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Aims: This study reviews the use of a titanium mesh cage (TMC) as an adjunct to intramedullary nail or plate reconstruction of an extra-articular segmental long bone defect. Patients and Methods: A total of 17 patients (aged 17 to 61 years) treated for a segmental long bone defect by nail or plate fixation and an adjunctive TMC were included. The bone defects treated were in the tibia (nine), femur (six), radius (one), and humerus (one). The mean length of the segmental bone defect was 8.4 cm (2.2 to 13); the mean length of the titanium mesh cage was 8.3 cm (2.6 to 13). The clinical and radiological records of the patients were analyzed retrospectively. Results: The mean time to follow-up was 55 months (12 to 126). Overall, 16 (94%) of the patients achieved radiological filling of their bony defect and united to the native bone ends proximally and distally, resulting in a functioning limb. Complications included device failure in two patients (12%), infection in two (12%), and wound dehiscence in one (6%). Four patients (24%) required secondary surgery, four (24%) had a residual limb-length discrepancy, and one (6%) had a residual angular limb deformity. Conclusion: A titanium mesh cage is a useful adjunct in the treatment of an extra-articular segmental defect in a long bone. Cite this article: Bone Joint J 2018;100-B:646-51.

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BACKGROUND: Previous studies on nutrition counselling self-efficacy have assessed small groups of dietitians in focused practice areas or evaluated the effectiveness of skills training on only a few skills. This descriptive study developed a comprehensive scale to examine self-efficacy in a large, cross-sectional sample of practising dietitians when performing various counselling skills that promote dietary behaviour changes. METHODS: A valid and reliable instrument was developed and administered through the Internet to survey dietitians in the USA from various areas of dietetics and with varying years of experience. Items included counselling self-efficacy, skill usage and counselling-related job characteristics. Of the 612 respondents, one group (n = 486) conducted counselling for more than 50% of their work week, and the other group (n = 126) for less than 50%. Factor analysis was used for scale development. Independent samples t-tests and chi-square tests were performed for group comparisons. Correlations and multiple regression analyses further assessed the relationships among variables. RESULTS: The resultant unidimensional scale contained 25 items. Dietitians reported high self-efficacy scores and frequent skill usage. Those who counsel for more than 50% of their work week were more likely to work in outpatient settings and private practice, reported higher self-efficacy scores, and held longer and repeated sessions. Self-efficacy scores were positively correlated with counselling-related job characteristics. Years of counselling experience and skill usage significantly predicted self-efficacy scores. CONCLUSIONS: Dietitians perceive themselves to be highly self-efficacious in using counselling skills which may contribute positively to their professional practice. However, the relationship between counselling self-efficacy and actual performance warrants further investigation.

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This study surveyed nutrition education materials which are low in cost, brief and the type most used in patient education to determine which might be useful with low literacy clients. Readability of 209 pamphlets from professional health organizations, commercial organizations, government agencies, and educational institutions was assessed using three different tests. Using the Flesch and Raygor tests, materials from educational institutions had significantly lower reading levels than materials from professional organizations and government agencies. No significant differences were seen among the sources using the Fry test. Sixty-eight percent (142) of the publications were written at ninth grade level or higher. Eleven percent (24) scored at sixth grade or below on either the Fry or Raygor scale. Only two publications were written at the third grade level. Many of the publications reviewed can be read and understood by many Americans, but there were few for the millions that have limited literacy skills.

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Forty-three menus that were to be used in a diet manual were designed to meet the requirements of a specific diet; provide 2,200 to 2,400 kcal, unless energy-restricted; meet the 1990 Dietary Guidelines for Americans; meet current recommendations for sodium (2g to 3 g/day), cholesterol (< or = 300 mg/day), and fiber (20g to 30 g/day); and meet or exceed the highest level for adults in the 1989 Recommended Dietary Allowances (RDAs). In addition, regular and low-fat, low-cholesterol menus for 1 week were collected from 11 hospitals throughout Arkansas. Menus were analyzed for energy, cholesterol, and 18 nutrients. Only 11% of the menus met the RDA for zinc. Half of the menus did not meet the RDA for vitamin B-6 and one third did not meet the RDA for iron. Zinc content of the menus was positively correlated (P < .001) with protein (r = .73) and with beef (r = .45). Vitamin B-6 was positively correlated with protein (r = .44, P < .001) and with all meat (r = .38, P < .01). Regular and low-fat, low-cholesterol hospital menus had the same nutrient inadequacies because they did not differ in total servings from any food group. These data indicate that the public may have difficulty choosing a diet that meets both the Dietary Guidelines and the RDAs.

