bluuebunny/crossref_metadata_2025 huggingface dataset:
Examining Factors That Predict Public Concern About the Collateral Consequences of Sex Crime Policy
Authors: Mancini Christina
Published: February 2013

Sex crime policies have been associated with unintended effects. One involves harassment of registered sex offenders. Despite this finding, and the prominent role of the public in reentry efforts, few studies have examined public opinion about this collateral consequence. By extension, virtually no scholarship has investigated predictors of concern. From a utilitarian perspective, it follows that among those who rely on the registry or who feel sex offenders are driven to reoffend, concern about the registry’s unintended effects will be reduced. In testing this hypothesis the study draws on responses from a national public opinion poll conducted in 2005—a critical time when state registries and online registry websites became increasingly available. Findings support an instrumental or utilitarian argument. Use of the registry and pessimism about offender rehabilitation significantly decreased public concern about registries’ negative outcomes. Implications for research and offender reentry debates are discussed.
A Bad Case of ‘Peanut Envy’: Concessions Markets and Monopoly Power at Chicago’s United Center
Authors: Dinces Sean
Published: February 2013

In recent decades, sports franchises have exploited their privileged relationship to the state in order to expand the scope of their local monopoly powers. This article examines efforts by the owners of the United Center, the home arena of the Chicago Bulls and Chicago Blackhawks, to eliminate competition from local peanut vendors. The owners benefited from court rulings rejecting the legitimacy of government intervention in local markets at the same time that they successfully lobbied municipal politicians to intervene on their behalf by passing anti-vendor legislation. This story not only offers a case study in how teams’ monopolistic privilege has extended to concessions markets, but also contributes to a broader understanding of how the neoliberal state works to minimize risk and maximize profitability for large-scale real estate investments like sports arenas. The methodological approach is interdisciplinary, drawing on legal and business history, urban geography and sociology, and radical political economy.
Religious Affiliation, Religious Attendance, and Participation in Social Change Organizations
Authors: Guo Chao , Webb Natalie J. , Abzug Rikki , Peck Laura R. A.
Published: February 2013

How does religion affect an individual’s likelihood of volunteering for social change causes? This study reports on findings from an analysis of the 2005 wave of the COPPS supplement to the PSID to examine the effects of religious tradition (affiliation) and religious attendance (religiosity) on social change volunteering. We find that adherents to the more liberal Christian denominations—mainline Protestant and Catholic—are more likely to volunteer with social change organizations than are Evangelicals. We also find that adherents to other minority religions such as Judaism and Buddhism and individuals with no religious belief are all more likely to volunteer with social change organizations than are Evangelicals. We find a positive and significant relationship between religious attendance and social change volunteering, but find little difference in the effect of religious attendance on social change volunteering between Evangelicals and other religious traditions (except for Catholics).
A simplified model for analysis of the post-impact motion of vehicles
Authors: Vangi Dario
Published: February 2013

In a collision between vehicles, the post-impact phase, where they translate and rotate, often has significant importance in the analysis and reconstruction of road accidents. Indeed, the calculation of errors made in this analysis will be reflected in later stages, compromising the correct identification of the accident scenario. Because of the uncertainty in the initial data as well the lack of data, simplified models are used in order to calculate the kinematic parameters of the vehicles. The literature offers some of these simplified models, even though the most reliable models require iterative calculations or numerical integration of the equations of motion. In the present work a model for the calculation of both the linear velocity and the angular velocity of the vehicle, which are useful for analysing the post-impact phase between vehicles, is built. The model is based on the schematization of the trajectory of the individual wheels with a cycloid, which is lengthened or shortened depending on the magnitude of the ratio of the translational velocity to the rotational velocity of the vehicle. The work dissipated by friction along this trajectory is calculated and then made equal to the loss in kinetic energy, assuming that the ratio of the angular velocity to the linear velocity during motion is constant. The model gives results comparable with the numerical integration of the equations of motion, when schematizing the vehicle as a rigid body with three degrees of freedom. The model is suitable in the field of road accident reconstruction owing to its simplicity of use. Indeed, it is necessary to consider only the friction coefficient between the tyre and the road, and to use only two uncoupled equations to find the values of the angular velocity and the translation.
A bumper model with dynamic contact stiffness for simulations of pedestrian legform impacts
Authors: Huang Jun , Xia Yong , Nie Bingbing , Zhou Qing
Published: February 2013

Car-to-pedestrian accidents have become a global problem, and car manufacturers have made great efforts to redesign the car for pedestrian protection. For fast computer simulations of pedestrian legform-to-bumper impacts, which are usually needed for the large design-of-experiments matrix, quite a number of simplified bumper models have been built to represent detailed finite element models adopted from full-vehicle models. However, it has been a difficult balance between simplifying the structure to achieve fast computation and keeping the essential characteristics to obtain valid results. This paper documents a development and validation of a simplified bumper system model. The spring stiffness properties are determined by considering the loading rate effect and the local deformation effect of the vehicle’s front-end structure, which is essential for legform impact simulations. To validate the simplified bumper system model, the simulation results from the simplified bumper system model and from a detailed bumper system model are compared. This study also indicates that, to improve the responses of the legform bending and shear, the vehicle’s bumper should be modelled as two separate spring systems since the impact interaction is within the knee joint centre of the legform.
The operational deflection shapes and transient analysis of the brake shoes in drum brake squeal
Authors: Abdul Hamid Muhammad N , Teoh Choe-Yung , Ripin Zaidi M
Published: February 2013

