bluuebunny/crossref_metadata_2025 huggingface dataset:
Groundwater Governance in India: A Legal and Institutional Perspective
Authors: Khara Deepratan Singh
Published: November 2022

Availability of and accessibility to groundwater have played a considerable role in India’s development, especially in the agriculture sector. Although the groundwater boom has provided numerous advantages, it has also created a slew of intractable problems in terms of overexploitation and resource depletion, leading to the emergence of a groundwater crisis. Although there exists a policy structure to address these concerns, India’s legal framework for groundwater governance and management is complex and multi-layered, with constitutional and statutory provisions of both the Central and state governments.

The present article aims to explore the nuances of groundwater governance in India from legal and institutional perspectives in an integrated manner. It examines the constitutional and right-based aspects of groundwater management as well as the evolution of associated groundwater policy measures undertaken so far.
Moving North and Coming Back: How Concerns about Different Types of Migrants Affect Social Policy Demands among Low- and High-Skilled Mexicans
Authors: Berens Sarah , Deeg Franziska
Published: November 2022

Middle-income countries experience various types of migration: transients, emigrants, refugees, and returnees. Their domestic economy is especially influenced by refugees and returnees. Since returnees and refugees vary in access to social policy programs and in skill composition, different types of migration should vary in “threat potential” for social policy demands, with the low-skilled responding more negatively to refugees, while the high-skilled face greater competition from returning natives. We test our argument with original survey data from Mexico, distinguishing respondents’ concerns about two distinct streams of migration: Central Americans seeking refuge in Mexico and Mexicans returning from living in the United States. Surprisingly, we find that the low-skilled's welfare preferences suffer neither type of migration concern, whereas high-skilled Mexicans oppose expanding social welfare when concern about returnees is high. Social solidarity in the welfare state is most depressed by returning natives.
Extending ontology pitfalls for better ontology evaluation
Authors: Özacar Tuğba
Published: November 2022

This article presents a framework that detects potential ontology building errors to improve the ontology quality. These potential errors are called ontology pitfalls in the literature. This work extends the existing ontology pitfall set in the literature and suggests new solutions for ontology repair. We have also developed a Java implementation for detection of the proposed pitfalls. These pitfalls were evaluated with well-known ontologies using this implementation.
More Social Justice, Less Administrative Support: Surprising Insights into Successful, Veteran Teachers at a Title I High School
Authors: Turner Janay Johns
Published: November 2022

In this case study, ten successful, veteran secondary teachers described their decision to remain teaching in a high-needs high school. These participants shared devotion to students, appreciation of colleagues, belief in social justice, and appreciation of diversity and challenge as reasons to continue teaching at the school. Surprisingly, there was no consensus regarding administrative support as a basis for continuing to teach.
Effects on sedentary behaviour of an approach to reduce sedentary behaviour in patients with minor ischaemic stroke: A randomised controlled trial
Authors: Ashizawa Ryota , Honda Hiroya , Take Koki , Yoshizawa Kohei , Kameyama Yuto , Yoshimoto Yoshinobu
Published: November 2022

Objectives

To determine the effects on sedentary behaviour of an approach that promotes reduction in sedentary behaviour in patients with minor ischaemic stroke after intervention and at follow-up.

Design

A randomised controlled trial.

Setting

During hospitalisation and after hospital discharge

Subjects

In total, 86 patients with minor ischaemic stroke admitted to an acute care hospital were assigned to the intervention (n = 43) and control (n = 43) groups.

Intervention

An intervention group that received an approach to reduce sedentary behaviour upon hospital admission until 3 months after discharge (education, self-monitoring, phone calls, etc.) and a control group that received the usual care during hospitalisation. From 3 to 6 months after discharge, no group received any intervention.

Main Outcome

The primary outcome was the change (%) in sedentary behaviour from baseline to post-intervention (3 months after discharge) and follow-up (6 months after discharge). Sedentary behaviour was measured at baseline (upon hospital admission), post-intervention, and at follow-up using accelerometers.

Results

At the post-intervention stage, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, −22.7%; control group, −14.9%; P = 0.013; effect size = 0.58). At follow-up too, the intervention group showed a significantly greater change in sedentary behaviour from baseline than that shown by the control group (sedentary behaviour: intervention group, −20.4%; control group, −13.6%; P = 0.025; effect size = 0.54).

