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Introduction: It has been shown that communication skills acquired during undergraduate medical education are of great importance. Hence, many countries require teaching communication as part of their medical curricula. To assess students’ learning progress, “Catering to the Patient”, as an aspect of showing empathy, should be evaluated. Since there was no description of a validated instrument fitting for this purpose, one had to be developed. To describe its process of development and its psychometric properties were the aims of this study.Methods: Based on the Calgary-Cambridge Observation Guide (CCOG), items describing catering to the patient were selected and modified. Cognitive pretest interviews were conducted to check understandability. Therefore, 7 raters assessed 1 video each (R=7, V=1). In a following pilot study (R=3, V=10) first psychometric properties were evaluated and necessary corrections in the preliminary evaluation form were carried out before the final evaluation form was used to assess students’ ability to cater to the patient and psychometric properties were described in detail (R=2, V=35).Results: The final assessment instrument, “catering to the patient – Marburg evaluation form”, contains 11 checklist items and two global ratings (items 12 and 13). In the final evaluation the inter-rater reliability (IRR) ranged from 0 to 0.562, the median was =0.305. Concerning item 13 (a global rating), 88.6% of the videos were scored with the maximum difference of one point. The internal consistency was very high (Cronbach’s α: α=0.937 and α=0.962), and the correlation between the checklist items and the global rating was high (Pearson’s : =0.898).Discussion: The assessment instrument “catering to the patient” is suitable for giving feedback and for using it in formative examinations. Its use for summative examinations can be considered. Further examinations should evaluate if a three-point Likert scale could reach higher values and if item 13 can be used as a stand-alone item.

Background: The estimated incidence of osteoporotic pelvic fractures among persons over age 60 in Germany is 224 per 100 000 persons per year, and rising. A number of surgical treatment options are available, but clinical long-term data are lacking. Methods: This review is based on pertinent publications and guidelines retrieved by a selective literature search, and on the authors' clinical experience. Results: Patients often report one or more relatively trivial traumatic incidents leading up to the fracture. They complain of pain in the hip, groin, or lower lumbar region, or of low back pain and sciatica. A new classification scheme entitled Fragility Fractures of the Pelvis (FFP) takes the morphology of the fracture into account and can be used as an aid to therapeutic decision-making (evidence level IV). The goal of treatment is early mobilization with adequate pain relief. Isolated anterior pelvic ring fractures (FFP I) and nondisplaced posterior pelvic ring fractures (FFP II) are usually stable and can be treated conservatively. Type III and IV injuries are unstable and should generally be treated surgically. Conclusion: Retrospective analyses have shown that osteoporotic pelvic fractures are associated with decreased mobility and independence and with a one-year mortality ranging from 9.5% to 27%. Prospective therapeutic trials are urgently needed. [ABSTRACT FROM AUTHOR]

Eye tracking is one of the most prominent modalities to track user attention while interacting with computational devices. Today, most of the current eye tracking frameworks focus on tracking the user gaze during website browsing or while performing other tasks and interactions with a digital device. Most frameworks have in common that they do not exploit gaze as an input modality. In this paper we describe the realization of a framework named viGaze. Its main goal is to provide an easy to use framework to exploit the use of eye gaze as an input modality in various contexts. Therefore it provides features to explore explicit and implicit interactions in complex virtual environments by using the eye gaze of a user for various interactions. The viGaze framework is flexible and can be easily extended to incorporate other input modalities typically used in Post-WIMP interfaces such as gesture or foot input. In this paper we describe the key components of our viGaze framework and additionally describe a user study that was conducted to test the framework. The user study took place in a virtual retail environment, which provides a challenging pervasive environment and contains complex interactions that can be supported by gaze. The participants performed two gaze-based interactions with products on virtual shelves and started an interaction cycle between the products and an advertisement monitor placed on the shelf. We demonstrate how gaze can be used in Post-WIMP interfaces to steer the attention of users to certain components of the system. We conclude by discussing the advantages provided through the viGaze framework and highlighting the potentials of gaze-based interaction. [ABSTRACT FROM AUTHOR]