The operational deflection shapes were used to identify the mode of vibration for the brake shoes in drum brake squeal. The measurement of the operational deflection shapes of the brake shoes during drum brake squeal, which was in the torsional mode, was similar to that of the modes obtained from the experimental modal analysis of the brake shoes under the in-contact static condition. A two-degree-of-freedom model was developed on the basis of the experimental modal analysis data within the limited bandwidth of the squeal frequency of 1850 Hz. In this work, the operational deflection shape was used for determination of a structural dynamic modification to be carried out on the brake shoes in order to maximize the damping of the torsional mode as a way to improve the stability of the system. The lumped-parameter model was then used to assess the effect of the structural dynamic modification on the squeal based on the transient analysis, which showed a similar trend and can assist brake designers in evaluating the critical parameter to obtain a squeal-free drum brake design.
Premixed charge compression ignition combustion modelling with a multi-zone approach including inter-zonal mixing
Authors: Egüz Ulaş , Leermakers Cornelis AJ , Somers Lambertus MT , de Goey Laurentius PH
Published: February 2013

Premixed charge compression ignition combustion is a clean and efficient alternative to classical diesel combustion. The concept of premixed charge compression ignition combustion is associated with early injection of the fuel while applying high exhaust gas recirculation levels and operation with a highly lean mixture such that ignition takes place (well) after the injection event. Thus, it is possible to reduce the soot emissions and the nitrogen oxide emissions simultaneously. Premixed charge compression ignition combustion is analysed using a multi-zone model. In the multi-zone model, chemical mechanisms which are much more detailed than those used in the computational fluid dynamics approaches can be introduced directly. The computational fluid dynamics model is still used to predict the initial fuel stratification in the cylinder, which is important to improve the quality of the model. For the analysis, dedicated experiments with n-heptane are used to evaluate the results of the model. In such a multi-zone model, 10 zones prove to be sufficient to describe the stratification with adequate resolution. It is observed that different fuel distributions have a large influence on the emissions when there is no mixing between the zones. To overcome this dependence, basic inter-zonal diffusive mixing is applied. The level of mixing is estimated with a sensitivity study. When the inter-zonal mixing is included, the emission results become much less sensitive to the crank angle at which the charge stratification is sampled and the simulation is initialized.
The Development of International Student Recruitment Policies in Taiwan
Authors: Ma Ai-hsuan Sandra
Published: February 2013

In recent decades many East Asian countries have initiated ambitious policies to increase their global prominence as education hubs. This article examines the development of Taiwan’s international student recruitment policies from 1950 to 2011, exemplifying the case in a non-Western, non-English speaking context. While Taiwan’s case is distinctive with the dominance of noneconomic factors in shaping the state policy orientation and agendas, the strong role of the state and the Confucian model of higher education constitute a valid example of developments in the internationalization of higher education in East Asia. The analysis further shows that the intertwining forces of localization, nationalization, and globalization influenced the policy development throughout three stages of the trajectory. These findings demonstrate the transformationalist viewpoint of globalization and support the “glonacal agency approach” proposed by Rhoades and Marginson claiming that local, national, and global domains are simultaneously significant in understanding globalization and higher education.
Predictors of Cognitive/Affective and Somatic Depression in Heart Failure Patients
Authors: Seo Yaewon , Yates Bernice , Dizona Paul , LaFramboise Louise , Norman Joseph
Published: February 2013

The effects of depression on patients with heart failure (HF) are substantial, yet the predictors remain unclear. The predictors of cognitive/affective and somatic depression in stable HF patients were studied. Using a cross-sectional design, 150 HF outpatients were recruited at two mid-Western HF clinics. Predictors included dyspnea with activities of daily living, family and friend social support, and loneliness; age and gender were control variables. All constructs were measured using standardized instruments. Structural equation modeling (SEM) showed that cognitive/affective depression was predicted by greater dyspnea and loneliness, whereas somatic depression was predicted by more dyspnea and friend support. Also, greater dyspnea was related to more loneliness and less friend support; less friend support was related to loneliness. Women reported more dyspnea and loneliness. Since cognitive/affective and somatic depression have different predictors, further study is warranted to identify HF patients at risk for depression and to establish interventions targeted at improving depression.
Registered Nurses’ Experiences of Priorities in Surgery Care
Authors: Sundin Karin , Fahlen Ulla , Lundgren Monica , Jacobsson Catrine
Published: February 2013