Conclusions

An approach to reduce sedentary behaviour in patients with minor ischaemic stroke effectively reduces sedentary behaviour, which is sustained up to follow-up.

Trial registration

This study is registered at www.umin.ac.jp/ctr/index/htm UMIN000038616.
Spread of misinformation during COVID-19: The case of Mauritius
Authors: Beebeejaun Ambareen
Published: November 2022

As COVID-19 continues to spread rapidly across the globe, it is imperative to regulate the content of information such that people have access to accurate information. Nevertheless, there is the fear that governments are abusing legislation to limit freedom of expression and that the pandemic is simply being used as an excuse to further obstruct free speech. As such, it is through the lens of human rights that this research critically examines the approaches undertaken by the Mauritian authorities to deal with misinformation during COVID-19. To achieve this research objective, the related laws on misinformation are critically assessed and a comparative analysis is caried out of international responses to misinformation during COVID-19. It has been noted that the law alone is not sufficient to deal with misinformation, and media literacy among citizens is also essential in this endeavour.
Hemostatic effect and safety evaluation of the absorbable macroporous polysaccharides composite hemostatic material prepared by a green fabrication approach
Authors: Wu Lihao , Ren Kang , Chen Gong , Wang Hongjian , Li Hongwei , Xu Ling
Published: November 2022

Carboxymethyl chitosan is widely used in the medical field such as wound healing and other medical fields. We previously fabricated the absorbable macroporous polysaccharides composite hemostatics (AMPCs) mainly composed of carboxymethyl chitosan which possess excellent hemostatic effect. To further elucidate the impact of CMCTs on the hemostatic effect and biosafety of AMPCs, carboxymethyl chitosan with different properties were used to prepare AMPCs. By comparing the physical and chemical properties, AMPCs performed high water absorption ability, especially Group 1 (swelling ratio reached 5792%), which facilitated the rapid formation of blood clots. It was confirmed by blood clotting index (BCI) and blood coagulation tests in vitro that Group 1 showed a slightly higher coagulation capacity than groups 2 and 3, which may be due to the positive charge on the surface of the cations in the salts attaches to the negative charge on the surface of the red blood cells, an electrostatic neutralization reaction occurs. The biosafety was a preliminary evaluation by implanted AMPCs into the back of Sprague-Dawley rats and the tissue was harvested after feeding for 28 days. The AMPCs exhibited good biosafety for whole blood and major organs during the degradation in vivo: during the degradation of AMPCs, excluding changes in some serum indicators, no tissue necrosis or inflammatory cell infiltration was observed in these organs, either by gross observation or histological analysis. These findings demonstrate that expecting to develop a highly functional and safe hemostatic agent based on Group 1 for rapid hemostasis applications in emergencies.
The stigma of the Chinese poll tax in colonial New Zealand
Authors: Vosslamber Rob , Yong Sue
Published: November 2022

This article considers colonial New Zealand's poll tax on Chinese immigrants. Poll taxes were recognised as a badge of slavery and therefore could be used to discriminate and stigmatise. This could only happen if the Chinese had first been labelled, stereotyped and separated from ‘normal’ society, and deprived of their status as full human beings. Anti-Chinese attitudes amongst politicians, lobby groups, the media and society in general paved the way for discriminatory legislation which imposed the poll tax. Since the Chinese were regarded as less than fully human, their liability to discrimination in the form of a poll tax was considered to be justified. Applying Goffman’s theory of stigma, as developed by Link and Phelan, this article analyses why the poll tax was discriminatory by referring to social discourse and to attitudes amongst the politicians and media. The poll tax illustrates how the practice of taxation contributed to discrimination and dehumanisation by referring to a specific form of taxation.
Taking Practical Steps: A Feminist Participatory Approach to Cocreating a Trauma- and Violence-Informed Physical Activity Program for Women
Authors: Darroch Francine E. , Varcoe Colleen , Montaner Gabriela Gonzalez , Webb Jessica , Paquette Michelle
Published: November 2022