This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF) of traumatic origin. We enrolled 103 patients (median age: 61.6 years) with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS). Secondary outcomes were Oswestry Disability Index (ODI), EuroQol-VAS, and analgesic consumption. 48 hours after surgery, a median relative decrease in pain intensity of 81.5% was observed associated with a significant reduction in analgesic intake. Improvements in disability (91.3% decrease in ODI score) and in quality of life (increase 21.1% of EQ-VAS score) were obtained 3 months after surgery. All results were maintained at 12 months. A reduction in the kyphotic angulation was observed postoperatively (-5.4±6.3°; p<0.001), remained at 12 months (-4.4±6.0°, p=0.002). No adverse events were implant-related and none required device removal. Three patients (2.9%) experienced procedure-related complications. The overall adjacent fracture rate up to 1 year after surgery was 2.9%. The SpineJack procedure is an effective, low-risk procedure for patients with traumatic VCF allowing a fast and sustained improvement in quality of life over 1 year after surgery. [ABSTRACT FROM AUTHOR]

Purpose. The treatment of vertebral burst fractures is still controversial. The aim of the study is to evaluate the purpose of additional percutaneous intravertebral reduction when combined with dorsal instrumentation. Methods. In this biomechanical cadaver study twenty-eight spine segments (T11-L3) were used (male donors, mean age 64.9 ± 6.5 years). Burst fractures of L1 were generated using a standardised protocol. After fracture all spines were allocated to four similar groups and randomised according to surgical techniques (posterior instrumentation; posterior instrumentation + intravertebral reduction device + cement augmentation; posterior instrumentation + intravertebral reduction device without cement; and intravertebral reduction device + cement augmentation). After treatment, 100000 cycles (100–600 N, 3 Hz) were applied using a servohydraulic loading frame. Results. Overall anatomical restoration was better in all groups where the intravertebral reduction device was used (p<0.05). In particular, it was possible to restore central endplates (p>0.05). All techniques decreased narrowing of the spinal canal. After loading, clearance could be maintained in all groups fitted with the intravertebral reduction device. Narrowing increased in the group treated with dorsal instrumentation. Conclusions. For height and anatomical restoration, the combination of an intravertebral reduction device with dorsal instrumentation showed significantly better results than sole dorsal instrumentation. [ABSTRACT FROM AUTHOR]

The purpose of this prospective multicentric observational study was to confirm the safety and clinical performance of a craniocaudal expandable implant used in combination with high viscosity PMMA bone cement for the treatment of vertebral compression fractures. Thirty-nine VCFs in 32 patients were treated using the SpineJack minimally invasive surgery protocol. Outcome was determined by using the Visual Analogue Scale for measuring pain, the Oswestry Disability Index for scoring functional capacity, and the self-reporting European Quality of Life scores for the quality of life. Safety was evaluated by reporting all adverse events. The occurrence of cement leakages was assessed by either radiographs or CT scan or both. Statistically significant improvements were found regarding pain, function, and quality of life. The global pain score reduction at 1 year was 80.9% compared to the preoperative situation and the result of the Oswestry Disability Index showed a decrease from 65.0% at baseline to 10.5% at 12 months postoperatively. The cement leakage rate was 30.8%. No device- or surgery-related complications were found. This observational study demonstrates promising and persistent results consisting of immediate and sustained pain relief and durable clinical improvement after the procedure and throughout the 1-year follow-up period. [ABSTRACT FROM AUTHOR]

Background: The aim of this cadaveric study was to compare a polyaxial (NCB®, Zimmer) to a fixed-angle monoaxial locking plate (PERILOC®, Smith & Nephew) in comminuted fractures of the distal femur regarding stability of the construct. Up to date there is no published biomechanical data concerning polyaxial plating in cadaveric distal femurs. Methods: Fourteen formalin fixed femora were scanned by dual-energy x-ray absorptiometry. As fracture model an unstable supracondylar comminuted fracture was simulated. Fractures were pairwise randomly fixed either with a mono- (group A) or a polyaxial (group B) distal femur plate. The samples were tested in a servohydraulic mechanical testing system starting with an axial loading of 200 N following an increase of 200 N in every step with 500 cycles in every sequence up to a maximum of 2 000 N. The end points were implant failure or relevant loss of reduction. Data records included for each specimen time, number of cycles, axial load and axial displacement. Statistical analysis was performed using the exact Wilcoxon signed rank test. Results: The mean donor age at the time of death was 75 years. The bone mass density (BMD) of the femurs in both groups was comparable and showed no statistically significant differences. Five bones failed before reaching the maximum applied force of 2000 N. Distribution curves of all samples in both groups, showing the plastic deformation in relation to the axial force, showed no statistically significant differences. Conclusions: Operative stabilization of distal femur fractures can be successfully and equally well achieved using either a monoaxial or a polyaxial locking plate. Polyaxial screw fixation may have advantages if intramedullary implants are present. [ABSTRACT FROM AUTHOR]