Priorities and allocation are complex tasks in health care. Unspoken and also often unconscious priorities frequently occur. Research concerning how registered nurses (RN) priorities are limited. The aim of this study was to illuminate the meanings of RNs’ lived experiences of priorities in surgery care. Narrative interviews were conducted with 10 RNs working in a department of surgery. The RNs interviewed had all worked for more than 5 years as RNs. A phenomenological-hermeneutic interpretation of the interviews was conducted. The findings revealed 3 themes: making a conscious allocation and priorities of care, doing unreflected good, and being qualified to determine. The RNs did not often comprehend their actions as prioritizing. They more often comprehended their nursing tasks as obvious and did not consider this as priorities. But in situations of ethical difficulty, the RNs reflected upon their priority and actions.
Does Computed Tomography Add Information on Radiographic Analysis in Detecting Periprosthetic Osteolysis After Total Ankle Arthroplasty?
Authors: Kohonen Ia , Koivu Helka , Pudas Tomi , Tiusanen Hannu , Vahlberg Tero , Mattila Kimmo
Published: February 2013

Background:

The major longer term complications of ankle arthroplasty are periprosthetic osteolysis and aseptic loosening. Follow-up studies of total hip arthroplasties show that measurements of periprosthetic osteolytic lesions on radiographs underestimate the size compared with those made on computed tomography (CT), and some of the lesions may even remain undetected on radiographs. However, it is unclear whether the same applies to total ankle arthroplasty (TAA).

Methods:

We retrospectively reviewed the radiographs of 123 patients who had undergone TAA with the Ankle Evolutive System (AES) implant. Of these, 43 (34.9%) had at least 1 large (greater than 10 mm) osteolytic lesion on radiographs at a minimum follow-up of 14 months (mean, 43.1 months; range, 14-85 months). Forty of the 43 patients underwent helical CT imaging.

Results:

Computed tomography showed more osteolytic lesions than radiographs around both tibial and talar components. CT also showed larger lesions than radiographs in 9 of 10 zones around prosthetic components. The difference was highly significant in 3 zones around the talar component.

Conclusion:

Computed tomography showed more and larger periprosthetic lesions than radiographs around an ankle prosthesis. Because osteolysis is progressive in nature, it presumably leads to component failure. Considering our results, we recommend adding CT imaging to postoperative follow-up after TAA for patients with suspected or known periprosthetic lucencies on radiographs.

Level of Evidence:

Level III, diagnostic study.
The Contribution of Medializing Calcaneal Osteotomy on Hindfoot Alignment in the Reconstruction of the Stage II Adult Acquired Flatfoot Deformity
Authors: Chan Jeremy Y. , Williams Benjamin R. , Nair Pallavi , Young Elizabeth , Sofka Carolyn , Deland Jonathan T. , Ellis Scott J.
Published: February 2013

Background:

Successful correction of hindfoot alignment in adult acquired flatfoot deformity (AAFD) is likely influenced by the degree of medializing calcaneal osteotomy (MCO) performed, but it is not known if other reconstruction procedures significantly contribute as well. The purpose of this study was to evaluate the correlation between common preoperative and postoperative variables and hindfoot alignment.

Methods:

Thirty patients with stage II AAFD undergoing flatfoot reconstruction were followed prospectively. Preoperative and postoperative radiographs were reviewed to assess for correction in hindfoot alignment as measured by the change in hindfoot moment arm. Nineteen variables were analyzed, including age, gender, height, weight, body mass index (BMI), medial cuneiform-fifth metatarsal height, anteroposterior (AP) talonavicular coverage, AP talus-first metatarsal, lateral talus-first metatarsal and calcaneal pitch angles as well as intraoperative use of the MCO, lateral column lengthening (LCL), Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament reconstruction, and gastrocnemius recession or Achilles lengthening. Mean age was 57.3 years (range, 22-77). Final radiographs were obtained at a mean of 47 weeks (range, 25-78) postoperatively.

Results:

Seven variables were found to significantly affect hindfoot moment arm. These were gender ( P < .05), the amount of MCO performed (P < .001), LCL (P < .01), first tarsometatarsal fusion (P < .01), spring ligament reconstruction (P < .01), medial cuneiform-fifth metatarsal height (P < .001), and calcaneal pitch angle (P < .05). Multivariate regression analysis revealed that MCO was the only significant predictor of hindfoot moment arm. The final regression model for MCO showed a good fit (R2 = .93, P < .001).

Conclusion:

Correction of hindfoot valgus alignment obtained in flatfoot reconstruction is primarily determined by the MCO procedure and can be modeled linearly. We believe that the hindfoot alignment view can serve as a valuable preoperative measurement to help surgeons adjust the proper amount of correction intraoperatively.

Level of Evidence:

Level IV, prospective case series.
Large and Deep Diabetic Heel Ulcers Need not Lead to Amputation
Authors: Shojaiefard Abolfazl , Khorgami Zhamak , Mohajeri-Tehrani Mohammad Reza , Larijani Bagher
Published: February 2013

Background:

Management of large and deep heel ulcers (LDHUs) is a challenge in patients with diabetic foot lesions. We assessed outcomes of a treatment protocol to save feet with LDHUs from amputation.

Methods:

We managed LDHUs (larger than 3 cm2) in diabetic feet using a multidisciplinary approach consisting of medical and surgical management, including revascularization and amputation, if necessary. For deep heel infection and/or gangrene, we frequently debrided and drained the deep spaces of the heel, as needed. In patients with non-ischemic feet, we made a flap from the heel pad with a broad pedicle. When satisfactory granulation tissue covered the base of the heel and the inner surface of the flap, we sutured the heel flap to its base.