Trauma- and violence-informed physical activity (TVIPA) is a feasible approach to improve access/engagement in physical activity for pregnant/parenting women with experiences of trauma. Through feminist participatory action research, 56 semistructured interviews were completed to understand TVIPA. Four themes were identified: (1) “I have to be on edge”: Trauma and violence pervade women's lives, (2) “It should be mandatory that you feel safe”: Emotional safety is essential, (3) “The opportunity to step up and be decision-makers and leaders”: Choice, collaboration, and connection create safety, and (4) “It's a good start for healing,” strengths-based and capacity building foster individual and community growth.
Audiologists’ Perceptions of Hearing Healthcare Resources and Services in South Africa’s Public Healthcare System
Authors: Bhamjee Aaqilah , le Roux Talita , Schlemmer Kurt , Graham Marien Alet , Mahomed-Asmail Faheema
Published: November 2022

Background:

Hearing loss poses a significant burden globally. Its prevalence is exceptionally high in countries across the African region, where healthcare resources and services remain inaccessible. This study aimed to describe audiologists’ perceptions regarding hearing healthcare resources and services within South Africa’s public healthcare system.

Methods:

A national self-developed telephonic survey was conducted with audiologists in public healthcare system hospitals across South Africa, with the final sample comprising 100 audiologists.

Results:

Most (82%) audiologists indicated that their hospitals did not have adequate hearing healthcare resources to render efficient audiology services to patients. Binaural amplification devices (invasive and non-invasive) for adults with bilateral hearing loss who adhered to the criteria for these devices were perceived to be unavailable in most hospitals. Audiologists also perceived that universal newborn hearing screening services, adult aural rehabilitation services, and follow-up care for all hearing devices post-warranty expiration were limited.

Conclusion:

Efforts should be made to upsurge hearing healthcare resources, including increasing the financial budgets allocated to audiology resources so that increased diagnostic and screening audiology equipment and hearing devices can be procured where required, and additional audiologists can be employed within the South African public sector hospitals where needed.
A natural history of temporary tube feeding care at a children’s hospital: A prospective audit of medical records
Authors: Syrmis Maryanne , Frederiksen Nadine , Reilly Claire , Bell Kristie
Published: November 2022

This chart audit characterized the natural history of temporary tube feeding use at a children’s hospital between 1 November 2018 and 30 November 2019. Data were collected from the decision-making phase until tube removal or 4 months post-tube insertion. Children’s tube feeding journeys were described, and associations determined between patient and service-related variables and outcomes of tube feeding duration and being discharged with a feeding tube. Four hundred and 94 patients were followed with a median age of 1.0 years (IQR 3.6). Many had respiratory illnesses ( n = 213, 43%) and received feeding tubes for inadequate oral intake related to acute illness ( n = 279, 57%). Seventy-one new feeding tubes were inserted per month (SD 27.63). Fifty-nine per cent of patients ( n = 290) received allied health consults. Although 40% of patients ( n = 199) experienced complications, most patients ( n = 460, 93%) ceased tube feeding within 4 months. Outcomes were associated with age, medical condition, reflux, primary reason for tube feeding, allied health consult, complication type, tube weaning plans and referral for longer-term feeding devices. Results highlighted a critical need for risk identification from the decision-making stage and standardization of practices during all phases of temporary tube feeding care.
‘Channel shift’: Technologically mediated policing and procedural justice
Authors: Wells Helen M , Aston Elizabeth V , Bradford Ben , O'Neill Megan , Clayton Estelle , Andrews Will
Published: November 2022

