40 with LEA groups, respectively. Neonatal outcomes were not different between these groups. LEA use was not associated with emergency cesarean delivery in the multivariable analysis. Our study showed that parturients aged ≥40 with LEA can expect similar LEA-associated labor outcomes to younger parturients with LEA. © 2016 Japan Society of Obstetrics and Gynecology.

Genome-wide identification and comparative expression analysis of LEA genes in watermelon and melon genomes.

PubMed

Celik Altunoglu, Yasemin; Baloglu, Mehmet Cengiz; Baloglu, Pinar; Yer, Esra Nurten; Kara, Sibel

2017-01-01

Late embryogenesis abundant (LEA) proteins are large and diverse group of polypeptides which were first identified during seed dehydration and then in vegetative plant tissues during different stress responses. Now, gene family members of LEA proteins have been detected in various organisms. However, there is no report for this protein family in watermelon and melon until this study. A total of 73 LEA genes from watermelon ( ClLEA ) and 61 LEA genes from melon ( CmLEA ) were identified in this comprehensive study. They were classified into four and three distinct clusters in watermelon and melon, respectively. There was a correlation between gene structure and motif composition among each LEA groups. Segmental duplication played an important role for LEA gene expansion in watermelon. Maximum gene ontology of LEA genes was observed with poplar LEA genes. For evaluation of tissue specific expression patterns of ClLEA and CmLEA genes, publicly available RNA-seq data were analyzed. The expression analysis of selected LEA genes in root and leaf tissues of drought-stressed watermelon and melon were examined using qRT-PCR. Among them, ClLEA - 12 - 17 - 46 genes were quickly induced after drought application. Therefore, they might be considered as early response genes for water limitation conditions in watermelon. In addition, CmLEA - 42 - 43 genes were found to be up-regulated in both tissues of melon under drought stress. Our results can open up new frontiers about understanding of functions of these important family members under normal developmental stages and stress conditions by bioinformatics and transcriptomic approaches.

The pivotal role of offloading in the management of neuropathic foot ulceration.

PubMed

Wu, Stephanie C; Crews, Ryan T; Armstrong, David G

2005-12-01

Lower extremity amputations among persons with diabetes are generally preceded by neuropathic foot ulcerations. Healing of diabetic ulcerations in a timely manner is of central importance in any plan for amputation prevention. With sufficient vascular supply, appropriate débridement, and infection control, the primary mode of healing a diabetic neuropathic foot ulcer is pressure dispersion. The total contact cast has been deemed by many to be the gold standard in offloading; however, modification of a standard removable cast walker to ensure patient compliance may be as efficacious in healing diabetic foot ulcers as the total contact cast. Combining an effective, easy to use offloading device that ensures patient compliance with advanced wound healing modalities may form a formidable team in healing ulcers and potentially averting lower limb amputations.

Major Adverse Limb Events and Mortality in Patients With Peripheral Artery Disease: The COMPASS Trial.

PubMed

Anand, Sonia S; Caron, Francois; Eikelboom, John W; Bosch, Jackie; Dyal, Leanne; Aboyans, Victor; Abola, Maria Teresa; Branch, Kelley R H; Keltai, Katalin; Bhatt, Deepak L; Verhamme, Peter; Fox, Keith A A; Cook-Bruns, Nancy; Lanius, Vivian; Connolly, Stuart J; Yusuf, Salim

2018-05-22

Patients with lower extremity peripheral artery disease (PAD) are at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There is limited information on the prognosis of patients who experience MALE. Among participants with lower extremity PAD, this study investigated: 1) if hospitalizations, MACE, amputations, and deaths are higher after the first episode of MALE compared with patients with PAD who do not experience MALE; and 2) the impact of treatment with low-dose rivaroxaban and aspirin compared with aspirin alone on the incidence of MALE, peripheral vascular interventions, and all peripheral vascular outcomes over a median follow-up of 21 months. We analyzed outcomes in 6,391 patients with lower extremity PAD who were enrolled in the COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial. COMPASS was a randomized, double-blind placebo-controlled study of low-dose rivaroxaban and aspirin combination or rivaroxaban alone compared with aspirin alone. MALE was defined as severe limb ischemia leading to an intervention or major vascular amputation. A total of 128 patients experienced an incident of MALE. After MALE, the 1-year cumulative risk of a subsequent hospitalization was 61.5%; for vascular amputations, it was 20.5%; for death, it was 8.3%; and for MACE, it was 3.7%. The MALE index event significantly increased the risk of experiencing subsequent hospitalizations (hazard ratio [HR]: 7.21; p < 0.0001), subsequent amputations (HR: 197.5; p < 0.0001), and death (HR: 3.23; p < 0.001). Compared with aspirin alone, the combination of rivaroxaban 2.5 mg twice daily and aspirin lowered the incidence of MALE by 43% (p = 0.01), total vascular amputations by 58% (p = 0.01), peripheral vascular interventions by 24% (p = 0.03), and all peripheral vascular outcomes by 24% (p = 0.02). Among individuals with lower extremity PAD, the development of MALE is associated with a poor prognosis, making prevention of this condition of utmost importance. The combination of rivaroxaban 2.5 mg twice daily and aspirin significantly lowered the incidence of MALE and the related complications, and this combination should be considered as an important therapy for patients with PAD. (Cardiovascular Outcomes for People Using Anticoagulation Strategies [COMPASS]; NCT01776424). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system following infrapopliteal endovascular interventions for critical limb ischemia.

PubMed

Darling, Jeremy D; McCallum, John C; Soden, Peter A; Meng, Yifan; Wyers, Mark C; Hamdan, Allen D; Verhagen, Hence J; Schermerhorn, Marc L

2016-09-01

The Society for Vascular Surgery (SVS) Lower Extremity Guidelines Committee has composed a new threatened lower extremity classification system that reflects the three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). Our goal was to evaluate the predictive ability of this scale following any infrapopliteal endovascular intervention for critical limb ischemia (CLI). From 2004 to 2014, a single institution, retrospective chart review was performed at the Beth Israel Deaconess Medical Center for all patients undergoing an infrapopliteal angioplasty for CLI. Throughout these years, 673 limbs underwent an infrapopliteal endovascular intervention for tissue loss (77%), rest pain (13%), stenosis of a previously treated vessel (5%), acute limb ischemia (3%), or claudication (2%). Limbs missing a grade in any WIfI component were excluded. Limbs were stratified into clinical stages 1 to 4 based on the SVS WIfI classification for 1-year amputation risk, as well as a novel WIfI composite score from 0 to 9. Outcomes included patient functional capacity, living status, wound healing, major amputation, major adverse limb events, reintervention, major amputation, or stenosis (RAS) events (> ×3.5 step-up by duplex), amputation-free survival, and mortality. Predictors were identified using Kaplan-Meier survival estimates and Cox regression models. Of the 596 limbs with CLI, 551 were classified in all three WIfI domains on a scale of 0 (least severe) to 3 (most severe). Of these 551, 84% were treated for tissue loss and 16% for rest pain. A Cox regression model illustrated that an increase in clinical stage increases the rate of major amputation (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.1-2.3). Separate regression models showed that a one-unit increase in the WIfI composite score is associated with a decrease in wound healing (HR, 1.2; 95% CI, 1.1-1.4) and an increase in the rate of RAS events (HR, 1.2; 95% CI, 1.1-1.4) and major amputations (HR, 1.4; 95% CI, 1.2-1.8). This study supports the ability of the SVS WIfI classification system to predict 1-year amputation, RAS events, and wound healing in patients with CLI undergoing endovascular infrapopliteal revascularization procedures. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl.

PubMed

Atıcı, Ahmet; Yılmaz, Engin; Karaman, Ayşe; Apaydın, Sema; Afşarlar, Çağatay Evrim

2017-01-01

Atıcı A, Yılmaz E, Karaman A, Apaydın S, Afşarlar ÇE. Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl. Turk J Pediatr 2017; 59: 90-92. Ovarian auto-amputation is an extremely rare condition commonly encountered in the perinatal period. Spontaneous or secondary torsion of the ovary caused by an ovarian lesion may result in infarction and subsequent auto-amputation of the ovary. This paper demonstrates a case that underwent laparoscopic appendectomy with an incidental calcified auto-amputated right ovary. A 16-year-old adolescent girl was admitted to our department with a history of one-day abdominal pain. Physical examination of the patient revealed abdominal tenderness and rigidity on right lower quadrant. Her white blood cell count was 11x103/mL, and C-reactive protein was 69 mg/L. The patient underwent a laparoscopic appendectomy with a provisional diagnosis of acute appendicitis, and further exploration revealed a 2x2 cm white ovoid mass floating freely in the pelvis. The left ovary was clearly identified in its usual localization, but the right tuba was blindly ending without any fimbria or ovary. Postoperative course of the patient was uneventful, and she was discharged on postoperative day 2. The histopathological examination revealed a necrotic calcified ovarian teratoma. Auto-amputated ovary is a rare occasion mostly encountered during perinatal period, and it may be unilateral or bilateral. An auto-amputated ovarian mass may rarely be a teratoma although the most common cause of auto-amputation during perinatal and adolescent period is ovarian torsion due to an ovarian cyst.

Identification and characterization of a LEA family gene CarLEA4 from chickpea (Cicer arietinum L.).

PubMed

Gu, Hanyan; Jia, Yuying; Wang, Xiansheng; Chen, Quanjia; Shi, Shubing; Ma, Lin; Zhang, Jusong; Zhang, Hua; Ma, Hao

2012-04-01

Late-embryogenesis abundant (LEA) proteins have been reported to be closely correlated with the acquisition of desiccation tolerance during seed development and response of plant to drought, salinity, and freezing, etc. In this study, a LEA gene, CarLEA4 (GenBank accession no. GU247511), was isolated from chickpea based on a cDNA library constructed with chickpea seedling leaves treated by polyethylene glycol (PEG). CarLEA4 contained two exons and one intron within genomic DNA sequence and encoded a putative polypeptide of 152 amino acids. CarLEA4 had a conserved pfam domain, and showed high similarity to the group 4 LEA proteins in secondary structure. It was localized in the nucleus. The transcripts of CarLEA4 were detected in many chickpea organs including seedling leaves, stems, roots, flowers, young pods, and young seeds. CarLEA4 was inhibited by leaf age and showed expression changes in expression during seed development, pod development and germination. Furthermore, the expression of CarLEA4 was strongly induced by drought, salt, heat, cold, ABA, IAA, GA(3) and MeJA. Our results suggest that CarLEA4 encodes a protein of LEA group 4 and may be involved in various plant developmental processes and abiotic stress responses.

Décision d'amputation dans la prise en charge initiale d'une luxation ouverte grave de la cheville à propos d'un cas observé à l'Hôpital Laquintinie de Douala suite à un accident par moto-taxi

PubMed Central

Tsatedem, Faustin Atemkeng; Tsiagadigui, Jean Gustave; Ndando, Richard Polle; Arabo, Mohamadou Saidou; Bayiha, Alphonse; Kenfack, Bruno

2012-01-01

La décision d'amputation pour traumatisme grave de membre n'est pas toujours facile à prendre. Les auteurs rapportent le cas d'un traumatisme ouvert de la cheville gauche avec luxation tibiotalienne complète, référé pour amputation. Il s'agit d'une passagère d'une moto-taxi percutée par une voiture. A l'admission, le pouls tibial postérieur était présent et le score dit MESS (Mangled Extremity Severity Score) côté à 5, ce qui a permis et d'éviter l'amputation. Après débridement et réduction, une broche transplantaire a permis d'immobiliser la cheville et de faire les pansements. L'amputation a été évitée. La cicatrisation dirigée de la peau a été suivie par la kinésithérapie. La mobilité de la cheville autorise une marche avec cannes au quatrième mois post-opératoire. Les auteurs recommandent l'utilisation du MESS dans la décision d'amputation après traumatisme grave de membre. PMID:23396997

Negative Consequences of Low Energy Availability in Natural Male Bodybuilding: A Review.

PubMed

Fagerberg, Petter

2018-05-03

Energy availability (EA) is a scientific concept describing how much energy is available for basic metabolic functions such as reproduction, immunity, and skeletal homeostasis. Carefully controlled studies on women have shown pathological effects of EA < 30 kcal/kg fat-free mass (FFM), and this state has been labeled low EA (LEA). Bodybuilding is a sport in which athletes compete to show muscular definition, symmetry, and low body fat (BF). The process of contest preparation in bodybuilding includes months of underfeeding, thus increasing the risk of LEA and its negative health consequences. As no well-controlled studies have been conducted in natural male bodybuilders on effects of LEA, the aim of this review was to summarize what can be extrapolated from previous relevant research findings in which EA can be calculated. The reviewed literature indicates that a prolonged EA < 25 kcal/kg FFM results in muscle loss, hormonal imbalances, psychological problems, and negatively affects the cardiovascular system when approaching the lower limits of BF (∼4%-5%) among males. Case studies on natural male bodybuilders who prepare for contest show muscle loss (>40% of total weight loss) with EA < 20 kcal/kg FFM, and in the study with the lowest observed BF (∼4 kg), major mood disturbance and hormonal imbalances co-occurred. Studies also underline the problem of BF overshoot during refeeding after extremes of LEA among males. A more tempered approach (EA > 25 kcal/kg FFM) might result in less muscle loss among natural male bodybuilders who prepare for contest, but more research is needed.

The Changing Face of Disability in the US Army: The Operation Enduring Freedom and Operation Iraqi Freedom Effect

DTIC Science & Technology

2012-01-01

osteoarthritis Fibromyalgia Diagnosis of fibromyalgia in which fibromyalgia itself is an unfitting condition Knee Any condition causing pain in or loss of function...ability significantly increased for all orthopaedic conditions, with the ex- ception of amputation, fibromyalgia , other lower extremity conditions...n = 3,143) P Value Amputation 1 0.06 33 1.05 ɘ.0001 Back painb 376 22.47 1,348 42.89 ɘ.0001 Foot and ankle 54 3.23 324 10.31 ɘ.0001 Fibromyalgia

Outcomes of lower extremity bypass performed for acute limb ischemia

PubMed Central

Baril, Donald T.; Patel, Virendra I.; Judelson, Dejah R.; Goodney, Philip P.; McPhee, James T.; Hevelone, Nathanael D.; Cronenwett, Jack L.; Schanzer, Andres

2013-01-01

Objective Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. Methods All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. Results Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation, deterioration in renal function, and respiratory complications. Patients who underwent lower extremity bypass for acute limb ischemia had no difference in rates of graft occlusion (18.1% vs 18.5%; P = .77), but did have significantly higher rates of limb loss (22.4% vs 9.7%; P < .0001) and mortality (20.9% vs 13.1%; P < .0001) at 1 year. On multivariable analysis, acute limb ischemia was an independent predictor of both major amputation (hazard ratio, 2.16; confidence interval, 1.38–3.40; P = .001) and mortality (hazard ratio, 1.41; confidence interval, 1.09–1.83; P = .009) at 1 year. Conclusions Patients who present with acute limb ischemia represent a less medically optimized subgroup within the population of patients undergoing lower extremity bypass. These patients may be expected to have more complex operations followed by increased rates of perioperative adverse events. Additionally, despite equivalent graft patency rates, patients undergoing lower extremity bypass for acute ischemia have significantly higher rates of major amputation and mortality at 1 year. PMID:23714364

Outcomes of lower extremity bypass performed for acute limb ischemia.

PubMed

Baril, Donald T; Patel, Virendra I; Judelson, Dejah R; Goodney, Philip P; McPhee, James T; Hevelone, Nathanael D; Cronenwett, Jack L; Schanzer, Andres

2013-10-01

Acute limb ischemia remains one of the most challenging emergencies in vascular surgery. Historically, outcomes following interventions for acute limb ischemia have been associated with high rates of morbidity and mortality. The purpose of this study was to determine contemporary outcomes following lower extremity bypass performed for acute limb ischemia. All patients undergoing infrainguinal lower extremity bypass between 2003 and 2011 within hospitals comprising the Vascular Study Group of New England were identified. Patients were stratified according to whether or not the indication for lower extremity bypass was acute limb ischemia. Primary end points included bypass graft occlusion, major amputation, and mortality at 1 year postoperatively as determined by Kaplan-Meier life table analysis. Multivariable Cox proportional hazards models were constructed to evaluate independent predictors of mortality and major amputation at 1 year. Of 5712 lower extremity bypass procedures, 323 (5.7%) were performed for acute limb ischemia. Patients undergoing lower extremity bypass for acute limb ischemia were similar in age (66 vs 67; P = .084) and sex (68% male vs 69% male; P = .617) compared with chronic ischemia patients, but were less likely to be on aspirin (63% vs 75%; P < .0001) or a statin (55% vs 68%; P < .0001). Patients with acute limb ischemia were more likely to be current smokers (49% vs 39%; P < .0001), to have had a prior ipsilateral bypass (33% vs 24%; P = .004) or a prior ipsilateral percutaneous intervention (41% vs 29%; P = .001). Bypasses performed for acute limb ischemia were longer in duration (270 vs 244 minutes; P = .007), had greater blood loss (363 vs 272 mL; P < .0001), and more commonly utilized prosthetic conduits (41% vs 33%; P = .003). Acute limb ischemia patients experienced increased in-hospital major adverse events (20% vs 12%; P < .0001) including myocardial infarction, congestive heart failure exacerbation, deterioration in renal function, and respiratory complications. Patients who underwent lower extremity bypass for acute limb ischemia had no difference in rates of graft occlusion (18.1% vs 18.5%; P = .77), but did have significantly higher rates of limb loss (22.4% vs 9.7%; P < .0001) and mortality (20.9% vs 13.1%; P < .0001) at 1 year. On multivariable analysis, acute limb ischemia was an independent predictor of both major amputation (hazard ratio, 2.16; confidence interval, 1.38-3.40; P = .001) and mortality (hazard ratio, 1.41; confidence interval, 1.09-1.83; P = .009) at 1 year. Patients who present with acute limb ischemia represent a less medically optimized subgroup within the population of patients undergoing lower extremity bypass. These patients may be expected to have more complex operations followed by increased rates of perioperative adverse events. Additionally, despite equivalent graft patency rates, patients undergoing lower extremity bypass for acute ischemia have significantly higher rates of major amputation and mortality at 1 year. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

76 FR 64005 - Standard Instrument Approach Procedures, and Takeoff Minimums and Obstacle Departure Procedures...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

.... The large number of SIAPs, Takeoff Minimums and ODPs, in addition to their complex nature and the need.... Part 97 is amended to read as follows: Effective 20 OCT 2011 Albert Lea, MN, Albert Lea Muni, RNAV (GPS) RWY 17, Amdt 2 Albert Lea, MN, Albert Lea Muni, RNAV (GPS) RWY 35, Amdt 1 Albert Lea, MN, Albert Lea...

Characterization of disability following traumatic through knee and transfemoral amputations.

PubMed

Tennent, David J; Polfer, Elizabeth M; Sgromolo, Nicole M; Krueger, Chad A; Potter, Benjamin K

2018-06-01

The purpose of this study is to characterize through knee and transfemoral amputations following severe traumatic injuries. A retrospective review of all transfemoral and through knee amputations sustained by United States military service members from 1 October 2001 to 30 July 2011 was conducted. Data from the Department of Defense Trauma Registry, the Armed Forces Health Longitudinal Technology Application, inpatient medical records and the Physical Evaluation Board Liaison Offices were queried in order to obtain characteristics related to injury sustained, demographics, treatment, and disability/mental health outcome data. A total of 1631 amputations in 1315 patients were identified. Of these there were 37 through knee and 296 were transfemoral amputations. Adequate records for detailed analysis were available on 140 and 25 transfemoral and through knee amputations respectively. There were no significant differences in demographic information, injury mechanism, initial injury severity score, or associated injuries, to include contralateral amputations. There was no significant difference in average disability rating (67.9% vs 78.3%, p = 0.46) or number of service members determined to be fully disabled (42.2% vs 28.6% p = 0.33) between the transfemoral and through knee amputation groups. Whereas there was no difference between groups preoperatively, the knee disarticulation group displayed a higher rate of mental health diagnoses post-amputation (96% vs 72%, p < 0.001) and a higher preponderance of anxiety related disorders than the transfemoral amputees (26.92% vs 12.96%, p = 0.0129). Among this military amputee through knee and transfemoral amputees displayed similar physical disability profiles. However, the through knee amputees displayed a higher level of anxiety related disorders and mental health diagnosis overall. While we don't believe this relationship to be causal in nature, this finding reflects the importance of paying particular attention to mental health in the final disposition of traumatic lower extremity amputees. Published by Elsevier Ltd.

Functional insights into the late embryogenesis abundant (LEA) protein family from Dendrobium officinale (Orchidaceae) using an Escherichia coli system

PubMed Central

Ling, Hong; Zeng, Xu; Guo, Shunxing

2016-01-01

Late embryogenesis abundant (LEA) proteins, a diverse family, accumulate during seed desiccation in the later stages of embryogenesis. LEA proteins are associated with tolerance to abiotic stresses, such as drought, salinity and high or cold temperature. Here, we report the first comprehensive survey of the LEA gene family in Dendrobium officinale, an important and widely grown medicinal orchid in China. Based on phylogenetic relationships with the complete set of Arabidopsis and Oryza LEA proteins, 17 genes encoding D. officinale LEAs (DofLEAs) were identified and their deduced proteins were classified into seven groups. The motif composition of these deduced proteins was correlated with the gene structure found in each LEA group. Our results reveal the DofLEA genes are widely distributed and expressed in tissues. Additionally, 11 genes from different groups were introduced into Escherichia coli to assess the functions of DofLEAs. Expression of 6 and 7 DofLEAs in E. coli improved growth performance compared with the control under salt and heat stress, respectively. Based on qPCR data, all of these genes were up-regulated in various tissues following exposure to salt and heat stresses. Our results suggest that DofLEAs play an important role in responses to abiotic stress. PMID:28004781

The photonic device for integrated evaluation of collateral circulation of lower extremities in patients with local hypertensive-ischemic pain syndrome

NASA Astrophysics Data System (ADS)

Pavlov, Volodymyr S.; Bezsmernyi, Yurii O.; Zlepko, Sergey M.; Bezsmertna, Halyna V.

2017-08-01

The given paper analyzes principles of interaction and analysis of the reflected optical radiation from biotissue in the process of assessment of regional hemodynamics state in patients with local hypertensive- ischemic pain syndrome of amputation stumps of lower extremities, applying the method of photoplethysmography. The purpose is the evaluation of Laser photoplethysmography (LPPG) diagnostic value in examination of patients with chronic ischemia of lower extremities. Photonic device is developed to determine the level of the peripheral blood circulation, which determines the basic parameters of peripheral blood circulation and saturation level. Device consists of two sensors: infrared sensor, which contains the infrared laser radiation source and photodetector, and red sensor, which contains the red radiation source and photodetector. LPPG method allows to determined pulsatility of blood flow in different areas of the foot and lower leg, the degree of compensation and conservation perspectives limb. Surgical treatment of local hypertensive -ischemic pain syndrome of amputation stumps of lower extremities by means of semiclosed fasciotomy in combination with revasculating osteotrepanation enabled to improve considerably regional hemodynamics in the tissues of the stump and decrease pain and hypostatic disorders.

34 CFR 200.71 - LEA eligibility.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (2) Greater than two percent of the LEA's total population ages 5 to 17 years, inclusive. (b...) 15 percent of the LEA's total population ages 5 to 17 years, inclusive. (c) Targeted grants. An LEA... least five percent of the LEA's total population ages 5 to 17 years, inclusive. (d) Education finance...

34 CFR 200.71 - LEA eligibility.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (2) Greater than two percent of the LEA's total population ages 5 to 17 years, inclusive. (b...) 15 percent of the LEA's total population ages 5 to 17 years, inclusive. (c) Targeted grants. An LEA... least five percent of the LEA's total population ages 5 to 17 years, inclusive. (d) Education finance...

Molecular and functional characterization of CaLEA6, the gene for a hydrophobic LEA protein from Capsicum annuum.

PubMed

Kim, Hyung-Sae; Lee, Jee Hyun; Kim, Jae Joon; Kim, Chang-Hoon; Jun, Sung-Soo; Hong, Young-Nam

2005-01-03

We used differential screening to isolate a full-length dehydration-responsive cDNA clone encoding a hydrophobic late embryogenesis abundant (LEA)-like protein from PEG-treated hot pepper leaves. Named CaLEA6 (for Capsicum annuum LEA), this gene belongs to the atypical hydrophobic LEA Group 6. The full-length CaLEA6 is 709 bp long with an open reading frame encoding 164 amino acids. It is predicted to produce a highly hydrophobic, but cytoplasmic, protein. The putative M(r) of CaLEA6 protein is 18 kDa, with a theoretical pI of 4.63. Based on our Southern blot analysis, CaLEA6 appears to exist as a small gene family. CaLEA6 was not expressed prior to any treatment, but its transcript was rapidly and greatly increased following trials with PEG, ABA, and NaCl. Chilling also induced its rapid induction, but to a much lesser extent. Accumulation of CaLEA6 protein occurred soon after NaCl applications, but considerably delayed after treatment with PEG. Tobacco plants that overexpressed CaLEA6 showed enhanced tolerance to dehydration and NaCl but not to chilling, as defined by their leaf fresh weights, Chl contents, and the general health status of the leaves. Therefore, we suggest that CaLEA6 protein plays a potentially protective role when water deficit is induced by dehydration and high salinity, but not low temperature.

In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization.

PubMed

Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Patel, Nileshkumar J; Patel, Samir V; Savani, Chirag; Singh, Vikas; Jhamnani, Sunny; Sonani, Rajesh; Lahewala, Sopan; Thakkar, Badal; Patel, Achint; Dave, Abhishek; Shah, Harshil; Bhatt, Parth; Jaiswal, Radhika; Ghatak, Abhijit; Gupta, Vishal; Deshmukh, Abhishek; Kondur, Ashok; Schreiber, Theodore; Grines, Cindy; Badheka, Apurva O

2016-02-15

Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications. Copyright © 2016 Elsevier Inc. All rights reserved.

In-hospital complications and mortality following major lower extremity amputations in a series of predominantly diabetic patients.

PubMed

Aragón-Sánchez, Javier; Hernández-Herrero, Maria J; Lázaro-Martínez, Jose L; Quintana-Marrero, Yurena; Maynar-Moliner, Manuel; Rabellino, Martín; Cabrera-Galván, Juan J

2010-03-01

The purpose of this study was to analyze the outcomes of major lower extremity amputations (MLEAs) in a series, including diabetic patients, with the aim to study whether diabetes mellitus is a risk factor of in-hospital mortality and perioperative complications. A retrospective analysis of 283 MLEAs (221 of these patients were diabetic and 62 were nondiabetic) performed between January 1, 1998, and December 31, 2008, at the General Surgery Department and Diabetic Foot Unit of La Paloma Hospital in Las Palmas de Gran Canaria (Canary Islands) was done. The significant risk factors of mortality were >" xbd="324" xhg="301" ybd="1481" yhg="1446"/>75 years of age (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 1.4-11.7), postoperative cardiac complications (OR = 12.3, 95% CI = 3.7-40.2) and postoperative respiratory complications (OR = 3.8, 95% CI = 1.0-13.3). No statistically significant risk factors were found related to the presence of systemic and wound-related complications. In diabetic patients, the significant risk factors of mortality were postoperative cardiological complications (OR = 13.6, 95% CI = 3.1-59.6), postoperative respiratory complications (OR = 5.9, 95% CI = 1.0-35.5), and first episode of amputation (OR = 5.9, 95% CI = 1.4-24.3). There were no statistically significant differences in the outcome of major amputations between diabetic and nondiabetic patients. Hospital stay was significantly longer in diabetic patients (P < .01) though when the patients with diabetic foot infections were excluded, this difference was not found.

Return-to-duty rates among US military combat-related amputees in the global war on terror: job description matters.

PubMed

Belisle, Jeffery G; Wenke, Joseph C; Krueger, Chad A

2013-08-01

The purpose of this study was to identify the differences seen between military occupation services (MOS) in terms of amputation patterns, subsequent disabling conditions, and their ability to return to duty. A retrospective study of major extremity amputations sustained by US service members between October 1, 2001, and July 30, 2011, was performed. Data obtained from the amputation database, Joint Trauma Theater Database, and the Physical Evaluation Board Liaison Office included demographics, amputation location(s), Injury Severity Scores (ISSs), disabling conditions, disability ratings, and disposition status. There were 1,221 major extremity amputees identified during the specified time frame, of which 899 had data regarding disabling conditions, ratings, and disposition. All service branches were represented. Personnel from the US Army (USA) Infantry were significantly (p < 0.0001) more likely to sustain an amputation than other MOS. The USA Infantry, the US Marine Corps Infantry and the USA Armor represented the top three specialties and accounted for more than 57% of all amputees. Approximately 89% of all service members did not return to duty, and the mean combined for all amputees was 76. USA Special Forces (USA SF) operators were significantly more likely to return to duty (p = 0.0022) and be found fit for duty (p = 0.0015) than all other MOS despite having a mean ISS (20) that was no different from those of other service members. No USA SF personnel were found to have posttraumatic stress disorder as a disabling condition. All amputees, regardless of MOS, are not likely to return to active duty and especially unlikely to be found fit for duty, except for members of the USA SF. The reason(s) for the increased return to duty for USA SF personnel remains unknown but a lack of posttraumatic stress disorder may be a contributing factor.

Descriptive Characteristics and Amputation Rates With Use of Intrepid Dynamic Exoskeleton Orthosis.

PubMed

Hill, Owen; Bulathsinhala, Lakmini; Eskridge, Susan L; Quinn, Kimberly; Stinner, Daniel J

2016-11-01

Advancements in ankle-foot orthotic devices, such as the Intrepid Dynamic Exoskeletal Orthosis (IDEO), are designed to improve function and reduce pain of the injured lower extremity. There is a paucity of research detailing the demographics, injury patterns and amputation outcomes of patients who have been prescribed an IDEO. The purpose of this study was to describe the demographics, presenting diagnosis and patterns of amputation in patients prescribed an IDEO at the Center for the Intrepid (CFI). The study population was comprised of 624 service members who were treated at the CFI and prescribed an IDEO between 2009 and 2014. Data were extracted from the Expeditionary Medical Encounter Database, Defense Manpower Data Center, Military Health System Data Repository, and CFI patient records for demographic and injury information as well as an amputation outcome. The most common injury category that received an IDEO prescription was injuries at or surrounding the ankle joint (25.0%), followed by tibia injuries (17.5%) and nerve injuries below the knee (16.4%). Over 80% of the sample avoided amputation within a one year time period using this treatment modality. Future studies should longitudinally track IDEO users for a longer term to determine the long term viability of the device. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Cycling with an amputation: A systematic review.

PubMed

Dyer, Bryce

2016-10-01

Cycling with any form of limb amputation has progressed from an activity of leisure or rehabilitation to elite level competition as part of the Paralympic Games programme. While it is often proposed that research into sport with an amputation can be extremely limited, this study intended to identify the volume, type and historical strategy in this area. This study comprises a documented systematic literature review of cycling undertaken with any form of limb amputation. This study used four online search engines to identify relevant peer-reviewed literature. These included SPORTDiscus, CINAHL, Scopus and MEDLINE. Google Scholar was also used as a secondary source. The initial results were then subjected to a set of pre-defined inclusion criteria. The resulting publications were then analysed for content and thematic commonality. The review identified 20 articles which met pre-defined inclusion criteria. The identified peer-reviewed publications were dated from the period 2004 to 2014. Three clear themes emerged from the historical research. There was both a paucity of peer-reviewed literature with respect to cycling with an amputation and the design of adaptive or assistive technology to replace limb loss. However, publications have been rising substantially over the last 5 years. This review study established the historical strategy and content of cycling with an amputation and identified the existing research themes. This will assist in summarising the current level of knowledge and help signpost such work in the future. © The International Society for Prosthetics and Orthotics 2015.

Effectiveness of Occupational Therapy Interventions for Lower-Extremity Musculoskeletal Disorders: A Systematic Review.

PubMed

Dorsey, Julie; Bradshaw, Michelle

Lower-extremity (LE) musculoskeletal disorders (MSDs) can have a major impact on the ability to carry out daily activities. The effectiveness of interventions must be examined to enable occupational therapy practitioners to deliver the most appropriate services. This systematic review examined the literature published between 1995 and July 2014 that investigated the effectiveness of occupational therapy interventions for LE MSDs. Forty-three articles met the criteria and were reviewed. Occupational therapy interventions varied on the basis of population subgroup: hip fracture, LE joint replacement, LE amputation or limb loss, and nonsurgical osteoarthritis and pain. The results indicate an overall strong role for occupational therapy in treating clients with LE MSDs. Activity pacing is an effective intervention for nonsurgical LE MSDs, and multidisciplinary rehabilitation is effective for LE joint replacement and amputation. Further research on specific occupational therapy interventions in this important area is needed. Copyright © 2017 by the American Occupational Therapy Association, Inc.

34 CFR 200.50 - SEA review of LEA progress.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false SEA review of LEA progress. 200.50 Section 200.50... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.50 SEA review of LEA progress. (a) State review. (1) An SEA must annually review the progress of each LEA in its State...

34 CFR 200.50 - SEA review of LEA progress.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 1 2012-07-01 2012-07-01 false SEA review of LEA progress. 200.50 Section 200.50... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.50 SEA review of LEA progress. (a) State review. (1) An SEA must annually review the progress of each LEA in its State...

34 CFR 200.50 - SEA review of LEA progress.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 1 2013-07-01 2013-07-01 false SEA review of LEA progress. 200.50 Section 200.50... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.50 SEA review of LEA progress. (a) State review. (1) An SEA must annually review the progress of each LEA in its State...

34 CFR 200.50 - SEA review of LEA progress.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 1 2014-07-01 2014-07-01 false SEA review of LEA progress. 200.50 Section 200.50... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.50 SEA review of LEA progress. (a) State review. (1) An SEA must annually review the progress of each LEA in its State...

34 CFR 200.50 - SEA review of LEA progress.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false SEA review of LEA progress. 200.50 Section 200.50... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.50 SEA review of LEA progress. (a) State review. (1) An SEA must annually review the progress of each LEA in its State...

Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts

PubMed Central

McGoldrick, Niall P; Butler, Joseph S; Lavelle, Maire; Sheehan, Stephen; Dudeney, Sean; O'Toole, Gary C

2016-01-01

Soft tissue sarcoma accounts for approximately 1% of all cancers diagnosed annually in the United States. When these rare malignant mesodermal tumours arise in the pelvis and extremities, they may potentially encase or invade large calibre vascular structures. This presents a major challenge in terms of safe excision while also leaving acceptable surgical margins. In recent times, the trend has been towards limb salvage with vascular reconstruction in preference to amputation. Newer orthopaedic and vascular reconstructive techniques including both synthetic and autogenous graft reconstruction have made complex limb-salvage surgery feasible. Despite this, limb-salvage surgery with concomitant vascular reconstruction remains associated with higher rates of post-operative complications including infection and amputation. In this review we describe the initial presentation and investigation of patients presenting with soft tissue sarcomas in the pelvis and extremities, which involve vascular structures. We further discuss the key surgical reconstructive principles and techniques available for the management of these complex tumours, drawn from our institution’s experience as a national tertiary referral sarcoma service. PMID:27190757

Resection and reconstruction of pelvic and extremity soft tissue sarcomas with major vascular involvement: Current concepts.

PubMed

McGoldrick, Niall P; Butler, Joseph S; Lavelle, Maire; Sheehan, Stephen; Dudeney, Sean; O'Toole, Gary C

2016-05-18

Soft tissue sarcoma accounts for approximately 1% of all cancers diagnosed annually in the United States. When these rare malignant mesodermal tumours arise in the pelvis and extremities, they may potentially encase or invade large calibre vascular structures. This presents a major challenge in terms of safe excision while also leaving acceptable surgical margins. In recent times, the trend has been towards limb salvage with vascular reconstruction in preference to amputation. Newer orthopaedic and vascular reconstructive techniques including both synthetic and autogenous graft reconstruction have made complex limb-salvage surgery feasible. Despite this, limb-salvage surgery with concomitant vascular reconstruction remains associated with higher rates of post-operative complications including infection and amputation. In this review we describe the initial presentation and investigation of patients presenting with soft tissue sarcomas in the pelvis and extremities, which involve vascular structures. We further discuss the key surgical reconstructive principles and techniques available for the management of these complex tumours, drawn from our institution's experience as a national tertiary referral sarcoma service.

Systematic review of the effectiveness of mirror therapy in upper extremity function.

PubMed

Ezendam, Daniëlle; Bongers, Raoul M; Jannink, Michiel J A

2009-01-01

This review gives an overview of the current state of research regarding the effectiveness of mirror therapy in upper extremity function. A systematic literature search was performed to identify studies concerning mirror therapy in upper extremity. The included journal articles were reviewed according to a structured diagram and the methodological quality was assessed. Fifteen studies were identified and reviewed. Five different patient categories were studied: two studies focussed on mirror therapy after an amputation of the upper limb, five studies focussed on mirror therapy after stroke, five studies focussed on mirror therapy with complex regional pain syndrome type 1 (CRPS1) patients, one study on mirror therapy with complex regional pain syndrome type 2 (CRPS2) and two studies focussed on mirror therapy after hand surgery other than amputation. Most of the evidence for mirror therapy is from studies with weak methodological quality. The present review showed a trend that mirror therapy is effective in upper limb treatment of stroke patients and patients with CRPS, whereas the effectiveness in other patient groups has yet to be determined.

Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures.

PubMed

Venkatadass, K; Grandhi, Tarani Sai Prasanth; Rajasekaran, S

2017-11-01

Open injuries in children are rare compared to adults. In children with major open injuries, there is no specific scoring system to guide when to amputate or salvage the limb. The use of available adult scoring systems may lead to errors in management. The role of Ganga Hospital Open Injury Severity Scoring (GHOISS) for open injuries in adults is well established and its applicability for pediatric open injuries has not been studied. This study was done to analyse the usefulness of GHOISS in pediatric open injuries and to compare it with MESS(Mangled Extremity Severity Score). All children (0-18 years) who were admitted with Open type IIIB injuries of lower limbs between January 2008 and March 2015 were included. MESS and GHOISS were calculated for all the patients. There were 50 children with 52 type IIIB Open injuries of which 39 had open tibial fractures and 13 had open femur fractures. Out of 52 type IIIB open injuries, 48 were salvaged and 4 were amputated. A MESS score of 7 and above had sensitivity of 25% for amputation while GHOISS of 17 and above was found to be more accurate for determining amputation with sensitivity of 75% and specificity of 93.75%. GHOISS is a reliable predictor of injury severity in type IIIB open fractures in children and can be used as a guide for decision-making. The use of MESS score in children has a lower predictive value compared to GHOISS in deciding amputation versus salvage. A GHOISS of 17 or more has the highest sensitivity and specificity to predict amputation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Predictive Ability of the SVS WIfI Classification System following First-time Lower Extremity Revascularizations

PubMed Central

Darling, Jeremy D.; McCallum, John C.; Soden, Peter A.; Guzman, Raul J.; Wyers, Mark C.; Hamdan, Allen D.; Verhagen, Hence J.; Schermerhorn, Marc L.