Results:

We managed 37 feet with LDHUs among 384 patients. Twenty-nine patients (78.4%) had neuropathy, 6 (16.2%) had ischemic diabetic feet, and 2 (5.4%) had both neuropathy and ischemia. Twelve (32.4%) had septic diabetic feet. We performed two femoropopliteal bypasses, 2 infrapopliteal bypasses, and 1 distal bypass (crural) for ischemic heel ulcers. Thirty-three of the 37 feet with heel lesions (89.2%) were salvaged using this multidisciplinary approach. These 33 LDHUs healed after 4 to 7 months (median, 6 months). Transtibial amputation was performed for 4 feet (10.8%; 2 ischemic and 2 neuropathic cases).

Conclusions:

Diabetic patients with LDHUs can be managed with a multidisciplinary approach to prevent amputation. If necessary, deep spaces of the heel can be debrided by elevating the heel pad like a flap and then performing satisfactory reconstruction.

Level of Evidence:

Level IV, retrospective case series.
Chevron Osteotomy of the First Metatarsal Stabilized With an Absorbable Pin
Authors: Morandi Alberto , Ungaro Emanuele , Fraccia Andrea , Sansone Valerio
Published: February 2013

Background:

The potential requirement for hardware removal originally fueled the development of bioabsorbable pins as an alternative to metal screws for fixing osteotomy sites in foot surgery. More recently, the concern regarding the adverse effects of metal implants may provide further grounds for using bioabsorbable rather than metal fixation.

Methods:

This is a prospective study of 383 consecutive patients (439 feet) who underwent a chevron osteotomy to correct a hallux valgus deformity performed between 2005 and 2010. In the study group of 251 patients (285 feet), the distal metatarsal osteotomy was fixed with a bioabsorbable pin made of poly-L-lactide and poly-DL-lactide (70:30 ratio). In the control group of 132 patients (154 feet), the osteotomy was fixed with a metal screw. The average follow-up was 27 months for the study group and 31 months for the control group.

Results:

We observed statistically significant improvements in the mean intermetatarsal angle of 6.1 ± 2.7 degrees in the study group and 5.2 ± 1.6 degrees in the control group ( P < .001) and in the mean hallux valgus angle of 14.8 ± 4.7 degrees and 15.5 ± 3.7 degrees, respectively ( P < .001). The mean ± SD improvement on the American Orthopaedic Foot and Ankle Society 100-point scale was 45 ± 11 points for the study group and 49 ± 15 points for the control ( P < .001). Our complication rate was 0.7% for the study group.

Conclusion:

Our study found that fixation with a bioabsorbable pin was as reliable as fixation with a metal screw and allowed major angular corrections. The bioabsorbable polymer was well tolerated, and the complication rate was low.

Level of Evidence:

Level IV, retrospective case series.
Recurrence of Acute Charcot Neuropathic Osteoarthropathy After Conservative Treatment
Authors: Osterhoff Georg , Böni Thomas , Berli Martin
Published: February 2013

Background:

Charcot neuropathic osteoarthropathy (CN) is a chronic, progressive-destructive process affecting the feet of patients with sensory neuropathy. Data on CN recurrence are underrepresented in the literature. The aim of the present study was to evaluate the rate of CN recurrence after its treatment and to find predisposing factors.

Methods:

Fifty-two patients (age 59 ± 11 years, 16 female) with acute CN with 57 affected feet were enrolled. Comorbidities, localization, and stage of disease at first diagnosis as well as ulcerations, need for surgery, noncompliance, and subsequent treatment (orthopedic footwear or orthotic treatment) during the course of therapy were recorded. During follow-up, the incidence of recurrence of CN was observed. Mean follow-up was 47 ± 40 months.

Results:

Diabetes was the most common reason for sensory neuropathy (79%). Recurrence of CN was seen in 13 feet (23%) with an interval of 27 ± 31 months (range, 3-102 months) after the end of initial immobilization. Patients with recurrence were immobilized for a shorter period of time and had a more advanced stage of CN at time of first diagnosis. Predictors of recurrence were noncompliance (odds ratio 19.7; confidence interval, 4.1-94.4; P < .001) and obesity (odds ratio 6.4; confidence interval, 1.6-25.9; P = .06).

Conclusions:

Recurrence of osteoarthropathic activity is a possible complication after conservative treatment of CN. Obesity and noncompliance are strong predictors for the recurrence of CN.

Level of Evidence:

Level III, retrospective comparative study.
Effect of Shoe Heel Height and Total-Contact Insert on Muscle Loading and Foot Stability While Walking
Authors: Hong Wei-Hsien , Lee Yung-Hui , Lin Yen-Hui , Tang Simon F. T. , Chen Hsieh-Ching
Published: February 2013

Background:

Women wearing high-heeled shoes often complain of foot instability and low-back pain. Previous studies have demonstrated that using total-contact inserts (TCIs) in running shoes reduces impact on leg muscles and alters rearfoot motion. This study investigated how shoe heel height and use of TCIs in high-heeled shoes affect the wearer’s rearfoot complex, muscle loading, and subjective comfort.