In recent years, police forces in the United Kingdom have introduced various technologies that alter the methods by which they interact with the public. In a parallel development, many forces have also begun to embrace the concept of procedural justice as a method through which to secure legitimacy and (in turn) public compliance and cooperation. What has not received sufficient attention, within policing or academia, is the extent to which these two trends are compatible, with the procedural justice literature still predicated on an assumption that police–public ‘contacts’ or ‘encounters’ are in-person. The effect of technologically mediating police–public contacts on ‘policing by consent’, is therefore unknown. In this article, we focus specifically on the possible implications of the Single Online Home (SOH) (a portal through which the public can report crime, get updates on cases, give feedback and pay fines, among other things, which is currently being rolled out across forces), considering ‘interactions’ between police and public where there is no physical co-presence. Noting the unique context that is policing, we draw on the limited existing research on procedural justice encounters in technologically mediated contexts to explore whether procedural justice theory is ‘future-proof’ for a policing context increasingly reliant on such encounters. We conclude that, through empirical research, we must update our conceptual understanding of what ‘contact’ can mean, and accept that current developments may in fact be transforming relationships rather than simply facilitating existing ones.
Maternal History of Adversity and Subsequent Mother–Child Interactions at Early Ages: A Systematic Review
Authors: Leite Ongilio Fernanda , Gaspardo Cláudia Maria , Linhares Maria Beatriz Martins
Published: November 2022

Adverse childhood experiences (ACEs) can negatively impact physical, emotional, cognitive, and social development, consequently affecting the next generation. The aim of the present study was to systematically review evidence from empirical studies on the association between maternal history of adversity in childhood (maltreatment and household dysfunction) and subsequent mother–child interactions at an early age. A search was performed in the PubMed, Web of Science, PsycINFO, EMBASE, Scopus, LILACS, and SciELO databases to identify studies, including measures of maternal childhood adversities and mother–child interaction, published between 2016 and 2022. Twenty-nine studies met the inclusion criteria. The results showed that in 90% of the studies, maternal childhood adversities negatively impacted subsequent mother–child interactions in early childhood, reducing maternal displays of affection, emotional availability, sensitivity, mother–child communication, and bonding. Biological factors (e.g., genetic and hormonal) and maternal emotional recognition moderated these associations. In addition, biological factors (i.e., neurobiological and hormonal) and psychosocial factors (e.g., depression, executive functioning, and violence) acted as mediators. Preventive interventions should be implemented to break out of the intergenerational cycle of violence that impacts mother–child interactions.
Infant Safe Sleep in the District of Columbia: Better for Both
Authors: Beth Howard Mary , Parrish Benjamin T. , Singletary Judith , Jarvis Lenore
Published: November 2022

Sudden unexpected infant death (SUID) rates within the District of Columbia (DC) vary, with rates 3 times higher in certain geographical areas than the cumulative rate in DC and 7 times higher than the national rate. The majority SUIDs are due to unsafe sleep practices. Although safe sleep education and resources are available in these areas, the high sleep-related infant mortality suggests unmet barriers to infant safe sleep. We sought to investigate potential contributions to local infant mortality through focus groups regarding infant sleep practices among DC caregivers. In this qualitative study, caregivers were probed regarding barriers and facilitators of infant sleep practices. Data were collected until thematic saturation was reached, then coded. Themes were developed and revised in an iterative manner. Fifteen caregivers participated in three focus groups. Themes included sources of infant sleep knowledge, challenges for infant sleep, and motivators for infant sleep choice. All caregivers reported knowledge of safe sleep practices. Infant sleep practices varied, and included unsafe practices such as bed sharing, co-sleeping, and use of swings or bouncers for infant sleep. Challenges of adhering to safe sleep practices included infant needs, competing family demands, the overwhelming nature of newborn sleep, threats, and conflicting information. Motivators for infant sleep practices included better sleep, convenience, safety, tradition, and needs of the infant and caregiver. Although caregivers report knowledge of safe sleep recommendations, actual infant sleep practices vary and include unsafe sleep practices. More focused interventions are needed to address this gap between safe sleep knowledge and practice.
Identification of the Constituents in Cnidii Fructus Active Against Trichomonas vaginalis Parasites
Authors: Yu Chien-Chih , Chiang Yi-Ting , Cham Thau-Ming
Published: November 2022