2017-01-01

OBJECTIVES The SVS WIfI (wound, ischemia, foot infection) classification system was proposed to predict 1-year amputation risk and potential benefit from revascularization. Our goal was to evaluate the predictive ability of this scale in a “real world” selection of patients undergoing a first time lower extremity revascularization for chronic limb threatening ischemia (CLTI). METHODS From 2005 to 2014, 1,336 limbs underwent a first time lower extremity revascularization for CLTI, of which 992 had sufficient data to classify all three WIfI components (wound, ischemia, and foot infection). Limbs were stratified into the SVS WIfI clinical stages (from 1 to 4) for 1-year amputation risk estimation, as well as a novel WIfI composite score from 0 to 9 (that weighs all WIfI variables equally) and a novel WIfI mean score from 0 to 3 (that can incorporate limbs missing any of the three WIfI components). Outcomes included major amputation, RAS events (revascularization, major amputation, or stenosis [>3.5× step-up by duplex]), and mortality. Predictors were identified using Cox regression models and Kaplan-Meier survival estimates. RESULTS Of the 1,336 first-time procedures performed, 992 limbs were classified in all three WIfI components (524 endovascular, 468 bypass; 26% rest pain, 74% tissue loss). Cox regression demonstrated that a one-unit increase in the WIfI clinical stage increases the risk of major amputation and RAS events in all limbs (Hazard Ratio [HR] 2.4; 95% Confidence Interval [CI] 1.7–3.2 and 1.2 [1.1–1.3], respectively). Separate models of the entire cohort, a bypass only cohort, and an endovascular only cohort showed that a one-unit increase in the WIfI mean score is associated with an increase in the risk of major amputation (all three cohorts; 5.3 [3.6–6.8], 4.1 [2.4–6.9], and 6.6 [3.8–11.6], respectively) and RAS events (all three cohorts; 1.7 [1.4–2.0], 1.9 [1.4–2.6], and 1.4 [1.1–1.9], respectively). The novel WIfI composite and WIfI mean scores were the only consistent predictors of mortality among the three cohorts, with the WIfI mean score proving most strongly predictive in the entire cohort (1.4 [1.1–1.7]), the bypass only cohort (1.5 [1.1–1.9]) and the endovascular only cohort (1.4 [1.0–1.8]). Although the individual WIfI wound component was able to predict mortality among all patients (1.1 [1.0–1.2]) and bypass only patients (1.2 [1.1–1.3]), no other individual WIfI component, nor the WIfI clinical stage, were able to significantly predict mortality among any cohort. CONCLUSION This study supports the ability of the SVS WIfI classification system to predict major amputation; however, the novel WIfI mean and WIfI composite scores predict amputation, RAS events, and mortality more consistently than any other current WIfI scoring system. The WIfI mean score allows inclusion of all limbs, and both novel scoring systems are easier to conceptualize, give equal weight to each WIfI component, and may provide clinicians more effective comparisons in outcomes between patients. PMID:28073665

Early Complications and Outcomes in Combat Injury Related Invasive Fungal Wound Infections: A Case-Control Analysis

PubMed Central

Lewandowski, Louis R.; Weintrob, Amy C.; Tribble, David R.; Rodriguez, Carlos J.; Petfield, Joseph; Lloyd, Bradley A.; Murray, Clinton K.; Stinner, Daniel; Aggarwal, Deepak; Shaikh, Faraz; Potter, Benjamin K.

2015-01-01

Objective Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures prior to initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure. Design Retrospective review and case-control analysis. Setting Military hospitals. Patients/Participants United States military personnel injured during combat operations (2009–2011). The IFI cases were identified based upon the presence of recurrent, necrotic extremity wounds with mold growth in culture and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury. Intervention None. Main Outcome Measurements Amputation revision rate and loss of functional levels. Results Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (p<0.001). Additionally, significantly (p<0.001) higher number of operative procedures and longer duration to initial wound closure was associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% CI: 1.17, 2.01). The supplemental matching analysis found similar results. Conclusions Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates. PMID:26360542

The Late Embryogenesis Abundant Protein Family in Cassava (Manihot esculenta Crantz): Genome-Wide Characterization and Expression during Abiotic Stress.

PubMed

Wu, Chunlai; Hu, Wei; Yan, Yan; Tie, Weiwei; Ding, Zehong; Guo, Jianchun; He, Guangyuan

2018-05-17

Late embryogenesis abundant (LEA) proteins, as a highly diverse group of polypeptides, play an important role in plant adaptation to abiotic stress; however, LEAs from cassava have not been studied in cassava. In this study, 26 LEA members were genome-wide identified from cassava, which were clustered into seven subfamily according to evolutionary relationship, protein motif, and gene structure analyses. Chromosomal location and duplication event analyses suggested that 26 MeLEAs distributed in 10 chromosomes and 11 MeLEA paralogues were subjected to purifying selection. Transcriptomic analysis showed the expression profiles of MeLEAs in different tissues of stem, leaves, and storage roots of three accessions. Comparative transcriptomic analysis revealed that the function of MeLEAs in response to drought may be differentiated in different accessions. Compared with the wild subspecies W14, more MeLEA genes were activated in cultivated varieties Arg7 and SC124 after drought treatment. Several MeLEA genes showed induction under various stresses and related signaling treatments. Taken together, this study demonstrates the transcriptional control of MeLEAs in tissue development and the responses to abiotic stress in cassava and identifies candidate genes for improving crop resistance to abiotic stress.

Treatment of Calcaneal Fracture With Severe Soft Tissue Injury and Osteomyelitis: A Case Report.

PubMed

Karns, Michael; Dailey, Steven K; Archdeacon, Michael T

2015-01-01

Advancements in surgical technique have resulted in the ability to reconstruct lower extremity injuries that would have previously been treated by amputation. Currently, a paucity of data is available specifically addressing limb amputation versus reconstruction for calcaneal fractures with severe soft tissue compromise. Reconstruction leaves the patient with their native limb; however, multiple surgeries, infections, chronic pain, and a poor functional outcome are very real possibilities. We present the case of a complex calcaneal fracture complicated by soft tissue injury and osteomyelitis that highlights the importance of shared decision-making between patient and surgeon when considering reconstruction versus amputation. This case exemplifies the need for open communication concerning the risks and benefits of treatment modalities while simultaneously considering the patient's expectations and desired outcomes. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol.

PubMed

Leijendekkers, Ruud A; Staal, J Bart; van Hinte, Gerben; Frölke, Jan Paul; van de Meent, Hendrik; Atsma, Femke; Nijhuis-van der Sanden, Maria W G; Hoogeboom, Thomas J

2016-11-22

Patients with lower extremity amputation frequently suffer from socket-related problems. This seriously limits prosthesis use, level of activity and health-related quality of life (HRQoL). An additional problem in patients with lower extremity amputation are asymmetries in gait kinematics possibly accounting for back pain. Bone-anchored prostheses (BAPs) are a possible solution for socket-related problems. Knowledge concerning the level of function, activity and HRQoL after surgery is limited. The aims of this ongoing study are to: a) describe changes in the level of function, activity, HRQoL and satisfaction over time compared to baseline before surgery; b) examine potential predictors for changes in kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort over time and level of stump pain at follow-up; c) examine potential mechanisms for change of back pain over time by identifying determinants, moderators and mediators. A prospective 5-year longitudinal study with multiple follow-ups. All adults, between May 2014 and May 2018, with lower extremity amputation receiving a press-fit BAP are enrolled consecutively. Patients with socket-related problems and trauma, tumour resection or stable vascular disease as cause of primary amputation will be included. Exclusion criteria are severe cognitive or psychiatric disorders. Follow-ups are planned at six-months, one-, two- and five-years after BAP surgery. The main study outcomes follow, in part, the ICF classification: a) level of function defined as kinematics in coronal plane, hip abductor strength, prosthetic use, back pain and stump pain; b) level of activity defined as mobility level and walking ability; c) HRQoL; d) satisfaction defined as prosthesis comfort and global perceived effect. Changes over time for the continuous outcomes and the dichotomized outcome (back pain) will be analysed using generalised estimating equations (GEE). Multivariate GEE will be used to identify potential predictors for change of coronal plane kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort and for the level of post-operative stump pain. Finally, potential mechanisms for change in back pain frequency will be explored using coronal plane kinematics as a potential determinant, stump pain as moderator and hip abductor strength as mediator. This study may identify predictors for clinically relevant outcome measures. NTR5776 . Registered 11 March 2016, retrospectively registered.

Incidence and morbidity of concomitant spine fractures in combat-related amputees.

PubMed

Bevevino, Adam J; Lehman, Ronald A; Tintle, Scott M; Kang, Daniel G; Dworak, Theodora C; Potter, Benjamin K

2014-04-01

High-energy blasts are the most frequent cause of combat-related amputations in Operations Iraqi and Enduring Freedom (OIF/OEF). The nondiscriminating effects of this mechanism often result in both appendicular and axial skeletal injuries. Despite this recognized coincident injury pattern, the incidence and consequence of spine fractures in trauma-related combat amputees are unknown. This study sought to determine the incidence and morbidity of the associated spine fractures on patients with traumatic lower extremity amputation sustained during OIF/OEF. Retrospective case control. Two hundred twenty-six combat-related lower extremity amputees presenting to a single institution and injured between 2003 and 2008 were included for analysis. Physiologic and functional outcome measures were used to determine the influence of spine fractures on combat amputees. Physiologic measures included intensive care unit (ICU) admission rates, injury severity score (ISS), rate of narcotic/neuropathic pain use, and heterotopic ossification (HO) rates. Functional outcome measures included return-to-duty rates and ambulatory status at final follow-up. Data from 300 consecutive combat-related lower extremity amputations were retrospectively reviewed and grouped. Group 1 consisted of amputees with associated spine fractures, and Group 2 consisted of amputees without spine fractures. The results of the two groups were compared with regard to initial presentation and final functional outcomes. A total of 226 patients sustained 300 lower extremity amputations secondary to combat-related injuries, the most common mechanism being an improvised explosive device. Twenty-nine of these patients had a spine fracture (13%). Group 1 had a higher ISS than Group 2 (30 vs. 19, p<.001). Group 1 patients were also more likely to be admitted to the ICU (86% vs. 46%, p<.001). Furthermore, Group 1 patients had a significantly higher rate of HO in their residual limbs (82% vs. 55%, p<.005). The incidence of spine fractures in combat-related amputees is 13%. The results suggest that combat-related amputees with spine fractures are more likely to sustain severe injuries to other body systems, as indicated by the significantly higher ISS and rates of ICU admission. This group also had a significantly higher rate of HO formation, which may be attributable to the greater local and/or systemic injuries sustained by these patients. Published by Elsevier Inc.

Characterization of the late embryogenesis abundant (LEA) proteins family and their role in drought stress tolerance in upland cotton.

PubMed

Magwanga, Richard Odongo; Lu, Pu; Kirungu, Joy Nyangasi; Lu, Hejun; Wang, Xingxing; Cai, Xiaoyan; Zhou, Zhongli; Zhang, Zhenmei; Salih, Haron; Wang, Kunbo; Liu, Fang

2018-01-15

Late embryogenesis abundant (LEA) proteins are large groups of hydrophilic proteins with major role in drought and other abiotic stresses tolerance in plants. In-depth study and characterization of LEA protein families have been carried out in other plants, but not in upland cotton. The main aim of this research work was to characterize the late embryogenesis abundant (LEA) protein families and to carry out gene expression analysis to determine their potential role in drought stress tolerance in upland cotton. Increased cotton production in the face of declining precipitation and availability of fresh water for agriculture use is the focus for breeders, cotton being the backbone of textile industries and a cash crop for many countries globally. In this work, a total of 242, 136 and 142 LEA genes were identified in G. hirsutum, G. arboreum and G. raimondii respectively. The identified genes were classified into eight groups based on their conserved domain and phylogenetic tree analysis. LEA 2 were the most abundant, this could be attributed to their hydrophobic character. Upland cotton LEA genes have fewer introns and are distributed in all chromosomes. Majority of the duplicated LEA genes were segmental. Syntenic analysis showed that greater percentages of LEA genes are conserved. Segmental gene duplication played a key role in the expansion of LEA genes. Sixty three miRNAs were found to target 89 genes, such as miR164, ghr-miR394 among others. Gene ontology analysis revealed that LEA genes are involved in desiccation and defense responses. Almost all the LEA genes in their promoters contained ABRE, MBS, W-Box and TAC-elements, functionally known to be involved in drought stress and other stress responses. Majority of the LEA genes were involved in secretory pathways. Expression profile analysis indicated that most of the LEA genes were highly expressed in drought tolerant cultivars Gossypium tomentosum as opposed to drought susceptible, G. hirsutum. The tolerant genotypes have a greater ability to modulate genes under drought stress than the more susceptible upland cotton cultivars. The finding provides comprehensive information on LEA genes in upland cotton, G. hirsutum and possible function in plants under drought stress.

Evaluation of changes to foot shape in females 5 years after mastectomy: a case-control study.

PubMed

Głowacka-Mrotek, Iwona; Sowa, Magdalena; Siedlecki, Zygmunt; Nowikiewicz, Tomasz; Hagner, Wojciech; Zegarski, Wojciech

2017-06-01

The aim of this study was to evaluate changes in foot shape of women 5 years after undergoing breast amputation. Evaluation of foot shape was performed using a non-invasive device for computer analysis of the plantar surface of the foot. Obtained results were compared between feet on the healthy breast side (F1) and on the amputated breast side (F2). 128 women aged 63.60 ± 8.83, 5-6 years after breast amputation were enrolled in this case-control study. Weight bearing on the lower extremity on the amputated breast side (F1) compared with the healthy breast side (F2) showed statistically significant differences (p < 0.01). Patients put more weight onto the healthy breast side. No statistically significant difference was found with regard to F1 and F2 foot length (p = 0.4239), as well as BETA (p = 0.4470) and GAMMA (p = 0.4566) angles. Highly statistically significant differences were noted with respect to foot width, ALPHA angle, and Sztriter-Godunov index-higher values were observed on the healthy breast side (p < 0.001). Highly statistically significant differences were also noted while comparing Clark's angles, higher values being observed on the operated breast side (p < 0.001). Differences in foot shape on the healthy breast side and amputated breast side constitute a long-term negative consequence of mastectomy, and can be caused by unbalanced weight put on feet on the healthy breast side compared to the amputated breast side.

Insights on Structure and Function of a Late Embryogenesis Abundant Protein from Amaranthus cruentus: An Intrinsically Disordered Protein Involved in Protection against Desiccation, Oxidant Conditions, and Osmotic Stress

PubMed Central

Saucedo, Alma L.; Hernández-Domínguez, Eric E.; de Luna-Valdez, Luis A.; Guevara-García, Angel A.; Escobedo-Moratilla, Abraham; Bojorquéz-Velázquez, Esaú; del Río-Portilla, Federico; Fernández-Velasco, Daniel A.; Barba de la Rosa, Ana P.

2017-01-01

Late embryogenesis abundant (LEA) proteins are part of a large protein family that protect other proteins from aggregation due to desiccation or osmotic stresses. Recently, the Amaranthus cruentus seed proteome was characterized by 2D-PAGE and one highly accumulated protein spot was identified as a LEA protein and was named AcLEA. In this work, AcLEA cDNA was cloned into an expression vector and the recombinant protein was purified and characterized. AcLEA encodes a 172 amino acid polypeptide with a predicted molecular mass of 18.34 kDa and estimated pI of 8.58. Phylogenetic analysis revealed that AcLEA is evolutionarily close to the LEA3 group. Structural characteristics were revealed by nuclear magnetic resonance and circular dichroism methods. We have shown that recombinant AcLEA is an intrinsically disordered protein in solution even at high salinity and osmotic pressures, but it has a strong tendency to take a secondary structure, mainly folded as α-helix, when an inductive additive is present. Recombinant AcLEA function was evaluated using Escherichia coli as in vivo model showing the important protection role against desiccation, oxidant conditions, and osmotic stress. AcLEA recombinant protein was localized in cytoplasm of Nicotiana benthamiana protoplasts and orthologs were detected in seeds of wild and domesticated amaranth species. Interestingly AcLEA was detected in leaves, stems, and roots but only in plants subjected to salt stress. This fact could indicate the important role of AcLEA protection during plant stress in all amaranth species studied. PMID:28439280

An Atypical Late Embryogenesis Abundant Protein OsLEA5 Plays a Positive Role in ABA-Induced Antioxidant Defense in Oryza sativa L.

PubMed

Huang, Liping; Zhang, MengYao; Jia, Jing; Zhao, Xixi; Huang, Xingxiu; Ji, E; Ni, Lan; Jiang, Mingyi

2018-05-01

OsLEA5 acts as a co-regulator of a transcriptional fact ZFP36 to enhance the expression and the activity of ascorbate peroxidase OsAPX1 to regulate seed germination in rice, but it it unknown whether OsLEA5 is also crucial in plant seedlings under stress conditions. To determine this, we generated OsLEA5 overexpression and knockdown rice plants. We found that overexpression of OsLEA5 in rice plants enhanced the tolerance to drought and salt stress; in contrast, an RNA interference (RNAi) mutant of OsLEA5 rice plants was more sensitive to drought and salinity. Further investigation found that various stimuli and ABA could induce OsLEA5 expression, and OsLEA5 acted downstream of ZFP36 to be involved in ABA-induced generation of hydrogen peroxide (H2O2), and the regulation of the expression and the activities of antioxidant defense enzymes in plants leaves, and OsLEA5 contributed to stabilize ZFP36. Additionally, OsLEA5 participates in the accumulation of ABA by up-regulating ABA biosynthesis genes and down-regulating ABA metabolism genes. Moreover, we found that two homologs of OsLEA5 (5C700, short for Os05g0526700; and 5C300, short for Os05g0584300) which were induced by ABA also interacted with ZFP36 separately; interestingly, the nuclear-located 5C700 could also act as a co-activator of ZFP36 to modulate OsAPX1, while 5C300 which was down-regulated by ABA induction acted as an ABA-induced inhibitor of ZFP36 to regulate OsAPX1. Hence, our conclusion is that OsLEA5 participates in the ABA-mediated antioxidant defense to function in drought and salt stress response in rice, and the 5C subgroup of LEAs contribute by acting as co-regulators of the transcription factor ZFP36.

Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes.

PubMed

Venkataraman, Kavita; Fong, Ngan Phoon; Chan, Kin Ming; Tan, Boon Yeow; Menon, Edward; Ee, Chye Hua; Lee, Kok Keng; Koh, Gerald Choon-Huat

2016-09-01

To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes. Retrospective medical records review. All community hospitals. Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation. Not applicable. Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient. Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation. Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Rehabilitation after the replantation on a 2-year-old girl with both amputated legs.

PubMed

Kim, Hyo Heon; Jeong, Jae-Ho; Kim, Yong Ha; Seul, Jung Hyun; Shon, Oog Jin

2005-04-01

We had an opportunity to perform replantation of both legs on a 2-year-old girl, and our decision to perform replantation rather than amputation surgery was carefully made taking her age, degree of crushing injury, ischaemic time and level of the amputation into consideration. Painstakingly designed rehabilitation treatments were continuously performed on this girl from the early stage after the operation, and the treatments were comprised of four parts; that is, flexion and extension exercise for the ankle in order to prevent it from stiffness or contracture, functional electrical stimulation (FES) in order to prevent muscular atrophy on the lower extremities, muscle strengthening exercise for the lower extremities, and electrical stimulation to regenerate the damaged nerves and to prevent muscular atrophy from occurring. For an objective assessment of the postoperative conditions, total active motion angles of the ankle joint were measured, and also EMG and NCV were conducted at the end of the first month as well as at the end of the 6th month. Total active motion angles of the ankle joint were increased progressively as time went on, from 15 to 60 degrees on the right and from 10 to 45 degrees on the left. NCV did not show any sensation or response from motor nerves, or amplitude decreased considerably 1 month after the operation; however, at the end of the 6th month conditions improved a great deal with both amplitude and latency. And most muscles that did not show any signals on EMG or showed less than normal at the end of the first month after the operation eventually recovered at the end of the 6th month. The patient had no particular difficulties in walking after 6 months or rather she started running in small steps showing her legs functioning superbly. An infant with both of lower extremities amputated is quite a rare case. We believe that the replantation surgery was successful due to the fact that carefully selected preoperative factors were taken into consideration and well designed postoperative rehabilitation program consisted of four parts was carried out continuously.

Functional characterization of the late embryogenesis abundant (LEA) protein gene family from Pinus tabuliformis (Pinaceae) in Escherichia coli.

PubMed

Gao, Jie; Lan, Ting

2016-01-19

Late embryogenesis abundant (LEA) proteins are a large and highly diverse gene family present in a wide range of plant species. LEAs are proposed to play a role in various stress tolerance responses. Our study represents the first-ever survey of LEA proteins and their encoding genes in a widely distributed pine (Pinus tabuliformis) in China. Twenty-three LEA genes were identified from the P. tabuliformis belonging to seven groups. Proteins with repeated motifs are an important feature specific to LEA groups. Ten of 23 pine LEA genes were selectively expressed in specific tissues, and showed expression divergence within each group. In addition, we selected 13 genes representing each group and introduced theses genes into Escherichia coli to assess the protective function of PtaLEA under heat and salt stresses. Compared with control cells, the E. coli cells expressing PtaLEA fusion protein exhibited enhanced salt and heat resistance and viability, indicating the protein may play a protective role in cells under stress conditions. Furthermore, among these enhanced tolerance genes, a certain extent of function divergence appeared within a gene group as well as between gene groups, suggesting potential functional diversity of this gene family in conifers.

Student involvement in wellness policies: a study of Pennsylvania local education agencies.

PubMed

Jomaa, Lamis H; McDonnell, Elaine; Weirich, Elaine; Hartman, Terryl; Jensen, Leif; Probart, Claudia

2010-01-01

Explore student-involvement goals in local wellness policies (LWPs) of local education agencies (LEAs) in Pennsylvania (PA) and investigate associations with LEA characteristics. An observational study that helped examine student-involvement goals. Public PA LEAs. LWPs submitted by 539 PA public LEAs. Six student-involvement goals analyzed as dependent variables. Correlations between demographic and policy characteristics of LEAs and student-involvement goals were measured. Policies developed by LEAs were abstracted and analyzed. Logistic regression models were developed to analyze relationships between student-involvement goals and the demographic and policy characteristics of LEAs. Majority of LEAs included policy goals that address student involvement in an array of activities related to wellness policy, food service, and role modeling. Regression models showed that LEAs with comprehensive and strong policies were most likely to include student-involvement goals regardless of LEA location, enrollment, or socioeconomic status of students. Student engagement in school nutrition policies has been shown to increase student acceptance in an array of health-related areas and is therefore promising in the area of obesity prevention. Comprehensiveness and rigor of LWPs were strongly correlated with the inclusion of student-involvement goals on LWPs. The upcoming reauthorization of the Child Nutrition programs in 2010 creates a good opportunity to address student involvement in LWPs. Copyright © 2010 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Identification of anti-Lea by platelet complement fixation.

PubMed

Ando, B; Ibayashi, H

1986-01-01

Two anti-Lea sera which were able to detect Lea antigen on platelets were identified in a screening for anti-platelet antibodies by means of a platelet complement fixation test. These two antisera hemolyzed erythrocytes without enzyme treatment. The anti-Lea activity could be completely absorbed by red cells, platelets and lymphocytes of Le(a+b-) donors but not by cells from Le(a-b+) or Le(a-b-) donors. The antibody activity against red cells was eliminated by treatment of the antisera with dithiothreitol, thereby suggesting that the activity resided in the IgM class of immunoglobulins. As the anti-Lea was more reactive at 37 degrees C than at room temperature against both red cells and platelets, we suggest that transfusion of platelets of Lea-negative donors should be considered for patients with this type of anti-Lea.

Recent advances in bioelectric prostheses

PubMed Central

Pasquina, Paul F.; Perry, Briana N.; Miller, Matthew E.; Ling, Geoffrey S.F.; Tsao, Jack W.

2015-01-01

Summary Worldwide prevalence of amputation has created an increasing demand for improved upper and lower extremity prostheses. Current prosthetics are often uncomfortable and difficult to control and provide limited functional restoration. Moreover, the inability to normalize anthropomorphic biomechanics with a prosthesis increases one's risk of developing long-term health risks such as arthritis, skin breakdown, and pain. Recent advances in bionic prosthetic development hold great promise for rehabilitation and improving quality of life with limb loss. This brief review discusses the current state of advanced prostheses, the integration of robotics in the care of individuals with major limb amputation, and some innovative surgical techniques that are being explored for clinical feasibility. PMID:29443190

Long-Term Follow-Up and Amputation-Free Survival in 497 Casualties with Combat-Related Vascular Injuries and Damage-Control Resuscitation

DTIC Science & Technology

2012-01-01

minutes). US casualties (n 111) had limb salvage attempted for 113 extremity vascular injuries (3 [2%] iliac , 33 [30%] femoral, 23 [20%] popliteal...Patients Amputation Survival Follow-Up, Mean (Range), d Iliac 1 1 1 3 3 (100%) 3 (100%) 347 (29 1,079) Femoral 10 20 3 33 29 (87.9%) 4 (12.1%) 33 (100...3 4 3 (75%) 1 (25%) 4 (100%) Radial 2 2 4 4 (100%) 4 (100%) Total 28 80 5 113 96 (84.9%) 16 (14.2%) 110 (99.1%) *One bilateral repair. J Trauma Acute

Student Involvement in Wellness Policies: A Study of Pennsylvania Local Education Agencies

ERIC Educational Resources Information Center

Jomaa, Lamis H.; McDonnell, Elaine; Weirich, Elaine; Hartman, Terryl; Jensen, Leif; Probart, Claudia

2010-01-01

Objective: Explore student-involvement goals in local wellness policies (LWPs) of local education agencies (LEAs) in Pennsylvania (PA) and investigate associations with LEA characteristics. Design: An observational study that helped examine student-involvement goals. Setting: Public PA LEAs. Participants: LWPs submitted by 539 PA public LEAs. Main…

Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees?

PubMed

Miller, Michelle; Wong, Wing Ki; Wu, Jing; Cavenett, Sally; Daniels, Lynne; Crotty, Maria

2008-10-01

To evaluate the utility of body mass index (BMI) and corrected-arm-muscle area (CAMA) as measures of nutritional health for lower-limb amputees attending prosthetics clinics. Cross-sectional study. Prosthetics clinic in Australia. Unilateral lower-extremity amputees (N=58; age range, 21-91y; 37 transtibial, 21 transfemoral) attending a regional prosthetics clinic between May and November 2003. Not applicable. Weight (without prosthesis), corrected and uncorrected for the amputated limb was used with height estimated from knee height to calculate corrected BMI (cBMI) and uncorrected BMI (uBMI). CAMA was calculated using the mean of triplicate mid-upper-arm circumference (MUAC) and triceps skinfold thickness (TST) measurements. The Mini Nutritional Assessment (MNA) and Assessment of Quality of Life were administered according to recommended protocols. The Pearson correlation was used to determine the strength and significance of associations between variables, and bivariate regression analyses were performed to determine whether an association existed between the nutritional variables (BMI, CAMA, MNA) and quality of life (QOL). There were no statistically significant differences in the measures of nutritional health according to site (transtibial, transfemoral) of amputation. MUAC, TST, and CAMA all showed moderate to high positive correlations (r range, .541-.782) with both cBMI and uBMI. The strength of the relationship between the MNA and cBMI/uBMI was weaker (r=.383, r=.380, respectively) but remained positive and statistically significant (P=.003). QOL was not associated with cBMI or uBMI but was related to CAMA (beta=-.132; P=.030) and MNA (beta=-.561; P=.017). For persons with unilateral lower-extremity amputation, measurement of upper-arm anthropometry may be a more useful indicator of nutritional health and its consequences than BMI.

Resection of the metatarsal head for diabetic foot ulcers.

PubMed

Wieman, T J; Mercke, Y K; Cerrito, P B; Taber, S W

1998-11-01

Diabetic foot ulceration is a worldwide health problem. Approximately 15% of the 10 million diabetic patients in the United States will develop a foot ulceration at some time in their lives. The presence of a foot ulcer in this population is extremely debilitating and dramatically increases the risk of lower extremity amputation, accounting for approximately 67,000 lost limbs each year. Additionally, the costs associated with treating foot ulcers in diabetic patients is a major expense in the overall care of this patient group. An 11-year retrospective study was conducted to evaluate 101 consecutive patients with diabetic ulcers of the forefoot who were treated using resection of the metatarsal head as the primary means of obtaining wound closure. The results indicate that 88% of the ulcers were healed by using this technique, and relatively more rapidly than would be expected when compared with historical norms. Resection of the metatarsal head is a safe and relatively inexpensive procedure that facilitates closure of the lesion, helps to control infection, and prevents countless and costly amputations.

Pretibial Located Stewart-Treves Syndrome: Uncommon Presentation in a Bulgarian Patient!

PubMed

Tchernev, Georgi; Yungareva, Irina; Mangarov, Hristo; Stavrov, Konstantin; Lozev, Ilia; Temelkova, Ivanka; Chernin, Svetoslav; Pidakev, Ivan; Tronnier, Michael

2018-04-15

The Stewart-Treves syndrome with localisation in the region of the lower extremities is not something unusual as clinical pathology, but the clinical diagnostics is rather difficult, and it can be further complicated maximally because of: the similar locoregional findings in patients with other cutaneous malignancies. Presented is a rare form of an epithelioid variant of the Stewart Treves syndrome in a woman, aged 81, localised in the region of the lower leg and significantly advanced only for 2 months. The diagnosis was confirmed histologically and immunohistochemically. Amputation of the affected extremity was planned. Discussed are important etiopathogenetic aspects regarding the approach in patients with lymphedema and possibility for development of the Stewart Treves syndrome. Analyzing the evidence from the literature worldwide, we concluded that perhaps the only reliable (to some extent) therapeutic option in patients with Stewart Treves Syndrome is 1) the early diagnostics and 2) the following inevitable radical excision or amputation with the maximal field of surgical security in the proximal direction.

The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing.

PubMed

Zhan, Luke X; Branco, Bernardino C; Armstrong, David G; Mills, Joseph L

2015-04-01

The purpose of this study was to evaluate whether the new Society for Vascular Surgery (SVS) Wound, Ischemia, and foot Infection (WIfI) classification system correlates with important clinical outcomes for limb salvage and wound healing. A total of 201 consecutive patients with threatened limbs treated from 2010 to 2011 in an academic medical center were analyzed. These patients were stratified into clinical stages 1 to 4 on the basis of the SVS WIfI classification. The SVS objective performance goals of major amputation, 1-year amputation-free survival (AFS) rate, and wound healing time (WHT) according to WIfI clinical stages were compared. The mean age was 58 years (79% male, 93% with diabetes). Forty-two patients required major amputation (21%); 159 (78%) had limb salvage. The amputation group had a significantly higher prevalence of advanced stage 4 patients (P < .001), whereas the limb salvage group presented predominantly as stages 1 to 3. Patients in clinical stages 3 and 4 had a significantly higher incidence of amputation (P < .001), decreased AFS (P < .001), and delayed WHT (P < .002) compared with those in stages 1 and 2. Among patients presenting with stage 3, primarily as a result of wound and ischemia grades, revascularization resulted in accelerated WHT (P = .008). These data support the underlying concept of the SVS WIfI, that an appropriate classification system correlates with important clinical outcomes for limb salvage and wound healing. As the clinical stage progresses, the risk of major amputation increases, 1-year AFS declines, and WHT is prolonged. We further demonstrated benefit of revascularization to improve WHT in selected patients, especially those in stage 3. Future efforts are warranted to incorporate the SVS WIfI classification into clinical decision-making algorithms in conjunction with a comorbidity index and anatomic classification. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Guideline for the management of wounds in patients with lower-extremity neuropathic disease: an executive summary.

PubMed

Crawford, Penny Ellen; Fields-Varnado, Myra

2013-01-01

This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline.

Do Countywide LEAs Allocate Expenditures Differently from Community-Centric LEAs? Evidence from National Center for Education Statistics Common Core Data

ERIC Educational Resources Information Center

DeLuca, Thomas A.

2015-01-01

As K-12 (kindergarten through twelfth grade) local education agencies (LEAs) face continued fiscal pressure, noninstructional service consolidation advocates point to states like Florida, with its countywide school systems, as an example of LEAs exploiting scale economies to reduce per-pupil spending, especially in administration and other…

[Reconstruction of the heel in a two-year-old boy after lawn mower injury].

PubMed

Kraus, R; Albrecht, J; Schnettler, R; von Pichler, M

2012-04-01

Lawn mower injuries in children usually involve the lower extremities and can lead to serious amputation injuries. Treatment should look not only at the acute reconstruction, but also on maintaining the ability to grow. We report the case of a two-year-old boy with amputation of the heel. The boy was run over by a lawn mower. He suffered a complete loss of heel soft tissue, 30 % of the os calcis and the Achilles tendon. The one-stage reconstruction was performed by transplantation of an iliac crest graft, fascia lata to reconstruct the Achilles tendon and a microvascular latissimus dorsi flap. After one year, the functional and cosmetic result is excellent, the bone graft is healed completely and shows growth trends. The successful treatment of such a severe amputation injury requires the interdisciplinary cooperation between paediatric traumatologists, plastic surgeons, physical therapists and orthopaedic shoemaker. The result justifies the great effort. © Georg Thieme Verlag KG Stuttgart · New York.

Heterotopic Ossification Following Extremity Blast Amputation: An Animal Model in the Sprague Dawley Rat

DTIC Science & Technology

2012-10-01

Buprenorphine (0.05 mg/kg) and 12 enrofloxacin (5 mg/kg) were administered subcutaneously for preemptive analgesia and 13 prophylactic antibacterial...cage with warmed bedding and was monitored until awakening from anesthesia. 19 Animals received antibiotics ( enrofloxacin , 5 mg/kg administered

Ubiquitous LEA29Y Expression Blocks T Cell Co-Stimulation but Permits Sexual Reproduction in Genetically Modified Pigs.

PubMed

Bähr, Andrea; Käser, Tobias; Kemter, Elisabeth; Gerner, Wilhelm; Kurome, Mayuko; Baars, Wiebke; Herbach, Nadja; Witter, Kirsti; Wünsch, Annegret; Talker, Stephanie C; Kessler, Barbara; Nagashima, Hiroshi; Saalmüller, Armin; Schwinzer, Reinhard; Wolf, Eckhard; Klymiuk, Nikolai

2016-01-01

We have successfully established and characterized a genetically modified pig line with ubiquitous expression of LEA29Y, a human CTLA4-Ig derivate. LEA29Y binds human B7.1/CD80 and B7.2/CD86 with high affinity and is thus a potent inhibitor of T cell co-stimulation via this pathway. We have characterized the expression pattern and the biological function of the transgene as well as its impact on the porcine immune system and have evaluated the potential of these transgenic pigs to propagate via assisted breeding methods. The analysis of LEA29Y expression in serum and multiple organs of CAG-LEA transgenic pigs revealed that these animals produce a biologically active transgenic product at a considerable level. They present with an immune system affected by transgene expression, but can be maintained until sexual maturity and propagated by assisted reproduction techniques. Based on previous experience with pancreatic islets expressing LEA29Y, tissues from CAG-LEA29Y transgenic pigs should be protected against rejection by human T cells. Furthermore, their immune-compromised phenotype makes CAG-LEA29Y transgenic pigs an interesting large animal model for testing human cell therapies and will provide an important tool for further clarifying the LEA29Y mode of action.

An assessment of the relationship between congenital transverse deficiency of the forearm and symbrachydactyly.

PubMed

Kallemeier, Patricia M; Manske, Paul R; Davis, Benjamin; Goldfarb, Charles A

2007-11-01

A relationship between symbrachydactyly and transverse deficiency has been suggested but has not been critically investigated or established by scientific studies. The purpose of this investigation was to evaluate a large group of patients with transverse deficiency of the forearm for clinical and radiologic features typically seen in patients with symbrachydactyly. A retrospective review of the medical records of 291 patients with a diagnosis of upper-extremity transverse deficiency at the level of the forearm was performed. Patient charts, photographs, and radiographs were evaluated for manifestations of symbrachydactyly; specifically, we clinically assessed for the presence of nubbins and skin invaginations and radiologically assessed for hypoplasia of the proximal radius and ulna. Two hundred seven patients had soft tissue nubbins at the end of their amputation stumps including 38 with the additional finding of skin invagination at the distal end. Another 36 extremities had a skin invagination alone. Twenty-nine of the extremities without nubbins or skin invaginations had hypoplasia of the proximal radius and ulna. Thus, 272 of the 291 extremities with transverse deficiency had manifestations of symbrachydactyly. The majority of patients with the diagnosis of transverse deficiency have soft tissue nubbins, skin invaginations, or hypoplasia of the proximal radius and ulna at the end of their amputation stumps. These clinical and radiologic features support the concept that transverse deficiency through the forearm represents a proximal continuum of symbrachydactyly.

Civilian traumatic vascular injuries of the upper extremity:report of the Iranian national trauma project.

PubMed

Rasouli, Mohammad R; Moini, Majid; Khaji, Ali

2009-12-01

The determination of the pattern of traumatic vascular injuries of the upper extremity in Iran was the aim of this study. Data of the Iranian national trauma project were used to identify patients with upper extremity vascular injuries. This project was conducted in 8 major cities from 2000-2004. A total of 113 cases with 130 vascular injuries were found, including 2 axillary, 18 brachial, and 69 radial and ulnar arteries. In 91 cases (81%), penetrating trauma was responsible. Associated nerve and/or upper extremity fractures were seen in 20% and 18% of cases, respectively. End-to-end anastomosis, interposition of saphenous graft, and ligation were used for the management of 44%, 28%, and 17%, respectively, of brachial artery injuries. Ulnar and radial artery injuries had been either ligated (n = 36; 52%) or sutured (n = 33; 48%). Median, ulnar, and radial nerve injuries, except for one, had all been sutured primarily. No patients needed fasciotomy. Amputation and mortality resulting from associated injuries occurred in 3 (2.6%) and 5 (4.4%) patients, respectively. This study revealed that stabbings are the most frequent causes of these injuries in Iran, in spite of the management of patients in level 3 trauma centers; the rate of amputation is acceptable. However, this study does not provide limb functions of the patients.