Methods:

Fifteen inexperienced high heel wearers walked under 6 test conditions formed by the cross-matching of shoe insert (with and without TCI) and heel height (1.0, 5.1, and 7.6 cm) at a speed of 1.3 m/s. The measures of interest were rearfoot kinematics; muscle activities by electromyography (EMG) of the tibialis anterior (TA), medial gastrocnemius (MG), quadriceps (QUA), hamstrings (HAM), and erector spinae (ES); and subjective comfort rating by visual analogue scale for each test condition.

Results:

The statistical results showed that elevated heel height significantly increased plantar flexion ( P < .001) and inversion ( P < .01) at heel strike, prolonged TA-MG co-contraction ( P < .001) and QUA activation period ( P < .001), and increased root mean square (RMS) EMG in all measured muscles (TA, MG, QUA, ES: P < .001; HAM: P < .01). The use of TCIs reduced the rearfoot inversion angle ( P < .01) and RMS EMG in both QUA and ES muscles ( P < .01) and increased comfort rating ( P < .001).

Conclusions:

These findings suggest that wearing high-heeled shoes adversely affects muscle control and reduces loads in QUA and ES muscles.

Clinical Relevance:

The use of a TCI may improve comfort rating and foot stability.
Reliability and Validity of a Mobile Phone for Radiographic Assessment of Ankle Injuries
Authors: Tennant Joshua N. , Shankar Viswanathan , Dirschl Douglas R.
Published: February 2013

Background:

Current mobile phone technology may allow orthopaedic surgeons to make clinical decisions using radiographs viewed on a small mobile device screen. The purpose of this study was to examine the reliability and validity of interpreting ankle fracture images viewed on a mobile device and a computer monitor, with a hypothesis that the agreement in clinical decision making between the mobile device and computer monitor would be high.

Methods:

A randomized interobserver and intraobserver reliability study was conducted in which 16 mortise and lateral ankle images representing a severity spectrum of malleolar ankle, plafond, and extra-articular tibial fractures were shown to volunteer orthopaedic surgeons on both an Apple fourth-generation iPod Touch and a 23-inch liquid crystal display (LCD) computer monitor. Participants answered a multiple-choice questionnaire for each image regarding diagnosis, severity, need for higher level imaging, need for acute inpatient versus outpatient management, and plan of treatment. Inter- and intraobserver reliability was assessed by kappa (κ), multirater kappa statistics, and intraclass correlation coefficient (ICC).

Results:

Ninety-three orthopaedic surgeon volunteers completed the study. Excellent intraobserver agreement (κ ≥ 0.8) was found for all variables measured, including diagnosis (median κ = 0.84), need for computed tomography scan (κ = 0.86), need for reduction (κ = 0.82), treatment setting (κ = 0.82), and treatment type (κ = 0.87). Interobserver agreement was consistent between the mobile device and computer screen. Interobserver agreement for the severity assessment had a slightly higher ICC for the mobile device compared with the computer monitor (ICC = 0.83 vs 0.79). Sixty-seven percent (62/93) said at the completion of the study they were “completely” or “very” comfortable using a mobile device as a primary viewing device for new emergency room, inpatient, or transfer request consults.

Conclusions:

Strong reliability for radiographic assessment of ankle injuries existed between a 23-inch computer monitor and a handheld mobile device. Further study is warranted to validate the technology to apply to other anatomic locations and imaging modalities.

Level of Evidence:

Level II, diagnostic study.
Perioperative Complications and Learning Curve of the Mobility Total Ankle System
Authors: Lee Kyung Tai , Lee Young Koo , Young Ki Won , Kim Jun Beom , Seo Yu Seok
Published: February 2013

Background:

Only 2 articles related to the recently developed Mobility Total Ankle System (Johnson & Johnson Medical/DePuy International, Leeds, UK) have been published to date. The purpose of this study was to determine the perioperative complications associated with the Mobility Total Ankle System and whether a learning curve exists for this system.

Materials and Methods:

We recruited 60 consecutive patients undergoing total ankle arthroplasty using the Mobility Total Ankle System for advanced osteoarthritis and rheumatoid arthritis between May 2008 and June 2010. Group A included the initial 30 patients who underwent surgery, and group B included the next 30 patients. Reporting of adverse perioperative events, including wound healing problems, fracture, aseptic loosening, tendinitis, component malposition, neuroma, and bony impingement, was limited to the first 3 months after the surgery.

Results:

Eleven of the 30 patients in group A developed complications (36.7%), and 1 died of an unknown cause 6 months after leaving the hospital. The complications in this group included medial malleolar fracture in 6 patients, lateral malleolar fracture in 1, wound healing problems in 2, and varus deformity in 2. Five of the 30 patients in group B developed complications (16.7%). The complications in this group included medial malleolar fracture in 1 patient, medial impingement in 2, Achilles tendon rupture in 1, and wound problems in 1. There was no statistically significant difference ( P = .08) between the 2 groups in the incidence of complications after total ankle replacement arthroplasty. There was also no significant difference between the 2 groups in the types of complications seen.