We present a large-scale quantitative contextual survey of the geocaching community in Germany, one of the world's largest geocaching communities. We investigate the features, attitudes, interests, andmotivations that characterise the German geocachers. Two anonymous surveys have been carried out on this issue in the year 2007. We conducted a large-scale qualitative general study based on web questionnaires and a more targeted study, which aimed at a comprehensive amount of revealed geocaches of a certain region. With sample sizes of n = 1982 (study 1: general study) and n = 310 (study 2: regional study) we provide a representative basis to ground previous qualitative research in this domain. In addition, we investigated the usage of technology in combination with traditional paper-based media by the geocachers. This knowledge can be used to reflect on past and future trends within the geocaching community. [ABSTRACT FROM AUTHOR]

Introduction: Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs. Materials and Methods: All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years). Results: Nine cases of OCF in 8 patients were identifed. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classifcation, 5 cases of Type III and 4 cases of Type I fractures were identifed. According to Tuli's classifcation, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classifcation or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological defcits the fnal follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only. Discussion: OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classifcation or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar. [ABSTRACT FROM AUTHOR]

Background Penetrating arterial injuries to the limbs are common injuries in high volume trauma centers. Their overall surgical results reported in the literature are satisfactory - apart of those of the popliteal artery that still may lead to a significant incidence in amputations. With the present study we assessed our outcome with penetrating arterial injuries to the limb as to see if the direct involvement of vascular surgeons in the management of popliteal artery injuries leads to an improved (lowered) amputation rate. Results were benchmarked with our published results from previous years. Methods All patients sustaining penetrating arterial injuries to the limbs admitted to the Chris Hani Baragwanath Academic Hospital during an 18- month period ending in September 2011 were included in this study. Axillary, brachial and femoral artery injuries were operated on by the trauma surgeons as in the past. All popliteal artery injuries were operated on by the vascular surgeons (new). Results There were a total of 113 patients with 116 injuries, as some patients had multiple vascular injuries: 10 axillary, 47 brachial, 34 femoral and 25 popliteal artery injuries. Outcome of axillary, brachial and femoral artery injury repair were excellent and not significantly different from our previous reported experience. Injury to the popliteal artery showed a diminished re-exploration rate from 34% down to 10% (p = 0,049) and a decrease of amputation rate from 16% to 11% which was statistically not significant (p = 0,8). Conclusion Penetrating arterial trauma to the axillary, brachial and femoral artery is followed by excellent results when operated by trauma surgeons. In the case of popliteal artery injury operated by the vascular surgeons, the results of this study do not show any statistically significant difference related to amputation rate from our previous reported studies when operated by trauma surgeons. Taking into consideration the diminished re-exploration rate and a tendency to a lower amputation rate, we feel that there is possible tendency of better outcome if operated by vascular surgeons. Multicenter studies with large number of enrolled patients will be required to prove the validity of this suggestion. [ABSTRACT FROM AUTHOR]