34 CFR 76.796 - What are the consequences of an SEA allocating more or fewer funds to a charter school LEA under...

Code of Federal Regulations, 2011 CFR

2011-07-01

... enrollment or eligibility data when the charter school LEA opens or significantly expands its enrollment... LEA is eligible when the charter school LEA actually opens or significantly expands its enrollment? 76... actually opens or significantly expands its enrollment? (a) An SEA that allocates more or fewer funds to a...

34 CFR 76.788 - What are a charter school LEA's responsibilities under this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... subpart? (a) Notice. At least 120 days before the date a charter school LEA is scheduled to open or... charter school LEA must provide to the SEA any available data or information that the SEA may reasonably... enrollment, the charter school LEA must provide actual enrollment and eligibility data to the SEA at a time...

34 CFR 76.796 - What are the consequences of an SEA allocating more or fewer funds to a charter school LEA under...

Code of Federal Regulations, 2010 CFR

2010-07-01

... enrollment or eligibility data when the charter school LEA opens or significantly expands its enrollment... LEA is eligible when the charter school LEA actually opens or significantly expands its enrollment? 76... actually opens or significantly expands its enrollment? (a) An SEA that allocates more or fewer funds to a...

34 CFR 76.788 - What are a charter school LEA's responsibilities under this subpart?

Code of Federal Regulations, 2010 CFR

2010-07-01

... subpart? (a) Notice. At least 120 days before the date a charter school LEA is scheduled to open or... charter school LEA must provide to the SEA any available data or information that the SEA may reasonably... enrollment, the charter school LEA must provide actual enrollment and eligibility data to the SEA at a time...

34 CFR 76.788 - What are a charter school LEA's responsibilities under this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

... subpart? (a) Notice. At least 120 days before the date a charter school LEA is scheduled to open or... charter school LEA must provide to the SEA any available data or information that the SEA may reasonably... enrollment, the charter school LEA must provide actual enrollment and eligibility data to the SEA at a time...

34 CFR 76.796 - What are the consequences of an SEA allocating more or fewer funds to a charter school LEA under...

Code of Federal Regulations, 2012 CFR

2012-07-01

... enrollment or eligibility data when the charter school LEA opens or significantly expands its enrollment... LEA is eligible when the charter school LEA actually opens or significantly expands its enrollment? 76... actually opens or significantly expands its enrollment? (a) An SEA that allocates more or fewer funds to a...

34 CFR 76.788 - What are a charter school LEA's responsibilities under this subpart?

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart? (a) Notice. At least 120 days before the date a charter school LEA is scheduled to open or... charter school LEA must provide to the SEA any available data or information that the SEA may reasonably... enrollment, the charter school LEA must provide actual enrollment and eligibility data to the SEA at a time...

34 CFR 76.788 - What are a charter school LEA's responsibilities under this subpart?

Code of Federal Regulations, 2014 CFR

2014-07-01

... subpart? (a) Notice. At least 120 days before the date a charter school LEA is scheduled to open or... charter school LEA must provide to the SEA any available data or information that the SEA may reasonably... enrollment, the charter school LEA must provide actual enrollment and eligibility data to the SEA at a time...

34 CFR 76.796 - What are the consequences of an SEA allocating more or fewer funds to a charter school LEA under...

Code of Federal Regulations, 2013 CFR

2013-07-01

... enrollment or eligibility data when the charter school LEA opens or significantly expands its enrollment... LEA is eligible when the charter school LEA actually opens or significantly expands its enrollment? 76... actually opens or significantly expands its enrollment? (a) An SEA that allocates more or fewer funds to a...

34 CFR 76.796 - What are the consequences of an SEA allocating more or fewer funds to a charter school LEA under...

Code of Federal Regulations, 2014 CFR

2014-07-01

... enrollment or eligibility data when the charter school LEA opens or significantly expands its enrollment... LEA is eligible when the charter school LEA actually opens or significantly expands its enrollment? 76... actually opens or significantly expands its enrollment? (a) An SEA that allocates more or fewer funds to a...

The Relationship Between Women's Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study.

PubMed

Orbach-Zinger, Sharon; Landau, Ruth; Harousch, Avi Ben; Ovad, Oren; Caspi, Liron; Kornilov, Evgeniya; Ioscovich, Alexander; Bracco, Danielle; Davis, Atara; Fireman, Shlomo; Hoshen, Moshe; Eidelman, Leonid A

2018-05-01

Postpartum depression (PPD) is associated with pain during and after delivery, with studies showing reduced rates among women delivering with labor epidural analgesia (LEA). We hypothesized that women who intend to deliver with LEA but do not receive it are at higher risk for PPD at 6 weeks due to the combined experience of untreated labor pain and unmatched expectations during labor, and evaluated the interaction between labor plans related to LEA, satisfaction with pain control when actually delivering with LEA, and PPD at 6 weeks after delivery. A total of 1497 women with a vaginal delivery were enrolled into this prospective longitudinal study. Women's initial intention to deliver with or without LEA, how they subsequently delivered, and satisfaction with pain relief were recorded on postpartum day 1. Primary aim was selected as PPD at 6 weeks among women intending to deliver with but subsequently delivering without LEA compared with the rest of the cohort. Primary outcome was PPD at 6 weeks using the Edinburgh Postnatal Depression Scale; PPD was defined with a score ≥10 (scale from 0 to 30). Demographic and obstetric data were recorded. Fisher exact test was used for comparisons between groups. The interaction between intention and actual delivery with regard to LEA and PPD was tested. Overall, 87 of 1326 women completing the study at 6 weeks had PPD (6.6%). For the primary aim, 439 (29.3%) delivered without LEA, of which 193 (12.9%) had intended to deliver with LEA; the PPD rate among these women was 8.1%, which was not statistically different from the rest of the cohort (6.3%; odds ratio [OR], 1.30; 95% confidence interval [CI], 0.72-2.38; P = .41). A total of 1058 women (70.7%) delivered with LEA and 439 (29.3%) delivered without; therefore, 1169 (78.1%) delivered as intended and 328 (21.9%) did not (unmatched expectations). Evaluating the interaction between effects, there was a strong negative additive interaction between intending to deliver without LEA and actually delivering with LEA (risk difference = -8.6%, 95% CI, 16.2%-1.6%; P = .014) suggesting that unmatched intention effect is significantly associated with negative outcome. In multiple regression analysis, while intending to deliver with LEA (OR, 1.06; 95% CI, 1.01-1.11; P = .029) and actually delivering with LEA (OR, 1.07; 95% CI, 1.01-1.13; P = .018) both increased the odds for PPD, the multiplicative interaction was protective (OR, 0.92; 95% CI, 0.86-0.99; P = .022), after adjusting for cofactors. Our study results did not demonstrate a significant increase in the odds for PPD at 6 weeks among women who intended to deliver with LEA but subsequently delivered without. However, we identified a protective interaction between intended LEA use and actual use on the incidence of PPD. Our data suggest an increased risk when women do not deliver as intended, particularly when not initially intending to deliver with LEA. The relationship between unplanned LEA and PPD may be mediated by a physically difficult delivery rather than or in addition to negative emotions related to unmet expectations or a sense of personal failure; therefore, counseling women after delivery to address any negative perceptions may be useful.

Ten Years at War: Comprehensive Analysis of Amputation Trends

DTIC Science & Technology

2012-01-01

Afghanistan and Iraq. J Trauma. 2010; 68:1476 1479. 8. Cohen SP, Brown C, Kurihara C, Plunkett A, Nguyen C, Strassels SA. Diagnoses and factors associated...related extremity injuries. Orthopaedics. 2010;33. 29. Morrison JJ, Hunt N, Midwinter M, Jansen J. Associated injuries in ca- sualties with traumatic

Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations.

PubMed

Darling, Jeremy D; McCallum, John C; Soden, Peter A; Guzman, Raul J; Wyers, Mark C; Hamdan, Allen D; Verhagen, Hence J; Schermerhorn, Marc L

2017-03-01

The Society for Vascular Surgery (SVS) Wound, Ischemia and foot Infection (WIfI) classification system was proposed to predict 1-year amputation risk and potential benefit from revascularization. Our goal was to evaluate the predictive ability of this scale in a real-world selection of patients undergoing a first-time lower extremity revascularization for chronic limb-threatening ischemia (CLTI). From 2005 to 2014, 1336 limbs underwent a first-time lower extremity revascularization for CLTI, of which 992 had sufficient data to classify all three WIfI components (wound, ischemia, and foot infection). Limbs were stratified into the SVS WIfI clinical stages (from 1 to 4) for 1-year amputation risk estimation, a novel WIfI composite score from 0 to 9 (that weighs all WIfI variables equally), and a novel WIfI mean score from 0 to 3 (that can incorporate limbs missing any of the three WIfI components). Outcomes included major amputation; revascularization, major amputation, or stenosis (>3.5× step-up by duplex; RAS) events; and death. Predictors were identified using Cox regression models and Kaplan-Meier survival estimates. Of the 1336 first-time procedures performed, 992 limbs were classified in all three WIfI components (524 endovascular and 468 bypass; 26% rest pain and 74% tissue loss). Cox regression demonstrated that a one-unit increase in the WIfI clinical stage increases the risk of major amputation (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.7-3.2) and RAS events in all limbs (HR, 1.2; 95% CI, 1.1-1.3). Separate models of the entire cohort, a bypass-only cohort, and an endovascular-only cohort showed that a one-unit increase in the WIfI mean score is associated with an increase in the risk of major amputation (all three cohorts: HR, 5.3 [95% CI, 3.6-6.8], 4.1 [2.4-6.9], and 6.6 [3.8-11.6], respectively) and RAS events (all three cohorts: HR, 1.7 [95% CI, 1.4-2.0], 1.9 [1.4-2.6], and 1.4 [1.1-1.9], respectively). The novel WIfI composite and WIfI mean scores were the only consistent predictors of death among the three cohorts, with the WIfI mean score proving most strongly predictive in the entire cohort (HR, 1.4; 95% CI, 1.1-1.7), the bypass-only cohort (HR, 1.5; 95% CI, 1.1-1.9), and the endovascular-only cohort (HR, 1.4; 95% CI, 1.0-1.8). Although the individual WIfI wound component was able to predict mortality among all patients (HR, 1.1; 95% CI, 1.0-1.2) and bypass-only patients (HR, 1.2; 95% CI, 1.1-1.3), neither the additional individual WIfI components nor the WIfI clinical stage were able to significantly predict mortality among any cohort. This study supports the ability of the SVS WIfI classification system to predict major amputation; however, the novel WIfI mean and WIfI composite scores predict amputation, RAS events, and mortality more consistently than any other current WIfI scoring system. The WIfI mean score allows inclusion of all limbs, and both novel scoring systems are easier to conceptualize, give equal weight to each WIfI component, and may provide clinicians more effective comparisons in outcomes between patients. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Outcomes of neuroischemic wounds treated by a multidisciplinary amputation prevention service.

PubMed

Vartanian, Shant M; Robinson, Kristin D; Ofili, Kene; Eichler, Charles M; Hiramoto, Jade S; Reyzelman, Alex M; Conte, Michael S

2015-04-01

Multidisciplinary amputation prevention teams decrease the frequency of major amputations by increasing the use of revascularization procedures and minor amputations. The outcomes of wound healing, wound recurrence, and ambulatory status are assumed to be improved but are not routinely reported. This study investigates the midterm outcomes of neuroischemic wounds treated by our multidisciplinary team. A retrospective review of patients with neuroischemic wounds treated at a single institution amputation prevention clinic from March 2012 to July 2013. Patient demographics, wound characteristics, procedural details, and clinical and functional outcomes were reviewed. Clinical end points under study included time to wound healing, reulceration rate, and ambulatory status. Over 16 months, there were 202 new patients and 1,355 clinic visits. Ninety-one limbs from 89 patients were treated for complex neuroischemic wounds. In 67% (61 of 91) of limbs, wounds were present for >6 weeks before referral. A history of previous revascularization was present in 39% (31 of 91), and 28% (22 of 91) had a previous minor amputation. Forty-one percent of wounds (38 of 91) were limited to the toes or the forefoot whereas 24% (22 of 91) involved the hindfoot or ankle. A total of 151 podiatric and 86 vascular interventions were performed, with an equal distribution of endovascular and open revascularizations. Complete healing was observed for 59% of wounds (54 of 91) over the observation period (median follow up, 207 days; range 56-561 days), and the average time to full healing was 12 weeks. Hindfoot wounds were predictive of failure to heal (odds ratio, 0.21; P < 0.01; 95% confidence interval, 0.06-0.68). Nineteen percent of patients (17 of 91) developed a new wound in the ipsilateral leg during follow-up. Three major amputations were performed (2 below-knee amputation and 1 above-knee amputation) for a major/minor amputation ratio of 0.06. Ambulatory status was preserved or improved in 74% (67 of 91) of patients. The 30-day readmission rate was 11%, which was lower than that observed (21%) in a contemporaneous but all-inclusive population of lower extremity revascularization procedures performed at our institution. Multidisciplinary limb salvage teams effectively heal wounds and maintain ambulatory status in patients with limb-threatening neuroischemic wounds. Patient specific factors, such as hindfoot or ankle wounds, can adversely influence the outcome. Even with aggressive care, healing can be prolonged and a substantial proportion of patients can be expected to have a recurrence, making subsequent surveillance mandatory. Our data also suggest that a coordinated amputation prevention program may help to minimize hospital readmissions in this high-risk population. Copyright © 2015 Elsevier Inc. All rights reserved.

Does a microprocessor-controlled prosthetic knee affect stair ascent strategies in persons with transfemoral amputation?

PubMed

Aldridge Whitehead, Jennifer M; Wolf, Erik J; Scoville, Charles R; Wilken, Jason M

2014-10-01

Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2(®)) uses flexion/extension resistance to allow step-over-step stair ascent. We compared self-selected stair ascent strategies between conventional and X2(®) prosthetic knees, examined between-limb differences, and differentiated stair ascent mechanics between X2(®) users and individuals without amputation. We also determined which factors are associated with differences in knee position during initial contact and swing within X2(®) users. Fourteen individuals with transfemoral amputation participated in stair ascent sessions while using conventional and X2(®) knees. Ten individuals without amputation also completed a stair ascent session. Lower-extremity stair ascent joint angles, moment, and powers and ground reaction forces were calculated using inverse dynamics during self-selected strategy and cadence and controlled cadence using a step-over-step strategy. One individual with amputation self-selected a step-over-step strategy while using a conventional knee, while 10 individuals self-selected a step-over-step strategy while using X2(®) knees. Individuals with amputation used greater prosthetic knee flexion during initial contact (32.5°, p = 0.003) and swing (68.2°, p = 0.001) with higher intersubject variability while using X2(®) knees compared to conventional knees (initial contact: 1.6°, swing: 6.2°). The increased prosthetic knee flexion while using X2(®) knees normalized knee kinematics to individuals without amputation during swing (88.4°, p = 0.179) but not during initial contact (65.7°, p = 0.002). Prosthetic knee flexion during initial contact and swing were positively correlated with prosthetic limb hip power during pull-up (r = 0.641, p = 0.046) and push-up/early swing (r = 0.993, p < 0.001), respectively. Participants with transfemoral amputation were more likely to self-select a step-over-step strategy similar to individuals without amputation while using X2(®) knees than conventional prostheses. Additionally, the increased prosthetic knee flexion used with X2(®) knees placed large power demands on the hip during pull-up and push-up/early swing. A modified strategy that uses less knee flexion can be used to allow step-over-step ascent in individuals with less hip strength.

Potential functions of LEA proteins from the brine shrimp Artemia franciscana - anhydrobiosis meets bioinformatics.

PubMed

Janis, Brett; Uversky, Vladimir N; Menze, Michael A

2017-10-23

Late embryogenesis abundant (LEA) proteins are a large group of anhydrobiosis-associated intrinsically disordered proteins, which are commonly found in plants and some animals. The brine shrimp Artemia franciscana is the only known animal that expresses LEA proteins from three, and not only one, different groups in its anhydrobiotic life stage. The reason for the higher complexity in the A. franciscana LEA proteome (LEAome), compared with other anhydrobiotic animals, remains mostly unknown. To address this issue, we have employed a suite of bioinformatics tools to evaluate the disorder status of the Artemia LEAome and to analyze the roles of intrinsic disorder in functioning of brine shrimp LEA proteins. We show here that A. franciscana LEA proteins from different groups are more similar to each other than one originally expected, while functional differences among members of group three are possibly larger than commonly anticipated. Our data show that although these proteins are characterized by a large variety of forms and possible functions, as a general strategy, A. franciscana utilizes glassy matrix forming LEAs concurrently with proteins that more readily interact with binding partners. It is likely that the function(s) of both types, the matrix-forming and partner-binding LEA proteins, are regulated by changing water availability during desiccation.

Accession Medical Standards Analysis and Research Activity

DTIC Science & Technology

2010-01-01

prosthetic implants and diseases of the musculoskeletal system and impairments and diseases of the spine, skull, limbs, and extremities; though...osteoporosis, pathologic fractures , bone cysts, and aseptic necrosis. Please note, when a majority of codes examined out to the fourth digit do not have a...including traumatic amputation, scrotum and testes 56 0.3 44 0.4 47 0.8 40 1.3 Late effect of fracture of lower extremities 89 0.5 64 0.5 44 0.8 22 0.7

The effect of social integration on outcomes after major lower extremity amputation.

PubMed

Hawkins, Alexander T; Pallangyo, Anthony J; Herman, Ayesiga M; Schaumeier, Maria J; Smith, Ann D; Hevelone, Nathanael D; Crandell, David M; Nguyen, Louis L

2016-01-01

Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D. We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (β, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis. In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Predictive factors for lower extremity amputations in diabetic foot infections

PubMed Central

Aziz, Zameer; Lin, Wong Keng; Nather, Aziz; Huak, Chan Yiong

2011-01-01

The objective of this study was to evaluate the epidemiology of diabetic foot infections (DFIs) and its predictive factors for lower extremity amputations. A prospective study of 100 patients with DFIs treated at the National University Hospital of Singapore were recruited in the study during the period of January 2005–June 2005. A protocol was designed to document patient's demographics, type of DFI, presence of neuropathy and/or vasculopathy and its final outcome. Predictive factors for limb loss were determined using univariate and stepwise logistic regression analysis. The mean age of the study population was 59.8 years with a male to female ratio of about 1:1 and with a mean follow-up duration of about 24 months. All patients had type 2 diabetes mellitus. Common DFIs included abscess (32%), wet gangrene (29%), infected ulcers (19%), osteomyelitis (13%), necrotizing fasciitis (4%) and cellulitis (3%). Thirteen patients were treated conservatively, while surgical debridement or distal amputation was performed in 59 patients. Twenty-eight patients had major amputations (below or above knee) performed. Forty-eight percent had monomicrobial infections compared with 52% with polymicrobial infections. The most common pathogens found in all infections (both monomicrobial and polymicrobial) were Staphylococcus aureus (39.7%), Bacteroides fragilis (30.3%), Pseudomonas aeruginosa (26.0%) and Streptococcus agalactiae (21.0%). Significant univariate predictive factors for limb loss included age above 60 years, gangrene, ankle-brachial index (ABI) <0.8, monomicrobial infections, white blood cell (WBC) count ≥ 15.0×109/L, erythrocyte sedimentation rate ≥100 mm/hr, C-reactive protein ≥15.0 mg/dL, hemoglobin (Hb) ≤10.0g/dL and creatinine ≥150 µmol/L. Upon stepwise logistic regression, only gangrene, ABI <0.8, WBC ≥ 15.0×109/L and Hb ≤10.0g/dL were significant. PMID:22396824

Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees.

PubMed

Ebrahimzadeh, Mohammad H; Moradi, Ali; Bozorgnia, Shahram; Hallaj-Moghaddam, Mohammad

2016-02-01

Long-term consequences and the activities of daily living of bilateral lower limb amputation are not well documented. The aims of our study were to identify the long-term effects of bilateral lower extremity amputations on daily activities and understand how these amputees cope with their mobility assistive devices. Cross-sectional study. A total of 291 veterans with war bilateral lower limb amputations accepted to participate in a cross-sectional study. The average of follow-up was 25.4 years. A total of 152 amputees (54%) were involved in sports averagely 6.7 h per week. Bilateral amputees walk 10 m by the average of 15 ± 33 s, and they could walk continuously with their prosthesis 315 ± 295 m. They wore their prosthesis 6.8 ± 1.7 days per week and 7.9 ± 8.1 h per day. Of these, 6.7% of bilateral lower limb amputees needed help to wear their prosthesis; 88.3% of amputees used assistant device for walking. According to this survey, 73 (42%) prostheses in right limb were appropriate, 95 (54.6%) needed to be replaced, and 6 (3.4) needed to be fixed. On the left side, it was 76 (42%), 92 (52.0%), and 9 (5.1%), respectively. A total of 203 (74.9%) amputees reported limitations in at least one domain of the activities of daily living. The most common single item that affected the patients was ascending and descending stairs by the score of 66% of normal population. Veterans with bilateral lower limb amputations suffering from vast categories of daily problems. This study and its results confirm that bilateral lower limb amputees have major progressive disabilities in daily activities and their social performance. This should attract the attention of amputees' administrative organizations, social workers, health-care providers and caregiver providers. © The International Society for Prosthetics and Orthotics 2014.

The development and validation of the AMPREDICT model for predicting mobility outcome after dysvascular lower extremity amputation.

PubMed

Czerniecki, Joseph M; Turner, Aaron P; Williams, Rhonda M; Thompson, Mary Lou; Landry, Greg; Hakimi, Kevin; Speckman, Rebecca; Norvell, Daniel C

2017-01-01

The objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation. Two prospective cohort studies during consecutive 4-year periods (2005-2009 and 2010-2014) were conducted at seven medical centers. Multiple demographic and biopsychosocial predictors were collected in the periamputation period among individuals undergoing their first major amputation because of complications of peripheral arterial disease or diabetes. The primary outcomes were iBASIC and iADVANCED mobility, as measured by the Locomotor Capabilities Index. Combined data from both studies were used for model development and internal validation. Backwards stepwise logistic regression was used to develop the final prediction models. The discrimination and calibration of each model were assessed. Internal validity of each model was assessed with bootstrap sampling. Twelve-month follow-up was reached by 157 of 200 (79%) participants. Among these, 54 (34%) did not achieve iBASIC mobility, 103 (66%) achieved at least iBASIC mobility, and 51 (32%) also achieved iADVANCED mobility. Predictive factors associated with reduced odds of achieving iBASIC mobility were increasing age, chronic obstructive pulmonary disease, dialysis, diabetes, prior history of treatment for depression or anxiety, and very poor to fair self-rated health. Those who were white, were married, and had at least a high-school degree had a higher probability of achieving iBASIC mobility. The odds of achieving iBASIC mobility increased with increasing body mass index up to 30 kg/m 2 and decreased with increasing body mass index thereafter. The prediction model of iADVANCED mobility included the same predictors with the exception of diabetes, chronic obstructive pulmonary disease, and education level. Both models showed strong discrimination with C statistics of 0.85 and 0.82, respectively. The mean difference in predicted probabilities for those who did and did not achieve iBASIC and iADVANCED mobility was 33% and 29%, respectively. Tests for calibration and observed vs predicted plots suggested good fit for both models; however, the precision of the estimates of the predicted probabilities was modest. Internal validation through bootstrapping demonstrated some overoptimism of the original model development, with the optimism-adjusted C statistic for iBASIC and iADVANCED mobility being 0.74 and 0.71, respectively, and the discrimination slope 19% and 16%, respectively. AMPREDICT-Mobility is a user-friendly prediction tool that can inform the patient undergoing a dysvascular amputation and the patient's provider about the probability of independence in either basic or advanced mobility at each major lower extremity amputation level. Copyright © 2016 Society for Vascular Surgery. All rights reserved.

Lea blood group antigen on human platelets.

PubMed

Dunstan, R A; Simpson, M B; Rosse, W F

1985-01-01

One- and two-stage radioligand assays were used to determine if human platelets possess the Lea antigen. Goat IgG anti-Lea antibody was purified by multiple adsorptions with Le(a-b-) human red blood cells, followed by affinity chromatography with synthetic Lea substance and labeling with 125I. Human IgG anti-Lea antibody was used either in a two stage radioassay with 125I-labeled mouse monoclonal IgG anti-human IgG as the second antibody or, alternatively, purified by Staph protein A chromatography, labeled with 125I, and used in a one-stage radioassay. Platelets from donors of appropriate red blood cell phenotypes were incubated with the antisera, centrifuged through phthalate esters, and assayed in a gamma scintillation counter. Dose response and saturation curve analysis demonstrate the presence of Lewis a antigen on platelets from Lea+ donors. Furthermore, platelets from an Le(a-b-) donor incubated in Le (a+b-) plasma adsorb Lea antigen in a similar manner to red blood cells. The clinical significance of these antigens in platelet transfusion remains undefined.

Extremity War Injuries VIII: sequelae of combat injuries.

PubMed

Andersen, Romney C; D'Alleyrand, Jean-Claude G; Swiontkowski, Marc F; Ficke, James R

2014-01-01

The 2013 Extremity War Injury symposium focused on the sequelae of combat-related injuries, including posttraumatic osteoarthritis, amputations, and infections. Much remains to be learned about posttraumatic arthritis, and there are few circumstances in which a definitive arthroplasty should be performed in an acutely injured and open joint. Although the last decade has seen tremendous advances in the treatment of combat upper extremity injuries, many questions remain unanswered, and continued research focusing on improving reconstruction of large segmental defects remains critical. Discussion of infection centered on the need for novel methods to reduce the bacterial load following the initial débridement procedures. Novel methods of delivering antimicrobial therapy and anti-inflammatory medications directly to the wound were discussed as well as the need for near real-time assessment of bacterial and fungal burden and further means of prevention and treatment of biofilm formation and the importance of animal models to test therapies discussed. Moderators and lecturers of focus groups noted the continuing need for improved prehospital care in the management of junctional injuries, identified optimal strategies for both surgical repair and/or reconstruction of the ligaments in multiligamentous injuries, and noted the need to mitigate bone mineral density loss following amputation and/or limb salvage as well as the necessity of developing better methods of anticipating and managing heterotopic ossification.

Evaluation from an LEA Perspective: Proceedings from an AERA Symposium. Annual Meeting of the American Educational Research Association (66th, New York, New York, March 19-23, 1982).

ERIC Educational Resources Information Center

Thompson, Bruce; And Others

The views of local education agency (LEA) evaluators tend to be underrepresented in the evaluation literature. This symposium was organized to fill this gap. The non-LEA symposium participants (Carol H. Weiss and Bruce Thompson) were asked to pose questions to the LEA participants (Steven Frankel, Montgomery County (MD) Public Schools; Freda…

The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion.

PubMed

Lane, R D; Quinlan, D M; Schwartz, G E; Walker, P A; Zeitlin, S B

1990-01-01

The Levels of Emotional Awareness Scale (LEAS) is based on a new cognitive-developmental model of emotional experience. The scale poses evocative interpersonal situations and elicits descriptions of the emotional responses of self and others which are scored using specific structural criteria. Forty undergraduates (20 of each sex) were tested. Interrater reliability and intratest homogeneity of the LEAS were strong. The LEAS was significantly correlated with two measures of maturity: the Washington University Sentence Completion Test (SCT) of Ego Development, and the Parental Descriptions Scale-a cognitive-developmental measure of object representation. In addition, the LEAS correlated positively with openness to experience and emotional range but not with measures of specific emotions, repression or the number of words used in the LEAS responses. These findings suggest that it is the level of emotion, not the specific quality of emotion, that is tapped by the LEAS.

VA Vascular Injury Study (VAVIS): VA-DoD extremity injury outcomes collaboration.

PubMed

Shireman, Paula K; Rasmussen, Todd E; Jaramillo, Carlos A; Pugh, Mary Jo

2015-02-03

Limb injuries comprise 50-60% of U.S. Service member's casualties of wars in Afghanistan and Iraq. Combat-related vascular injuries are present in 12% of this cohort, a rate 5 times higher than in prior wars. Improvements in medical and surgical trauma care, including initial in-theatre limb salvage approaches (IILS) have resulted in improved survival and fewer amputations, however, the long-term outcomes such as morbidity, functional decline, and risk for late amputation of salvaged limbs using current process of care have not been studied. The long-term care of these injured warfighters poses a significant challenge to the Department of Defense (DoD) and Department of Veterans Affairs (VA). The VA Vascular Injury Study (VAVIS): VA-DoD Extremity Injury Outcomes Collaborative, funded by the VA, Health Services Research and Development Service, is a longitudinal cohort study of Veterans with vascular extremity injuries. Enrollment will begin April, 2015 and continue for 3 years. Individuals with a validated extremity vascular injury in the Department of Defense Trauma Registry will be contacted and will complete a set of validated demographic, social, behavioral, and functional status measures during interview and online/ mailed survey. Primary outcome measures will: 1) Compare injury, demographic and geospatial characteristics of patients with IILS and identify late vascular surgery related limb complications and health care utilization in Veterans receiving VA vs. non-VA care, 2) Characterize the preventive services received by individuals with vascular repair and related outcomes, and 3) Describe patient-reported functional outcomes in Veterans with traumatic vascular limb injuries. This study will provide key information about the current process of care for Active Duty Service members and Veterans with polytrauma/vascular injuries at risk for persistent morbidity and late amputation. The results of this study will be the first step for clinicians in VA and military settings to generate evidence-based treatment and care approaches to these injuries. It will identify areas where rehabilitation medicine and vascular specialty care or telehealth options are needed to allow for better planning, resource utilization, and improved DoD-to-VA care transitions.

LEAping to conclusions: a computational reanalysis of late embryogenesis abundant proteins and their possible roles.

PubMed

Wise, Michael J

2003-10-29

The late embryogenesis abundant (LEA) proteins cover a number of loosely related groups of proteins, originally found in plants but now being found in non-plant species. Their precise function is unknown, though considerable evidence suggests that LEA proteins are involved in desiccation resistance. Using a number of statistically-based bioinformatics tools the classification of a large set of LEA proteins, covering all Groups, is reexamined together with some previous findings. Searches based on peptide composition return proteins with similar composition to different LEA Groups; keyword clustering is then applied to reveal keywords and phrases suggestive of the Groups' properties. Previous research has suggested that glycine is characteristic of LEA proteins, but it is only highly over-represented in Groups 1 and 2, while alanine, thought characteristic of Group 2, is over-represented in Group 3, 4 and 6 but under-represented in Groups 1 and 2. However, for LEA Groups 1 2 and 3 it is shown that glutamine is very significantly over-represented, while cysteine, phenylalanine, isoleucine, leucine and tryptophan are significantly under-represented. There is also evidence that the Group 4 LEA proteins are more appropriately redistributed to Group 2 and Group 3. Similarly, Group 5 is better found among the Group 3 LEA proteins. There is evidence that Group 2 and Group 3 LEA proteins, though distinct, might be related. This relationship is also evident in the overlapping sets of keywords for the two Groups, emphasising alpha-helical structure and, at a larger scale, filaments, all of which fits well with experimental evidence that proteins from both Groups are natively unstructured, but become structured under stress conditions. The keywords support localisation of LEA proteins both in the nucleus and associated with the cytoskeleton, and a mode of action similar to chaperones, perhaps the cold shock chaperones, via a role in DNA-binding. In general, non-globular and low-complexity proteins, such as the LEA proteins, pose particular challenges in determining their functions and modes of action. Rather than masking off and ignoring low-complexity domains, novel tools and tool combinations are needed which are capable of analysing such proteins in their entirety.

Self injury of extremities leading to amputation while handling local bomb.

PubMed

Bhadani, Umesh Kumar

2013-05-01

Self injury while making material which has a tendency to blast is dangerous- whether it is fire cracker or local bomb. Some villagers living nearby forest make bomb to scare wild animals to protect their pet animals. A 22-year old girl while making this kind of local bomb, got injured badly. The injury was sustained while making bomb in a sitting position with face down as it is evident form type of injury. There was lacerated injury of both hands leading to amputation of both hands above wrists. Lacerated injury was present on medial sides of both thighs and gun powder marks on face. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Upper extremity limb loss: functional restoration from prosthesis and targeted reinnervation to transplantation.

PubMed

Carlsen, Brian T; Prigge, Pat; Peterson, Jennifer

2014-01-01

For several decades, prosthetic use was the only option to restore function after upper extremity amputation. Recent years have seen advances in the field of prosthetics. Such advances include prosthetic design and function, activity-specific devices, improved aesthetics, and adjunctive surgical procedures to improve both form and function. Targeted reinnervation is one exciting advance that allows for more facile and more intuitive function with prosthetics following proximal amputation. Another remarkable advance that holds great promise in nearly all fields of medicine is the transplantation of composite tissue, such as hand and face transplantation. Hand transplantation holds promise as the ultimate restorative procedure that can provide form, function, and sensation. However, this procedure still comes with a substantial cost in terms of the rehabilitation and toxic immunosuppression and should be limited to carefully selected patients who have failed prosthetic reconstruction. Hand transplantation and prosthetic reconstruction should not be viewed as competing options. Rather, they are two treatment options with different risk/benefit profiles and different indications and, hence vastly different implications. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Study of model systems to test the potential function of Artemia group 1 late embryogenesis abundant (LEA) proteins.

PubMed

Warner, Alden H; Guo, Zhi-hao; Moshi, Sandra; Hudson, John W; Kozarova, Anna

2016-01-01

Embryos of the brine shrimp, Artemia franciscana, are genetically programmed to develop either ovoviparously or oviparously depending on environmental conditions. Shortly upon their release from the female, oviparous embryos enter diapause during which time they undergo major metabolic rate depression while simultaneously synthesize proteins that permit them to tolerate a wide range of stressful environmental events including prolonged periods of desiccation, freezing, and anoxia. Among the known stress-related proteins that accumulate in embryos entering diapause are the late embryogenesis abundant (LEA) proteins. This large group of intrinsically disordered proteins has been proposed to act as molecular shields or chaperones of macromolecules which are otherwise intolerant to harsh conditions associated with diapause. In this research, we used two model systems to study the potential function of the group 1 LEA proteins from Artemia. Expression of the Artemia group 1 gene (AfrLEA-1) in Escherichia coli inhibited growth in proportion to the number of 20-mer amino acid motifs expressed. As well, clones of E. coli, transformed with the AfrLEA-1 gene, expressed multiple bands of LEA proteins, either intrinsically or upon induction with isopropyl-β-thiogalactoside (IPTG), in a vector-specific manner. Expression of AfrLEA-1 in E. coli did not overcome the inhibitory effects of high concentrations of NaCl and KCl but modulated growth inhibition resulting from high concentrations of sorbitol in the growth medium. In contrast, expression of the AfrLEA-1 gene in Saccharomyces cerevisiae did not alter the growth kinetics or permit yeast to tolerate high concentrations of NaCl, KCl, or sorbitol. However, expression of AfrLEA-1 in yeast improved its tolerance to drying (desiccation) and freezing. Under our experimental conditions, both E. coli and S. cerevisiae appear to be potentially suitable hosts to study the function of Artemia group 1 LEA proteins under environmentally stressful conditions.

Law Enforcement and Gun Retailers as Partners for Safely Storing Guns to Prevent Suicide: A Study in 8 Mountain West States.

PubMed

Runyan, Carol W; Brooks-Russell, Ashley; Brandspigel, Sara; Betz, Marian; Tung, Gregory; Novins, Douglas; Agans, Robert

2017-11-01

To examine the extent to which law enforcement agencies (LEAs) and gun retailers are willing to offer voluntary, temporary storage as a part of an overall suicide prevention effort. We invited all LEAs and gun retailers in 8 US states to respond to questionnaires asking about their willingness to offer temporary gun storage and their recommendations to gun owners about safe storage. We collected data in 2016 from 448 LEAs and 95 retailers (response rates of 53% and 25%, respectively). Three quarters of LEAs (74.8%; 95% confidence interval [CI] = 72.1, 77.5) indicated they already provided temporary storage compared with 47.6% (95% CI = 39.2, 56.0) of retailers. LEAs were most willing to provide storage when a gun owner was concerned about the mental health of a family member. Retailers were more receptive than were LEAs to providing storage when visitors were coming or for people wanting storage while traveling. Both groups recommended locking devices within the home, but LEAs were slightly more favorable to storing guns away from the home. Law enforcement agencies and gun retailers are important resources for families concerned about suicide.

Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

PubMed Central

Nazerani, Shahram; Maghari, Ahmad; Kalantar Motamedi, Mohammad Hosein; Vahedian Ardakani, Jalal; Rashidian, Nikdokht; Nazerani, Tina

2012-01-01

ABSTRACT Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition. PMID:24350113

Microsurgery within reconstructive surgery of extremities.

PubMed

Pheradze, I; Pheradze, T; Tsilosani, G; Goginashvili, Z; Mosiava, T

2006-05-01

Reconstructive surgery of extremities is an object of a special attention of surgeons. Vessel and nerve damages, deficiency of soft tissue, bone, associated with infection results in a complete loss of extremity function, it also raises a question of amputation. The goal of the study was to improve the role of microsurgery in reconstructive surgery of limbs. We operated on 294 patients with various diseases and damages of extremities: pathology of nerves, vessels, tissue loss. An original method of treatment of large simultaneous functional defects of limbs has been used. Good functional and aesthetic results were obtained. Results of reconstructive operations on extremities might be improved by using of microsurgery methods. Microsurgery is deemed as a method of choice for extremities' reconstructive surgery as far as outcomes achieved through application of microsurgical technique significantly surpass the outcomes obtained through the use of routine surgical methods.

Cryopreservation of lipid bilayers by LEA proteins from Artemia franciscana and trehalose.

PubMed

Moore, Daniel S; Hand, Steven C

2016-10-01

The capacity of Late Embryogenesis Abundant (LEA) proteins and trehalose to protect liposomes against freezing-induced damage was examined by measuring the leakage of 5(6)-carboxyfluorescein (CF). Liposomes were prepared to simulate the lipid compositions of the inner leaflet of the plasma membrane, outer mitochondrial membrane (OMM), and inner mitochondrial membrane (IMM). Two recombinant LEA proteins belonging to Group 3 (AfrLEA2 and AfrLEA3m) were expressed and purified from embryos of Artemia franciscana. Only OMM-like liposomes were significantly protected by AfrLEA2 and AfrLEA3m against freeze-thaw damage; at the highest protein:lipid mass ratio tested, leakage of CF was 56.3% of control with AfrLEA3m and 29.3% with AfrLEA2. By comparison, trehalose provided protection to all compositional types. The greatest stabilization during freezing occurred when trehalose was present on both sides of the bilayer. When mitochondria isolated from rat liver were freeze-thawed in trehalose solution, the OMM remained intact based on the absence of increased oxygen consumption when cytochrome c was added during oxidative phosphorylation (OXPHOS). Respiratory control ratios (OXPHOS/LEAK) were depressed by only 30% after freeze-thawing in trehalose compared to non-frozen controls, which indicated some retention of OXPHOS capacity by the IMM. Trehalose then was loaded into the matrix (0.24 μmol/mg mitochondrial protein) by transient opening of the permeability transition pore, a procedure optimized for retention of OMM integrity. Surprisingly, respiratory control ratios were not improved after freeze-thawing with external plus matrix trehalose, when compared to external trehalose alone. This result could perhaps be explained by insufficient accumulation of matrix trehalose. Copyright © 2016 Elsevier Inc. All rights reserved.