Conclusions:

Perioperative complications associated with total ankle replacement arthroplasty using the Mobility Total Ankle System were seen in 16 of 60 patients. Group A had a higher incidence of perioperative complications than did group B. However, the difference was not statistically significant. Either the expertise of the surgeon or the simplicity of the total ankle system can affect the learning curve, although these things were not specifically quantified in this study.

Level of Evidence:

Level III, comparative case series.
Influence of Osteomyelitis Location in the Foot of Diabetic Patients With Transtibial Amputation
Authors: Faglia Ezio , Clerici Giacomo , Caminiti Maurizio , Curci Vincenzo , Somalvico Francesco
Published: February 2013

Background:

To evaluate the prevalence of osteomyelitis in different areas of the foot and the possible correlation between localization and outcome of major amputation.

Methods:

From January 2008 to December 2010, a total of 350 diabetic patients were admitted to our diabetic foot unit for the surgical treatment of osteomyelitis. Osteomyelitis was diagnosed when both the probe-to-bone maneuver and plain radiography were positive. In all of these patients, osteomyelitis was confirmed by histological examination.

Results:

Osteomyelitis was localized to the forefoot in 300 (85.7%) patients, to the midfoot in 27 (7.7%) patients, and to the hindfoot in the remaining 23 (6.75) patients. On average, foot lesions had developed 6.6 ± 5.6 months before admission to our unit. Transtibial amputation was performed in 1 (0.33%) patient with forefoot osteomyelitis, in 5 (18.5%) patients with midfoot osteomyelitis, and in 12 (52.2%) patients with osteomyelitis of the heel (χ2 = 128.4, P < .001). Multivariate analysis showed the independent role that osteomyelitis in the heel region had in major amputation outcome (odds ratio 15.3; P < .001; confidence interval, 17.4-5336.0), dialysis treatment (odds ratio 6.3; P = .012; confidence interval, 2.5-1667.2), and leukocyte count greater than 103 mm3 (odds ratio 2.25; P = .036; confidence interval, 1.1-76.6).

Conclusions:

We found a higher rate of transtibial amputation when osteomyelitis involved the heel instead of the midfoot or forefoot in diabetic patients.

Level of Evidence:

Level III, retrospective comparative series.
Quantitative Analysis of Torsional Stiffness in Supplemental One-Third Tubular Plate Fixation in the Management of Isolated Syndesmosis Injuries
Authors: Clanton Thomas O. , Matheny Lauren M. , Jarvis Hannah C. , Lewis Eric V. , Ambrose Catherine G.
Published: February 2013

Background:

Disruption of the distal tibia and fibula articulation or syndesmosis can occur without fracture, and isolated syndesmotic disruption is often treated operatively. Following syndesmotic screw removal, a period of protected weight-bearing usually follows to allow the screw holes to heal. Our hypothesis was that supplementing transsyndesmotic fixation with a one-third tubular plate would potentially increase the torsional stiffness about the ankle, thus reducing the risk of fracture after screw removal and potentially allowing a faster return to weight-bearing and sport.

Methods:

Ten pairs of fresh frozen cadaveric specimens were divided into 2 groups. In group 1 (7 pairs), each left extremity underwent the placement, and subsequent removal, of a 4.5-mm transsyndesmotic screw in a tricortical fashion. The matching right extremity underwent the same procedure but with the addition of a one-third tubular plate, which remained in situ after screw removal. In group 2 (3 pairs), the left specimens had a screw placed and removed while the right limbs remained intact. All specimens were tested under an axial preload and a torsional load until failure.

Results:

In group 1, the results demonstrated an increase in torsional stiffness in 5 of 7 specimens with supplemental fixation of a one-third tubular plate. In group 2, the presence of the screw hole alone reduced the torsional stiffness in all specimens tested when compared with intact specimens. However, neither of these differences were statistically significant.

Conclusion:

From this study, we can conclude that the use of supplementary one-third tubular plate fixation demonstrated a trend toward increasing the torsional stiffness following transsyndesmotic screw removal.

Clinical Relevance:

We believe the trend toward improved stiffness justifies the continued use of our technique, although further studies are necessary to confirm it.
The Rate of Sural Nerve Violation Using the Achillon Device
Authors: Aibinder William R. , Patel Ashish , Arnouk Johnny , El-Gendi Hebah , Korshunov Yevgeniy , Mitgang Joshua , Uribe Jaime
Published: February 2013

Background:

Management of acute Achilles tendon rupture remains controversial. Open repair results in lower rerupture rates but is associated with complications from wound healing. Percutaneous and limited open repairs minimize soft tissue complications; however, there is a theoretical increased risk of sural nerve injury. We evaluated the risk of sural nerve violation with the Achillon limited open repair device in cadavers.

Methods:

This cadaveric study consisted of 2 parts. The first part evaluated the frequency and location of sural nerve violation using the standard Achillon protocol in 18 intact embalmed left lower limbs. The second part involved device manipulation with 30 degrees of either internal or external rotation in 13 paired, intact embalmed lower limbs.