The treatment of painful osteoporotic vertebral compression fractures using transpedicular cement augmentation has grown significantly over the last two decades. The benefits of balloon kyphoplasty compared to conservative treatment remain controversial and are discussed in the literature. The complication rates of vertebroplasty and kyphoplasty are considered to be low. The focus of this study was the analysis of acute and clinically relevant complications related to this procedure. In our department, all patients treated between February 2002 and February 2011 with percutaneous cement augmentation (372 patients, 522 augmented vertebral bodies) were prospectively recorded. Demographic data, comorbidities, fracture types, intraoperative data and all complications were documented. The pre- and post-operative pain-level and neurological status (Frankel-Score) were evaluated. All patients underwent a standardized surgical procedure. Two hundred and ninety-seven patients were treated solely by balloon kyphoplasty; 216 females (72.7%) and 81 males (27.3%). Average patient age was 76.21 years (±10.71, range 35-98 years). Average American Society Anestesiologists score was 3.02. According to the Orthopedic Trauma Association classification, there were 69 A 1.1 fractures, 177 A 1.2 fractures, 178 A 3.1.1 fractures and 3 A 3.1.3 fractures. Complications were divided into preoperative, intraoperative and postoperative events. There were 4 pre-operative complications: 3 patients experienced persistent pain after the procedure. In one case, the pedicles could not be visualized during the procedure and the surgery was terminated. One hundred and twenty-nine (40.06%) of the patients showed intraoperative cement leaking outside the vertebras, one severe hypotension and tachycardia as reaction to the inflation of the balloons, and there was one cardiac arrest during surgery. Postoperative subcutaneous hematomas were observed in 3 cases, 13 patients developed a urinary tract infection, and 2 patients died during hospitalization. Twenty-four patients (8.1%) returned because of new pain events and 23 patients reported a new painful fracture. Balloon kyphoplasty is a save and effective procedure to treat patients with painful vertebral compression fractures. Rapid patient mobilization after kyphoplasty, as well as a prompt reintegration into the social environment, are possible. Compared to other surgical procedures, especially in patients with an average age of 75 years, balloon kyphoplasty seems to offer some advantages. However, the procedure still has a potential for serious complications and should be performed by well trained personnel. [ABSTRACT FROM AUTHOR]

Based on resource-oriented conceptions of successful lifespan development, we propose three principles for evaluating assistive technology: (a) net resource release; (b) person specificity, and (c) proximal versus distal frames of evaluation. We discuss how these general principles can aid the design and evaluation of assistive technology in adulthood and old age, and propose two technological strategies, one targeting sensorimotor and the other cognitive functioning. The sensorimotor strategy aims at releasing cognitive resources such as attention and working memory by reducing the cognitive demands of sensory or sensorimotor aspects of performance. The cognitive strategy attempts to provide adaptive and individualized cuing structures orienting the individual in time and space by providing prompts that connect properties of the environment to the individual’s action goals. We argue that intelligent assistive technology continuously adjusts the balance between ‘environmental support’ and ‘self-initiated processing’ in person-specific and aging-sensitive ways, leading to enhanced allocation of cognitive resources. Furthermore, intelligent assistive technology may foster the generation of formerly latent cognitive resources by activating developmental reserves (plasticity). We conclude that ‘lifespan technology’, if co-constructed by behavioral scientists, engineers, and aging individuals, offers great promise for improving both the transition from middle adulthood to old age and the degree of autonomy in old age in present and future generations. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Knowing the locations and spatio-temporal paths of individual mice is an essential prerequisite for behavioral analysis of large groups of laboratory mice. Traditional observations have been carried out by trained humans who are able to distinguish more than fifty behavioral patterns. This is a tedious labor limited with respect to length of observation time. In this paper we propose a tracking solution based on the integration of GIS and RFID (Radio Frequency Identification) technology to automatically collect 24h/7days of movement data. Appropriate cage design and antenna placement are discussed. A software solution is presented to facilitate the recording (JerryTS), visualization, and analysis (TOM) of mice movements. [ABSTRACT FROM AUTHOR]

We examined sex differences in spatial navigation performance using an ecologically relevant experimental paradigm in which virtual maze-like museums are projected in front of a treadmill. Thirty-two 20–30-year-old adults (16 women/16 men) performed a way-finding task in city-block (straight corridors) or variable (irregular corridors) topographies while walking on the treadmill. Sex differences in spatial navigation performance were reduced in variable topographies, suggesting less reliance on spatial relational learning among women. Also, spatial geometric knowledge of the mazes continued to be higher in men after all participants had attained perfect place-finding performance. Results indicate that sex differences in spatial navigation performance are modulated by interactions between environmental demands and sex differences in spatial processing. [ABSTRACT FROM AUTHOR]

The article discusses the application of peephole metaphor using steerable projector technology to create a mixed-reality room. The peephole metaphor is a virtual layer superimposed on a physical environment. The layer can become visible and audible when an individual opens a peephole from his physical world into the virtual layer. There are three basic properties of the virtual layer, spatial continuity, temporal persistence and consistency across peepholes. There are two types of peepholes, user-initiated peephole and system-initiated peephole. User-initiated peepholes are actively created and manipulated by the user whereas system-initiated peepholes open through a display under the environmental's control. Peepholes are generally suitable for time-multiplexed displays such as steerable projectors as they restrict simultaneous display. The peephole metaphor provides a terminology, a mental model and a proper way to describe different types of interactions in mixed reality environments.