The intrinsically disordered protein LEA7 from Arabidopsis thaliana protects the isolated enzyme lactate dehydrogenase and enzymes in a soluble leaf proteome during freezing and drying.

PubMed

Popova, Antoaneta V; Rausch, Saskia; Hundertmark, Michaela; Gibon, Yves; Hincha, Dirk K

2015-10-01

The accumulation of Late Embryogenesis Abundant (LEA) proteins in plants is associated with tolerance against stresses such as freezing and desiccation. Two main functions have been attributed to LEA proteins: membrane stabilization and enzyme protection. We have hypothesized previously that LEA7 from Arabidopsis thaliana may stabilize membranes because it interacts with liposomes in the dry state. Here we show that LEA7, contrary to this expectation, did not stabilize liposomes during drying and rehydration. Instead, it partially preserved the activity of the enzyme lactate dehydrogenase (LDH) during drying and freezing. Fourier-transform infrared (FTIR) spectroscopy showed no evidence of aggregation of LDH in the dry or rehydrated state under conditions that lead to complete loss of activity. To approximate the complex influence of intracellular conditions on the protective effects of a LEA protein in a convenient in-vitro assay, we measured the activity of two Arabidopsis enzymes (glucose-6-P dehydrogenase and ADP-glucose pyrophosphorylase) in total soluble leaf protein extract (Arabidopsis soluble proteome, ASP) after drying and rehydration or freezing and thawing. LEA7 partially preserved the activity of both enzymes under these conditions, suggesting its role as an enzyme protectant in vivo. Further FTIR analyses indicated the partial reversibility of protein aggregation in the dry ASP during rehydration. Similarly, aggregation in the dry ASP was strongly reduced by LEA7. In addition, mixtures of LEA7 with sucrose or verbascose reduced aggregation more than the single additives, presumably through the effects of the protein on the H-bonding network of the sugar glasses. Copyright © 2015 Elsevier B.V. All rights reserved.

Intraoperative fluorescence angiography: a review of applications and outcomes in war-related trauma.

PubMed

Green, J Marshall; Sabino, Jennifer; Fleming, Mark; Valerio, Ian

2015-03-01

In the recent Iraq and Afghanistan conflicts, survival rates from complex battlefield injuries have continued to improve. The resulting war-related wounds are challenging, with confounding issues making assessment of tissue perfusion subjective and variable. This review discusses the utility of intraoperative fluorescence angiography, and its usefulness as an objective tool to evaluate the perfusion of tissues in the face of complex war-related injuries. A retrospective review of all war-related traumatic and reconstructive cases employing intraoperative indocyanine green laser angiography (ICGLA) was performed. Data analyzed included indication for use, procedure success/failure rates, modifications performed, and perfusion-related complications. Anatomical regions assessed were extremity, head and neck, truncal, and intra-abdominal viscera. The endpoint of specific interest involved the decision for additional debridement of poorly perfused tissue, as based on the ICGLA findings. Over a 3-year period, this study examined 123 extremity soft tissue flaps, 41 extremity injuries including amputation and/or amputation revision cases, 13 craniofacial flaps, and 9 truncal/abdomen/gastrointestinal cases in which ICGLA was utilized to assess tissue perfusion and viability. A total of 35 (18.8%) of cases employing ICGLA required intraoperative modifications to address perfusion-related issues. Intraoperative fluorescent angiography is an objective, useful tool to assess various war-related traumatic injuries. This study expands on prior cited indications for ICGLA to include (1) guiding debridement in heavily contaminated wounds, (2) providing improved assessment of avulsion soft tissue injuries, (3) allowing for rapid detection of vascular and/or microvascular compromise in soft tissue and osseous flap reconstructions, (4) reducing and preventing perfusion-related complications in trauma, amputation closures, and reconstruction procedures, (5) contributing to better outcomes in certain complex orthopedic and composite tissue injuries, and (6) enabling improved postoperative wound and reconstruction assessment in those cases of perfusion-related issues that arise within a delayed setting. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system.

PubMed

Cull, David L; Manos, Ginger; Hartley, Michael C; Taylor, Spence M; Langan, Eugene M; Eidt, John F; Johnson, Brent L

2014-12-01

The Society for Vascular Surgery (SVS) recently established the Lower Extremity Threatened Limb Classification System, a staging system using Wound characteristic, Ischemia, and foot Infection (WIfI) to stratify the risk for limb amputation at 1 year. Although intuitive in nature, this new system has not been validated. The purpose of the following study was to determine whether the WIfI system is predictive of limb amputation and wound healing. Between 2007 and 2010, we prospectively obtained data related to wound characteristics, extent of infection, and degree of postrevascularization ischemia in 139 patients with foot wounds who presented for lower extremity revascularization (158 revascularization procedures). After adapting those data to the WIfI classifications, we analyzed the influence of wound characteristics, extent of infection, and degree of ischemia on time to wound healing; empirical Kaplan-Meier survival curves were compared with theoretical outcomes predicted by WIfI expert consensus opinion. Of the 158 foot wounds, 125 (79%) healed. The median time to wound healing was 2.7 months (range, 1-18 months). Factors associated with wound healing included presence of diabetes mellitus (P = .013), wound location (P = .049), wound size (P = .007), wound depth (P = .004), and degree of ischemia (P < .001). The WIfI clinical stage was predictive of 1-year limb amputation (stage 1, 3%; stage 2, 10%; stage 3, 23%; stage 4, 40%) and wound nonhealing (stage 1, 8%; stage 2, 10%; stage 3, 23%; stage 4, 40%) and correlated with the theoretical outcome estimated by the SVS expert panel. The theoretical framework for risk stratification among patients with critical limb ischemia provided by the SVS expert panel appears valid. Further validation of the WIfI classification system with multicenter data is justified. Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Keratin, luminal epithelial antigen and carcinoembryonic antigen in human urinary bladder carcinomas. An immunohistochemical study.

PubMed

Nathrath, W B; Arnholdt, H; Wilson, P D

1982-01-01

14 urinary bladder carcinomas of all main types were investigated with antisera to "broad spectrum keratin" (aK), "luminal epithelial antigen" (aLEA) and carcinoembryonic antigen (aCEA), using an indirect immunoperoxidase method on formalin fixed paraffin embedded sections. Keratin and LEA were both present in normal transitional epithelium, papilloma and carcinoma in situ whereas CEA was absent. Transitional cell carcinomas reacted with both aK and aLEA whereas CEA was seen only in a few foci. In squamous metaplasia and squamous carcinoma reaction with aK was particularly strong, while LEA was almost lacking and CEA was present in necrotic centres. In adenocarcinomas aK and aLEA reacted equally while aCEA reacted only on the surface.

LEA Detection and Tracking Method for Color-Independent Visual-MIMO

PubMed Central

Kim, Jai-Eun; Kim, Ji-Won; Kim, Ki-Doo

2016-01-01

Communication performance in the color-independent visual-multiple input multiple output (visual-MIMO) technique is deteriorated by light emitting array (LEA) detection and tracking errors in the received image because the image sensor included in the camera must be used as the receiver in the visual-MIMO system. In this paper, in order to improve detection reliability, we first set up the color-space-based region of interest (ROI) in which an LEA is likely to be placed, and then use the Harris corner detection method. Next, we use Kalman filtering for robust tracking by predicting the most probable location of the LEA when the relative position between the camera and the LEA varies. In the last step of our proposed method, the perspective projection is used to correct the distorted image, which can improve the symbol decision accuracy. Finally, through numerical simulation, we show the possibility of robust detection and tracking of the LEA, which results in a symbol error rate (SER) performance improvement. PMID:27384563

LEA Detection and Tracking Method for Color-Independent Visual-MIMO.

PubMed

Kim, Jai-Eun; Kim, Ji-Won; Kim, Ki-Doo

2016-07-02

Communication performance in the color-independent visual-multiple input multiple output (visual-MIMO) technique is deteriorated by light emitting array (LEA) detection and tracking errors in the received image because the image sensor included in the camera must be used as the receiver in the visual-MIMO system. In this paper, in order to improve detection reliability, we first set up the color-space-based region of interest (ROI) in which an LEA is likely to be placed, and then use the Harris corner detection method. Next, we use Kalman filtering for robust tracking by predicting the most probable location of the LEA when the relative position between the camera and the LEA varies. In the last step of our proposed method, the perspective projection is used to correct the distorted image, which can improve the symbol decision accuracy. Finally, through numerical simulation, we show the possibility of robust detection and tracking of the LEA, which results in a symbol error rate (SER) performance improvement.

The continuing conundrum of the LEA proteins.

PubMed

Tunnacliffe, Alan; Wise, Michael J

2007-10-01

Research into late embryogenesis abundant (LEA) proteins has been ongoing for more than 20 years but, although there is a strong association of LEA proteins with abiotic stress tolerance particularly dehydration and cold stress, for most of that time, their function has been entirely obscure. After their initial discovery in plant seeds, three major groups (numbered 1, 2 and 3) of LEA proteins have been described in a range of different plants and plant tissues. Homologues of groups 1 and 3 proteins have also been found in bacteria and in certain invertebrates. In this review, we present some new data, survey the biochemistry, biophysics and bioinformatics of the LEA proteins and highlight several possible functions. These include roles as antioxidants and as membrane and protein stabilisers during water stress, either by direct interaction or by acting as molecular shields. Along with other hydrophilic proteins and compatible solutes, LEA proteins might also serve as "space fillers" to prevent cellular collapse at low water activities. This multifunctional capacity of the LEA proteins is probably attributable in part to their structural plasticity, as they are largely lacking in secondary structure in the fully hydrated state, but can become more folded during water stress and/or through association with membrane surfaces. The challenge now facing researchers investigating these enigmatic proteins is to make sense of the various in vitro defined functions in the living cell: Are the LEA proteins truly multi-talented, or are they still just misunderstood?

A general model for estimating lower extremity inertial properties of individuals with transtibial amputation.

PubMed

Ferris, Abbie E; Smith, Jeremy D; Heise, Gary D; Hinrichs, Richard N; Martin, Philip E

2017-03-21

Lower extremity joint moment magnitudes during swing are dependent on the inertial properties of the prosthesis and residual limb of individuals with transtibial amputation (TTA). Often, intact limb inertial properties (INTACT) are used for prosthetic limb values in an inverse dynamics model even though these values overestimate the amputated limb's inertial properties. The purpose of this study was to use subject-specific (SPECIFIC) measures of prosthesis inertial properties to generate a general model (GENERAL) for estimating TTA prosthesis inertial properties. Subject-specific mass, center of mass, and moment of inertia were determined for the shank and foot segments of the prosthesis (n=11) using an oscillation technique and reaction board. The GENERAL model was derived from the means of the SPECIFIC model. Mass and segment lengths are required GENERAL model inputs. Comparisons of segment inertial properties and joint moments during walking were made using three inertial models (unique sample; n=9): (1) SPECIFIC, (2) GENERAL, and (3) INTACT. Prosthetic shank inertial properties were significantly smaller with the SPECIFIC and GENERAL model than the INTACT model, but the SPECIFIC and GENERAL model did not statistically differ. Peak knee and hip joint moments during swing were significantly smaller for the SPECIFIC and GENERAL model compared with the INTACT model and were not significantly different between SPECIFIC and GENERAL models. When subject-specific measures are unavailable, using the GENERAL model produces a better estimate of prosthetic side inertial properties resulting in more accurate joint moment measurements for individuals with TTA than the INTACT model. Copyright © 2017 Elsevier Ltd. All rights reserved.

34 CFR 200.36 - Communication with parents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.36 Communication with parents. (a) Throughout the school improvement process, the State, LEA, or school must communicate with the parents of each child attending the school. (b) The State, LEA, or school must ensure that...

34 CFR 200.36 - Communication with parents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.36 Communication with parents. (a) Throughout the school improvement process, the State, LEA, or school must communicate with the parents of each child attending the school. (b) The State, LEA, or school must ensure that...

34 CFR 200.36 - Communication with parents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.36 Communication with parents. (a) Throughout the school improvement process, the State, LEA, or school must communicate with the parents of each child attending the school. (b) The State, LEA, or school must ensure that...

34 CFR 200.36 - Communication with parents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.36 Communication with parents. (a) Throughout the school improvement process, the State, LEA, or school must communicate with the parents of each child attending the school. (b) The State, LEA, or school must ensure that...

34 CFR 200.36 - Communication with parents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.36 Communication with parents. (a) Throughout the school improvement process, the State, LEA, or school must communicate with the parents of each child attending the school. (b) The State, LEA, or school must ensure that...

34 CFR 200.63 - Consultation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Programs Operated by Local Educational Agencies Participation of Eligible Children in Private Schools § 200... private school children. (b) At a minimum, the LEA must consult on the following: (1) How the LEA will identify the needs of eligible private school children. (2) What services the LEA will offer to eligible...

34 CFR 200.71 - LEA eligibility.

Code of Federal Regulations, 2011 CFR

2011-07-01

... least five percent of the LEA's total population ages 5 to 17 years, inclusive. (d) Education finance... 34 Education 1 2011-07-01 2011-07-01 false LEA eligibility. 200.71 Section 200.71 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION...

34 CFR 200.71 - LEA eligibility.

Code of Federal Regulations, 2010 CFR

2010-07-01

... least five percent of the LEA's total population ages 5 to 17 years, inclusive. (d) Education finance... 34 Education 1 2010-07-01 2010-07-01 false LEA eligibility. 200.71 Section 200.71 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION...

Not Just Location: LEAs and Inequalities among Schools

ERIC Educational Resources Information Center

Yair, Gad

2005-01-01

Purpose: With growing decentralization, local education authorities (LEAs) face new tasks and responsibilities in providing schools with administrative services and resources. This study aims to use a multilevel framework to assess the extent to which LEAs differentially affect the provision of resources and administrative services to schools, and…

34 CFR 200.77 - Reservation of funds by an LEA.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 200.48, unless the LEA meets these requirements with non-Title I funds; (d) Address the professional development needs of instructional staff, including— (1) Professional development requirements under § 200.52(a)(3)(iii) if the LEA has been identified for improvement or corrective action; and (2) Professional...

ACCEPTABILITY OF A FUNCTIONAL-COSMETIC ARTIFICIAL HAND FOR YOUNG CHILDREN.

ERIC Educational Resources Information Center

FISHMAN, SIDNEY; KAY, HECTOR W.

SEVENTY-SEVEN CHILDREN, AGED 4 YEARS TO 12 YEARS, 4 MONTHS AND EXEMPLIFYING ALL LEVELS OF UPPER EXTREMITY AMPUTATION (PROSTHETIC TYPE) FROM WRIST-DISARTICULATION TO SHOULDER-DISARTICULATION, WORE THE APRL-SIERRA CHILD SIZE MODEL NUMBER 1 HAND FOR APPROXIMATELY 4 MONTHS. CHILD AND PARENTS MADE FOUR CLINIC VISITS FOR INITIAL SCREENING, FITTING, 2…

The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

PubMed

Mills, Joseph L; Conte, Michael S; Armstrong, David G; Pomposelli, Frank B; Schanzer, Andres; Sidawy, Anton N; Andros, George

2014-01-01

Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population. Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Vascular Pythiosis of the Lower Extremity in Northern Thailand: Ten Years' Experience.

PubMed

Reanpang, Termpong; Orrapin, Saritphat; Orrapin, Saranat; Arworn, Supapong; Kattipatanapong, Thanate; Srisuwan, Tanop; Vanittanakom, Nongnuch; Lekawanvijit, Suree P; Rerkasem, Kittipan

2015-09-01

Pythiosis is a disease caused by Pythium insidiosum, a fungus-like organism. P. insidiosum is pathogenic in mammals, particularly in horses, dogs, and humans. Human pythiosis can be classified into 4 types: (1) cutaneous/subcutaneous, (2) ocular, (3) vascular, and (4) disseminated pythiosis. Vascular pythiosis is a rare disease but a serious limb- and life-threatening infection. We reviewed 22 cases over a 10-year period in Maharaj Nakorn Chiang Mai/Chiang Mai University Hospital. The survival rate was around 63.6% during our follow-up period. The only effective treatment was complete excision of the infected tissue, which was done mainly by major amputation, such as above-knee amputation. This report raises awareness of this disease, which needs preemptive diagnosis and appropriate treatment. © The Author(s) 2015.

Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation.

PubMed

Mueller, M J; Strube, M J; Allen, B T

1997-04-01

To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA). Thirty patients with diabetes and TMA participated (mean age 62 +/- 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments. All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe. The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.

77 FR 26531 - Request for Information To Gather Technical Expertise Pertaining to the Disaggregation of Asian...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... information to help State educational agencies (SEAs), local educational agencies (LEAs), schools, and... student population. SEAs, LEAs, schools, and IHEs might then use those data to improve their ability to... seeking information on disaggregation practices that SEAs, LEAs, schools, and IHEs use when collecting and...

34 CFR 200.53 - LEA corrective action.

Code of Federal Regulations, 2011 CFR

2011-07-01

... SEA to identify an LEA for corrective action; and (ii) Any underlying staffing, curriculum, or other problems in the LEA; (2) Is designed to meet the goal that each group of students described in § 200.13(b... programmatic funds or reduce administrative funds. (ii) Institute and fully implement a new curriculum based on...

34 CFR 200.53 - LEA corrective action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... SEA to identify an LEA for corrective action; and (ii) Any underlying staffing, curriculum, or other problems in the LEA; (2) Is designed to meet the goal that each group of students described in § 200.13(b... programmatic funds or reduce administrative funds. (ii) Institute and fully implement a new curriculum based on...

49 CFR 25.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Access to schools operated by LEAs. 25.420 Section... Basis of Sex in Education Programs or Activities Prohibited § 25.420 Access to schools operated by LEAs... other school or educational unit operated by such recipient, unless such recipient otherwise makes...

10 CFR 1042.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Access to schools operated by LEAs. 1042.420 Section 1042... in Education Programs or Activities Prohibited § 1042.420 Access to schools operated by LEAs. A... school or educational unit operated by such recipient, unless such recipient otherwise makes available to...

Approaches to the management of shotgun injuries.

PubMed

Flint, L M; Cryer, H M; Howard, D A; Richardson, J D

1984-05-01

Shotgun wounds present specific challenges for the surgeon. Multiple penetrating wounds frequently involve large anatomic areas with potential multi-system injury. Experience with 121 patients sustaining shotgun wounds over the 5-year period ending 31 December 1981 was reviewed to assess results and evaluate treatment protocols. Sixty-six patients had chest wounds with pleural penetration. Twenty-four wounds were minor and were observed. Each had less than five pellets penetrating the pleura. Twenty-two patients had close-range injuries. Fourteen of these required chest tube drainage alone and eight patients required thoracotomy for control of bleeding. Eleven patients died, six as a direct result of the chest injury. In 55 patients with abdominal-retroperitoneal wounds exploratory operations were done if more than four pellets were thought to be lodged intraperitoneally or if signs of peritonitis were present, while lesser wounds without peritoneal findings were observed. In the 15 patients who did not have exploratory operations, there were no deaths or major complications. Thirty-five patients had exploratory operations. Two patients had five intraperitoneal missiles and no clinical evidence of peritonitis but were found to have significant intestinal perforations. Four patients died. Eighty-three patients with extremity wounds were classified according to location of injury. Forty-five had upper extremity wounds, with nine vascular injuries. Two patients died and one limb was amputated because of soft tissue infection. Thirty-eight patients had lower extremity wounds. Five had major vascular injuries. Preoperative arteriography was obtained in 13 patients with extremity injuries; the results of one of these were falsely negative. There were no deaths or amputations.(ABSTRACT TRUNCATED AT 250 WORDS)

Labour analgesia with intrathecal fentanyl decreases maternal stress.

PubMed

Cascio, M; Pygon, B; Bernett, C; Ramanathan, S

1997-06-01

Lumbar epidural analgesia (LEA) decreases maternal stress as measured by maternal circulating plasma catecholamine concentrations. Intrathecal fentanyl (ITF) provides effective labour analgesia but its effect on maternal epinephrine (Epi) and norepinephrine (NE) concentrations is not known. This study assesses whether ITF reduces maternal stress in the same manner as conventional LEA. Twenty-four healthy women in active labour received either 25 micrograms ITF (n = 12) or epidural lidocaine 1.5% (n = 12) for analgesia. Venous blood samples were collected before anaesthesia and at five minute intervals for 30 min following anaesthesia for the measurement of plasma Epi and NE by high performance liquid chromatography. Maternal blood pressure (BP), heart rate (HR), visual analog scores (VAS) to pain and pruritus were recorded at the same time. Both ITF and LEA decreased pain VAS scores, maternal BP, and plasma Epi concentrations with only minimal effects on plasma NE concentrations. Intrathecal fentanyl (ITF) and LEA reduced plasma epi to a similar extent, with ITF reducing the levels slightly faster than LEA. Intrathecal fentanyl(ITF) and LEA reduced plasma Epi concentrations by 52% and 51%, respectively (P value < 0.01). We conclude that ITF is as effective as LEA in producing pain relief in the labouring patient. Intrathecal Fentanyl (ITF) is also capable of reducing maternal plasma epinephrine concentration, thus avoiding the possibly deleterious side effects of excess amounts of this catecholamine during labour.

77 FR 12257 - Proposed Priorities, Requirements, Definitions, And Selection Criteria; Teacher Incentive Fund...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-29

... stipends for teachers who agree to observe their peers for evaluative purposes. By proposing to design its... criteria that are designed to ensure that TIF grantees use high-quality LEA-wide evaluation and support...- designed and implemented LEA-wide. In this notice, we define an HCMS as the system an LEA uses to make...

34 CFR 222.183 - How does an LEA apply for a grant?

Code of Federal Regulations, 2010 CFR

2010-07-01

... fiscal year. An LEA must submit a separate application for each school for which it proposes a project, and may submit more than one application for a single school if multiple projects are proposed. Examples: 1. An LEA wants to receive both an emergency and a modernization grant for one school that has a...

34 CFR 222.171 - What LEAs may be eligible for Discretionary Construction grants?

Code of Federal Regulations, 2011 CFR

2011-07-01

... such factors as an LEA's total assessed value of real property that may be taxed for school purposes... 34 Education 1 2011-07-01 2011-07-01 false What LEAs may be eligible for Discretionary Construction grants? 222.171 Section 222.171 Education Regulations of the Offices of the Department of...

34 CFR 300.2 - Applicability of this part to State and local agencies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... educational agencies (LEAs), educational service agencies (ESAs), and public charter schools that are not otherwise included as LEAs or ESAs and are not a school of an LEA or ESA. (iii) Other State agencies and schools (such as Departments of Mental Health and Welfare and State schools for children with deafness or...

The LEA's Role in a Decentralized School System: The School Principals' View

ERIC Educational Resources Information Center

Addi-Raccah, Audrey; Gavish, Yakov

2010-01-01

Since the wave of school reform decentralization, schools now maintain a more dynamic and diverse relationship with their environment than they did in the past. School principals' relationships with the local educational authority (LEA) are a prominent example of this change in Israel. LEAs try to gain more pedagogic influence over schools while…

34 CFR 222.171 - What LEAs may be eligible for Discretionary Construction grants?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION IMPACT AID PROGRAMS Impact...; (iii) Be eligible for funding for heavily impacted LEAs under section 8003(b)(2) of the Act; or (iv... such factors as an LEA's total assessed value of real property that may be taxed for school purposes...

34 CFR 222.171 - What LEAs may be eligible for Discretionary Construction grants?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION IMPACT AID PROGRAMS Impact...; (iii) Be eligible for funding for heavily impacted LEAs under section 8003(b)(2) of the Act; or (iv... such factors as an LEA's total assessed value of real property that may be taxed for school purposes...

24 CFR 3.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Access to schools operated by LEAs... Prohibited § 3.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

45 CFR 2555.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Access to schools operated by LEAs. 2555.420... Activities Prohibited § 2555.420 Access to schools operated by LEAs. A recipient that is a local educational... vocational education operated by such recipient; or (b) Any other school or educational unit operated by such...

32 CFR 196.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false Access to schools operated by LEAs. 196.420... Prohibited § 196.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

13 CFR 113.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Access to schools operated by LEAs....420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not, on... operated by such recipient; or (b) Any other school or educational unit operated by such recipient, unless...

10 CFR 5.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Access to schools operated by LEAs. 5.420 Section 5.420... Activities Prohibited § 5.420 Access to schools operated by LEAs. A recipient that is a local educational... vocational education operated by such recipient; or (b) Any other school or educational unit operated by such...

32 CFR 196.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Access to schools operated by LEAs. 196.420... Prohibited § 196.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

24 CFR 3.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Access to schools operated by LEAs... Prohibited § 3.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

45 CFR 2555.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Access to schools operated by LEAs. 2555.420... Activities Prohibited § 2555.420 Access to schools operated by LEAs. A recipient that is a local educational... vocational education operated by such recipient; or (b) Any other school or educational unit operated by such...

[Apotemnophilia as a contemporary frame for psychological suffering].

PubMed

Baubet, T; Gal, B; Dendoncker-Viry, S; Masquelet, A C; Gatt, M-T; Moro, M R

2007-09-01

The word was created in 1977. It was first used to describe an extreme paraphilia concerning both the search for amputees as sexual partners, and the fantasies and wishes to be amputated linked to a sexual arousal. More recently, the number of self-demand amputations appears to have raised. Some amputations of healthy legs have even been performed in hospital settings, raising important ethical issues. A new category of trouble has been described: the Body Integrity Identity Disorder (BIID). Criterias for its diagnosis have been developed and submitted to DSM V task force. According to clinicians who support the existence of BIID, this disorder is not a paraphilia, don't overlap with other psychiatric disorders and could be in some ways compared to transexualism. The patient's health would therefore require the amputation of healthy limbs in order to themselves and to help them to become according to their . Still according to those clinicians, psychiatric symptoms would be either a consequence of the shame resulting from this condition, or a consequence of the doctor's refusal to perform these amputations. An ever growing litterature on the web support this opinion, but the scientific litterature is still very scarce. In this paper, we analyse available scientific datas. This review does not support the existence of BIID as a discrete nor a specific condition. In a second part of this paper, we describe the case of a young woman who started asking for above-the-knee leg amputation after a minor knee trauma, while complaining for pain and leg rigidity. Her medical state worsened, probably because of repeated self-inflicted lesions and food restriction, leading to a severe undernutrition and life-threatening hypokaliemia. After some time, her medical state required amputation. This surgery did not resolve her psychological suffering. She never talked about amputation as a way to achieve herself. She did not meet the criterias for BIID. We consider her trouble as an association of a factitious disorder with a borderline personality disorder. In the last part of this paper, we discuss the scientific litterature about apotemnophilia and BIID. We support the idea that BIID can be considered as a culture-bound syndrome, a contemporary frame for psychological suffering. We think that BIID does not have neither intrinsic nor unequivocal psychopathological meaning. It is a (Elliott), a common pathway for the expression of very different kinds of psychological suffering. Apotemnophilia and BIID are raising important ethical and practical issues for psychiatrists: their opinion will probably be requested by patients and surgical teams having to deal with patient asking for healthy limbs amputation.

Law Enforcement Agency Defibrillation (LEA-D): proceedings of the National Center for Early Defibrillation Police AED Issues Forum.

PubMed

Mosesso, Vincent N; Newman, Mary M; Ornato, Joseph P; Paris, Paul M; Andersen, Leon; Brinsfield, Kathryn; Dunnavant, Gregory R; Frederick, Jay; Groh, William J; Johnston, Steven; Lerner, E Brooke; Murphy, George P; Myerburg, Robert J; Rosenberg, Donald G; Savino, Mitchell; Sayre, Michael R; Sciammarella, Joseph; Schoen, Valerie; Vargo, Philip; van Alem, Anouk; White, Roger D

2002-01-01

Why does LEA-D intervention seem to work in some systems but not others? Panelists agreed that some factors that delay rapid access to treatment, such as long travel distances in rural areas, may represent insurmountable barriers. Other factors, however, may be addressed more readily. These include: absence of a medical response culture, discomfort with the role of medical intervention, insecurity with the use of medical devices, a lack of proactive medical direction, infrequent refresher training, and dependence on EMS intervention. Panelists agreed that successful LEA-D programs possess ten key attributes (Table 6). In the end, the goal remains "early" defibrillation, not "police" defibrillation. It does not matter whether the rescuer wears a blue uniform--or any uniform, for that matter--so long as the defibrillator reaches the victim quickly. If LEA personnel routinely arrive at medical emergencies after other emergency responders or after 8 minutes have elapsed from the time of collapse, an LEA-D program will be unlikely to provide added value. Similarly, if police frequently arrive first, but the department is unwilling or unable to cultivate the attributes of successful LEA-D programs, efforts to improve survival may not be realized. In most communities, however, LEA-D programs have tremendous lifesaving potential and are well worth the investment of time and resources. Law enforcement agencies considering adoption of AED programs should review the frequency with which police arrive first at medical emergencies and LEA response intervals to determine whether AED programs might help improve survival in their communities. It is time for law enforcement agency defibrillation to become the rule, not the exception.

LEA polypeptide profiling of recalcitrant and orthodox legume seeds reveals ABI3-regulated LEA protein abundance linked to desiccation tolerance.

PubMed

Delahaie, Julien; Hundertmark, Michaela; Bove, Jérôme; Leprince, Olivier; Rogniaux, Hélène; Buitink, Julia

2013-11-01

In contrast to orthodox seeds that acquire desiccation tolerance during maturation, recalcitrant seeds are unable to survive drying. These desiccation-sensitive seeds constitute an interesting model for comparative analysis with phylogenetically close species that are desiccation tolerant. Considering the importance of LEA (late embryogenesis abundant) proteins as protective molecules both in drought and in desiccation tolerance, the heat-stable proteome was characterized in cotyledons of the legume Castanospermum australe and it was compared with that of the orthodox model legume Medicago truncatula. RNA sequencing identified transcripts of 16 homologues out of 17 LEA genes for which polypeptides are detected in M. truncatula seeds. It is shown that for 12 LEA genes, polypeptides were either absent or strongly reduced in C. australe cotyledons compared with M. truncatula seeds. Instead, osmotically responsive, non-seed-specific dehydrins accumulated to high levels in the recalcitrant cotyledons compared with orthodox seeds. Next, M. truncatula mutants of the abscisic acid insensitive3 (ABI3) gene were characterized. Mature Mtabi3 seeds were found to be desiccation sensitive when dried below a critical water content of 0.4 g H2O g DW(-1). Characterization of the LEA proteome of the Mtabi3 seeds revealed a subset of LEA proteins with severely reduced abundance that were also found to be reduced or absent in C. australe cotyledons. Transcripts of these genes were indeed shown to be ABI3 responsive. The results highlight those LEA proteins that are critical to desiccation tolerance and suggest that comparable regulatory pathways responsible for their accumulation are missing in both desiccation-sensitive genotypes, revealing new insights into the mechanistic basis of the recalcitrant trait in seeds.

LEA polypeptide profiling of recalcitrant and orthodox legume seeds reveals ABI3-regulated LEA protein abundance linked to desiccation tolerance

PubMed Central

Hundertmark, Michaela; Buitink, Julia

2013-01-01

In contrast to orthodox seeds that acquire desiccation tolerance during maturation, recalcitrant seeds are unable to survive drying. These desiccation-sensitive seeds constitute an interesting model for comparative analysis with phylogenetically close species that are desiccation tolerant. Considering the importance of LEA (late embryogenesis abundant) proteins as protective molecules both in drought and in desiccation tolerance, the heat-stable proteome was characterized in cotyledons of the legume Castanospermum australe and it was compared with that of the orthodox model legume Medicago truncatula. RNA sequencing identified transcripts of 16 homologues out of 17 LEA genes for which polypeptides are detected in M. truncatula seeds. It is shown that for 12 LEA genes, polypeptides were either absent or strongly reduced in C. australe cotyledons compared with M. truncatula seeds. Instead, osmotically responsive, non-seed-specific dehydrins accumulated to high levels in the recalcitrant cotyledons compared with orthodox seeds. Next, M. truncatula mutants of the ABSCISIC ACID INSENSITIVE3 (ABI3) gene were characterized. Mature Mtabi3 seeds were found to be desiccation sensitive when dried below a critical water content of 0.4g H2O g DW–1. Characterization of the LEA proteome of the Mtabi3 seeds revealed a subset of LEA proteins with severely reduced abundance that were also found to be reduced or absent in C. australe cotyledons. Transcripts of these genes were indeed shown to be ABI3 responsive. The results highlight those LEA proteins that are critical to desiccation tolerance and suggest that comparable regulatory pathways responsible for their accumulation are missing in both desiccation-sensitive genotypes, revealing new insights into the mechanistic basis of the recalcitrant trait in seeds. PMID:24043848

Comparison of optotypes of Amsterdam Picture Chart with those of Tumbling-E, LEA symbols, ETDRS, and Landolt-C in non-amblyopic and amblyopic patients.

PubMed

Engin, O; Despriet, D D G; van der Meulen-Schot, H M; Romers, A; Slot, X; Sang, M Tjon Fo; Fronius, M; Kelderman, H; Simonsz, H J

2014-12-01

To compare optotypes of the Amsterdam Picture Chart (APK) with those of Landolt-C (LC), Tumbling-E (TE), ETDRS and LEA symbols (LEA), to assess their reliability in measuring visual acuity (VA). We recruited healthy controls with equal VA and amblyopes with ≥2 LogMAR lines interocular difference. New logarithmic charts were developed with LC, TE, ETDRS, LEA, and APK with identical size and spacing (four optotypes) between optotypes. Charts were randomly presented at 5 m under DIN EN ISO 8596 and 8597 conditions. VA was measured with LC (LC-VA), TE, ETDRS, LEA, and APK, using six out of ten optotypes answered correctly as threshold. In 100 controls aged 17-31, LC-VA was -0.207 ± SD 0.089 LogMAR. Visual acuity measured with TE differed from LC-VA by 0.021 (positive value meaning less recognizable), with ETDRS 0.012, with Lea 0.054, and with APK 0.117. In 46 amblyopic eyes with LC-VA <0.5 LogMAR, the difference was for TE 0.017, for ETDRS 0.017, for LEA 0.089, and for APK 0.213. In 13 amblyopic eyes with LC-VA ≥0.5 LogMAR, the difference was for TE 0.122, ETDRS 0.047, LEA 0.057, and APK 0.019. APK optotypes had a lower percentage of passed subjects at each LogMAR line compared to Landolt-C. The 11 APK optotypes had different thresholds. Small APK optotypes were recognized worse than all other optotypes, probably because of their thinner lines. Large APK optotypes were recognized relatively well, possibly reflecting recognition acuity. Differences between the thresholds of the 11 APK optotypes reduced its sensitivity further.

Comparing the surgical timelines of military and civilians traumatic lower limb amputations

PubMed Central

Staruch, R.M.T.; Jackson, P.C.; Hodson, J.; Yim, G.; Foster, M.A.; Cubison, T.; Jeffery, S.L.A.

2016-01-01

The care and challenges of injured service have been well documented in the literature from a variety of specialities. The aim of this study was to analyse the surgical timelines of military and civilian traumatic amputees and compare the surgical and resuscitative interventions. A retrospective review of patient notes was undertaken. Military patients were identified from the Joint Theatre Trauma Registry (JTTR) in 2009. Civilian patients were identified using the hospital informatics database. Patient demographics, treatment timelines as well as surgical and critical care interventions were reviewed. In total 71 military patients sustained traumatic amputations within this time period. This represented 11% of the total injury demographic in 2009. Excluding upper limb amputees 46 patients sustained lower extremity amputations. These were investigated further. In total 21 civilian patients were identified in a 7-year period. Analysis revealed there was a statistically significant difference between patient age, ITU length of stay, blood products used and number of surgical procedures between military and civilian traumatic amputees. This study identified that military patients were treated for longer in critical care and required more surgical interventions for their amputations. Despite this, their time to stump closure and length of stay were not statistically different compared to civilian patients. Such observations reflect the importance of an Orthoplastic approach, as well as daily surgical theatre co-ordination and weekly multi-disciplinary meetings in providing optimal care for these complex patients. This study reports the epidemiological observed differences between two lower limb trauma groups. PMID:26958343

Residual limb skin temperature and thermal comfort in people with amputation during activity in a cold environment.

PubMed

Segal, Ava D; Klute, Glenn K

2016-01-01

Thermal comfort remains a common problem for people with lower-limb amputation. Both donning a prosthesis and engaging in activity at room temperature can increase residual limb skin temperature; however, the effects of activity on skin temperature and comfort in more extreme environments remain unknown. We examined residual limb skin temperatures and perceived thermal comfort (PTC; 11-point Likert scale) of participants with unilateral transtibial amputation (n = 8) who were snowshoeing in a cold environment. Residual limb skin temperature increased by 3.9°C [3.0°C to 4.7°C] (mean difference [95% confidence interval (CI)], p < 0.001) after two 30 min exercise sessions separated by a 5 min rest session. Minimal cooling (-0.2°C [-1.1°C to 0.6°C]) occurred during the rest period. Similar changes in PTC were found for the residual limb, intact limb, and whole body, with a mean scale increase of 1.6 [1.1 to 2.1] and 1.3 [0.8 to 1.8] for the first and second exercise sessions, respectively (p < 0.001). Activity in a cold environment caused similar increases in residual limb skin temperature as those found in studies conducted at room temperature. Participants with amputation perceived warming as their skin temperature increased during exercise followed by the perception of cooling during rest, despite minimal associated decreases in skin temperature.

38 CFR 3.310 - Disabilities that are proximately due to, or aggravated by, service-connected disease or injury.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (Authority: 38 U.S.C. 1110 and 1131) (c) Cardiovascular disease. Ischemic heart disease or other cardiovascular disease developing in a veteran who has a service-connected amputation of one lower extremity at... proximately due to, or aggravated by, service-connected disease or injury. 3.310 Section 3.310 Pensions...

Major lower extremity lawn mower injuries in children.