Results:

In the first part, 5 of 18 specimens had at least 1 suture passing through the sural nerve. Eight of the 54 needle passes (14.8%) directly pierced the substance of the sural nerve. With internal rotation, 8 of 13 specimens had at least 1 violation of the nerve. Ten of the 39 needle passes (25.6%) directly pierced the substance of the sural nerve. With external rotation, no nerves were violated, significantly decreasing the risk of sural nerve violation versus neutral ( P = .038) and internal rotation ( P = .001). When sural nerve violation was evaluated in regard to instrument outlet, there was a higher risk in the proximal needle passer (outlet no. 3) compared with the distal needle passer (outlet no. 1) with both neutral testing and internal rotation ( P = .027).

Conclusion:

This study demonstrated the potential risk for sural nerve injury using the Achillon device.

Clinical Relevance:

External rotation of the Achillon decreased the rate of sural nerve violation. This may optimize its use in Achilles tendon repairs.
A constitutive model for a linearly elastic peridynamic body
Authors: Aguiar Adair R , Fosdick Roger
Published: February 2013

Constitutive modeling within peridynamic theory considers the collective deformation at each time of all the material within a δ-neighborhood of any point of a peridynamic body. The assignment of the parameter δ, called the horizon, is treated as a material property. The difference displacement quotient field in this neighborhood, rather than the extension scalar field, is used to generate a three-dimensional state-based linearly elastic peridynamic theory. This yields an enhanced interpretation of the kinematics between bonds that includes both length and relative angle changes. A free energy function for a linearly elastic isotropic peridynamic material that contains four material constants is proposed as a model, and it is used to obtain the force vector state and the associated modulus state for this material. These states are analogous to, respectively, the stress field and the fourth-order elasticity tensor in classical linear theory. In the limit of small horizon, we find that only three of the four peridynamic material constants are related to the classical elastic coefficients of an isotropic linear elastic material, with one of the three constants being arbitrary. The fourth peridynamic material constant, which accounts for the coupling effect of both bond length and relative angle change, has no effect on the limit, but remains a part of the peridynamic model. The determination of the two undetermined constants is the subject of future investigation. Peridynamic models proposed elsewhere in the literature depend on the deformation state through its dilatational and deviatoric parts and contain only two peridynamic material constants, in analogy to the classical linear elasticity theory. Observe from above that our model depends on both length and relative angle changes, as in classical linear theory, but, otherwise, is not limited to having only two material constants. In addition, our model corresponds to a nonordinary material, which represents a substantial break with classical models.
Motivations for Sex Among Low-Income African American Young Women
Authors: Deardorff Julianna , Suleiman Ahna Ballonoff , Dal Santo Teresa S. , Flythe Michelle , Gurdin J. Barry , Eyre Stephen L.
Published: February 2013

African American young women exhibit higher risk for sexually transmitted infections, including HIV/AIDS, compared with European American women, and this is particularly true for African American women living in low-income contexts. We used rigorous qualitative methods, that is, domain analysis, including free listing ( n = 20), similarity assessment ( n = 25), and focus groups (four groups), to elicit self-described motivations for sex among low-income African American young women (19-22 years). Analyses revealed six clusters: Love/Feelings, For Fun, Curiosity, Pressured, For Money, and For Material Things. Focus groups explored how African American women interpreted the clusters in light of condom use expectations. Participants expressed the importance of using condoms in risky situations, yet endorsed condom use during casual sexual encounters less than half the time. This study highlights the need for more effective intervention strategies to increase condom use expectations among low-income African American women, particularly in casual relationships where perceived risk is already high.
Culturally Appropriate Photonovel Development and Process Evaluation for Hepatitis B Prevention in Chinese, Korean, and Vietnamese American Communities
Authors: Lee Sunmin , Yoon Hyeyeon , Chen Lu , Juon Hee-Soon
Published: February 2013

Asian Americans have disproportionately high prevalence of chronic hepatitis B virus infection in the United States and yet have low hepatitis B screening and vaccination rates. We developed three photonovels specifically designed for Chinese, Korean, and Vietnamese Americans and evaluated their cultural relevance and effectiveness in increasing self-efficacy and intention to have a hepatitis B screening. Photonovels’ storylines were drawn from focus group themes, and lay people from each community played actors/actresses in community settings. Photonovels were pilot tested, revised, and distributed in a hepatitis B intervention. A two-page process evaluation questionnaire was mailed to 441 participants after one month. Descriptive analysis and multiple logistic regressions were conducted to assess the overall evaluation of the photonovel and to assess factors associated with self-efficacy and intention to have hepatitis B screening. Eighty-four percent of participants responded to the process evaluation. The majority of participants either strongly agreed or agreed that the cancer information in the photonovel was helpful, the story was written by someone who knows the community, and the information was easy to understand. Overall, more than 80% of them thought this photonovel was a good teaching tool. Favorable evaluation of the photonovel was associated with both having intention and self-efficacy to have a hepatitis B screening in the next 5 months. When stratified by level of education and income, the associations were stronger among the lower income and education groups. Culturally appropriate photonovels are useful tools to promote hepatitis B screening among Asian Americans, especially among those of lower socioeconomic status.
Applying the Dynamic Social Systems Model to HIV Prevention in a Rural African Context
Authors: Siegler Aaron J. , Mbwambo Jessie K. , DiClemente Ralph J.
Published: February 2013