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This study surveyed students in Adult Basic Education (ABE) Programs in Arkansas to determine their pattern of food choices. The results indicated that entire food groups, e.g. vegetables, fruits, or milk were not included in the diets of many participants. This population more frequently chose high fat than low fat foods. Regression analyses indicated that the choice of low fat products increased with age and family income level. The most dramatic trends were in changes in consumption of dairy products, fruits, and vegetables. These data support the need for nutrition education in Arkansans with less than a high school education.

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Dietary salt (NaCl) has been implicated in the etiology of hypertension and atherosclerosis, although its role remains controversial. The human preference for salted foods is well-known and many investigators believe the taste for salt is acquired. An experiment we conducted suggests that the baboon does not have an acquired taste for salt. A sample of 36 baboons from a population of 70 baboons of known sire, sex, and dietary history was used; each had been raised since birth on a diet of fixed salt content in a study of dietary salt and blood pressure. Given this unique group of animals, we decided to test whether baboons raised on one dietary salt level (low, medium, or high) would prefer a different level. After baseline consumption was measured for 9 days, we offered each animal equal amounts of all 3 diets simultaneously in a counterbalanced randomized sequence for 9 days, controlling for tray position preference and color preference. We measured consumption of each diet by weighing the amount of food remaining. Our statistical analyses indicated an overwhelming preference for the lowest dietary salt level, regardless of which diet the animal had been fed since birth (p less than 0.0001).

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Lead acetate was fed to 4 groups of 2 horses each to study chronic lead intoxication. A 5th group of 3 horses was maintained as controls. The leas was fed in capsules, with the minimum dosage of 6.25 mg/kg/day of lead as lead acetate (group I). The dose was increased from group I through group IV in an approximate geometric series, with each group being given about 125% of the dose given the previous group. These doses were given for 105 days, a period designated as phase 1. Since clinical signs were not observed after 105 days, the doses were increased and fed for an additional 190 days (days 106 to 295). This period was designated phase 2. The smallest daily dose in phase 2 was set at about 125% of the largest daily dose in phase 1. The doses in each group was increased by about 125% of that of the previous group, as was done in phase 1. Seven horses died or were euthanatized after 18 to 190 days of phase 2 (123 to 295 days after the 1st dose). One horse in group I did not develop any clinical signs of intoxication. Dose-related responses were unnoticed with doses larger than 15.3 mg/kg/day. All horses given lead had increased blood lead and serum iron concentrations. During phase 2, the hematocrit (erythrocyte volume) and hemoglobin contents were depressed. The lead concentration in kidney, liver, spleen, pancreas, brain, bone, and heart was increased in the treated horses. The dose level required to produce lead intoxication was greater than that reported for cattle and that estimated in epizootiologic studies of horses.

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Ammi majus (bishop's weed) grows on the coastal region of southern United States and in other parts of the world. This plant causes severe photosensitization in livestock and probably contributes to the severe photosensitization outbreaks seen in Texas. Sheep were fed finely ground seed of A majus via stomach tube at dose rates of 1, 2, 4, and 8 g/kg of body weight and exposed to sunlight. The single dose of 8 g/kg produced severe clinical signs (in 24 to 48 hours): cloudy cornea, conjunctivokeratitis, photophobia, and edema of the muzzle, ears, and vulva. Daily dosing at 2 and 4 g/kg produced (in 72 to 96 hours) similar signs, whereas the smallest dose (1 g/kg) produced mild irritation of the muzzle. Pathologic changes included (1) corneal edema and marked neutrophilic infiltration of the cornea and corneal/ciliary process, (2) subacute ulcerative and exudative dermatitis of the skin of ears, muzzle, and vulva, and (3) mild focal tubular degeneration (vacuolar type) of the kidney.

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Feeding Ammi majus to cattle and sheep caused photosensitization in both species. It also caused photosensitization in human beings who had dermal contact with the plant and subsequent exposure to sunlight.

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Studies with smallhead sneezeweed (Helenium microcephalum DC) indicated that a sesquiterpene lactone, helenalin, is the only significant toxic constituent present. The oral median lethal dose of helenalin for 5 mammalian species was between 85 and 105 mg/kg.

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