PubMed

Dormans, J P; Azzoni, M; Davidson, R S; Drummond, D S

1995-01-01

Between 1983 and 1993, 16 children with 18 lower extremity power lawn mower-related injuries were treated at Children's Hospital of Philadelphia. Eleven of 16 patients (69%) were bystanders or nonoperators. The average age at injury was 4 years 9 months. Length of follow-up averaged 3 years 10 months. There was an average of 4.9 procedures per patient. Fourteen of the 18 limbs injured required eventual amputation (78%). We propose a new classification of lawn mower injuries in children. The most common injury (16 of 18 limbs) was a shredding type injury and was either intercalary or distal. The second was a paucilaceration type (two of 18 limbs). Of the four salvaged limbs, there were two shredding type injuries, and on most recent follow-up are considered to have poor results. The two patients with the paucilaceration type injuries and limb salvage are considered to have excellent results. All patients with a shredding type injury ultimately required amputation or had poor results with the salvaged limb. Limb salvage surgery was associated with prolonged hospitalizations, a higher incidence of surgical problems, a longer treatment course, and more complications than early ablative procedures.

Isolated limb infusion with fotemustine after dacarbazine chemosensitisation for inoperable loco-regional melanoma recurrence.

PubMed

Bonenkamp, J J; Thompson, J F; de Wilt, J H; Doubrovsky, A; de Faria Lima, R; Kam, P C A

2004-12-01

Isolated limb infusion (ILI) is a simple yet effective alternative to conventional isolated limb perfusion for the treatment of advanced melanoma of the extremities. The study group comprised 13 patients with very advanced limb disease who had failed to achieve a satisfactory response to one or more ILIs with melphalan, and in whom amputation was the only other realistic treatment option. The aim of this study was to evaluate the efficacy and toxicity of ILI with fotemustine after systemic chemosensitisation with dacarbazine (DTIC). Complete remission was achieved in four patients and partial remission in eight patients, with a median response duration of 3 months. Limb salvage was achieved in five of 12 assessable patients (42%). Limb toxicity peaked 9 days after ILI; two patients experienced Wieberdink grade IV (severe) toxicity and four patients had grade V toxicity (requiring early amputation). ILI with fotemustine after DTIC chemosensitisation can be successful when gross limb disease has not been controlled by one or more ILIs with melphalan. However, it cannot be recommended as a routine method of treatment for advanced melanoma of the extremities because of the high incidence of severe limb toxicity.

Management of war-related vascular injuries: experience from the second gulf war.

PubMed

Jawas, Ali; Abbas, Alaa K; Nazzal, Munier; Albader, Marzoog; Abu-Zidan, Fikri M

2013-07-01

To study the biomechanism, pattern of injury, management, and outcome of major vascular injuries treated at Mubarak Al-Kabeer Teaching Hospital, Kuwait during the Second Gulf War. This is a descriptive retrospective study. War-related injured patients who had major vascular injuries and were treated at Mubarak Al-Kabeer Teaching Hospital from August 1990 to September 1991 were studied. Studied variables included age, gender, anatomical site of vascular injury, mechanism of injury, associated injuries, type of vascular repair, and clinical outcome. 36 patients having a mean (SD) age of 29.8 (10.2) years were studied. 32 (89%) were males and 21 (58%) were civilians. Majority of injuries were caused by bullets (47.2%) and blast injuries (47.2%). Eight patients (22%) presented with shock.There were 31 arterial injuries, common and superficial femoral artery injuries were most common (10/31). Arterial repair included interposition saphenous vein graft in seven patients, thrombectomy with end-to-end / lateral repair in twelve patients, vein patch in two patients, and arterial ligation in four patients. Six patients had arterial ligation as part of primary amputation. 3/21 (14.3%) patients had secondary amputation after attempted arterial vascular repair of an extremity. There were a total of 17 venous injuries, 13 managed by lateral suture repair and 4 by ligation. The median (range) hospital stay was 8 (1-76) days. 5 patients died (14%). Major vascular injuries occurred in 10% of hospitalized war-related injured patients. Our secondary amputation rate of extremities was 14%. The presence of a vascular surgeon within a military surgical team is highly recommended. Basic principles and techniques of vascular repair remain an essential part of training general surgeons because it may be needed in unexpected wars.

Effects of a powered ankle-foot prosthesis on kinetic loading of the unaffected leg during level-ground walking

PubMed Central

2013-01-01

Background People with a lower-extremity amputation that use conventional passive-elastic ankle-foot prostheses encounter a series of stress-related challenges during walking such as greater forces on their unaffected leg, and may thus be predisposed to secondary musculoskeletal injuries such as chronic joint disorders. Specifically, people with a unilateral transtibial amputation have an increased susceptibility to knee osteoarthritis, especially in their unaffected leg. Previous studies have hypothesized that the development of this disorder is linked to the abnormally high peak knee external adduction moments encountered during walking. An ankle-foot prosthesis that supplies biomimetic power could potentially mitigate the forces and knee adduction moments applied to the unaffected leg of a person with a transtibial amputation, which could, in turn, reduce the risk of knee osteoarthritis. We hypothesized that compared to using a passive-elastic prosthesis, people with a transtibial amputation using a powered ankle-foot prosthesis would have lower peak resultant ground reaction forces, peak external knee adduction moments, and corresponding loading rates applied to their unaffected leg during walking over a wide range of speeds. Methods We analyzed ground reaction forces and knee joint kinetics of the unaffected leg of seven participants with a unilateral transtibial amputation and seven age-, height- and weight-matched non-amputees during level-ground walking at 0.75, 1.00, 1.25, 1.50, and 1.75 m/s. Subjects with an amputation walked while using their own passive-elastic prosthesis and a powered ankle-foot prosthesis capable of providing net positive mechanical work and powered ankle plantar flexion during late stance. Results Use of the powered prosthesis significantly decreased unaffected leg peak resultant forces by 2-11% at 0.75-1.50 m/s, and first peak knee external adduction moments by 21 and 12% at 1.50 and 1.75 m/s, respectively. Loading rates were not significantly different between prosthetic feet. Conclusions Use of a biomimetic powered ankle-foot prosthesis decreased peak resultant force at slow and moderate speeds and knee external adduction moment at moderate and fast speeds on the unaffected leg of people with a transtibial amputation during level-ground walking. Thus, use of an ankle-foot prosthesis that provides net positive mechanical work could reduce the risk of comorbidities such as knee osteoarthritis. PMID:23758860

Pediatric Lower Extremity Lawn Mower Injuries and Reconstruction: Retrospective 10-Year Review at a Level 1 Trauma Center.

PubMed

Branch, Leslie G; Crantford, John C; Thompson, James T; Tannan, Shruti C

2017-11-01

From 2004 to 2013, there were 9341 lawn mower injuries in children under 20 years old. The incidence of lawn mower injuries in children has not decreased since 1990 despite implementation of various different prevention strategies. In this report, the authors review the results of pediatric lawn mower-related lower-extremity injuries treated at a tertiary care referral center as well as review the overall literature. A retrospective review was performed at a level 1 trauma center over a 10-year period (2005-2015). Patients younger than 18 years who presented to the emergency room with lower extremity lawn mower injuries were included. Of the 27 patients with lower-extremity lawn mower injuries during this period, the mean age at injury was 5.5 years and Injury Severity Score was 7.2. Most (85%) patients were boys and the predominant type of mower causing injury was a riding lawn mower (96%). Injury occurred in patients who were bystanders in 78%, passengers in 11%, and operators in 11%. Mean length of stay was 12.2 days, and mean time to reconstruction was 7.9 days. Mean number of surgical procedures per patient was 4.1. Amputations occurred in 15 (56%) cases with the most common level of amputation being distal to the metatarsophalangeal joint (67%). Reconstructive procedures ranged from direct closure (41%) to free tissue transfer (7%). Major complications included infection (7%), wound dehiscence (11%), and delayed wound healing (15%). Mean follow up was 23.6 months and 100% of the patients were ambulatory after injury. The subgroup of patients with the most severe injuries, highest number of amputations, and need for overall surgical procedures were patients aged 2 to 5 years. A review of the literature also showed consistent findings. This study demonstrates the danger and morbidity that lawn mowers present to the pediatric population, particularly children aged 2 to 5 years. Every rung of the so-called reconstructive ladder is used in caring for these children. Increased public awareness is insufficient to decrease the incidence of these injuries. These products should have additional warning labels and meet updated changes to the design of lawn mowers to prevent these mutilating injuries successfully.

34 CFR 76.791 - On what basis does an SEA determine whether a charter school LEA that opens or significantly...

Code of Federal Regulations, 2011 CFR

2011-07-01

... school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... charter school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... eligible to receive funds under a covered program based on actual enrollment or other eligibility data for...

34 CFR 76.791 - On what basis does an SEA determine whether a charter school LEA that opens or significantly...

Code of Federal Regulations, 2010 CFR

2010-07-01

... school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... charter school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... eligible to receive funds under a covered program based on actual enrollment or other eligibility data for...

34 CFR 76.791 - On what basis does an SEA determine whether a charter school LEA that opens or significantly...

Code of Federal Regulations, 2013 CFR

2013-07-01

... school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... charter school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... eligible to receive funds under a covered program based on actual enrollment or other eligibility data for...

34 CFR 76.791 - On what basis does an SEA determine whether a charter school LEA that opens or significantly...

Code of Federal Regulations, 2014 CFR

2014-07-01

... school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... charter school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... eligible to receive funds under a covered program based on actual enrollment or other eligibility data for...

34 CFR 76.791 - On what basis does an SEA determine whether a charter school LEA that opens or significantly...

Code of Federal Regulations, 2012 CFR

2012-07-01

... school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... charter school LEA that opens or significantly expands its enrollment is eligible to receive funds under a... eligible to receive funds under a covered program based on actual enrollment or other eligibility data for...

34 CFR 222.187 - Which year's data must an SEA or LEA provide?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Which year's data must an SEA or LEA provide? 222.187 Section 222.187 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY... data must an SEA or LEA provide? (a) Except as provided in paragraph (b) of this section, the Secretary...

Biosynthesis and Immunolocalization of Lewis a-Containing N-Glycans in the Plant Cell1

PubMed Central

Fitchette, Anne-Catherine; Cabanes-Macheteau, Marion; Marvin, Laure; Martin, Barry; Satiat-Jeunemaitre, Béatrice; Gomord, Véronique; Crooks, Kim; Lerouge, Patrice; Faye, Loïc; Hawes, Chris

1999-01-01

We recently demonstrated the presence of a new asparagine-linked complex glycan on plant glycoproteins that harbors the Lewis a (Lea), or Galβ(1-3)[Fucα(1-4)]GlcNAc, epitope, which in mammalian cells plays an important role in cell-to-cell recognition. Here we show that the monoclonal antibody JIM 84, which is widely used as a Golgi marker in light and electron microscopy of plant cells, is specific for the Lea antigen. This antigen is present on glycoproteins of a number of flowering and non-flowering plants, but is less apparent in the Cruciferae, the family that includes Arabidopsis. Lea-containing oligosaccharides are found in the Golgi apparatus, and our immunocytochemical experiments suggest that it is synthesized in the trans-most part of the Golgi apparatus. Lea epitopes are abundantly present on extracellular glycoproteins, either soluble or membrane bound, but are never observed on vacuolar glycoproteins. Double-labeling experiments suggest that vacuolar glycoproteins do not bypass the late Golgi compartments where Lea is built, and that the absence of the Lea epitope from vacuolar glycoproteins is probably the result of its degradation by glycosidases en route to or after arrival in the vacuole. PMID:10517824

Diabetic foot syndrome (DFS) in patients with diabetes. A multicenter German/Austrian DPV analysis on 33,870 DFS patients among 358,986 adult subjects with diabetes.

PubMed

Bohn, Barbara; Grünerbel, Arthur; Altmeier, Marcus; Giesche, Carsten; Pfeifer, Martin; Wagner, Christian; Heise, Nikolai; Best, Frank; Fasching, Peter; Holl, Reinhard W

2018-05-03

The diabetic foot syndrome (DFS) is a serious complication in patients with diabetes increasing the risk for minor/major amputations. This analysis aimed to examine differences in diabetes patients with or without DFS stratified by type 1 (T1D) or type 2 diabetes (T2D). Adult patients (≥20y of age) with diabetes from the German/Austrian DPV-registry were included. The cross-sectional study comprised 45,722 subjects with T1D (n DFS =2,966) and 313,264 with T2D (n DFS =30,904). In DFS, minor/major amputations were analyzed. To compare HbA 1C , neuropathy, nephropathy, cardiovascular disease risk factors, and macrovascular complications between patients with our without DFS, regression models were conducted. Confounders: age, sex, diabetes duration. In patients with DFS, a minor amputation was documented in 27.2% (T1D) and 25.9% (T2D), a major amputation in 10.2% (T1D) and 11.3% (T2D). Regression models revealed that neuropathy was more frequent in subjects with DFS compared to patients without DFS (T1D: 70.7 vs. 29.8%; T2D: 59.4% vs. 36.9%; both p<0.0001). Hypertension, nephropathy, peripheral vascular disease, stroke, or myocardial infarction were more common compared to patients without DFS (all p<0.0001). In T1D with DFS, a slightly higher HbA 1C (8.11% vs. 7.95%; p<0.0001) and in T2D with DFS a lower HbA 1C (7.49% vs. 7.69%, p<0.0001) was observed. One third of the patients with DFS had an amputation of the lower extremity. Especially neuropathy or peripheral vascular disease were more prevalent in patients with DFS. New concepts to prevent DFS-induced amputations and to reduce cardiovascular risk factors before the occurrence of DFS are necessary. This article is protected by copyright. All rights reserved.

Management of diabetic foot disease and amputation in the Irish health system: a qualitative study of patients' attitudes and experiences with health services.

PubMed

Delea, Sarah; Buckley, Claire; Hanrahan, Andrew; McGreal, Gerald; Desmond, Deirdre; McHugh, Sheena

2015-07-01

Diabetes is an increasingly prevalent chronic illness that places a huge burden on the individual, the health system and society. Patients with active foot disease and lower limb amputations due to diabetes have a significant amount of interaction with the health care services. The purpose of this study was to explore the attitudes and experiences of foot care services in Ireland among people with diabetes and active foot disease or lower limb amputations. A purposive sample of individuals who had either active foot disease or a lower limb amputation as a result of diabetes were recruited from the Prosthetic, Orthotic and Limb Absence Rehabilitation (POLAR) Unit of an Irish hospital. One-to-one interviews were conducted in the POLAR unit using a semi-structured topic guide. Thematic analysis was used to identify, analyse and describe patterns within the data. Ten males participated in the study. Most participants expressed a need for emotional support alongside the medical management of their condition. There were substantial differences between participants with regard to the level of education and information they appeared to have received regarding their illness. There were also variations in levels of service received. Transport and medication costs were considered barriers. Having a medical card, which entitles the holder to free medical care, eased the burden of the patient's illness. A number of participants attributed some of the problems they faced with services to the health care system as a whole rather than health care professionals. Results suggest that rehabilitation services should place a strong focus on psychological as well as physical adjustment to active foot disease or lower limb amputations. The delivery of services needs to be standardised to ensure equal access to medical care and supplies among people with or at risk of lower extremity amputations. The wider social circumstances of patients should be taken into consideration by health care professionals to provide effective support while patients adjust to this potentially life changing complication. The patient's perspective should also be used to inform health service managers and health professionals on ways to improve services.

34 CFR 222.3 - How does a local educational agency apply for assistance under section 8002 or 8003 of the Act?

Code of Federal Regulations, 2011 CFR

2011-07-01

... LEA must file a complete and signed application within the time limits required by paragraph (b)(2) of... section 8002 or 8003 of the Act? An LEA must meet the following application requirements to be considered..., the LEA must— (1) File with the Secretary a complete and signed application for payment under section...

34 CFR 222.3 - How does a local educational agency apply for assistance under section 8002 or 8003 of the Act?

Code of Federal Regulations, 2010 CFR

2010-07-01

... LEA must file a complete and signed application within the time limits required by paragraph (b)(2) of... section 8002 or 8003 of the Act? An LEA must meet the following application requirements to be considered..., the LEA must— (1) File with the Secretary a complete and signed application for payment under section...

34 CFR 222.40 - How does a local educational agency select a local contribution rate based on generally...

Code of Federal Regulations, 2014 CFR

2014-07-01

... LEAs exclusive of significantly impacted LEAs described in § 222.39(b)(1)) that matches the factor or... these factors, if it were not excluded as significantly impacted in § 222.39(b)(1). Example. An LEA..., size, location, or a combination of these factors, (that is, in the case of the significantly impacted...

34 CFR 222.40 - How does a local educational agency select a local contribution rate based on generally...

Code of Federal Regulations, 2012 CFR

2012-07-01

... LEAs exclusive of significantly impacted LEAs described in § 222.39(b)(1)) that matches the factor or... these factors, if it were not excluded as significantly impacted in § 222.39(b)(1). Example. An LEA..., size, location, or a combination of these factors, (that is, in the case of the significantly impacted...

34 CFR 222.40 - How does a local educational agency select a local contribution rate based on generally...

Code of Federal Regulations, 2011 CFR

2011-07-01

... LEAs exclusive of significantly impacted LEAs described in § 222.39(b)(1)) that matches the factor or... these factors, if it were not excluded as significantly impacted in § 222.39(b)(1). Example. An LEA..., size, location, or a combination of these factors, (that is, in the case of the significantly impacted...

34 CFR 222.40 - How does a local educational agency select a local contribution rate based on generally...

Code of Federal Regulations, 2013 CFR

2013-07-01

... LEAs exclusive of significantly impacted LEAs described in § 222.39(b)(1)) that matches the factor or... these factors, if it were not excluded as significantly impacted in § 222.39(b)(1). Example. An LEA..., size, location, or a combination of these factors, (that is, in the case of the significantly impacted...

Use and Complications of Operative Control of Arterial Inflow in Combat Casualties with Traumatic Lower-extremity Amputations Caused by Improvised Explosive Devices

DTIC Science & Technology

2013-08-01

explosive devices Henrietta Poon, MRCS, Jonathan J. Morrison, MRCS, Jon C. Clasper, DPhil, FRCSEd(Orth), Mark J. Midwinter, MD, FRCS, and Jan O. Jansen...the IP group, compared with the EP, although this does not achieve statistical significance, likely owing to a lack of power within the study. The war

The bizarre request for amputation.

PubMed

Barnes, Rachel

2011-12-01

Apotemnophilia is a condition where sufferers wish to be an amputee. Currently, belief in the medical profession is that it is part of the spectrum of body dysmorphic disorder and as such patients are denied surgical correction. This can lead sufferers to extreme lengths. Proponents seek to have the disorder reclassified to a body identity integrity disorder such as gender identity disorder. In this way treatment modalities could be reassessed.

The Effect of Clinical Care Location on Clinical Outcomes After Peripheral Vascular Intervention in Medicare Beneficiaries.

PubMed

Turley, Ryan S; Mi, Xiaojuan; Qualls, Laura G; Vemulapalli, Sreekanth; Peterson, Eric D; Patel, Manesh R; Curtis, Lesley H; Jones, W Schuyler

2017-06-12

Modifications in reimbursement rates by Medicare in 2008 have led to peripheral vascular interventions (PVI) being performed more commonly in outpatient and office-based clinics. The objective of this study was to determine the effects of this shift in clinical care setting on clinical outcomes after PVI. Modifications in reimbursement have led to peripheral vascular intervention (PVI) being more commonly performed in outpatient hospital settings and office-based clinics. Using a 100% national sample of Medicare beneficiaries from 2010 to 2012, we examined 30-day and 1-year rates of all-cause mortality, major lower extremity amputation, repeat revascularization, and all-cause hospitalization by clinical care location of index PVI. A total of 218,858 Medicare beneficiaries underwent an index PVI between 2010 and 2012. Index PVIs performed in inpatient settings were associated with higher 1-year rates of all-cause mortality (23.6% vs. 10.4% and 11.7%; p < 0.001), major lower extremity amputation (10.1% vs. 3.7% and 3.5%; p < 0.001), and all-cause repeat hospitalization (63.3% vs. 48.5% and 48.0%; p < 0.001), but lower rates of repeat revascularization (25.1% vs. 26.9% vs. 38.6%; p < 0.001) when compared with outpatient hospital settings and office-based clinics, respectively. After adjustment for potential confounders, patients treated in office-based clinics remained more likely than patients in inpatient hospital settings to require repeat revascularization within 1 year across all specialties. There was also a statistically significant interaction effect between location of index revascularization and geographic region on the occurrence of all-cause hospitalization, repeat revascularization, and lower extremity amputation. Index PVI performed in office-based settings was associated with a higher hazard of repeat revascularization when compared with other settings. Differences in clinical outcomes across treatment settings and geographic regions suggest that inconsistent application of PVI may exist and highlights the need for studies to determine optimal delivery of PVI in clinical practice. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Innovations in prosthetic interfaces for the upper extremity.

PubMed

Kung, Theodore A; Bueno, Reuben A; Alkhalefah, Ghadah K; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S

2013-12-01

Advancements in modern robotic technology have led to the development of highly sophisticated upper extremity prosthetic limbs. High-fidelity volitional control of these devices is dependent on the critical interface between the patient and the mechanical prosthesis. Recent innovations in prosthetic interfaces have focused on several control strategies. Targeted muscle reinnervation is currently the most immediately applicable prosthetic control strategy and is particularly indicated in proximal upper extremity amputations. Investigation into various brain interfaces has allowed acquisition of neuroelectric signals directly or indirectly from the central nervous system for prosthetic control. Peripheral nerve interfaces permit signal transduction from both motor and sensory nerves with a higher degree of selectivity. This article reviews the current developments in each of these interface systems and discusses the potential of these approaches to facilitate motor control and sensory feedback in upper extremity neuroprosthetic devices.

French Flight Test Program LEA Status

DTIC Science & Technology

2010-09-01

RTO-EN-AVT-185 17 - 1 French Flight Test Program LEA Status Francois FALEMPIN MBDA France 1 avenue Reaumur Le Plessis Robinson FRANCE ...TITLE AND SUBTITLE French Flight Test Program LEA Status 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT ...Bouchez, Nicolas Gascoin, Measurement for fuel reforming for scramjet thermal management: status of COMPARER project - AIAA-2009-7373. French

Xenografted islet cell clusters from INSLEA29Y transgenic pigs rescue diabetes and prevent immune rejection in humanized mice.

PubMed

Klymiuk, Nikolai; van Buerck, Lelia; Bähr, Andrea; Offers, Monika; Kessler, Barbara; Wuensch, Annegret; Kurome, Mayuko; Thormann, Michael; Lochner, Katharina; Nagashima, Hiroshi; Herbach, Nadja; Wanke, Rüdiger; Seissler, Jochen; Wolf, Eckhard

2012-06-01

Islet transplantation is a potential treatment for type 1 diabetes, but the shortage of donor organs limits its routine application. As potential donor animals, we generated transgenic pigs expressing LEA29Y, a high-affinity variant of the T-cell costimulation inhibitor CTLA-4Ig, under the control of the porcine insulin gene promoter. Neonatal islet cell clusters (ICCs) from INSLEA29Y transgenic (LEA-tg) pigs and wild-type controls were transplanted into streptozotocin-induced hyperglycemic NOD-scid IL2Rγ(null) mice. Cloned LEA-tg pigs are healthy and exhibit a strong β-cell-specific transgene expression. LEA-tg ICCs displayed the same potential to normalize glucose homeostasis as wild-type ICCs after transplantation. After adoptive transfer of human peripheral blood mononuclear cells, transplanted LEA-tg ICCs were completely protected from rejection, whereas reoccurrence of hyperglycemia was observed in 80% of mice transplanted with wild-type ICCs. In the current study, we provide the first proof-of-principle report on transgenic pigs with β-cell-specific expression of LEA29Y and their successful application as donors in a xenotransplantation model. This approach may represent a major step toward the development of a novel strategy for pig-to-human islet transplantation without side effects of systemic immunosuppression.

Pediatric Amblyopia Risk Investigation Study (PARIS).

PubMed

Savage, Howard I; Lee, Hester H; Zaetta, Deneen; Olszowy, Ronald; Hamburger, Ellie; Weissman, Mark; Frick, Kevin

2005-12-01

To assess the learning curve, testability, and reliability of vision screening modalities administered by pediatric health extenders. Prospective masked clinical trial. Two hundred subjects aged 3 to 6 underwent timed screening for amblyopia by physician extenders, including LEA visual acuity (LEA), stereopsis (RDE), and noncycloplegic autorefraction (NCAR). Patients returned for a comprehensive diagnostic eye examination performed by an ophthalmologist or optometrist. Average screening time was 5.4 +/- 1.6 minutes (LEA), 1.9 +/- 0.9 minutes (RDE), and 1.7 +/- 1.0 minutes (NCAR). Test time for NCAR and RDE fell by 40% during the study period. Overall testability was 92% (LEA), 96% (RDE), and 94% (NCAR). Testability among 3-year-olds was 73% (LEA), 96% (RDE), and 89% (NCAR). Reliability of LEA was moderate (r = .59). Reliability of NCAR was high for astigmatism (Cyl) (r = .89), moderate for spherical equivalent (SE) (r = .66), and low for anisometropia (ANISO) (r = .38). Correlation of cycloplegic autorefraction (CAR) with gold standard cycloplegic retinoscopic refraction (CRR) was very high for SE (.85), CYL (.77), and moderate for ANISO (.48). With NCAR, physician extenders can quickly and reliably detect astigmatism and spherical refractive error in one-third the time it takes to obtain visual acuity. LEA has a lower initial cost, but is time consuming, moderately reliable, and more difficult for 3-year-olds. Shorter examination time and higher reliability may make NCAR a more efficient screening tool for refractive amblyopia in younger children. Future study is needed to determine the sensitivity and specificity of NCAR and other screening methods in detecting amblyopia and amblyopia risk factors.

Revision of the Australian species of the weevil genus Trigonopterus Fauvel

PubMed Central

Riedel, Alexander; Tänzler, Rene

2016-01-01

Abstract The Australian species of the genus Trigonopterus Fauvel are revised. Eight previously recognized species are redescribed and 24 additional new species are described: Trigonopterus allaetus Riedel, sp. n., Trigonopterus athertonensis Riedel, sp. n., Trigonopterus australinasutus Riedel, sp. n., Trigonopterus australis Riedel, sp. n., Trigonopterus bisignatus Riedel, sp. n., Trigonopterus bisinuatus Riedel, sp. n., Trigonopterus boolbunensis Riedel, sp. n., Trigonopterus cooktownensis Riedel, sp. n., Trigonopterus daintreensis Riedel, sp. n., Trigonopterus deplanatus Riedel, sp. n., Trigonopterus finniganensis Riedel, sp. n., Trigonopterus fraterculus Riedel, sp. n., Trigonopterus garradungensis Riedel, sp. n., Trigonopterus hasenpuschi Riedel, sp. n., Trigonopterus hartleyensis Riedel, sp. n., Trigonopterus kurandensis Riedel, sp. n., Trigonopterus lewisensis Riedel, sp. n., Trigonopterus montanus Riedel, sp. n., Trigonopterus monteithi Riedel, sp. n., Trigonopterus mossmanensis Riedel, sp. n., Trigonopterus oberprieleri Riedel, sp. n., Trigonopterus robertsi Riedel, sp. n., Trigonopterus terraereginae Riedel, sp. n., Trigonopterus yorkensis Riedel, sp. n.. All new species are authored by the taxonomist-in-charge, Alexander Riedel. Lectotypes are designated for the following names: Idotasia aequalis Pascoe, Idotasia albidosparsa Lea, Idotasia evanida Pascoe, Idotasia laeta Lea, Idotasia rostralis Lea, Idotasia sculptirostris Lea, Idotasia squamosa Lea. A new combination of the name Idotasia striatipennis Lea is proposed: Trigonopterus striatipennis (Lea), comb. n.. A key to the species is provided. Australian Trigonopterus occur in coastal Queensland, narrowly crossing into New South Wales. The southern parts of the range are inhabited by species found on foliage. A rich fauna of 19 edaphic species inhabiting the leaf litter of tropical forests is reported for the first time from the Australian Wet Tropics. PMID:26877696

Delivery of cosmetic covers to persons with transtibial and transfemoral amputations in an outpatient prosthetic practice.

PubMed

Highsmith, M Jason; Kahle, Jason T; Knight, Molly; Olk-Szost, Ayla; Boyd, Melinda; Miro, Rebecca M

2016-06-01

Limb loss negatively impacts body image to the extent that functional activity and societal participation are affected. Scientific literature is lacking on the subject of cosmetic covering for prostheses and the rate of cosmetic cover utilization by cover type, gender, amputation level, and type of healthcare reimbursement. To describe the delivery of cosmetic covers in lower limb prostheses in a sample of people with lower extremity amputation. Cross-sectional design Patient records from an outpatient practice were reviewed for people who received a transtibial or transfemoral prosthesis within a selected 2-year period. A total of 294 records were reviewed. Regardless of the amputation level, females were significantly (p ≤ 0.05) more likely to receive a cover. Type of insurance did not affect whether or not a cover was used, but Medicare reimbursed more pull-up skin covers. There were differences regarding cosmetic cover delivery based on gender, and Medicare reimbursed for more pull-up skin covers at the transtibial level than other reimbursors did. This analysis was conducted in a warm, tropical geographic region of the United States. Results may differ in other parts of the world based on many factors including climate and local views of body image and disability. Cosmetic covering rates are clinically relevant because they provide insight into which gender is utilizing more cosmetic covers. Furthermore, it can be determined which type of covers are being utilized with greater frequency and which insurance type is providing more coverage for them. © The International Society for Prosthetics and Orthotics 2015.

Outcome of patients with reduced ankle brachial index undergoing open heart surgery with cardiopulmonary bypass.

PubMed

Meyborg, Matthias; Abdi-Tabari, Zila; Hoffmeier, Andreas; Engelbertz, Christiane; Lüders, Florian; Freisinger, Eva; Malyar, Nasser M; Martens, Sven; Reinecke, Holger

2016-05-01

In open heart surgery using cardiopulmonary bypass, perfusion of the lower extremities is markedly reduced which may induce critical ischaemia in patients with pre-existing peripheral artery disease. Whether these patients have an increased risk for amputation and should better undergo peripheral revascularization prior to surgery remains unclear. From 1 January 2009 to 31 December 2010, 785 consecutive patients undergoing open heart surgery were retrospectively included. In 443 of these patients, preoperative ankle brachial index (ABI) measurements were available. The cohort was divided into four groups: (i) ABI < 0.5, (ii) ABI 0.5-0.69, (iii) ABI 0.7-0.89 or (iv) ABI ≥ 0.9. Follow-up data of 413 (93.2%) patients were analysed with regard to mortality and amputations. The groups differed significantly in terms of age, cardiac risk factors, performed cardiac surgery and renal function. Postoperative delayed wound healing was significantly associated with lower ABI (25.9, 15.2, 27.0 and 9.6% in Groups I-IV, respectively, P = 0.003), whereas 30-day mortality was not significantly higher in patients with lower ABI (0, 4.3, 8.1 and 3.9%, respectively, P = 0.4). Kaplan-Meier models showed a significantly lower long-term survival over 4 years in patients with reduced ABI (P = 0.001, long-rank test) while amputations occurred rarely with only one minor amputation in Group II (P = 0.023). Patients with reduced ABIs undergoing heart surgery showed more wound-healing disturbances, and higher long-term mortality compared with those with normal ABIs. However, no perioperative ischaemia requiring amputation occurred. Thus, reduced ABIs were not associated with increased peripheral risks in open heart surgery but ABI may be helpful in selecting the site for saphenectomy to potentially avoid delayed healing of related wounds in legs with severely impaired arterial perfusion. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Upper extremity prosthesis user perspectives on unmet needs and innovative technology.

PubMed

Benz, Heather L; Jia Yao; Rose, Laura; Olgac, Okan; Kreutz, Karen; Saha, Anindita; Civillico, Eugene F

2016-08-01

The needs of individuals with upper limb amputation and congenital limb difference are not being fully met by current prostheses, as evidenced by prosthesis rejection, non-wear, and user reports of pain and challenging activities. Emerging technologies such as dexterous sensorized robotic limbs, osseointegrated prostheses, implantable EMG electrodes, and electrical stimulation for sensory feedback have the potential to address unmet needs, but pose additional risks. We plan to assess upper limb prosthesis user needs and perspectives on these new benefits and risks using an extensive quantitative survey. In preparation for this survey, we report here on qualitative interviews with seven individuals with upper limb amputation or congenital limb difference. Unstructured text was mined using topic modeling and the results compared with identified themes. A more complete understanding of how novel technologies could address real user concerns will inform implementation of new technologies and regulatory decision-making.

Upper Extremity Prosthesis User Perspectives on Unmet Needs and Innovative Technology

PubMed Central

Benz, Heather L.; Yao, Jia; Rose, Laura; Olgac, Okan; Kreutz, Karen; Saha, Anindita; Civillico, Eugene F.

2017-01-01

The needs of individuals with upper limb amputation and congenital limb difference are not being fully met by current prostheses, as evidenced by prosthesis rejection, non-wear, and user reports of pain and challenging activities. Emerging technologies such as dexterous sensorized robotic limbs, osseointegrated prostheses, implantable EMG electrodes, and electrical stimulation for sensory feedback have the potential to address unmet needs, but pose additional risks. We plan to assess upper limb prosthesis user needs and perspectives on these new benefits and risks using an extensive quantitative survey. In preparation for this survey, we report here on qualitative interviews with seven individuals with upper limb amputation or congenital limb difference. Unstructured text was mined using topic modeling and the results compared with identified themes. A more complete understanding of how novel technologies could address real user concerns will inform implementation of new technologies and regulatory decision-making. PMID:28268333

Third-degree burn leading to partial foot amputation--why a notebook is no laptop.

PubMed

Paprottka, Felix Julian; Machens, Hans-Günther; Lohmeyer, Jörn Andreas

2012-08-01

So far a few case reports about laptops causing burns have been published. Now for the first time, we report on a case, in which notebook-induced thermal injuries placed in a patient's lap resulted in severe second- and third-degree burns. As a consequence, a partial amputation of the left foot had to be performed. Furthermore, we measured maximum temperatures of 12 popular laptops, which were running full load for 3 h. For this experiment air circulation underneath the device was blocked in order to simulate surrounding conditions, which were present when the patient got injured. Although this setting may be the reason for most of all notebook burns, this kind of test has not been part of any scientific publication until now. Patients with lower extremity sensation, altered consciousness or decreased peripheral sensitivity have a higher risk for thermal injuries. Copyright © 2012. Published by Elsevier Ltd.

A molecular analysis of desiccation tolerance mechanisms in the anhydrobiotic nematode Panagrolaimus superbus using expressed sequenced tags

PubMed Central

2012-01-01

Background Some organisms can survive extreme desiccation by entering into a state of suspended animation known as anhydrobiosis. Panagrolaimus superbus is a free-living anhydrobiotic nematode that can survive rapid environmental desiccation. The mechanisms that P. superbus uses to combat the potentially lethal effects of cellular dehydration may include the constitutive and inducible expression of protective molecules, along with behavioural and/or morphological adaptations that slow the rate of cellular water loss. In addition, inducible repair and revival programmes may also be required for successful rehydration and recovery from anhydrobiosis. Results To identify constitutively expressed candidate anhydrobiotic genes we obtained 9,216 ESTs from an unstressed mixed stage population of P. superbus. We derived 4,009 unigenes from these ESTs. These unigene annotations and sequences can be accessed at http://www.nematodes.org/nembase4/species_info.php?species=PSC. We manually annotated a set of 187 constitutively expressed candidate anhydrobiotic genes from P. superbus. Notable among those is a putative lineage expansion of the lea (late embryogenesis abundant) gene family. The most abundantly expressed sequence was a member of the nematode specific sxp/ral-2 family that is highly expressed in parasitic nematodes and secreted onto the surface of the nematodes' cuticles. There were 2,059 novel unigenes (51.7% of the total), 149 of which are predicted to encode intrinsically disordered proteins lacking a fixed tertiary structure. One unigene may encode an exo-β-1,3-glucanase (GHF5 family), most similar to a sequence from Phytophthora infestans. GHF5 enzymes have been reported from several species of plant parasitic nematodes, with horizontal gene transfer (HGT) from bacteria proposed to explain their evolutionary origin. This P. superbus sequence represents another possible HGT event within the Nematoda. The expression of five of the 19 putative stress response genes tested was upregulated in response to desiccation. These were the antioxidants glutathione peroxidase, dj-1 and 1-Cys peroxiredoxin, an shsp sequence and an lea gene. Conclusions P. superbus appears to utilise a strategy of combined constitutive and inducible gene expression in preparation for entry into anhydrobiosis. The apparent lineage expansion of lea genes, together with their constitutive and inducible expression, suggests that LEA3 proteins are important components of the anhydrobiotic protection repertoire of P. superbus. PMID:22281184

Sensory Feedback for Lower Extremity Prostheses Incorporating Targeted Muscle Reinnervation (TMR)

DTIC Science & Technology

2016-10-01

amputation to establish baselines and guide development. The second technique makes use of Virtual Reality ( VR ) to provide visual and tactile...of view in VR (left) and real world (right) Figure 6: Confidence for offsets presented to Site 1 (closest to the knee) on the right in blue, and...presentations Three presentations were given at the Northwest Biomechanics Symposium 2016 Technologies or techniques We have pioneered a VR

Extremity War Injuries: Current Management and Research Priorities

DTIC Science & Technology

2012-01-01

sal- vage and amputation. The 13 articles generated from this symposium ad- dress these topics as well as multi- modal strategies for pain control...reconstruction, and reha- bilitation. The last seven articles of this supplement address lessons learned, outcomes measures, current strategies, and knowledge... bioburden , which has resulted in im- proved patient care. At the EWI VII Symposium, sev- eral research priorities were outlined in the areas of acute care

Management of Complex Extremity Injuries: Tourniquets, Compartment Syndrome Detection, Fasciotomy, and Amputation Care

DTIC Science & Technology

2012-01-01

result in rhabdomyolysis, hyperkalemia , or both. In these cases, myoglobin from the damaged tissue can be released with the potential of causing renal...laboratory, “crankcase” or dark urine should lead to a high index of suspicion. Potassium can also be released, causing hyperkalemia and the potential of...cardiac arrhythmias. Treatment of rhabdomyolysis and of hyperkalemia is similar: Check for tourniquets and remove if possible. Restore

Development of Osseointegrated Implants for Soldier Amputees Following Orthopaedic Extremity Trauma

DTIC Science & Technology

2008-08-01

specimens, histology and mechanical testing of implants. The second focus of Year 2 was human morphometric studies on variations due to ethnicity, gender...custom implants in above-knee patients with amputations would require expensive custom type implants, a morphometric study was conducted on human...male and female cadaveric femurs. Morphometric variations of the periosteal surface of long bones have been identified with changing age, gender and

Major Extremity Trauma Research Consortium (METRC) 2011 Annual Report

DTIC Science & Technology

2011-01-01

military treatment centers (MTFs). METRC is designed to meet these needs. Anchored by a Data Coordinating Center at the Johns Hopkins Bloomberg...talus or crush injuries only). Excluded from the registry are hip fractures in patients 60 years or older and fractures to the wrist, hand, ankle ...OUTLET: Outcomes following severe distal tibia, ankle and/or foot trauma: comparison of limb salvage vs. transtibial amputation STATUS: Master protocol

Principles of management: the diabetic foot.