This study applied the Dynamic Social Systems Model (DSSM) to the issue of HIV risk among the Maasai tribe of Tanzania, using data from a cross-sectional, cluster survey among 370 randomly selected participants from Ngorongoro and Siha Districts. A culturally appropriate survey instrument was developed to explore traditions reportedly coadunate with sexual partnership, including “wife sharing”, fertility rituals, and various traditional dances. One dance, esoto, accounted for more than two thirds of participants’ lifetime sexual partners ( n = 10.5). The DSSM, combining structural and systems theories, was applied to systematize complex multilevel factors regarding esoto practice. Participants reported multifaceted beliefs regarding esoto; a majority viewed the dance as exciting and essential, yet most men feared social stigma and three quarters of women had experienced physical punishment for nonattendance. In multivariate logistic regression, esoto attendance was predicted by female gender (adjusted odds ratio [AOR] = 4.67, 95% confidence interval [CI] = 1.6-13.2), higher positive beliefs regarding esoto (AOR = 2.84, 95% CI = 1.9-4.2), and Maasai life cycle events (AOR = 0.06, 95% CI = 0.01-0.47). The DSSM proved useful for characterizing esoto and for revealing feedback loops that maintain esoto, thus indicating avenues for future interventions.
Impact response of sandwich beams with various curvatures and debonds
Authors: Baba Buket Okutan
Published: February 2013

This article presents experimental results of the impact response and failure characteristics of curved composite sandwich beam with debond. The objective of this study is to determine how the curvature and debond affects the contact force, displacement, absorbed energy, and damage type under impact loading. An instrumented drop-weight impact test are performed on sandwich beams made of carbon/epoxy face sheets and polyurethane foam core material with four different radii of curvature and debonds between the top and bottom interface of face sheet and foam core. Impact energy was kept constant of 4 J. The contact force and displacement histories of curved sandwich composites with debond are measured to determine the impact response. The results are compared with those of flat beams with the same dimensions and no debond. They indicate that the value of the contact force increases as the curvature angle increases for the beam with no debond. Opposed to the beams with no debond, the contact force decreases as the curvature angle increases for the beam with debond. These results show that curvature angle and debond are important mechanical parameters that must be considered in the design of structures.
The Multiple Sclerosis Intimacy and Sexuality Questionnaire — re-validation and development of a 15-item version with a large US sample
Authors: Foley Frederick W , Zemon Vance , Campagnolo Denise , Marrie Ruth Ann , Cutter Gary , Tyry Tuula , Beier Meghan , Farrell Eileen , Vollmer Timothy , Schairer Laura
Published: February 2013

Background:

Sexual dysfunction is common in multiple sclerosis (MS) but reliable and valid measurement in this population is needed.

Objective:

The objective of this research is to re-validate the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 in a large US sample.

Methods:

A total of 6300 MS patients from the NARCOMS registry completed the MSISQ-19. Unforced principal component analysis utilizing oblique rotation with Kaiser Normalization validated its construct validity.

Results:

The scree plot supported a three-component solution, with 63% of total variance explained. The components mirrored the original validation study measuring primary, secondary, and tertiary sexual dysfunction. PCA suggested the scale could be shortened to 15 items, which were found to apply equally well to males and females (with one primary item specific for each sex). The components were moderately intercorrelated (Pearson rs ranged from 0.5 to 0.67). The secondary subscale correlated most highly with self-reported disability ( r (6081) = 0.44, p < 0.001), whereas the tertiary subscale correlated most highly with psychological distress ( r (5992) = –.37, p < 0.001). Cronbach’s alpha for the total scale (0.92) and the subscales (primary, 0.87; secondary, 0.82; tertiary, 0.91) demonstrated good reliability.

Conclusion:

The revised 15-item MSISQ is a reliable and valid measure of sexual dysfunction in men and women with MS.
Dendritic cells in multiple sclerosis: key players in the immunopathogenesis, key players for new cellular immunotherapies?
Authors: Nuyts AH , Lee WP , Bashir-Dar R , Berneman ZN , Cools N
Published: February 2013

Many studies have demonstrated the role of the adaptive immune system in the pathogenesis of multiple sclerosis (MS). Recent data suggest that dendritic cells (DCs), which are innate immune cells, also contribute to the pathogenesis of MS. In patients with MS, DCs are abundantly present in brain lesions, and display an altered phenotype and/or function as compared with this in healthy controls. DCs are thus in the position to pathologically influence the effector function of (auto-reactive) T and B cells. Interestingly, current first-line immunomodulating therapies for MS have been shown to restore DC phenotype and function, albeit in a non-specific manner. To date, clinical trials using agents specifically targeting DC function are ongoing. Moreover, several studies worldwide are currently investigating possible strategies to develop tolerogenic DCs. This review focuses on the phenotypic and functional alterations of conventional DCs and plasmacytoid DCs in patients with MS. Furthermore, we discuss how existing immunomodulating therapies for MS patients affect DC function and address future perspectives in the development of immunotherapies specifically targeting DCs.