Ethanol extracts of Cnidii Fructus, the dried fruits of Cnidium monnieri (L.) Cusson, have been externally applied in the treatment of Trichomonas vaginalis. However, the precise identity of the major constituents responsible for activity against T. vaginalis is unknown, but there is probability they are coumarin derivatives. In this study, the anti- Trichomonas activity of 4 major coumarin derivative constituents of Cnidii Fructus, namely, osthole, xanthotoxin, isopimpinellin, and bergapten, was characterized in terms of the resulting kinetics of growth and morphology of T. vaginalis upon treatment. The results demonstrated that osthole and xanthotoxol had significant trichomonacidal ability, while isopimpinellin and bergapten displayed low or no inhibitory efficacy toward T. vaginalis parasites. Our study suggests that the coumarin derivatives osthole and xanthotoxol can be potentially used as a basis for the development and design of new drugs for application in alternative or synergistic therapy against T. vaginalis.
Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients
Authors: Dittrich Tolga D , Sporns Peter B , Kriemler Lilian F , Rudin Salome , Nguyen Anh , Zietz Annaelle , Polymeris Alexandros A , Tränka Christopher , Thilemann Sebastian , Wagner Benjamin , Altersberger Valerian L , Piot Ines , Barinka Filip , Hänsel Martin , Gensicke Henrik , Engelter Stefan T , Lyrer Philippe A , Sutter Raoul , Nickel Christian H , Katan Mira , Peters Nils , Michels Lars , Kulcsár Zsolt , Karwacki Grzegorz M , Pileggi Marco , Cereda Carlo , Wegener Susanne , Bonati Leo H , Fischer Urs , Psychogios Marios , De Marchis Gian Marco
Published: November 2022

Background:

The DEFUSE-3 and DAWN trials showed that mechanical thrombectomy (MT) improves the outcome of selected patients with anterior circulation large vessel occlusions (LVO) up to 24 h after stroke onset. However, it is unknown whether only those patients fulfilling the trial inclusion criteria benefit, or whether benefit is seen in a broader range of patients presenting between 6 and 24 h.

Aims:

We determined whether fulfilling the DEFUSE-3 and DAWN selection criteria affects outcomes in MT patients in clinical practice.

Methods:

We reviewed adult patients with LVO treated with MT between 6 and 24 h after stroke onset at five Swiss stroke centers between 2014 and 2021. We compared two groups: (1) patients who satisfied neither DEFUSE-3 nor DAWN criteria (NDND) and (2) those who satisfied DEFUSE-3 or DAWN criteria (DOD). We used logistic regression to examine the impact of trial eligibility on two safety outcomes (symptomatic intracranial hemorrhage [sICH] and all-cause mortality at 3 months) and two efficacy outcomes (modified Rankin Score [mRS] shift toward lower categories and mRS of 0–2 at 3 months).

Results:

Of 174 patients who received MT, 102 (59%) belonged to the NDND group. Rates of sICH were similar between the NDND group and the DOD group (3% vs. 4%, p = 1.00). Multivariable regression revealed no differences in 3-month all-cause mortality (aOR 2.07, 95% CI 0.64–6.84, p = 0.23) or functional outcomes (mRS shift: acOR 0.81, 95% CI 0.37–1.79, p = 0.60; mRS 0–2: aOR 0.91, 95% CI 0.31–2.57, p = 0.85).

Conclusion:

Among adult patients with LVO treated with MT between 6 and 24 h, safety and efficacy outcomes were similar between DEFUSE-3/DAWN eligible and ineligible patients. Our data provide a compelling rationale for randomized trials with broader inclusion criteria for MT.
The efficacy of sensory neural entrainment on acute and chronic pain: A systematic review and meta-analysis
Authors: Maddison Rhys , Nazar Hamde , Obara Ilona , Vuong Quoc C
Published: November 2022

Background

Changes to the power of neural oscillations in cortical and sub-cortical structures can change pain perception. Rhythmic sensory stimulation is a non-invasive method that can increase power in specific frequencies of neural oscillations. If the stimulation frequency targets those frequencies related to pain perception, such as alpha or theta frequencies, there can be a reduction in perceived pain intensity. Thus, sensory neural entrainment may provide an alternative to pharmacological intervention for acute and chronic pain. This review aimed to identify and critically appraise the evidence on the effectiveness of sensory entrainment methods for pain perception.

Methods

We undertook a systematic search across Medline, Embase, PsycInfo, Web of Science and Scopus in November 2020 to identify studies investigating the efficacy of sensory entrainment on adults. We assessed studies for their quality using the PRISMA checklist. A random-effects model was used in a meta-analysis to measure the effect of entrainment on pain perception.