PubMed

Wieman, T Jeffery

2005-08-01

Diabetes mellitus affects 5-10% of the US population at some point in their lives. Hyperglycemia produces serious chronic complications. Peripheral neuropathy is one of the most serious of these. Peripheral neuropathy, in the lower extremities, leads to plantar foot ulceration. Secondary infection of these ulcers is by far the leading cause of major amputations of feet and legs. Proper preventative care will dramatically reduce ulcer formation and costs related to this complication.

[Pedal bypass using venous allograft].

PubMed

Pluháčková, H; Staffa, R; Konečný, Z; Kříž, Z; Vlachovský, R

Pedal or distal crural bypass surgery for limb salvage is a method with very good long-term results. For patients in whom a suitable autologous venous graft is not available, the use of a venous allograft is an alternative procedure. A 68 years old man with ischaemic disease of lower extremities and gangrene of the left foot was admitted to our Centre in August 2014. He underwent percutaneous transluminal angioplasty of crural arteries of his left lower extremity. This, however, failed to improve peripheral circulation. The patient was then indicated for pedal or distal crural vascular reconstruction. Since no suitable autologous vein was available, distal bypass surgery using a donor graft remained the only option for limb salvage. Amputation of the toes on the left foot due to gangrene was necessary. Subsequently, femoro-pedal bypass to the left common plantar artery was performed using a great saphenous vein allograft. The post-operative course was without complications, the pedal bypass was patent and toe amputation was with good healing. The patient remained in follow-up care. A good outcome of vascular reconstruction with an allograft depends on the availability of a suitable allograft and good patient compliance with post-operative care. In the case presented here, the pedal bypass grafting by means of an allograft helped to save the patients limb. pedal bypass venous allograft limb salvage.

Factors Associated With Late Specialized Rehabilitation among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

PubMed Central

Kurichi, Jibby E.; Xie, Dawei; Kwong, Pui L.; Bates, Barbara E.; Vogel, W. Bruce; Stineman, Margaret G.

2011-01-01

Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units. PMID:21389847

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections.

PubMed

Schmidt, Brian M; McHugh, Jonathan B; Patel, Rajiv M; Wrobel, James S

2018-04-01

Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. Prognostic, Level I: Prospective.

The Ubiquitous Distribution of Late Embryogenesis Abundant Proteins across Cell Compartments in Arabidopsis Offers Tailored Protection against Abiotic Stress[C][W][OPEN

PubMed Central

Candat, Adrien; Paszkiewicz, Gaël; Neveu, Martine; Gautier, Romain; Logan, David C.; Avelange-Macherel, Marie-Hélène; Macherel, David

2014-01-01

Late embryogenesis abundant (LEA) proteins are hydrophilic, mostly intrinsically disordered proteins, which play major roles in desiccation tolerance. In Arabidopsis thaliana, 51 genes encoding LEA proteins clustered into nine families have been inventoried. To increase our understanding of the yet enigmatic functions of these gene families, we report the subcellular location of each protein. Experimental data highlight the limits of in silico predictions for analysis of subcellular localization. Thirty-six LEA proteins localized to the cytosol, with most being able to diffuse into the nucleus. Three proteins were exclusively localized in plastids or mitochondria, while two others were found dually targeted to these organelles. Targeting cleavage sites could be determined for five of these proteins. Three proteins were found to be endoplasmic reticulum (ER) residents, two were vacuolar, and two were secreted. A single protein was identified in pexophagosomes. While most LEA protein families have a unique subcellular localization, members of the LEA_4 family are widely distributed (cytosol, mitochondria, plastid, ER, and pexophagosome) but share the presence of the class A α-helix motif. They are thus expected to establish interactions with various cellular membranes under stress conditions. The broad subcellular distribution of LEA proteins highlights the requirement for each cellular compartment to be provided with protective mechanisms to cope with desiccation or cold stress. PMID:25005920

Health Information in Tongan (lea faka-Tonga)

MedlinePlus

... Centers for Disease Control and Prevention S Expand Section Suicide Protecting Your Child from Suicide - English PDF Protecting Your Child from Suicide - lea faka-Tonga (Tongan ) PDF Protecting ...

Efficient Hardware Implementation of the Lightweight Block Encryption Algorithm LEA

PubMed Central

Lee, Donggeon; Kim, Dong-Chan; Kwon, Daesung; Kim, Howon

2014-01-01

Recently, due to the advent of resource-constrained trends, such as smartphones and smart devices, the computing environment is changing. Because our daily life is deeply intertwined with ubiquitous networks, the importance of security is growing. A lightweight encryption algorithm is essential for secure communication between these kinds of resource-constrained devices, and many researchers have been investigating this field. Recently, a lightweight block cipher called LEA was proposed. LEA was originally targeted for efficient implementation on microprocessors, as it is fast when implemented in software and furthermore, it has a small memory footprint. To reflect on recent technology, all required calculations utilize 32-bit wide operations. In addition, the algorithm is comprised of not complex S-Box-like structures but simple Addition, Rotation, and XOR operations. To the best of our knowledge, this paper is the first report on a comprehensive hardware implementation of LEA. We present various hardware structures and their implementation results according to key sizes. Even though LEA was originally targeted at software efficiency, it also shows high efficiency when implemented as hardware. PMID:24406859

Prior failed ipsilateral percutaneous endovascular intervention in patients with critical limb ischemia predicts poor outcome after lower extremity bypass

PubMed Central

Nolan, Brian W.; De Martino, Randall R.; Stone, David H.; Schanzer, Andres; Goodney, Philip P.; Walsh, Daniel W.; Cronenwett, Jack L.

2017-01-01

Background Although open surgical bypass remains the standard revascularization strategy for patients with critical limb ischemia (CLI), many centers now perform peripheral endovascular intervention (PVI) as the first-line treatment for these patients. We sought to determine the effect of a prior ipsilateral PVI (iPVI) on the outcome of subsequent lower extremity bypass (LEB) in patients with CLI. Methods A retrospective cohort analysis of all patients undergoing infrainguinal LEB between 2003 and 2009 within hospitals comprising the Vascular Study Group of New England (VSGNE) was performed. Primary study endpoints were major amputation and graft occlusion at 1 year postoperatively. Secondary outcomes included in-hospital major adverse events (MAE), 1-year mortality, and composite 1-year major adverse limb events (MALE). Event rates were determined using life table analyses and comparisons were performed using the log-rank test. Multivariate predictors were determined using a Cox proportional hazards model with multilevel hierarchical adjustment. Results Of 1880 LEBs performed, 32% (n = 603) had a prior infrainguinal revascularization procedure (iPVI, 7%; ipsilateral bypass, 15%; contralateral PVI, 3%; contralateral bypass, 17%). Patients with prior iPVI, compared with those without a prior iPVI, were more likely to be women (32 vs 41%; P = .04), less likely to have tissue loss (52% vs 63%; P = .02), more likely to require arm vein conduit (16% vs 5%; P = .001), and more likely to be on statin (71% vs 54%; P = .01) and beta blocker therapy (92% vs 81%; P = .01) at the time of their bypass procedure. Other demographic factors were similar between these groups. Prior PVI or bypass did not alter 30-day MAE and 1-year mortality after the index bypass. In contrast, 1-year major amputation and 1-year graft occlusion rates were significantly higher in patients who had prior iPVI than those without (31% vs 20%; P = .046 and 28% vs 18%; P = .009), similar to patients who had a prior ipsilateral bypass (1 year major amputation, 29% vs 20%; P = .022; 1 year graft occlusion, 33% vs 18%; P = .001). Independent multivariate predictors of higher 1-year amputation and graft occlusion rates were prior iPVI, prior ipsilateral bypass, dialysis dependence, prosthetic conduit and distal (tibial and pedal) bypass target. Conclusions Prior iPVI is highly predictive for poor outcome in patients undergoing LEB for CLI with higher 1-year amputation and graft occlusion rates than those without prior revascularization, similar to prior ipsilateral bypass These findings provide information, which may help with the complex decisions surrounding revascularization options in patients with CLI. PMID:21802888

34 CFR 200.52 - LEA improvement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... through 200.20; (v) Address— (A) The fundamental teaching and learning needs in the schools of the LEA... effective methods and instructional strategies grounded in scientifically based research; and (ii) Address...

34 CFR 200.52 - LEA improvement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... through 200.20; (v) Address— (A) The fundamental teaching and learning needs in the schools of the LEA... effective methods and instructional strategies grounded in scientifically based research; and (ii) Address...

34 CFR 200.52 - LEA improvement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... through 200.20; (v) Address— (A) The fundamental teaching and learning needs in the schools of the LEA... effective methods and instructional strategies grounded in scientifically based research; and (ii) Address...

34 CFR 200.52 - LEA improvement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... through 200.20; (v) Address— (A) The fundamental teaching and learning needs in the schools of the LEA... effective methods and instructional strategies grounded in scientifically based research; and (ii) Address...

Brain’s DNA Repair Response to Neurotoxicants

DTIC Science & Technology

2007-01-01

Creppy et al., 1983b; Haubeck et al., 1981; Lea et al., 1989; Stormer and Lea, 1995), teratogenic (Arora et al., 1983; Fukui et al., 1992; Szczech and Hood...aminoacyl-tRNA synthetases and on the growth and protein synthesis of hepatoma cells. Toxicol Lett 1983a;19:217–24. Creppy EE, Stormer FC, Roschenthaler R...1989;2:179–248. Lea T, Steien K, Stormer FC. Mechanism of ochratoxin A-induced immuno- suppression. Mycopathologia 1989;107:153–9. Lebrun S, Follmann W

Intrinsically disordered proteins as molecular shields†

PubMed Central

Chakrabortee, Sohini; Tripathi, Rashmi; Watson, Matthew; Kaminski Schierle, Gabriele S.; Kurniawan, Davy P.; Kaminski, Clemens F.; Wise, Michael J.; Tunnacliffe, Alan

2017-01-01

The broad family of LEA proteins are intrinsically disordered proteins (IDPs) with several potential roles in desiccation tolerance, or anhydrobiosis, one of which is to limit desiccation-induced aggregation of cellular proteins. We show here that this activity, termed molecular shield function, is distinct from that of a classical molecular chaperone, such as HSP70 – while HSP70 reduces aggregation of citrate synthase (CS) on heating, two LEA proteins, a nematode group 3 protein, AavLEA1, and a plant group 1 protein, Em, do not; conversely, the LEA proteins reduce CS aggregation on desiccation, while HSP70 lacks this ability. There are also differences in interaction with client proteins – HSP70 can be co-immunoprecipitated with a polyglutamine-containing client, consistent with tight complex formation, whereas the LEA proteins can not, although a loose interaction is observed by Förster resonance energy transfer. In a further exploration of molecular shield function, we demonstrate that synthetic polysaccharides, like LEA proteins, are able to reduce desiccation-induced aggregation of a water-soluble proteome, consistent with a steric interference model of anti-aggregation activity. If molecular shields operate by reducing intermolecular cohesion rates, they should not protect against intramolecular protein damage. This was tested using the monomeric red fluorescent protein, mCherry, which does not undergo aggregation on drying, but the absorbance and emission spectra of its intrinsic fluorophore are dramatically reduced, indicative of intramolecular conformational changes. As expected, these changes are not prevented by AavLEA1, except for a slight protection at high molar ratios, and an AavLEA1-mCherry fusion protein is damaged to the same extent as mCherry alone. A recent hypothesis proposed that proteomes from desiccation-tolerant species contain a higher degree of disorder than intolerant examples, and that this might provide greater intrinsic stability, but a bioinformatics survey does not support this, since there are no significant differences in the degree of disorder between desiccation tolerant and intolerant species. It seems clear therefore that molecular shield function is largely an intermolecular activity implemented by specialist IDPs, distinct from molecular chaperones, but with a role in proteostasis. PMID:21909508

Intrinsically disordered proteins as molecular shields.

PubMed

Chakrabortee, Sohini; Tripathi, Rashmi; Watson, Matthew; Schierle, Gabriele S Kaminski; Kurniawan, Davy P; Kaminski, Clemens F; Wise, Michael J; Tunnacliffe, Alan

2012-01-01

The broad family of LEA proteins are intrinsically disordered proteins (IDPs) with several potential roles in desiccation tolerance, or anhydrobiosis, one of which is to limit desiccation-induced aggregation of cellular proteins. We show here that this activity, termed molecular shield function, is distinct from that of a classical molecular chaperone, such as HSP70 - while HSP70 reduces aggregation of citrate synthase (CS) on heating, two LEA proteins, a nematode group 3 protein, AavLEA1, and a plant group 1 protein, Em, do not; conversely, the LEA proteins reduce CS aggregation on desiccation, while HSP70 lacks this ability. There are also differences in interaction with client proteins - HSP70 can be co-immunoprecipitated with a polyglutamine-containing client, consistent with tight complex formation, whereas the LEA proteins can not, although a loose interaction is observed by Förster resonance energy transfer. In a further exploration of molecular shield function, we demonstrate that synthetic polysaccharides, like LEA proteins, are able to reduce desiccation-induced aggregation of a water-soluble proteome, consistent with a steric interference model of anti-aggregation activity. If molecular shields operate by reducing intermolecular cohesion rates, they should not protect against intramolecular protein damage. This was tested using the monomeric red fluorescent protein, mCherry, which does not undergo aggregation on drying, but the absorbance and emission spectra of its intrinsic fluorophore are dramatically reduced, indicative of intramolecular conformational changes. As expected, these changes are not prevented by AavLEA1, except for a slight protection at high molar ratios, and an AavLEA1-mCherry fusion protein is damaged to the same extent as mCherry alone. A recent hypothesis proposed that proteomes from desiccation-tolerant species contain a higher degree of disorder than intolerant examples, and that this might provide greater intrinsic stability, but a bioinformatics survey does not support this, since there are no significant differences in the degree of disorder between desiccation tolerant and intolerant species. It seems clear therefore that molecular shield function is largely an intermolecular activity implemented by specialist IDPs, distinct from molecular chaperones, but with a role in proteostasis.

Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

PubMed Central

Highsmith, M. Jason; Andrews, Casey R.; Millman, Claire; Fuller, Ashley; Kahle, Jason T.; Klenow, Tyler D.; Lewis, Katherine L.; Bradley, Rachel C.; Orriola, John J.

2016-01-01

Lower extremity (LE) amputation patients who use prostheses have gait asymmetries and altered limb loading and movement strategies when ambulating. Subsequent secondary conditions are believed to be associated with gait deviations and lead to long-term complications that impact function and quality of life as a result. The purpose of this study was to systematically review the literature to determine the strength of evidence supporting gait training interventions and to formulate evidence statements to guide practice and research related to therapeutic gait training for lower extremity amputees. A systematic review of three databases was conducted followed by evaluation of evidence and synthesis of empirical evidence statements (EES). Eighteen manuscripts were included in the review, which covered two areas of gait training interventions: 1) overground and 2) treadmill-based. Eight EESs were synthesized. Four addressed overground gait training, one covered treadmill training, and three statements addressed both forms of therapy. Due to the gait asymmetries, altered biomechanics, and related secondary consequences associated with LE amputation, gait training interventions are needed along with study of their efficacy. Overground training with verbal or other auditory, manual, and psychological awareness interventions was found to be effective at improving gait. Similarly, treadmill-based training was found to be effective: 1) as a supplement to overground training; 2) independently when augmented with visual feedback and/or body weight support; or 3) as part of a home exercise plan. Gait training approaches studied improved multiple areas of gait, including sagittal and coronal biomechanics, spatiotemporal measures, and distance walked. PMID:28066520

War-related extremity injuries in children: 89 cases managed in a combat support hospital in Afghanistan.

PubMed

Bertani, A; Mathieu, L; Dahan, J-L; Launay, F; Rongiéras, F; Rigal, S

2015-05-01

Meeting paediatric needs is among the priorities of western healthcare providers working in Afghanistan. Insufficient information is available on paediatric wartime injuries to the extremities. Our objective here was to describe these injuries and their management on the field. We retrospectively reviewed consecutive cases of injuries to the extremities in children (< 16 years of age) due to weapons and managed at the Kabul International Airport (KaIA) Combat Support Hospital between June 2009 and April 2013. We identified 89 patients with a mean age of 10.2 ± 3.5 years and a total of 137 elemental lesions. Explosive devices accounted for most injuries (78.6%) and carried a significantly higher risk of multiple lesions. There were 54 bone lesions (traumatic amputations and fractures) and 83 soft-tissue lesions. The amputation rate was 18%. Presence of bone lesions was associated with a higher risk of injury to blood vessels and nerves. Of the 89 patients, four (4.5%) died and eight (9%) were transferred elsewhere. Of the 77 remaining patients, at last follow-up (median, one month; range, 0.1-16 months), 73 (95%) had achieved a full recovery (healed wound and/or fracture) or were recovering with no expectation that further surgery would be needed. Despite the absence of paediatric surgeons, the combat support hospital provided appropriate care at the limb salvage and reconstruction phases. The highly specialised treatments needed to manage sequelae were very rarely provided. These treatments probably deserve to be developed in combat support hospitals. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Quality of time spent without symptoms of disease or toxicity of treatment for transmetatarsal amputation versus digital amputation in diabetic patients with digital gangrene.

PubMed

Elsherif, Mohamed; Tawfick, Wael; Canning, Patrick; Hynes, Niamh; Sultan, Sherif

2018-04-01

Aim We aim to compare the outcome of diabetic patients with gangrenous toes who were managed initially either by digital amputation or by transmetatarsal amputation. The null hypothesis is that transmetatarsal amputation had less theatre trips and better healing. Materials and Methods A parallel observational comparative study of all diabetic patients who underwent either digital or transmetatarsal amputation in a tertiary referral center from 2002 through 2015. Comorbid conditions, subsequent amputations, hospital stay, and readmission were noted. Results A total of 223 patients underwent minor amputation during the study period, of which 147 patients were diabetic and 76 patients were non-diabetic. Seventy-seven patients had digital amputation and 70 transmetatarsal amputation in diabetic patients. Demographics were similar in both groups. The median time to major amputation was (400 ± IQR 1205 days) in the digital amputation group, compared to 690 ± IQR 891 days in the transmetatarsal amputation group ( P = 0.974). 29.9% of digital amputations and 15.7% of transmetatarsal amputations in diabetic patients, required minor amputations or revision procedures ( P = 0.04). Median length of hospital stay was (20 days, IQR 27) in the digital group and (17 days, IQR17) in the transmetatarsal amputation group ( P = 0.17). Need for re-admission was 48.1% in digital patients compared to 50% in transmetatarsal amputation patients ( P = 0.81). Quality of time spent without symptoms of disease or toxicity of treatment (Q-TWiST) was (315 days, IQR 45) in digital group and (346 days, IQR 48) in the transmetatarsal amputation patients ( P = 0.099). Conclusion Despite the lack of statistical significance, transmetatarsal amputation offered better outcome in the diabetic patients, with less re-intervention rate, shorter hospital stays, less theatre trips, and longer time without toxicity (TWiST).

34 CFR 200.52 - LEA improvement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... through 200.20; (v) Address— (A) The fundamental teaching and learning needs in the schools of the LEA... described in sections 1118 and 1119, respectively, of the ESEA. (Approved by the Office of Management and...

Heterotopic Ossification Following Extremity Blast Amputation: An Animal Model in the Sprague Dawley Rat

DTIC Science & Technology

2016-03-01

to their pre-injury baseline activities after a week. One animal assigned to the irradiation group died at two weeks post op of unknown causes and was...kg) and enrofloxacin (5 mg/kg) were administered subcutaneously for preemptive analge- sia and prophylactic antibacterial coverage, respectively. The...Buprenorphine (0.05 mg/kg) and enrofloxacin (5 mg/kg) were administered subcutaneously for preemptive analgesia and prophylactic antibacterial coverage

Evaluation of Spine Health and Spine Mechanics in Service Members with Traumatic Lower Extremity Amputation or Injury

DTIC Science & Technology

2016-10-01

LBP risk. Using a novel set of clinical, experimental, and computational methods, we expect to demonstrate a positive association between abnormal ...this will reduce the substantial economic costs associated with its treatment and promote enhancements in psychological health and overall quality of...implicit integration algorithm inside an FE software (ABAQUS, Version 6.13, Dassault Systemes Simulia, Providence, RI). The outputs of equations of

Pain and pain-related interference in adults with lower-limb amputation: comparison of knee-disarticulation, transtibial, and transfemoral surgical sites.

PubMed

Behr, James; Friedly, Janna; Molton, Ivan; Morgenroth, David; Jensen, Mark P; Smith, Douglas G

2009-01-01

Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study was to determine whether individuals with knee-disarticulation amputations have worse pain and pain-related interference with physical function than do individuals with transtibial or transfemoral amputations. We analyzed cross-sectional survey data provided by 42 adults with lower-limb amputations. These individuals consisted of 14 adults reporting knee-disarticulation amputation in one limb and best-matched cases (14 reporting transfemoral amputation and 14 reporting transtibial amputation) from a larger cross-sectional sample of 472 individuals. Participants were rigorously matched based on time since amputation, reason for amputation, age, sex, diabetes diagnosis, and pain before amputation. Continuous outcome variables were analyzed by one-way analysis of variance. Categorical outcomes were analyzed by Pearson chi-square statistic. Given the relatively small sample size and power concerns, mean differences were also described by estimated effect size (Cohen's d). Of the 42 participants, 83% were male. They ranged in age from 36 to 85 (median = 55.1, standard deviation = 11.0). Most amputations were of traumatic origin (74%), and participants were on average 12.4 years from their amputations at the time of the survey. Individuals with transtibial amputation reported significantly more prosthesis use than did individuals with knee-disarticulation amputation. Amputation levels did not significantly differ in phantom limb pain, residual limb pain, back pain, and pain-related interference with physical function. Estimates of effect size, however, indicated that participants with knee-disarticulation amputation reported less phantom limb pain, phantom limb pain-related interference with physical function, residual limb pain, residual limb pain-related interference with physical function, and back pain-related interference with physical function than did participants with transtibial or transfemoral amputations. This study demonstrated that patients with knee-disarticulation amputation used prostheses significantly less than did patients with transtibial amputation. However, no evidence was found that patients with knee-disarticulation amputation have worse outcomes in terms of pain and pain-related interference with physical function; in fact, they may have more favorable long-term outcomes.

Regulation of GPR119 receptor activity with endocannabinoid-like lipids.

PubMed

Syed, Samreen K; Bui, Hai Hoang; Beavers, Lisa S; Farb, Thomas B; Ficorilli, James; Chesterfield, Amy K; Kuo, Ming-Shang; Bokvist, Krister; Barrett, David G; Efanov, Alexander M

2012-12-15

The GPR119 receptor plays an important role in the secretion of incretin hormones in response to nutrient consumption. We have studied the ability of an array of naturally occurring endocannabinoid-like lipids to activate GPR119 and have identified several lipid receptor agonists. The most potent receptor agonists identified were three N-acylethanolamines: oleoylethanolamine (OEA), palmitoleoylethanolamine, and linoleylethanolamine (LEA), all of which displayed similar potency in activating GPR119. Another lipid, 2-oleoylglycerol (2-OG), also activated GPR119 receptor but with significantly lower potency. Endogenous levels of endocannabinoid-like lipids were measured in intestine in fasted and refed mice. Of the lipid GPR119 agonists studied, the intestinal levels of only OEA, LEA, and 2-OG increased significantly upon refeeding. Intestinal levels of OEA and LEA in the fasted mice were low. In the fed state, OEA levels only moderately increased, whereas LEA levels rose drastically. 2-OG was the most abundant of the three GPR119 agonists in intestine, and its levels were radically elevated in fed mice. Our data suggest that, in lean mice, 2-OG and LEA may serve as physiologically relevant endogenous GPR119 agonists that mediate receptor activation upon nutrient uptake.

34 CFR 222.184 - What information must an application contain?

Code of Federal Regulations, 2012 CFR

2012-07-01

... LEA. (g) Fiscal data including the LEA's— (1) Maximum bonding capacity; (2) Amount of bonded debt; (3... application package. (Approved by the Office of Management and Budget under control number 1810-0657...

Development of Korean Academy of Medical Sciences Guideline for rating physical disability of upper extremity.

PubMed

Park, Jung Ho; Kim, Hee-Chun; Lee, Jae Hoon; Kim, Jin Soo; Roh, Si Young; Yi, Cheol Ho; Kang, Yoon Kyoo; Kwon, Bum Sun

2009-05-01

While the lower extremities support the weight and move the body, the upper extremities are essential for the activities of daily living, which require many detailed movements. Therefore, a disability of the upper extremity function should include a limitation of all motions of the joints and sensory loss, which affects the activities. In this study, disabilities of the upper extremities were evaluated according to the following conditions: 1) amputation, 2) joint contracture, 3) diseases of upper extremity, 4) weakness, 5) sensory loss of the finger tips, and 6) vascular and lymphatic diseases. The order of 1) to 6) is the order of major disability and there is no need to evaluate a lower order disability when a higher order one exists in the same joint or a part of the upper extremity. However, some disabilities can be either added or substituted when there are special contributions from multiple disabilities. An upper extremity disability should be evaluated after the completion of treatment and full adaptation when further functional changes are not expected. The dominance of the right or left hand before the disability should not be considered when there is a higher rate of disability.

A Group 6 Late Embryogenesis Abundant Protein from Common Bean Is a Disordered Protein with Extended Helical Structure and Oligomer-forming Properties*

PubMed Central

Rivera-Najera, Lucero Y.; Saab-Rincón, Gloria; Battaglia, Marina; Amero, Carlos; Pulido, Nancy O.; García-Hernández, Enrique; Solórzano, Rosa M.; Reyes, José L.; Covarrubias, Alejandra A.

2014-01-01

Late embryogenesis-abundant proteins accumulate to high levels in dry seeds. Some of them also accumulate in response to water deficit in vegetative tissues, which leads to a remarkable association between their presence and low water availability conditions. A major sub-group of these proteins, also known as typical LEA proteins, shows high hydrophilicity and a high percentage of glycine and other small amino acid residues, distinctive physicochemical properties that predict a high content of structural disorder. Although all typical LEA proteins share these characteristics, seven groups can be distinguished by sequence similarity, indicating structural and functional diversity among them. Some of these groups have been extensively studied; however, others require a more detailed analysis to advance in their functional understanding. In this work, we report the structural characterization of a group 6 LEA protein from a common bean (Phaseolus vulgaris L.) (PvLEA6) by circular dichroism and nuclear magnetic resonance showing that it is a disordered protein in aqueous solution. Using the same techniques, we show that despite its unstructured nature, the addition of trifluoroethanol exhibited an intrinsic potential in this protein to gain helicity. This property was also promoted by high osmotic potentials or molecular crowding. Furthermore, we demonstrate that PvLEA6 protein is able to form soluble homo-oligomeric complexes that also show high levels of structural disorder. The association between PvLEA6 monomers to form dimers was shown to occur in plant cells by bimolecular fluorescence complementation, pointing to the in vivo functional relevance of this association. PMID:25271167

A preliminary evaluation of limb salvage surgery for osteosarcoma around knee joint.

PubMed

Wu, Xing; Cai, Zheng-Dong; Chen, Zheng-Rong; Yao, Zhen-Jun; Zhang, Guang-Jian

2012-01-01

To evaluate the effectiveness and drawbacks of diversified procedures of limb salvage surgery (LSS), providing a reference of rational surgical criterion of LSS. Fifty eight patients with stage IIB extremity osteosarcoma around knee joint area between 1992 and 2002 were studied retrospectively. Among them, 43 patients were treated by LSS followed by reconstruction. Reconstruction approaches included re-implantation of irradiation-devitalized tumor bone (n = 12), autoclaving-devitalized tumor bone (n = 8), prosthetic replacement (n = 11), allograft transplantation (n = 8) and vascularized fibula autograft implantation (n = 4). Amputations were performed in 15 patients. Patients were followed up for 6-16 years. There were no significant difference between LSS and amputation groups regarding disease free survival and local recurrence rates. The actuarial 5-year continuous disease free survival and local recurrence rate were 30.0% and 25.0% in patients of devitalized LSS group, whereas those were 56.5% and 8.7% in patients of non-devitalized reconstruction group. The complication rate was significantly higher in LSS group compared to amputation group (P = 0.003). LSS with non-devitalized procedures is the optimal treatment for osteosarcoma around knee joint area. Prosthesis implantation is the preferred option for bone reconstruction following LSS. Prevention and treatment of post-operative complications should be paid more attention to get good long-term outcomes of surgery.

34 CFR 200.25 - Schoolwide programs in general.

Code of Federal Regulations, 2014 CFR

2014-07-01

... families under paragraph (b)(1)(ii) of this section, the LEA may use a measure of poverty that is different from the measure or measures of poverty used by the LEA to identify and rank school attendance areas...

34 CFR 200.25 - Schoolwide programs in general.

Code of Federal Regulations, 2011 CFR

2011-07-01

... families under paragraph (b)(1)(ii) of this section, the LEA may use a measure of poverty that is different from the measure or measures of poverty used by the LEA to identify and rank school attendance areas...

34 CFR 200.25 - Schoolwide programs in general.

Code of Federal Regulations, 2010 CFR

2010-07-01

... families under paragraph (b)(1)(ii) of this section, the LEA may use a measure of poverty that is different from the measure or measures of poverty used by the LEA to identify and rank school attendance areas...

Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

PubMed

Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L

2005-10-01

To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

A cross flow-through pedicle free latissimus dorsi flap for high voltage electrical burns.

PubMed

Gencel, Eyuphan; Eser, Cengiz; Kesiktas, Erol; Tabakan, Ibrahim; Yavuz, Metin

2016-06-01

The management of a high voltage electrical injury and lower limb salvage remains a challenging task for plastic surgeons. Reconstruction with flaps is often the only alternative to limb amputation. The purpose of this study was to present a cross flow-through pedicle free latissimus dorsi muscle flap for the salvage of severely traumatized lower limbs perfused by one remaining vessel (a single vessel lower limb) in high voltage electrical injuries. In this retrospective study, between 2000 and 2014, six men underwent cross-leg free Latissimus dorsi muscle flap operations for limb salvage. They had soft tissue lower leg defects due to high voltage electrical injuries. Their medical records were retrospectively reviewed. All had only one artery that perfused the leg. Free pedicled thoracodorsal artery latissimus dorsi flaps were harvested and connected to the contralateral posterior tibial artery. All defects were successfully covered. No flap loss or major amputation occurred during follow-up (mean; 5.9 years). A computerized tomography angiogram showed intact vessel continuity in the recipient vascular system. The patients were able to walk without any apparatus or assistance after long term follow-up. We recommend that the cross flow-through pedicle free muscle flap should be considered as a salvage procedure for single vessel lower extremities resulting from high voltage electrical burns. Extremity perfusion was not compromised by this procedure. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Spontaneous gas gangrene in a patient with Crohn's disease.

PubMed

Vaidya, Yash P; Vaidya, Tanvi P

2012-01-01

Spontaneous gas gangrene is necrosis of muscles in the absence of trauma, causing an acutely painful and potentially fatal condition. However, the occurrence of this condition in Crohn's disease has been very rarely documented. In this extremely rare case we describe an occurrence of spontaneous gas gangrene, in a known case of Crohn's disease. The patient presented with fever and pain in the left arm and abdomen. After admission and initial management with antibiotics, the patient developed crepitus in the arm and myonecrosis necessitating a fasciotomy and later an emergency amputation of his left upper limb. The pathogenesis of gas gangrene in inflammatory bowel disease is not fully understood. Management includes aggressive antibiotic administration followed by amputation of the non-salvageable limb. A high index of suspicion of such rare complications is a must and surgical intervention is life saving; however, the efficacy of anti-gas gangrene serum is controversial. We recommend use of a multipronged approach in such cases with high mortality rates.

Spontaneous gas gangrene in a patient with Crohn’s disease

PubMed Central

Vaidya, Yash P.; Vaidya, Tanvi P.

2012-01-01

Summary Background: Spontaneous gas gangrene is necrosis of muscles in the absence of trauma, causing an acutely painful and potentially fatal condition. However, the occurrence of this condition in Crohn’s disease has been very rarely documented. Case Report: In this extremely rare case we describe an occurrence of spontaneous gas gangrene, in a known case of Crohn’s disease. The patient presented with fever and pain in the left arm and abdomen. After admission and initial management with antibiotics, the patient developed crepitus in the arm and myonecrosis necessitating a fasciotomy and later an emergency amputation of his left upper limb. The pathogenesis of gas gangrene in inflammatory bowel disease is not fully understood. Management includes aggressive antibiotic administration followed by amputation of the non-salvageable limb. Conclusions: A high index of suspicion of such rare complications is a must and surgical intervention is life saving; however, the efficacy of anti-gas gangrene serum is controversial. We recommend use of a multipronged approach in such cases with high mortality rates. PMID:23569538

One-stage thumb lengthening with use of an osteocutaneous 2nd metacarpal flap.

PubMed

Givissis, Panagiotis; Stavridis, Stavros I; Ditsios, Konstantinos; Christodoulou, Anastasios

2009-12-01

Traumatic thumb amputation represents an extremely disabling entity, thus rendering its reconstruction a procedure of paramount importance. A case of a patient, who sustained a traumatic amputation of his left index finger at the metacarpophalangeal joint and of his left thumb in the middle of the proximal phalanx 4 months ago and was initially treated elsewhere, is described. For the thumb reconstruction, an osteocutaneous flap of the radial side of the 2nd metacarpal, which consisted of a 3, 5-cm bony segment with the overlying skin and its blood and nerve supply was used. The flap was transferred and fixed with a plate and screws to the palmar-medial side of the stump of the thumb, while the 1st web space was deepened by removing the rest of the second metacarpal, while a partial skin graft was used to cover a remaining gap. Thumb functionality was restored immediately postoperatively, and the overall result was satisfactory.

Anatomical and neuropsychological effects of cluster munitions.

PubMed

Fares, Youssef; Fares, Jawad

2013-12-01

The aim of this article is to investigate the effects of cluster munitions on the different environmental, anatomical and neuropsychological levels. We conducted a study to explore the effects of sub-munitions on Lebanese victims. The study included a total of 407 cases that have been subjected to the detonation of unexploded sub-munitions in Lebanon, between 2006 and 2011. In our series, 356 casualties were injured and 51 were dead. 382 were males and 25 were females. We recorded 83 cases of amputations, and injuries involving cranio-facial regions, thorax, abdomen, and upper and lower extremities. These injuries lead to loss of function, body disfiguration, and chronic pain caused by the injuries or the amputations, as well as post-traumatic stress disorder. The peripheral nervous system was mostly affected and patients suffered from significant psychosocial tribulations. Cluster munitions harm human beings and decrease biodiversity. Survivors suffer from physical and psychological impairments. Laws should be passed and enforced to ban the use of these detrimental weapons that have negative effects on ecosystem and societal levels.

Elective amputation of a "healthy limb".

PubMed

Blom, Rianne M; Guglielmi, Valeria; Denys, Damiaan

2016-10-01

Patients with body integrity identity disorder (BIID) experience a strong desire for amputation from very early on. BIID patients are often dismissed when they share their wish for amputation with surgeons. Consequently, patients resort to self-amputation, including complications and sometimes death. BIID patients are not psychotic and are mentally competent to oversee the consequences of an elective amputation. The authors offer arguments in favor of elective amputation.

Lower-limb reconstruction with chimeric flaps: The quad flap.

PubMed

Azouz, Solomon M; Castel, Nikki A; Vijayasekaran, Aparna; Rebecca, Alanna M; Lettieri, Salvatore C

2018-05-07

Early soft-tissue coverage is critical for treating traumatic open lower-extremity wounds. As free-flap reconstruction evolves, injuries once thought to be nonreconstructable are being salvaged. Free-tissue transfer is imperative when there is extensive dead space or exposure of vital structures such as bone, tendon, nerves, or blood vessels. We describe 2 cases of lower-extremity crush injuries salvaged with the quad flap. This novel flap consists of parascapular, scapular, serratus, and latissimus dorsi free flaps in combination on one pedicle. This flap provides the large amount of soft-tissue coverage necessary to cover substantial defects from skin degloving, tibia and fibula fractures, and soft-tissue loss. In case 1, a 51-year-old woman was struck by an automobile and sustained bilateral tibia and fibula fractures, a crush degloving injury of the left leg, and a right forefoot traumatic amputation. She underwent reconstruction with a contralateral quad free flap. In case 2, a 53-year-old man sustained a right tibia plateau fracture with large soft-tissue defects from a motorcycle accident. He had a crush degloving injury of the entire anterolateral compartment over the distal and lower third of the right leg. The large soft-tissue defect was reconstructed with a contralateral quad flap. In both cases, the donor site was closed primarily and without early flap failures. There was one surgical complication, an abscess in case 2; the patient was taken back to the operating room for débridement of necrotic tissue. There have been no long-term complications in either case. Both patients achieved adequate soft-tissue coverage, avoided amputation, and had satisfactory aesthetic and functional outcomes. With appropriate surgical technique and patient selection, the quad-flap technique is promising for reconstructing the lower extremity. © 2018 Wiley Periodicals, Inc.

Lower limb amputations: differences between the genders and long-term survival.

PubMed

Heikkinen, M; Saarinen, J; Suominen, V P; Virkkunen, J; Salenius, J

2007-09-01

The purpose of the study was to evaluate possible differences between genders in amputation incidence, revascularization activity before and survival after amputation. This population-based study was carried out in a well-defined geographical area, where all vascular surgical consultations and reconstructions are performed in one university hospital. All amputations performed in the region during 1990 - 1999 were identified from the hospital central registers. According to patient's identity codes, the Cause of Death Registry of Statistics Finland provided death data. Amputation data were cross-linked with the local vascular registry using identity codes. Women were found to be 8 years older than men (p < 0.0001). Major amputations comprised 73.4% in males and 77.7% in females. The age-standardized amputation incidence among males was 338 and among females 226 (per 10(6) inhabitants/year) (p < 0.001). The most prominent difference was seen in amputations due to trauma, where the age-adjusted major amputation incidence was over three-fold among males compared to females. The proportion of patients who had undergone vascular procedure before amputation was 23% in both genders. Median survival after amputation was 943 days in men and 716 in women (p = 0.01). When the higher age of women was considered, there was no significant difference between the genders. Survival was poorer among diabetics in both genders and the difference was significant in males. The amputation incidence was found to be higher in men compared to women in all etiologic subgroups except malignant tumour. Almost one in 4 patients had undergone vascular surgical reconstruction before amputation in both genders. There was no significant difference between the genders in survival after amputation. Subjects with diabetes had a poorer survival after major amputation than those without diabetes.

Low-energy density and high fiber intake are dietary concerns in female endurance athletes.

PubMed

Melin, A; Tornberg, Å B; Skouby, S; Møller, S S; Faber, J; Sundgot-Borgen, J; Sjödin, A

2016-09-01

Low or reduced energy availability (LEA) is linked to functional hypothalamic oligomenorrhea/amenorrhea (FHA), which is frequently reported in weight-sensitive sports. This makes LEA a major nutritional concern for female athletes. The aim of this study was to describe dietary characteristics of athletes with LEA and/or FHA. Endurance athletes (n = 45) were recruited from national teams and competitive clubs. Protocols included gynecological examination, body composition, eating disorder evaluation, and 7-day dietary intake and EA assessment. Athletes with disordered eating behavior/eating disorders (n = 11), menstrual dysfunction other than FHA (n = 5), and low dietary record validity (n = 4) were excluded. Remaining subjects (n = 25) were characterized by EA [optimal: ≥ 45 kcal (188 kJ)/kg fat-free mass (FFM)/day (n = 11), LEA: < 45 kcal (188 kJ)/kg FFM/day (n = 14)] and reproductive function [eumenorrhea (EUM; n = 10), FHA (n = 15)]. There was no difference in EA between FHA and EUM subjects. However, FHA and LEA subjects shared the same dietary characteristics of lower energy density (ED) [(P = 0.012; P = 0.020), respectively], and fat content [(P = 0.047; P = 0.027), respectively]. Furthermore, FHA subjects had a lower intake of carbohydrate-rich foods (P = 0.019), higher fiber content (P < 0.001), and drive for thinness score (P = 0.003). Conclusively, low ED together with high fiber content may constitute targets for dietary intervention in order to prevent and treat LEA and FHA in female athletes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Stiffness and ultimate load of osseointegrated prosthesis fixations in the upper and lower extremity.

PubMed

Welke, Bastian; Hurschler, Christof; Föller, Marie; Schwarze, Michael; Calliess, Tilman

2013-07-11

Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall. We therefore investigated the bending stiffness and ultimate bending moment of such devices implanted in human and synthetic bones. Eight human specimens and 16 synthetic models of the proximal femora were implanted with lower extremity prostheses and eight human specimens and six synthetic humeri were implanted with upper extremity prostheses. They were dissected according to typical amputation levels and underwent loading in a material testing machine in a four-point bending setup. Bending stiffness, ultimate bending moment and fracture modes were determined in a load to failure experiment. Additionally, axial pull-out was performed on eight synthetic specimens of the lower extremity. Maximum bending moment of the synthetic femora was 160.6±27.5 Nm, the flexural rigidity of the synthetic femora was 189.0±22.6 Nm2. Maximum bending moment of the human femora was 100.4±38.5 Nm, and the flexural rigidity was 137.8±29.4 Nm2. The maximum bending moment of the six synthetic humeri was 104.9±19.0 Nm, and the flexural rigidity was 63.7±3.6 Nm2. For the human humeri the maximum bending moment was 36.7±11.0 Nm, and the flexural rigidity at was 43.7±10.5 Nm2. The maximum pull-out force for the eight synthetic femora was 3571±919 N. Significant differences were found between human and synthetic specimens of the lower and upper extremity regarding maximum bending moment, bending displacement and flexural rigidity. The results of this study are relevant with respect to previous finding regarding the load at the interfaces of osseointegrated prosthesis fixation devices and are crucial for the development of safety devices intended to protect the bone-implant interface from damaging loadings.

Stiffness and ultimate load of osseointegrated prosthesis fixations in the upper and lower extremity

PubMed Central

2013-01-01

Background Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall. We therefore investigated the bending stiffness and ultimate bending moment of such devices implanted in human and synthetic bones. Methods Eight human specimens and 16 synthetic models of the proximal femora were implanted with lower extremity prostheses and eight human specimens and six synthetic humeri were implanted with upper extremity prostheses. They were dissected according to typical amputation levels and underwent loading in a material testing machine in a four-point bending setup. Bending stiffness, ultimate bending moment and fracture modes were determined in a load to failure experiment. Additionally, axial pull-out was performed on eight synthetic specimens of the lower extremity. Results Maximum bending moment of the synthetic femora was 160.6±27.5 Nm, the flexural rigidity of the synthetic femora was 189.0±22.6 Nm2. Maximum bending moment of the human femora was 100.4±38.5 Nm, and the flexural rigidity was 137.8±29.4 Nm2. The maximum bending moment of the six synthetic humeri was 104.9±19.0 Nm, and the flexural rigidity was 63.7±3.6 Nm2. For the human humeri the maximum bending moment was 36.7±11.0 Nm, and the flexural rigidity at was 43.7±10.5 Nm2. The maximum pull-out force for the eight synthetic femora was 3571±919 N. Conclusion Significant differences were found between human and synthetic specimens of the lower and upper extremity regarding maximum bending moment, bending displacement and flexural rigidity. The results of this study are relevant with respect to previous finding regarding the load at the interfaces of osseointegrated prosthesis fixation devices and are crucial for the development of safety devices intended to protect the bone-implant interface from damaging loadings. PMID:23844992

Pediatric lower extremity mower injuries.

PubMed

Hill, Sean M; Elwood, Eric T

2011-09-01

Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

Contralateral structural femoral autograft use in treatment of an open periarticular knee fracture to perform knee arthrodesis.

PubMed

Mack, Andrew W; Helgeson, Melvin D; Tis, John E

2008-09-01

Combat-related blast injuries often cause devastating extremity trauma. We report a case of a 21-year-old male service member who sustained massive bilateral lower extremity trauma secondary to a blast injury. His orthopaedic injuries included a near traumatic disarticulation of the right knee and a left open type IIIB periarticular knee fracture with traumatic patellectomy, loss of the extensor mechanism, and segmental loss of the distal 11 cm of his femur. Definitive treatment of his injuries included a contralateral structural cortical femoral autograft which was implanted into the left knee segmental defect to facilitate knee fusion with an intramedullary knee fusion nail and a right transfemoral amputation. Radiographic evidence of solid fusion was obtained 8 months postoperatively. Currently, the patient is a community ambulator with the aid of his right lower extremity prosthetic limb and cane.

Early Reconstructions of Complex Lower Extremity Battlefield Soft Tissue Wounds

PubMed Central

Ebrahimi, Ali; Nejadsarvari, Nasrin; Ebrahimi, Azin; Rasouli, Hamid Reza

2017-01-01

BACKGROUND Severe lower extremity trauma as a devastating combat related injury is on the rise and this presents reconstructive surgeons with significant challenges to reach optimal cosmetic and functional outcomes. This study assessed early reconstructions of complex lower extremity battlefield soft tissue wounds. METHODS This was a prospective case series study of battled field injured patients which was done in the Department of Plastic Surgery, Baqiyatallah University of Medical Sciences hospitals, Tehran, Iran between 2013-2015. In this survey, 73 patients were operated for reconstruction of lower extremity soft tissue defects due to battlefield injuries RESULTS Seventy-three patients (65 men, 8 womens) ranging from 21-48 years old (mean: 35 years) were enrolled. Our study showed that early debridement and bone stabilization and later coverage of complex battlefields soft tissue wounds with suitable flaps and grafts of lower extremity were effective method for difficult wounds managements with less amputation and infections. CONCLUSION Serial debridement and bone stabilization before early soft tissue reconstruction according to reconstructive ladder were shown to be essential steps. PMID:29218283

34 CFR 200.71 - LEA eligibility.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 1 2012-07-01 2012-07-01 false LEA eligibility. 200.71 Section 200.71 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED Improving Basic...

Immunohistochemical localisation of keratin and luminal epithelial antigen in myoepithelial and luminal epithelial cells of human mammary and salivary gland tumours.

PubMed

Nathrath, W B; Wilson, P D; Trejdosiewicz, L K

1982-01-01

Rabbit antisera to human 40-63 000 MW epidermal keratin, one batch with restricted distribution of reactivity from an initial (aK1) and one with "broad spectrum" distribution of reactivity from a late bleeding (aK), and to "luminal epithelial antigen" (aLEA) were applied to formalin fixed paraffin embedded sections of human normal and neoplastic mammary and salivary glands using an indirect immunoperoxidase method. aK1 reacted with myoepithelial cells, aLEA with luminal epithelial cells and aK with both cell types in normal mammary and salivary gland. In breast carcinomas the majority of intraluminal and infiltrating carcinoma cells reacted with aLEA but not with aK1 which reacted only with surrounding myoepithelial cells. aK reacted with both myoepithelial cells and with intraluminal and infiltrating tumour cells. In the salivary gland adenomas the majority of cells reacted with aK, and those cells arranged in a tubular fashion reacted with aLEA.

Current (2004-07) Conditions and Changes in Ground-Water Levels from Predevelopment to 2007, Southern High Plains Aquifer, Southeast New Mexico-Lea County Underground Water Basin

USGS Publications Warehouse

Tillery, Anne

2008-01-01

The Southern High Plains aquifer is the principal aquifer and primary source of water in southeastern New Mexico. The Lea County portion of the aquifer covers approximately the northern two thirds of the 4,393-square-mile county. Successful water-supply planning for New Mexico's Southern High Plains requires knowledge of the current aquifer conditions and a context from which to estimate future trends given current aquifer-management policy. Maps representing water-level declines, current (2007) water levels, aquifer saturated thickness, and depth to water accompanied by hydrographs from representative wells for the Southern High Plains aquifer in the Lea County Underground Water Basin were prepared in cooperation with the New Mexico Office of the State Engineer. Results of this mapping effort show the water level has declined as much as 97 feet in the Lea County Underground Water Basin from predevelopment (1914-54) to 2007 with rates as high as 0.88 feet per year.

Laparoscopic Management of Autoamputated Ovary in Newborns: A Report of 2 Cases.

PubMed

Ladenhauf, Hannah N; Brandtner, Martha G; Ardelean, Mircia A; Schimke, Christa; Metzger, Roman

Intrauterine autoamputation of the ovary is an extremely rare diagnosis in the pediatric population. The current literature is limited to contradictory recommendations, while a standard management protocol for autoamputated adnexa secondary to intrauterine ovarian torsion is yet to be established. We report 2 cases of auto-amputation of the ovary, leading to a free-floating intra-abdominal cyst in the newborn. Laparoscopic management was successful in both cases. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

Final Report of the Lower Extremity Assessment Program (LEAP 99-2). Volume 2

DTIC Science & Technology

2000-08-01

conflict to see large-scale use of landmines. Anti- personnel landmines have played a significant role in every major conflict since. In the 1970s and 1980s ...combatants and civilians. From 1980 to 1993, the incidence of landmine-related injuries doubled, resulting in an estimated 2000 deaths or injuries per month...Antonelli, E. E., & Hislop , H., (1976). Energy cost of walking of amputees: The influence of level of amputation. Journal of Bone and Joint Surgery. 58-A, 42

A systematic review of outcomes after revision amputation for treatment of traumatic finger amputation

PubMed Central

Yuan, Frank; McGlinn, Evan P.; Giladi, Aviram M.; Chung, Kevin C.

2015-01-01

Background Revision amputations are often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact poorly understood. We performed a systematic review to evaluate outcomes of revision amputations and amputation wound coverage techniques. Methods We searched all available English literature in PubMed and EMBASE for articles reporting outcomes of non-replantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes (PROs), and complications. Results 1659 articles were screened, yielding 43 studies for review. Mean static 2-point discrimination (2-PD) was 5.0 ± 1.5 mm (n=23 studies) overall. Mean static 2-PD was 6.1 ± 2.4 mm after local flap procedures and 3.8 ± 0.4 mm after revision amputation. Mean total active motion (TAM) was 93 ± 8% of normal (n=6 studies) overall. Mean TAM was 90 ± 9% of normal after local flap procedures and 95% of normal after revision amputation. 77% of patients report cold intolerance after revision amputation. 91% of patients (217/238) report “satisfactory” or “good/excellent” ratings regardless of treatment. Conclusion Revision amputation and conservative treatments result in better static 2-PD outcomes compared to local flaps. All techniques preserve TAM, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report “satisfactory,” “good,” or “excellent” ratings in appearance and quality of life with all non-replantation techniques. Level of Evidence III PMID:26111316

Interleaving lattice for the Argonne Advanced Photon Source linac

NASA Astrophysics Data System (ADS)

Shin, S.; Sun, Y.; Dooling, J.; Borland, M.; Zholents, A.

2018-06-01

To realize and test advanced accelerator concepts and hardware, a beam line is being reconfigured in the linac extension area (LEA) of the Argonne Advanced Photon Source (APS) linac. A photocathode rf gun installed at the beginning of the APS linac will provide a low emittance electron beam into the LEA beam line. The thermionic rf gun beam for the APS storage ring and the photocathode rf gun beam for the LEA beam line will be accelerated through the linac in an interleaved fashion. In this paper, the design studies for interleaving lattice realization in the APS linac is described with the initial experiment result.

34 CFR 303.23 - Local educational agency.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND...— (i) Authorized by State law to develop, manage, and provide services or programs to LEAs; and (ii... school, including a public charter school that is established as an LEA under State law. (3) Entities...

34 CFR 303.23 - Local educational agency.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND...— (i) Authorized by State law to develop, manage, and provide services or programs to LEAs; and (ii... school, including a public charter school that is established as an LEA under State law. (3) Entities...

Literacy Education Action.

ERIC Educational Resources Information Center

Clymer, Carol

The Literacy Education Action (LEA) program was established in the fall of 1985 under the initiative of the president of the El Paso Community College (Texas). During 1985 and 1986, LEA concentrated on developing its own literacy tutoring program, including recruiting and training volunteers and community members with reading skills below the…

34 CFR 300.155 - Hearings relating to LEA eligibility.

Code of Federal Regulations, 2010 CFR

2010-07-01

... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Additional Eligibility Requirements § 300.155... 34 Education 2 2010-07-01 2010-07-01 false Hearings relating to LEA eligibility. 300.155 Section 300.155 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF...

34 CFR 300.155 - Hearings relating to LEA eligibility.

Code of Federal Regulations, 2011 CFR

2011-07-01

... EDUCATION OF CHILDREN WITH DISABILITIES State Eligibility Additional Eligibility Requirements § 300.155... 34 Education 2 2011-07-01 2010-07-01 true Hearings relating to LEA eligibility. 300.155 Section 300.155 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF...

34 CFR 300.815 - Subgrants to LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... responsible for providing education to children aged three through five years, including public charter... 34 Education 2 2011-07-01 2010-07-01 true Subgrants to LEAs. 300.815 Section 300.815 Education...

34 CFR 300.816 - Allocations to LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... numbers of children with disabilities aged three through five years currently provided special education... 34 Education 2 2010-07-01 2010-07-01 false Allocations to LEAs. 300.816 Section 300.816 Education...

34 CFR 300.815 - Subgrants to LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH... responsible for providing education to children aged three through five years, including public charter... 34 Education 2 2010-07-01 2010-07-01 false Subgrants to LEAs. 300.815 Section 300.815 Education...

22 CFR 229.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 229.420 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 229.420 Access to schools operated by LEAs...

34 CFR 222.174 - What prohibitions apply to these funds?

Code of Federal Regulations, 2014 CFR

2014-07-01

..., and air conditioning (HVAC) system. The LEA has not made any commitments for the HVAC system because... would not be supplanting if the LEA received an emergency grant under this program to pay for the HVAC system. (Authority: 20 U.S.C. 7707(b)) ...

34 CFR 222.174 - What prohibitions apply to these funds?

Code of Federal Regulations, 2012 CFR

2012-07-01

..., and air conditioning (HVAC) system. The LEA has not made any commitments for the HVAC system because... would not be supplanting if the LEA received an emergency grant under this program to pay for the HVAC system. (Authority: 20 U.S.C. 7707(b)) ...

34 CFR 222.174 - What prohibitions apply to these funds?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., and air conditioning (HVAC) system. The LEA has not made any commitments for the HVAC system because... would not be supplanting if the LEA received an emergency grant under this program to pay for the HVAC system. (Authority: 20 U.S.C. 7707(b)) ...

34 CFR 222.174 - What prohibitions apply to these funds?

Code of Federal Regulations, 2011 CFR

2011-07-01

..., and air conditioning (HVAC) system. The LEA has not made any commitments for the HVAC system because... would not be supplanting if the LEA received an emergency grant under this program to pay for the HVAC system. (Authority: 20 U.S.C. 7707(b)) ...

34 CFR 222.174 - What prohibitions apply to these funds?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., and air conditioning (HVAC) system. The LEA has not made any commitments for the HVAC system because... would not be supplanting if the LEA received an emergency grant under this program to pay for the HVAC system. (Authority: 20 U.S.C. 7707(b)) ...

34 CFR 200.74 - Use of an alternative method to distribute grants to LEAs with fewer than 20,000 total residents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... poverty measure consistently for small LEAs across the State for all Title I, part A programs. (d) Based on the alternative poverty data selected, the SEA must— (1) Re-determine eligibility of its small...

34 CFR 200.74 - Use of an alternative method to distribute grants to LEAs with fewer than 20,000 total residents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... poverty measure consistently for small LEAs across the State for all Title I, part A programs. (d) Based on the alternative poverty data selected, the SEA must— (1) Re-determine eligibility of its small...

34 CFR 200.74 - Use of an alternative method to distribute grants to LEAs with fewer than 20,000 total residents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... poverty measure consistently for small LEAs across the State for all Title I, part A programs. (d) Based on the alternative poverty data selected, the SEA must— (1) Re-determine eligibility of its small...

34 CFR 200.74 - Use of an alternative method to distribute grants to LEAs with fewer than 20,000 total residents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... poverty measure consistently for small LEAs across the State for all Title I, part A programs. (d) Based on the alternative poverty data selected, the SEA must— (1) Re-determine eligibility of its small...

34 CFR 200.74 - Use of an alternative method to distribute grants to LEAs with fewer than 20,000 total residents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... poverty measure consistently for small LEAs across the State for all Title I, part A programs. (d) Based on the alternative poverty data selected, the SEA must— (1) Re-determine eligibility of its small...

Layered Ensemble Architecture for Time Series Forecasting.

PubMed

Rahman, Md Mustafizur; Islam, Md Monirul; Murase, Kazuyuki; Yao, Xin

2016-01-01

Time series forecasting (TSF) has been widely used in many application areas such as science, engineering, and finance. The phenomena generating time series are usually unknown and information available for forecasting is only limited to the past values of the series. It is, therefore, necessary to use an appropriate number of past values, termed lag, for forecasting. This paper proposes a layered ensemble architecture (LEA) for TSF problems. Our LEA consists of two layers, each of which uses an ensemble of multilayer perceptron (MLP) networks. While the first ensemble layer tries to find an appropriate lag, the second ensemble layer employs the obtained lag for forecasting. Unlike most previous work on TSF, the proposed architecture considers both accuracy and diversity of the individual networks in constructing an ensemble. LEA trains different networks in the ensemble by using different training sets with an aim of maintaining diversity among the networks. However, it uses the appropriate lag and combines the best trained networks to construct the ensemble. This indicates LEAs emphasis on accuracy of the networks. The proposed architecture has been tested extensively on time series data of neural network (NN)3 and NN5 competitions. It has also been tested on several standard benchmark time series data. In terms of forecasting accuracy, our experimental results have revealed clearly that LEA is better than other ensemble and nonensemble methods.

Lower-Limb Amputation and Effect of Posttraumatic Stress Disorder on Department of Veterans Affairs Outpatient Cost Trends

DTIC Science & Technology

2015-07-01

JRRD Volume 52, Number 7, 2015Pages 827–838Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs...lower- limb amputations and limb injuries. We evaluated the effect of lower-limb injury, amputation(s), and PTSD on outpatient costs, adjusting for...amputation status and significant parameters were tested (p  0.05) and models stratified by significant effect modi- fiers (p  0.05). For cost categories

45 CFR 2555.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Access to schools operated by LEAs. 2555.420... NATIONAL AND COMMUNITY SERVICE NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or...

45 CFR 2555.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Access to schools operated by LEAs. 2555.420... NATIONAL AND COMMUNITY SERVICE NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or...

45 CFR 2555.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 4 2013-10-01 2013-10-01 false Access to schools operated by LEAs. 2555.420... NATIONAL AND COMMUNITY SERVICE NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or...

28 CFR 54.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

....420 Section 54.420 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) NONDISCRIMINATION ON THE... operated by LEAs. A recipient that is a local educational agency shall not, on the basis of sex, exclude...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

28 CFR 54.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 54.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not, on the basis of sex, exclude...

43 CFR 41.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not, on the basis of sex, exclude...

34 CFR 300.817 - Reallocation of LEA funds.

Code of Federal Regulations, 2011 CFR

2011-07-01

... education and related services to all children with disabilities aged three through five years residing in... special education and related services to all children with disabilities aged three through five years... 34 Education 2 2011-07-01 2010-07-01 true Reallocation of LEA funds. 300.817 Section 300.817...

76 FR 17629 - Applications for New Awards; Transition to Teaching Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

... teachers in high-need schools operated by high-need local educational agencies (LEAs), including charter schools that operate as high-need LEAs. Priorities: This notice contains two competitive preference... Preference Priorities: Competitive Preference Priority 1 is from section 2313(c) of the Elementary and...

34 CFR 300.816 - Allocations to LEAs.

Code of Federal Regulations, 2014 CFR

2014-07-01

... numbers of children enrolled in public and private elementary schools and secondary schools within the LEA... data. For the purpose of making grants under this section, States must apply on a uniform basis across... private elementary and secondary schools and the numbers of children living in poverty. (Authority: 20 U.S...

34 CFR 300.816 - Allocations to LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... numbers of children enrolled in public and private elementary schools and secondary schools within the LEA... data. For the purpose of making grants under this section, States must apply on a uniform basis across... private elementary and secondary schools and the numbers of children living in poverty. (Authority: 20 U.S...

34 CFR 200.8 - Assessment reports.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assessment is given; (ii) In an understandable and uniform format, including an alternative format (e.g... understand. (b) Itemized score analyses for LEAs and schools. (1) A State's academic assessment system must produce and report to LEAs and schools itemized score analyses, consistent with § 200.2(b)(4), so that...

34 CFR 200.8 - Assessment reports.

Code of Federal Regulations, 2014 CFR

2014-07-01

... assessment is given; (ii) In an understandable and uniform format, including an alternative format (e.g... understand. (b) Itemized score analyses for LEAs and schools. (1) A State's academic assessment system must produce and report to LEAs and schools itemized score analyses, consistent with § 200.2(b)(4), so that...

34 CFR 300.816 - Allocations to LEAs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... numbers of children enrolled in public and private elementary schools and secondary schools within the LEA... data. For the purpose of making grants under this section, States must apply on a uniform basis across... private elementary and secondary schools and the numbers of children living in poverty. (Authority: 20 U.S...

34 CFR 300.816 - Allocations to LEAs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... numbers of children enrolled in public and private elementary schools and secondary schools within the LEA... data. For the purpose of making grants under this section, States must apply on a uniform basis across... private elementary and secondary schools and the numbers of children living in poverty. (Authority: 20 U.S...

34 CFR 200.8 - Assessment reports.

Code of Federal Regulations, 2012 CFR

2012-07-01

... assessment is given; (ii) In an understandable and uniform format, including an alternative format (e.g... understand. (b) Itemized score analyses for LEAs and schools. (1) A State's academic assessment system must produce and report to LEAs and schools itemized score analyses, consistent with § 200.2(b)(4), so that...

34 CFR 200.8 - Assessment reports.

Code of Federal Regulations, 2010 CFR

2010-07-01

... assessment is given; (ii) In an understandable and uniform format, including an alternative format (e.g... understand. (b) Itemized score analyses for LEAs and schools. (1) A State's academic assessment system must produce and report to LEAs and schools itemized score analyses, consistent with § 200.2(b)(4), so that...

34 CFR 200.8 - Assessment reports.

Code of Federal Regulations, 2011 CFR

2011-07-01

... assessment is given; (ii) In an understandable and uniform format, including an alternative format (e.g... understand. (b) Itemized score analyses for LEAs and schools. (1) A State's academic assessment system must produce and report to LEAs and schools itemized score analyses, consistent with § 200.2(b)(4), so that...

34 CFR 300.817 - Reallocation of LEA funds.

Code of Federal Regulations, 2010 CFR

2010-07-01

... education and related services to all children with disabilities aged three through five years residing in... special education and related services to all children with disabilities aged three through five years... 34 Education 2 2010-07-01 2010-07-01 false Reallocation of LEA funds. 300.817 Section 300.817...

34 CFR 222.18 - What amount does the Secretary forgive?

Code of Federal Regulations, 2010 CFR

2010-07-01

... SECONDARY EDUCATION, DEPARTMENT OF EDUCATION IMPACT AID PROGRAMS General § 222.18 What amount does the... hardship), and the LEA's current expenditure closing balance for the LEA's fiscal year immediately...'s preceding fiscal year's current expenditure closing balance is more than ten percent of its TCE...

34 CFR Appendix B to Part 300 - Proportionate Share Calculation

Code of Federal Regulations, 2010 CFR

2010-07-01

... CHILDREN WITH DISABILITIES Pt. 300, App. B Appendix B to Part 300—Proportionate Share Calculation Each LEA... the parentally-placed private school children with disabilities enrolled in private elementary schools... LEA's subgrant under section 611(f) of the Act for children with disabilities aged 3 through 21. This...

LEA Title VII Program Evaluations. Panel Presentations.

ERIC Educational Resources Information Center

Balu, Raj

These panel presentations focus on LEA Title VII Program Evaluations. Raj Balu, an administrator of bilingual programs in Chicago presents information regarding the bilingual education program in the Chicago public schools, as well as information on Title VII programs and what kind of evaluation is being done. Jesus Salazar, who is currently…

78 FR 2978 - Combined Notice of Filings #2

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-15

.... Applicants: Lea Power Partners, LLC. Description: Lea Power Partners, LLC's Updated Market Power Analysis and....m. ET 1/28/13. Docket Numbers: ER12-72-002. Applicants: Public Service Company of New Mexico. Description: Public Service Company of New Mexico submits tariff filing per 35: PNM Filing of Former NITSA and...

34 CFR 200.42 - Corrective action.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Corrective action. 200.42 Section 200.42 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.42 Corrective action. (a) Definition. “Corrective action” means action by an LEA that— (1) Substantially and directly responds to— (i...

34 CFR 200.42 - Corrective action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Corrective action. 200.42 Section 200.42 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.42 Corrective action. (a) Definition. “Corrective action” means action by an LEA that— (1) Substantially and directly responds to— (i...

34 CFR 200.32 - Identification for school improvement.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Identification for school improvement. 200.32 Section... Improving Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.32 Identification for school improvement. (a)(1)(i) An LEA must identify for school improvement any elementary or...

34 CFR 200.41 - School improvement plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false School improvement plan. 200.41 Section 200.41... Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.41 School improvement plan. (a)(1) Not later than three months after an LEA has identified a school for improvement...

34 CFR 200.32 - Identification for school improvement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Identification for school improvement. 200.32 Section... Improving Basic Programs Operated by Local Educational Agencies Lea and School Improvement § 200.32 Identification for school improvement. (a)(1)(i) An LEA must identify for school improvement any elementary or...

[Desire for amputation in body integrity identity disorder].

PubMed

Blom, Rianne M; Hennekam, Raoul C M

2014-01-01

Body integrity identity disorder (BIID) is a rare neuropsychiatric disorder in which patients experience a mismatch between the real and experienced body from childhood. BIID results in a strong desire to amputate or paralyse one or more limbs. We describe two BIID patients. A 40-year-old healthy male suffered daily from his desire for amputation, and therefore made a request for amputation at our academic medical centre. A 61-year-old male proceeded to self-amputation to create the body he had wished for, thereby curing himself from BIID. To date, no treatment has been found for BIID. Therefore patients often proceed to self-amputation, which could lead to serious and even dangerous complications. These case histories suggest that elective amputation may be a treatment for BIID. Many doctors, however, will question the admissibility of amputation of a healthy limb.

Rheolytic thrombectomy in the management of limb ischemia: 30-day results from a multicenter registry.

PubMed

Ansel, Gary M; George, Barry S; Botti, Charles F; McNamara, Thomas O; Jenkins, J Stephen; Ramee, Steven R; Rosenfield, Kenneth; Noethen, Alice A; Mehta, Tejas

2002-08-01

To evaluate the use of rheolytic thrombectomy (RT) with the AngioJet catheter for treatment of lower extremity ischemia due to arterial/graft thrombotic occlusion. A retrospective multicenter review was performed of 99 consecutive patients (52 men; mean age 67 +/- 13 years, range 30-90) who underwent RT for thrombotic occlusions in native arteries (n=80) or bypass grafts (n=19). Pre- and postprocedural limb ischemia and in-hospital events were evaluated. Amputation and mortality rates at 30 days were determined. The majority of patients (78.8%) presented within 14 days of symptom onset. RT resulted in substantial to complete thrombus removal in 70 (70.7%) patients and partial in 22 (22.2%); there was no angiographic change in 7 (7.1%). Adjunctive post RT thrombolysis was used in 37 patients. Underlying stenoses found in 81 limbs were treated with one or more of the following procedures: balloon angioplasty (n=62), stenting (n=35), or nonemergent surgical revision (n=5). In-hospital complications included 2 major amputations, 5 cases of minor tissue loss, 7 rethromboses, and 3 cases of transient renal insufficiency. Four (4.0% patients died in-hospital; the 95 surviving patients all had viable limbs at discharge. Mortality and amputation rates at 30 days were 7.1% and 4.0%, respectively. Percutaneous treatment of thrombotic occlusions with RT, followed by definitive treatment of the underlying stenosis, is a promising therapeutic option for patients with limb-threatening ischemia.

In Situ Venous Bypass for Chronic Hand Ischemia: A Review of 25 Cases in 23 Patients.

PubMed

Cornejo, Agustin; Neaman, Keith C; Srinivasan, Ramesh C; Mithani, Suhail K; Pederson, William C

2016-06-01

Chronic ischemia of the hand in the setting of atherosclerotic disease is a challenging problem that leads to serial amputations and significant morbidity. Salvage using an in situ venous bypass has been described. In selected cases, leaving the vein in situ for bypass allows a good size match for anastomosis at the wrist or palmar arch. Due to the rarity of the condition, there is a paucity of data regarding the efficacy of this technique. Outcomes in 23 consecutive patients that underwent a total of 25 in situ vein grafts over a 16-year period were retrospectively reviewed. Eighteen were men and 5 were women with a mean age of 61 years. Target vessels at the wrist or palmar arch were identified on preoperative vascular imaging. The cephalic vein (n = 19, 76%) was most commonly used followed by the basilic vein (n = 6, 24%). Overall patency rate at a mean follow-up period of 12.1 months was 92%. Success as determined by both symptomatic improvement and resolution of the ischemic changes or toleration of revision amputation was achieved in 16 (64%) cases. Postoperative complications occurred in ten cases (40 %). Progression of ischemia occurred in 7 cases (28 %) and 3 (12 %) of these cases required a hand amputation. In situ vein grafts in the upper extremity offer good short-term patency rates and can be used for salvage of chronic hand ischemia.

Factors Influencing Functional Outcomes and Return-to-Work After Amputation: A Review of the Literature.

PubMed

Darter, Benjamin J; Hawley, Carolyn E; Armstrong, Amy J; Avellone, Lauren; Wehman, Paul

2018-02-03

Purpose Amputation is a life changing event that can significantly impact an individual's physical and mental well-being. Our objective was to review literature exploring the impact of amputation upon a person's functioning and inclusion in the workplace. Methods Medline, CINAHL, and PsycINFO were searched using keywords related to amputation, employment and community reintegration. Eligible studies were published since 2000 and one of the following study designs: randomized controlled trial, non-randomized controlled trial, retrospective study, prospective study, concurrent cohort study, or cross sectional study. Studies for civilians with amputation as well as service members and Veterans with amputation were considered for inclusion. Results The search identified 995 articles, 25 of which met inclusion/exclusion criteria and were included in the review. While strong evidence for correlations and predictors of outcomes after amputation were limited, multiple factors were identified as contributing to physical functioning and employment after amputation. Conclusions Outcomes after amputation can vary widely with many potentially inter-related factors contributing. The factors identified may also serve to inform the development of interventions aiming to improve functional performance and reintegration after amputation. Furthermore, the review highlights the need for more high quality prospective studies.

Alternatives to thumb replantation in three cases of traumatic amputation of the thumb.

PubMed

Matey, P; Peart, F C

1999-01-01

Three cases of complete amputation of the thumb are reported in which the amputated distal parts were not suitable for replantation. In all cases there were either complete or incomplete amputations of other digits. Two different techniques were used for thumb reconstruction: 1) pollicization of a partially amputated digit with transposition microsurgery in case 1; and 2) replantation of a less important amputated digit to the thumb stump for cases 2 and 3. These microsurgical efforts successfully restored thumb function in all three patients.

A nationwide analysis of 30-day readmissions related to critical limb ischemia.

PubMed

Masoomi, Reza; Shah, Zubair; Quint, Clay; Hance, Kirk; Vamanan, Karthik; Prasad, Anand; Hoel, Andrew; Dawn, Buddhadeb; Gupta, Kamal

2018-06-01

Objectives There is paucity of information regarding critical limb ischemia-related readmission rates in patients admitted with critical limb ischemia. We studied 30-day critical limb ischemia-related readmission rate, its predictors, and clinical outcomes using a nationwide real-world dataset. Methods We did a secondary analysis of the 2013 Nationwide Readmissions Database. We included all patients with a primary diagnosis of extremity rest pain, ulceration, and gangrene secondary to peripheral arterial disease. From this group, all patients readmitted with similar diagnosis within 30 days were recorded. Results Of the total 25,111 index hospitalization for critical limb ischemia, 1270 (5%) were readmitted with a primary diagnosis of critical limb ischemia within 30 days. The readmission rate was highest (9.5%) for the group that did not have any intervention (revascularization or major amputation) and was lowest for surgical revascularization and major amputation groups (2.6% and 1.3%, P value <0.001 for all groups). Severity of critical limb ischemia at index admission was associated with a significantly higher rate of 30-day readmission. Critical limb ischemia-related readmission was associated with a higher rate of major amputation (29.6% vs. 16.2%, P<0.001), a lower rate of any revascularization procedure (46% vs. 62.6%, P<0.001), and a higher likelihood of discharge to a skilled nursing facility (43.2% vs. 32.2%, P<0.001) compared to index hospitalization. Conclusions In patients with primary diagnosis of critical limb ischemia, 30-day critical limb ischemia-related readmission rate was affected by initial management strategy and the severity of critical limb ischemia. Readmission was associated with a significantly higher rate of amputation, increased length of stay, and a more frequent discharge to an alternate care facility than index admission and thus may serve as a useful quality of care metric in critical limb ischemia patients.

Epidemiology of traumatic upper limb amputations.

PubMed

Pomares, G; Coudane, H; Dap, F; Dautel, G

2018-04-01

While published data on functional outcomes after upper limb amputations are plentiful, epidemiology data are relatively rare. This led us to performing an epidemiology study of traumatic upper limb amputations at our facility. This retrospective study spanned a 10-year period of cases seen at the SOS Main (Hand emergency center) of the Nancy University Hospital in France. Patients who suffered traumatic amputation of the upper limb were identified and divided into two groups: replantation and surgical amputation. All anatomical amputation levels were retained. Non-traumatic amputations were excluded. Epidemiology data (sex, age, dominant side, injured side) was collected along with the specific anatomical level of the injury, the injury mechanism and whether it was work-related. We also looked at the success rate of microsurgery and whether multi-finger amputations were partial or complete. In parallel, the annual incidence of amputations seen at the SOS Main over this period was calculated. Over the 10-year period, 1715 traumatic upper-limb amputations were identified, which was 3% of all cases seen at the SOS Main. Most of the cases involved middle-aged men. Revascularization was attempted in one-third of cases and microsurgery was successful in 70% of cases. The surgical amputation group consisted of 1132 patients with a mean age of 59 years, while the replantation group consisted of 583 patients with a mean age of 48 years. The primary mechanism of injury was a table saw. This injury, which must be addressed urgently, is not very common in everyday practice. This is contrary to lower limb amputations, which are more common and occur in the context of micro- and macroangiopathy in older patients. The success rate of microsurgery in this cohort must be placed in the context of age, amputation level and mechanism. The functional outcomes are not always as good as the vascular outcomes. This data is invaluable as it fills a gap in our knowledge about amputations. IV. Copyright © 2018. Published by Elsevier Masson SAS.

Work-related amputations in Michigan, 1997.

PubMed

Stanbury, Martha; Reilly, Mary Jo; Rosenman, Kenneth D

2003-10-01

Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan. Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997. Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment. In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed. Copyright 2003 Wiley-Liss, Inc.

Sexual function in adolescent and young adult survivors of lower extremity bone tumors.

PubMed

Barrera, Maru; Teall, Tanya; Barr, Ronald; Silva, Mariana; Greenberg, Mark

2010-12-15

Improving survival rates and new surgical options have led to increased interest regarding late effects and quality of life in adolescent and young adult survivors of bone cancers, including their sexual functioning. This study investigated sexual functioning in adolescent and young adult survivors of lower limb bone tumors, in relation to surgical treatments, gender differences, depressive symptoms, global self worth, and physical disability. Twenty-eight participants (age range 18-32 years) completed measures of gender specific sexual function, depressive symptoms, global self worth, and physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and amputation or Van Nes rotationplasty (AMP). Male survivors reported significantly higher scores than females on total sexual function scores (P = 0.050), sexual drive (P = 0.002), and frequency of sexual thoughts, fantasies or erotic dreams (P = 0.021). Men also reported significantly better physical functioning scores than women (P = 0.012). LS scored significantly lower on frequency of sexual thoughts, fantasies and erotic dreams (P = 0.048) and frequency of sexual experiences (P = 0.016) compared with AMP. In addition, LS reported significantly more depressive symptoms scores (P = 0.004) and lower self worth scores (P = 0.037), than AMP. These results suggest that male survivors of lower extremity bone tumors experience better sexual functioning than women. Survivors of limb sparing surgeries struggle with sexual function, depressive symptoms, and poor self-perception compared to Van Nes rotationplasty and amputation survivors. Copyright © 2010 Wiley-Liss, Inc.

Complex regional pain syndrome type I (RSD): pathology of skeletal muscle and peripheral nerve.

PubMed

van der Laan, L; ter Laak, H J; Gabreëls-Festen, A; Gabreëls, F; Goris, R J

1998-07-01

Reflex sympathetic dystrophy (RSD) (recently reclassified as complex regional pain syndrome type I) is a syndrome occurring in extremities and, when chronic, results in severe disability and untractable pain. RSD may be accompanied by neurologic symptoms even when there is no previous neurologic lesion. There is no consensus as to the pathogenic mechanism involved in RSD. To gain insight into the pathophysiology of RSD, we studied histopathology of skeletal muscle and peripheral nerve from patients with chronic RSD in a lower extremity. In eight patients with chronic RSD, an above-the-knee amputation was performed because of a nonfunctional limb. Specimens of sural nerves, tibial nerves, common peroneal nerves, gastrocnemius muscles, and soleus muscles were obtained from the amputated legs and analyzed by light and electron microscopy. In all patients, the affected leg showed similar neurologic symptoms such as spontaneous pain, hyperpathy, allodynia, paresis, and anesthesia dolorosa. The nerves showed no consistent abnormalities of myelinated fibers. In four patients, the C-fibers showed electron microscopic pathology. In all patients, the gastrocnemius and soleus muscle specimens showed a decrease of type I fibers, an increase of lipofuscin pigment, atrophic fibers, and severely thickened basal membrane layers of the capillaries. In chronic RSD, efferent nerve fibers were histologically unaffected; from afferent fibers, only C-fibers showed histopathologic abnormalities. Skeletal muscle showed a variety of histopathologic findings, which are similar to the histologic abnormalities found in muscles of patients with diabetes.

Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations.

PubMed

Kulkarni, J; Adams, J; Thomas, E; Silman, A

1998-08-01

To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides. Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations. Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening. The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded. Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast, from published general population surveys only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips. There was a significant decrease in femoral neck BMD in the amputated side (p <0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees (p = 0.0027) as compared to normal age- and sex-matched population. Male war veterans with unilateral major lower limb amputations develop significantly more osteoarthritis of the hip than expected on both ipsi- and contralateral sides. Amputation was also associated with loss of bone density. Above-knee amputees develop significantly more hip osteoarthritis and osteopenia of greater severity in the amputated side than below-knee amputees.

The effect of limb amputation on standing weight distribution in the remaining three limbs in dogs.

PubMed

Cole, Grayson Lee; Millis, Darryl

2017-01-16

Despite the fact that limb amputation is a commonly performed procedure in veterinary medicine, quantitative data regarding outcomes are lacking. The intention of this study was to evaluate the effect of limb amputation on weight distribution to the remaining three limbs at a stance in dogs. Ten dogs with a prior forelimb amputation and ten dogs with a prior hindlimb amputation; all of which had no history of orthopaedic or neural disease in the remaining three limbs were included in the study. Standing weight bearing was evaluated with a commercial stance analyzer in all dogs. Five valid trials were obtained and a mean percentage of weight bearing was calculated for each remaining limb. The dogs with a previous forelimb amputation, and also those with a previous hindlimb amputation, had the largest mean increase in weight bearing in the contralateral forelimb. In conclusion, proactive monitoring of orthopaedic disease in the contralateral forelimb may be advisable in dogs with a previous limb amputation. In addition, when determining candidacy for a limb amputation, disease of the contralateral forelimb should be thoroughly evaluated.

Driving ability following upper limb amputation.

PubMed

Burger, Helena; Marincek, Crt

2013-10-01

In the existing literature, there is scarce information about subjects with upper limb amputation and driving. The aim of this study was to find out how frequently subjects following upper limb amputation have problems when driving; most frequently proposed adaptations and, when possible, factors that influence driving ability. Retrospective clinical study. Medical records were reviewed of all subjects following upper limb amputation who had been amputated in the last 5 years and those with congenital upper limb deficiency who in the last 5 years turned 17. Out of 37 subjects, 7 did not attend the clinic for assessment of driving abilities. They were significantly older at the time of the amputation (p < 0.001). To the remaining 30 who attended driving assessment, zero to four car adaptations (two on average) were proposed. There were no correlations between the number of suggested car adaptations and the age at the time of the amputation, amputation level, education and severity of phantom limb pain. Type of prosthesis also did not influence the number of car adaptations. Most people following upper limb amputation need at least one car adaptation for safe driving.

43 CFR 41.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.420 Access to schools... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Access to schools operated by LEAs. 41.420...

43 CFR 41.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 41.420 Access to schools... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Access to schools operated by LEAs. 41.420...

78 FR 8508 - Combined Notice of Filings #1

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

..., Inc. for an order pursuant to Section 203 of the Federal Power Act. Filed Date: 1/18/13 Accession... Applicants: Lea Power Partners, LLC, Waterside Power, LLC Description: Notice of change in status of Lea Power Partners, LLC, et al. Filed Date: 1/18/13 Accession Number: 20130118-5260 Comments Due: 5 p.m. ET...

A Comparative Case-Study of School-LEA-NGO Interactions across Different Socio-Economic Strata in Israel

ERIC Educational Resources Information Center

Yemini, Miri; Cegla, Ariel; Sagie, Netta

2018-01-01

This study examines the interaction between non-governmental organization (NGO), the Local Education Authority (LEA), and public schools in communities of different socioeconomic backgrounds in Israel. We characterize how schools serving more and less affluent communities create, cultivate, and preserve interactions with NGOs; how NGOs form, and…

The World Factbook 1999

DTIC Science & Technology

1999-01-01

Arequipa, Ayacucho, Cajamarca, Callao*, Cusco, Huancavelica, Huanuco, lea, Junin, La Libertad, Lambayeque, Lima, Loreto, Madre de Dios , Moquegua...Inca (from Cusco, Madre de Dios , Apurimac), La Libertad (from La Libertad), Los Libertadores-Huari (from lea, Ayacucho, Huancavelica), Mariategui...industrial emissions; rivers polluted from raw sewage, heavy metals , detergents; deforestation; forest damage from air pollution and resulting acid rain

49 CFR 25.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 25.420 Transportation Office of the Secretary of Transportation NONDISCRIMINATION ON THE BASIS OF SEX... Basis of Sex in Education Programs or Activities Prohibited § 25.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not, on the basis of sex, exclude any person...

40 CFR 5.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not, on the basis of sex, exclude...

School District (K-12) Pandemic Influenza Planning Checklist

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2009

2009-01-01

Local educational agencies (LEAs) play an integral role in protecting the health and safety of their district's staff, students and their families. The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed this checklist to assist LEAs in developing and/or improving plans to prepare…

34 CFR 200.51 - Notice of SEA action.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 1 2012-07-01 2012-07-01 false Notice of SEA action. 200.51 Section 200.51 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.51 Notice of SEA action. (a) In general. (1) An SEA must— (i) Communicate with parents throughout the review of an LEA under...

34 CFR 200.49 - SEA responsibilities for school improvement, corrective action, and restructuring.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false SEA responsibilities for school improvement, corrective... Agencies Lea and School Improvement § 200.49 SEA responsibilities for school improvement, corrective action... subject to corrective action on January 7, 2002, the SEA must ensure that the LEA for that school provides...

34 CFR 200.51 - Notice of SEA action.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Notice of SEA action. 200.51 Section 200.51 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.51 Notice of SEA action. (a) In general. (1) An SEA must— (i) Communicate with parents throughout the review of an LEA under...

34 CFR 200.51 - Notice of SEA action.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 1 2014-07-01 2014-07-01 false Notice of SEA action. 200.51 Section 200.51 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.51 Notice of SEA action. (a) In general. (1) An SEA must— (i) Communicate with parents throughout the review of an LEA under...

34 CFR 200.51 - Notice of SEA action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Notice of SEA action. 200.51 Section 200.51 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.51 Notice of SEA action. (a) In general. (1) An SEA must— (i) Communicate with parents throughout the review of an LEA under...

34 CFR 200.51 - Notice of SEA action.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 1 2013-07-01 2013-07-01 false Notice of SEA action. 200.51 Section 200.51 Education... Programs Operated by Local Educational Agencies Lea and School Improvement § 200.51 Notice of SEA action. (a) In general. (1) An SEA must— (i) Communicate with parents throughout the review of an LEA under...

34 CFR 222.171 - What LEAs may be eligible for Discretionary Construction grants?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false What LEAs may be eligible for Discretionary Construction grants? 222.171 Section 222.171 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION IMPACT AID PROGRAMS Impact...

40 CFR 5.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not, on the basis of sex, exclude...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2014 CFR

2014-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2013 CFR

2013-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2012 CFR

2012-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

34 CFR 200.20 - Making adequate yearly progress.

Code of Federal Regulations, 2011 CFR

2011-07-01

... adequate yearly progress. A school or LEA makes AYP if it complies with paragraph (c) and with either paragraph (a) or (b) of this section separately in reading/language arts and in mathematics. (a)(1) A school... school or LEA, respectively, meets or exceeds the State's other academic indicators under § 200.19. (2...

Theme with Variations: Social Policy, Community Care and Adult Education.

ERIC Educational Resources Information Center

Lavender, Peter

1990-01-01

Changes in British social policy regarding community health care has implications for local education agency (LEA) providers of adult continuing education. LEAs will either have a role in providing staff training and other learning opportunities, will be forced to provide cheaper forms of community care, or will be ignored altogether. (SK)

34 CFR 200.70 - Allocation of funds to LEAs in general.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Allocation of funds to LEAs in general. 200.70 Section 200.70 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION TITLE I-IMPROVING THE ACADEMIC ACHIEVEMENT OF THE DISADVANTAGED...

34 CFR 200.29 - Consolidation of funds in a schoolwide program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... committee established by the LEA under section 7114(c)(4) of the ESEA approves the inclusion of these funds... IDEA for that fiscal year, divided by the number of children with disabilities in the jurisdiction of the LEA, and multiplied by the number of children with disabilities participating in the schoolwide...

State-Level Analysis of School Punitive Discipline Practices in Florida

ERIC Educational Resources Information Center

Gagnon, Joseph Calvin; Gurel, Sungur; Barber, Brian R.

2017-01-01

The purpose of this study was to identify statewide trends in school approaches to student discipline and examine the associations between punitive discipline practices and student, school, and local education agency (LEA) characteristics. In addition, we compared punitive disciplinary practices for schools and LEAs that do and do not allow…

Every Student Succeeds Act State and Local Report Cards: Non-Regulatory Guidance

ERIC Educational Resources Information Center

US Department of Education, 2017

2017-01-01

The Elementary and Secondary Education Act of 1965 (ESEA), as amended by the Every Student Succeeds Act (ESSA), and implementing regulations maintain requirements for State educational agencies (SEAs), local educational agencies (LEAs) to prepare and disseminate report cards that provide information on State, LEA, and school performance and…

44 CFR 19.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Access to schools operated by... Activities Prohibited § 19.420 Access to schools operated by LEAs. A recipient that is a local educational... vocational education operated by such recipient; or (b) Any other school or educational unit operated by such...

43 CFR 41.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Access to schools operated by LEAs. 41.420... on the Basis of Sex in Education Programs or Activities Prohibited § 41.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

14 CFR 1253.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Access to schools operated by LEAs. 1253... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 1253.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

38 CFR 23.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Access to schools... Prohibited § 23.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

28 CFR 54.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Access to schools operated by LEAs. 54... on the Basis of Sex in Education Programs or Activities Prohibited § 54.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

6 CFR 17.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 6 Domestic Security 1 2011-01-01 2011-01-01 false Access to schools operated by LEAs. 17.420... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 17.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

44 CFR 19.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Access to schools operated by... Activities Prohibited § 19.420 Access to schools operated by LEAs. A recipient that is a local educational... vocational education operated by such recipient; or (b) Any other school or educational unit operated by such...

38 CFR 23.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Access to schools... Prohibited § 23.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

43 CFR 41.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Access to schools operated by LEAs. 41.420... on the Basis of Sex in Education Programs or Activities Prohibited § 41.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

40 CFR 5.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Access to schools operated by LEAs. 5... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 5.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

6 CFR 17.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Access to schools operated by LEAs. 17.420... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 17.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

14 CFR 1253.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Access to schools operated by LEAs. 1253.420... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 1253.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

31 CFR 28.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Access to schools operated by LEAs... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 28.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

Association between Functional Severity and Amputation Type with Rehabilitation Outcomes in Patients with Lower Limb Amputation

PubMed Central

Graham, James E.; Reistetter, Timothy A.; Kumar, Amit; Niewczyk, Paulette; Granger, Carl V.; Ottenbacher, Kenneth J.

2014-01-01

The purpose of this study was to determine independent influences of functional level and lower limb amputation type on inpatient rehabilitation outcomes. We conducted a secondary data analysis for patients with lower limb amputation who received inpatient medical rehabilitation (N = 26,501). The study outcomes included length of stay, discharge functional status, and community discharge. Predictors included the 3-level case mix group variable and a 4-category amputation variable. Age of the sample was 64.5 years (13.4) and 64% were male. More than 75% of patients had a dysvascular-related amputation. Patients with bilateral transfemoral amputations and higher functional severity experienced longest lengths of stay (average 13.7 days) and lowest functional rating at discharge (average 79.4). Likelihood of community discharge was significantly lower for those in more functionally severe patients but did not differ between amputation categories. Functional levels and amputation type are associated with rehabilitation outcomes in inpatient rehabilitation settings. Patients with transfemoral amputations and those in case mix group 1003 (admission motor score less than 36.25) generally experience poorer outcomes than those in other case mix groups. These relationships may be associated with other demographic and/or health factors, which should be explored in future research. PMID:25400948

Maladaptive plasticity: imprinting of past experiences onto phantom limb schemata.

PubMed

Giummarra, Melita Joy; Georgiou-Karistianis, Nellie; Nicholls, Michael E R; Gibson, Stephen J; Chou, Michael; Bradshaw, John L

2011-10-01

Phantom limb perception is common following amputation, and is sometimes characterised by pain that resembles the characteristics, intensity or location of past pain. We tested Flor's model that phantom pain results from memory for long-lasting znoxious input. We report a questionnaire study of 283 amputees, that explored the experience of painful, non-painful and postural somatosensory memories in the phantom. We explore the impact of pre-amputation pain and impairment duration, and complications in the limb (eg, infection, gangrene, surgery, and vascular disease). Differences in mood, coping and adjustment to amputation are also explored in those with somatosensory pain memories. Our findings support Flor's model, as amputation-related and non-amputation-related pain memories, and non-painful memories comprised pains or sensations that were either enduring/recurring pains or sensations (eg, ingrown toenail, corns, chilblains, arthritis-type pain in winter, night-cramps, or holding a tennis racquet), or resulted from a painful event with a "core-trauma" element (eg, fracture, crushing/penetration injury). Pain memories related to amputation were more common following functional impairment before amputation; infection or surgery prior to amputation; or having diabetic or vascular amputations-which are associated with multiple complications, including neuropathic changes, infection and prior surgery. Furthermore, participants with amputation-related pain memories exhibited higher sensory pain ratings, as well as poorer mood and adjustment to the limitations of amputation. We propose that somatosensory pain memories likely relate to the generation and maintenance of limb representations upon which intense or emotionally powerful past experiences have been imprinted.

Morphological features of different polyploids for adaptation and molecular characterization of CC-NBS-LRR and LEA gene families in Agave L.

PubMed

Tamayo-Ordóñez, M C; Rodriguez-Zapata, L C; Narváez-Zapata, J A; Tamayo-Ordóñez, Y J; Ayil-Gutiérrez, B A; Barredo-Pool, F; Sánchez-Teyer, L F

2016-05-20

Polyploidy has been widely described in many Agave L. species, but its influence on environmental response to stress is still unknown. With the objective of knowing the morphological adaptations and regulation responses of genes related to biotic (LEA) and abiotic (NBS-LRR) stress in species of Agave with different levels of ploidy, and how these factors contribute to major response of Agave against environmental stresses, we analyzed 16 morphological trials on five accessions of three species (Agave tequilana Weber, Agave angustifolia Haw. and Agave fourcroydes Lem.) with different ploidy levels (2n=2x=60 2n=3x=90, 2n=5x=150, 2n=6x=180) and evaluated the expression of NBS-LRR and LEA genes regulated by biotic and abiotic stress. It was possible to associate some morphological traits (spines, nuclei, and stomata) to ploidy level. The genetic characterization of stress-related genes NBS-LRR induced by pathogenic infection and LEA by heat or saline stresses indicated that amino acid sequence analysis in these genes showed more substitutions in higher ploidy level accessions of A. fourcroydes Lem. 'Sac Ki' (2n=5x=150) and A. angustifolia Haw. 'Chelem Ki' (2n=6x=180), and a higher LEA and NBS-LRR representativeness when compared to their diploid and triploid counterparts. In all studied Agave accessions expression of LEA and NBS-LRR genes was induced by saline or heat stresses or by infection with Erwinia carotovora, respectively. The transcriptional activation was also higher in A. angustifolia Haw. 'Chelem Ki' (2n=6x=180) and A. fourcroydes 'Sac Ki' (2n=5x=150) than in their diploid and triploid counterparts, which suggests higher adaptation to stress. Finally, the diploid accession A. tequilana Weber 'Azul' showed a differentiated genetic profile relative to other Agave accessions. The differences include similar or higher genetic representativeness and transcript accumulation of LEA and NBS-LRR genes than in polyploid (2n=5x=150 and 2n=6x=180) Agave accessions, thus suggesting a differentiated selection pressure for overcoming the lower ploidy level of the diploid A. tequilana Weber 'Azul'. Copyright © 2016 Elsevier GmbH. All rights reserved.

Standing balance in people with trans-tibial amputation due to vascular causes: A literature review.

PubMed

Seth, Mayank; Lamberg, Eric

2017-08-01

Balance is an important variable to consider during the rehabilitation process of individuals with trans-tibial amputation. Limited evidence exists on the balance abilities of people with trans-tibial amputation due to vascular causes. The purpose of this article is to review literature and determine if standing balance is diminished in people with trans-tibial amputation due to vascular causes. Literature review. Data were obtained from PubMed, Google Scholar, OandP.org , CINHAL, and Science Direct. Studies were selected only if they included standing balance assessment of people with unilateral trans-tibial amputation due to vascular causes. The review yielded seven articles that met the inclusion criteria. The general test methodology required participants to stand still on force platforms, with feet together, while center of pressure or postural sway was recorded. According to the findings of this review, individuals with trans-tibial amputees due to vascular causes have diminished balance abilities. Limited evidence suggests their balance might be further diminished as compared to individuals with trans-tibial amputation due to trauma. Although the evidence is limited, because of the underlying pathology and presence of comorbidities in individuals with trans-tibial amputation due to vascular causes, one cannot ignore these findings, as even a minor injury from a fall may develop into a non-healing ulcer and affect their health and well-being more severely than individuals with trans-tibial amputation due to trauma. Clinical relevance Individuals with trans-tibial amputation due to vascular causes have diminished balance abilities compared to healthy individuals and individuals with trans-tibial amputation due to trauma. This difference should be considered when designing and fabricating prostheses. Prosthetists and rehabilitation clinicians should consider designing amputation cause-specific rehabilitation interventions, focussing on balance and other functional limitations related to comorbidities of amputation.

Lea's Shield: a study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide.

PubMed

Mauck, C; Glover, L H; Miller, E; Allen, S; Archer, D F; Blumenthal, P; Rosenzweig, A; Dominik, R; Sturgen, K; Cooper, J; Fingerhut, F; Peacock, L; Gabelnick, H L

1996-06-01

The purpose of this study was to evaluate the safety, efficacy and acceptability of Lea's Shield, a new vaginal contraceptive barrier device, when used with either spermicidal or non-spermicidal lubricant. One-hundred-eighty-five (185) women enrolled at six centers. Half were randomized to use the device with spermicide and half with a non-spermicidal lubricant. To be eligible, volunteers had to be 18-40 years old (inclusive), in good health with regular menses, sexually active in an ongoing relationship and at risk for pregnancy, and willing to use Lea's Shield as their sole means of contraception for six months. Participants were seen at admission, one week, one month, three months and six months. Gross cumulative life table rates were calculated for pregnancy and others reasons for discontinuation. Adverse experiences and responses to an acceptability questionnaire were evaluated. One-hundred-eighty-two (182) volunteers contributed data to the analysis of safety and 146 to that of contraceptive efficacy. The unadjusted six-month life table pregnancy rate was 8.7 per 100 women for spermicide users and 12.9 for non-spermicide users (p = 0.287). After controlling for age, center, and frequent prior use of barrier methods, the adjusted six-month life table pregnancy rate was 5.6 for spermicide users and 9.3 for non-spermicide users (p = 0.086), indicating that use of spermicide lowered pregnancy rates, although not significantly, during typical use. For purposes of comparison, it is important to note that this study differed from the cap/diaphragm and sponge/ diaphragm studies in that a high percentage (84%) of volunteers were parous. For reasons that are unclear, pregnancy rates among parous women using barrier contraceptives tend to be higher than among nulliparous women. Indeed, in this study there were no pregnancies among nulliparous users of Lea's Shield. Standardization of parity of this study population on those of the cap/diaphragm and sponge/diaphragm studies suggests that unadjusted pregnancy rates for this device would have been considerably lower (2.2 and 2.9 per 100 users of spermicide and non-spermicide, respectively) had the study been done using the populations of earlier studies. Since no directly comparative study has been done, these figures provide a tentative estimate of the relative efficacy of Lea's Shield compared with the sponge, cap, and diaphragm. There were no serious adverse experiences attributed to the use of Lea's Shield. Acceptability was very good. Seventy-five percent (75%) of women responded to an end-of-study questionnaire; 87% of these reported that they would recommend Lea's Shield to a friend. Lea's Shield is a new vaginal contraceptive that does not require clinician fitting. Pregnancy rates in this study compare favorably with other studies of barrier contraceptive methods including the cervical cap, diaphragm, and sponge, even though this study was done with greater rigor and with a greater percentage of parous women than previous barrier studies. Lea's Shield appears to be safe and very acceptable to study volunteers.

Preventing diabetic foot disease: lessons from the Medicare therapeutic shoe demonstration.

PubMed Central

Wooldridge, J; Bergeron, J; Thornton, C

1996-01-01

OBJECTIVES. Every year about 38,000 elderly people with diabetes have a lower extremity amputation. Therapeutic shoes are prescribed by clinicians specializing in foot care to prevent foot ulcerations and amputations among at-risk patients with diabetes. Medicare ran a 3-year demonstration of a therapeutic-shoe benefit for beneficiaries with diabetes. Medicare added the benefit nationwide in May 1993. METHODS. This paper describes the benefit and its implementation in the demonstration based on demonstration records, a patient survey, and discussions with clinicians and shoe suppliers before and during the demonstration. RESULTS. During the demonstration, far fewer beneficiaries applied for the therapeutic shoes than were eligible for them. The paper discusses reasons for the low beneficiary application rate and the associated low participation rate among physicians treating patients with diabetes. CONCLUSIONS. The benefit is unlikely to be used any more in the national program than in the demonstration unless physicians are educated in the role therapeutic shoes can play in diabetic foot disease, they prescribe the shoes for their patients, and they increase their patients' awareness of the shoes' value. PMID:8669516

Can an ankle-foot orthosis change hearts and minds?

PubMed

Patzkowski, Jeanne C; Blanck, Ryan V; Owens, Johnny G; Wilken, Jason M; Blair, James A; Hsu, Joseph R

2011-01-01

The current military conflicts of Operation Enduring Freedom and Operation Iraqi Freedom have been characterized by high-energy explosive wounding patterns, with the majority affecting the extremities. While many injuries have resulted in amputation, surgical advances have allowed the orthopaedic surgeon to pursue limb salvage in the face of injuries once considered unsalvageable. The military limb salvage patient is frequently highly active and motivated and expresses significant frustration with the slow nature of limb salvage rehabilitation and continued functional deficits. Inspired by these patients, efforts at this institution began to provide them with a more dynamic orthosis. Utilizing techniques and technology resulting from cerebral palsy, stroke, and amputation research, the Intrepid Dynamic Exoskeletal Orthosis was created. To date, this device has significantly improved the functional capabilities of the limb salvage wounded warrior population when combined with a high-intensity rehabilitation program. Clinical and biomechanical research is currently underway at this institution in order to fully characterize the device, its effect on patients, and what can be done to modify future generations of the device to best serve the combat-wounded limb salvage population.

Saving the limb in diabetic patients with ischemic foot lesions complicated by acute infection.

PubMed

Clerici, Giacomo; Faglia, Ezio

2014-12-01

Ischemia and infection are the most important factors affecting the prognosis of foot ulcerations in diabetic patients. To improve the outcome of these patients, it is necessary to aggressively treat 2 important pathologies--namely, occlusive arterial disease affecting the tibial and femoral arteries and infection of the ischemic diabetic foot. Each of these 2 conditions may lead to major limb amputation, and the presence of both critical limb ischemia (CLI) and acute deep infection is a major risk factor for lower-extremity amputation. Thus, the management of diabetic foot ulcers requires specific therapeutic approaches that vary significantly depending on whether foot lesions are complicated by infection and/or ischemia. A multidisciplinary team approach is the key to successful treatment of a diabetic foot ulcer: ischemic diabetic foot ulcers complicated by acute deep infection pose serious treatment challenges because high levels of skill, organization, accuracy, and timing of intervention are required to maximize the chances of limb salvage: these complex issues are better managed by a multidisciplinary clinical group. © The Author(s) 2014.

Pre and post-amputation mobility of trans-tibial amputees: correlation to medical problems, age and mortality.

PubMed

Johnson, V J; Kondziela, S; Gottschalk, F

1995-12-01

This retrospective study compares pre and post-amputation mobility and the influence of age and associated medical problems. Data from the charts of 120 male patients who underwent unilateral trans-tibial (below-knee) amputation at the Dallas Veteran's Administration Hospital between June, 1983 and October, 1991, were collected and analyzed. Mobility was assessed with a six level scale developed by Volpicelli et al. (1983). The presence of cardiac disease, pulmonary disease (COPD), peripheral vascular disease (PVD), diabetes mellitus, degenerative joint disease, blindness, cerebral vascular accident (CVA), and age are correlated with changes in mobility after amputation. Older patients had more medical problems and lower post-amputation scores Individual medical problems did not influence mobility scores, but the presence of COPD and PVD lowered pre-amputation mobility scores. Cardiac disease and diabetes mellitus influenced post-amputation mobility scores by lowering them, either together or individually. Regardless of age, however, patients with more medical problems were poor ambulators. The cause of amputation per se did not influence mobility scores.

Reduced Incidence of Foot-Related Hospitalisation and Amputation amongst Persons with Diabetes in Queensland, Australia

PubMed Central

Lazzarini, Peter A.; O’Rourke, Sharon R.; Russell, Anthony W.; Derhy, Patrick H.; Kamp, Maarten C.

2015-01-01

Objective To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia) between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management. Methods All data from cases admitted for the principal reason of diabetes foot-related hospitalisation or amputation in Queensland from 2005–2010 were obtained from the Queensland Hospital Admitted Patient Data Collection dataset. Incidence rates for foot-related hospitalisation (admissions, bed days used) and amputation (total, minor, major) cases amongst persons with diabetes were calculated per 1,000 person-years with diabetes (diabetes population) and per 100,000 person-years (general population). Age-sex standardised incidence and age-sex adjusted Poisson regression models were also calculated for the general population. Results There were 4,443 amputations, 24,917 hospital admissions and 260,085 bed days used for diabetes foot-related complications in Queensland. Incidence per 1,000 person-years with diabetes decreased from 2005 to 2010: 43.0% for hospital admissions (36.6 to 20.9), 40.1% bed days (391 to 234), 40.0% total amputations (6.47 to 3.88), 45.0% major amputations (2.18 to 1.20), 37.5% minor amputations (4.29 to 2.68) (p < 0.01 respectively). Age-sex standardised incidence per 100,000 person-years in the general population also decreased from 2005 to 2010: 23.3% hospital admissions (105.1 to 80.6), 19.5% bed days (1,122 to 903), 19.3% total amputations (18.57 to 14.99), 26.4% major amputations (6.26 to 4.61), 15.7% minor amputations (12.32 to 10.38) (p < 0.01 respectively). The age-sex adjusted incidence rates per calendar year decreased in the general population (rate ratio (95% CI)); hospital admissions 0.949 (0.942–0.956), bed days 0.964 (0.962–0.966), total amputations 0.962 (0.946–0.979), major amputations 0.945 (0.917–0.974), minor amputations 0.970 (0.950–0.991) (p < 0.05 respectively). Conclusions There were significant reductions in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in the population of Queensland over a recent six-year period. PMID:26098890

45 CFR 86.35 - Access to schools operated by L.E.A.s.

Code of Federal Regulations, 2012 CFR

2012-10-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.35 Access to schools operated by L.E.A.s. A recipient which is a local educational agency shall not, on the basis of sex...

45 CFR 86.35 - Access to schools operated by L.E.A.s.

Code of Federal Regulations, 2010 CFR

2010-10-01

... NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.35 Access to schools operated by L.E.A.s. A recipient which is a local educational agency shall not, on the basis of sex...

34 CFR 76.789 - What are an SEA's responsibilities under this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAMS How Does a State or Local Educational Agency Allocate Funds to Charter Schools? Reponsibilities...) Information. Upon receiving notice under § 76.788(a) of the date a charter school LEA is scheduled to open or significantly expand its enrollment, an SEA must provide the charter school LEA with timely and meaningful...

34 CFR 76.789 - What are an SEA's responsibilities under this subpart?

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAMS How Does a State or Local Educational Agency Allocate Funds to Charter Schools? Reponsibilities...) Information. Upon receiving notice under § 76.788(a) of the date a charter school LEA is scheduled to open or significantly expand its enrollment, an SEA must provide the charter school LEA with timely and meaningful...

34 CFR 200.32 - Identification for school improvement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... defined under §§ 200.13 through 200.20. (ii) In identifying schools for improvement, an LEA— (A) May base... LEA must, in accordance with § 200.44, provide public school choice to all students in the school. (c... LEA must— (i) In accordance with § 200.44, provide public school choice to all students in the school...

34 CFR 200.32 - Identification for school improvement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... defined under §§ 200.13 through 200.20. (ii) In identifying schools for improvement, an LEA— (A) May base... LEA must, in accordance with § 200.44, provide public school choice to all students in the school. (c... LEA must— (i) In accordance with § 200.44, provide public school choice to all students in the school...

34 CFR 200.12 - Single State accountability system.

Code of Federal Regulations, 2014 CFR

2014-07-01

... and secondary schools and LEAs in the State make AYP as defined in §§ 200.13 through 200.20. (b) The... achievement of all public elementary and secondary school students; (3) Be the same accountability system the State uses for all public elementary and secondary schools and all LEAs in the State; and (4) Include...

34 CFR 76.789 - What are an SEA's responsibilities under this subpart?

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAMS How Does a State or Local Educational Agency Allocate Funds to Charter Schools? Reponsibilities...) Information. Upon receiving notice under § 76.788(a) of the date a charter school LEA is scheduled to open or significantly expand its enrollment, an SEA must provide the charter school LEA with timely and meaningful...

34 CFR 200.12 - Single State accountability system.

Code of Federal Regulations, 2013 CFR

2013-07-01

... and secondary schools and LEAs in the State make AYP as defined in §§ 200.13 through 200.20. (b) The... achievement of all public elementary and secondary school students; (3) Be the same accountability system the State uses for all public elementary and secondary schools and all LEAs in the State; and (4) Include...

34 CFR 200.32 - Identification for school improvement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... defined under §§ 200.13 through 200.20. (ii) In identifying schools for improvement, an LEA— (A) May base... LEA must, in accordance with § 200.44, provide public school choice to all students in the school. (c... LEA must— (i) In accordance with § 200.44, provide public school choice to all students in the school...

34 CFR 76.789 - What are an SEA's responsibilities under this subpart?

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAMS How Does a State or Local Educational Agency Allocate Funds to Charter Schools? Reponsibilities...) Information. Upon receiving notice under § 76.788(a) of the date a charter school LEA is scheduled to open or significantly expand its enrollment, an SEA must provide the charter school LEA with timely and meaningful...

34 CFR 611.47 - What are a scholarship recipient's reporting responsibilities upon the close of the LEA's...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false What are a scholarship recipient's reporting... EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM Scholarships § 611.47 What are a scholarship recipient...'s academic year, a scholarship recipient whose LEA reports under § 611.46(a) that he or she is...

34 CFR 611.47 - What are a scholarship recipient's reporting responsibilities upon the close of the LEA's...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false What are a scholarship recipient's reporting... EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM Scholarships § 611.47 What are a scholarship recipient...'s academic year, a scholarship recipient whose LEA reports under § 611.46(a) that he or she is...

34 CFR 611.47 - What are a scholarship recipient's reporting responsibilities upon the close of the LEA's...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false What are a scholarship recipient's reporting... EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM Scholarships § 611.47 What are a scholarship recipient...'s academic year, a scholarship recipient whose LEA reports under § 611.46(a) that he or she is...

34 CFR 611.47 - What are a scholarship recipient's reporting responsibilities upon the close of the LEA's...

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 3 2013-07-01 2013-07-01 false What are a scholarship recipient's reporting... EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM Scholarships § 611.47 What are a scholarship recipient...'s academic year, a scholarship recipient whose LEA reports under § 611.46(a) that he or she is...

34 CFR 200.72 - Procedures for adjusting allocations determined by the Secretary to account for eligible LEAs not...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Procedures for adjusting allocations determined by the Secretary to account for eligible LEAs not on the Census list. 200.72 Section 200.72 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION...

34 CFR 200.72 - Procedures for adjusting allocations determined by the Secretary to account for eligible LEAs not...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Procedures for adjusting allocations determined by the Secretary to account for eligible LEAs not on the Census list. 200.72 Section 200.72 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION...

Further Education outside the Jurisdiction of Local Education Authorities in Post-War England

ERIC Educational Resources Information Center

Simmons, Robin

2014-01-01

This article revisits the three decades following the end of World War Two--a time when, following the 1944 Education Act, local education authorities (LEAs) were the key agencies responsible for running the education system across England. For the first time, there was a statutory requirement for LEAs to secure adequate facilities for further…

76 FR 71417 - Privacy Act of 1974, as Amended; Computer Matching Program (SSA/Law Enforcement Agencies (LEA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-17

...; Computer Matching Program (SSA/ Law Enforcement Agencies (LEA)) Match Number 5001 AGENCY: Social Security... protections for such persons. The Privacy Act, as amended, regulates the use of computer matching by Federal... accordance with the Privacy Act of 1974, as amended by the Computer Matching and Privacy Protection Act of...

34 CFR 200.78 - Allocation of funds to school attendance areas and schools.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of private school children, the LEA may— (A) Use the same poverty data the LEA uses to count public school children; (B)(1) Use comparable poverty data from a survey of families of private school students... based on a representative sample if complete actual data are unavailable; (C) Use comparable poverty...

34 CFR 200.78 - Allocation of funds to school attendance areas and schools.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of private school children, the LEA may— (A) Use the same poverty data the LEA uses to count public school children; (B)(1) Use comparable poverty data from a survey of families of private school students... based on a representative sample if complete actual data are unavailable; (C) Use comparable poverty...

34 CFR 200.78 - Allocation of funds to school attendance areas and schools.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of private school children, the LEA may— (A) Use the same poverty data the LEA uses to count public school children; (B)(1) Use comparable poverty data from a survey of families of private school students... based on a representative sample if complete actual data are unavailable; (C) Use comparable poverty...

34 CFR 200.78 - Allocation of funds to school attendance areas and schools.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of private school children, the LEA may— (A) Use the same poverty data the LEA uses to count public school children; (B)(1) Use comparable poverty data from a survey of families of private school students... based on a representative sample if complete actual data are unavailable; (C) Use comparable poverty...

34 CFR 222.172 - What activities may an LEA conduct with funds received under this program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... for free public education to ensure the health and safety of students and personnel, including... facility used for free public education to provide school facilities that support a contemporary... 34 Education 1 2010-07-01 2010-07-01 false What activities may an LEA conduct with funds received...

34 CFR 611.47 - What are a scholarship recipient's reporting responsibilities upon the close of the LEA's...

Code of Federal Regulations, 2010 CFR

2010-07-01

... EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM Scholarships § 611.47 What are a scholarship recipient... 34 Education 3 2010-07-01 2010-07-01 false What are a scholarship recipient's reporting responsibilities upon the close of the LEA's academic year? 611.47 Section 611.47 Education Regulations of the...

18 CFR 1317.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Access to schools... § 1317.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

15 CFR 8a.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Access to schools operated by LEAs. 8a... Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 8a.420 Access to schools...; or (b) Any other school or educational unit operated by such recipient, unless such recipient...

18 CFR 1317.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Access to schools... § 1317.420 Access to schools operated by LEAs. A recipient that is a local educational agency shall not... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

36 CFR 1211.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Access to schools operated by... Prohibited § 1211.420 Access to schools operated by LEAs. A recipient that is a local educational agency... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

36 CFR 1211.420 - Access to schools operated by LEAs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Access to schools operated by... Prohibited § 1211.420 Access to schools operated by LEAs. A recipient that is a local educational agency... education operated by such recipient; or (b) Any other school or educational unit operated by such recipient...

Reduction of uterine prolapse in a sow by laparotomy.

PubMed

Raleigh, P J

1977-01-29

In the past, total uterine prolapse in the sow has been regarded as a grave condition because manipulative reposition through the vulva and vagina is extremely difficult, if not impossible, and amputation is merely a salvage procedure with a mortality rate approaching 100 percent. Laparotomy as a means of facilitating reduction of the prolapse in the sow appears to have been overlooked although it is a standard procedure in dogs and cats. This report describes a case of uterine prolapse in a sow successfully treated by laparotomy.

[A case of complete self-mutilation of penis].

PubMed

Tomita, Masayuki; Maeda, Shigetaka; Kimura, Takahiro; Ikemoto, Isao; Oishi, Yukihiko

2002-04-01

Self-mutilation of the penis is extremely rare. A 69-year-old man was admitted after having amputated his own penis completely from its root. He had no history of psychiatric illness, but his physical condition on admission was abnormal. We performed urethrocutaneostomy, rather than replantation of the penis, because of the danger that he would reinjure himself. The patient was treated by a psychiatrist under a diagnosis of alcoholic dementia. To our knowledge, this is the 24th case of self-mutilation of the penis reported in the Japanese literature.