Results

Our systematic review yielded nine studies fitting the search criteria. Studies investigated the effect of visual and auditory entrainment on pain intensity rating, electrophysiological markers of pain and amount of analgesia needed during surgery. The meta-analysis suggests that alpha (8–13 Hz) sensory entrainment is effective for acute pain perception, whereas theta (4–7 Hz) entrainment is effective for chronic pain.

Conclusions

Although there is heterogeneity in the current evidence, our review highlights the potential use of sensory entrainment to affect acute and chronic pain. Further research is required regarding the timing, duration and frequency of the stimulation to determine the best application for maximum efficacy.
Towards adaptive technology in routine mental health care
Authors: Lamo Yngve , Mukhiya Suresh K , Rabbi Fazle , Aminifar Amin , Lillehaug Svein I , Tørresen Jim , H Pham Minh , Côtè-Allard Ulysse , Noori Farzan M , Guribye Frode , Inal Yavuz , Flobakk Eivind , Wake Jo D , Myklebost Sunniva , Lundervold Astri J , Hammar Aasa , Nordby Emilie , Kahlon Smiti , Kenter Robin , Sekse Ragnhild JT , Griffin Kristine F , Jakobsen Petter , Ødegaard Ketil Joachim , Skar Yngvar S , Nordgreen Tine
Published: November 2022

This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.
Defining covert recording: A qualitative study exploring the experiences of clinicians when a patient records a hospital clinical encounter using a smartphone without consent
Authors: Ryan Laura , Weir Kelly A , Maskell Jessica , Bevan Lily , Le Brocque Robyne
Published: November 2022

Background

Patients use their smartphones to covertly record their clinical encounters in hospital. However, this issue is poorly understood. Insight into the clinician perspective will help inform policies and practices that deliver safe environments for patients and clinicians.

Objective

This study aimed to gain a deep understanding of clinician attitudes and behaviours when a patient covertly records a hospital clinical encounter using a smartphone.

Methods

Semi-structured interviews were undertaken with 20 hospital clinicians. Participants were recruited via purposive and snowball sampling. Interviews were conducted in person or via Microsoft Teams. Interviews were digitally audio recorded and transcribed. Data was analysed using thematic analysis.

Results

Most of the 20 participants reported they had either suspected or experienced a patient covertly recording a clinical encounter. Covert recordings occurred across a broad range of clinical disciplines and contexts. Themes were identified from participant perspectives, including discernment of patient intention, likeliness to consent to the recording if asked, anticipated risks and potential benefits associated with the covert recording. These themes have led to the categorisation of three forms of covert recording: (1) Intentional Covert Recording (2) Inadvertently – Covert Recording, and (3) Beneficial Covert Recording.

Conclusion

Clinicians have varied experiences and responses when a patient covertly records a clinical encounter. Findings indicate that nuanced strategies may be required to support clinicians to manage covert recording, whilst balancing the needs of patients.
Repair of Acute Grade 3 Combined Posterolateral Corner Avulsion Injuries Using an Enhanced Fixation Technique
Authors: Moran Jay , Kahan Joseph B. , Schneble Christopher A. , McLaughlin William M. , Green Joshua S. , Gillinov Stephen M. , Cheng Ryan , Patel Rohan R. , Jimenez Andrew E. , LaPrade Robert F. , Schenck Robert C. , Medvecky Michael J.
Published: November 2022

Background:

Previous studies have suggested that surgical repair of the posterolateral corner (PLC) may be inferior to reconstruction.

Hypothesis:

We hypothesized that acute repair (<3 weeks) of avulsion-type PLC multiligament knee injuries with no midsubstance injury would lead to lower failure rates than previously reported for PLC repair.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 28 patients with multiligament knee injuries who underwent acute repair between January 2007 and June 2018 of a PLC avulsion injury with no evidence of midsubstance tearing were included. All PLC avulsion injuries were treated using a transosseous Krackow suture pull-through technique without graft augmentation. Outcome metrics included lateral joint-space widening with varus stress, patient-reported clinical varus instability, patient-reported outcome measures (PROMs), and any subsequent revision or salvage procedure.

Results:

The mean time from injury to repair was 8.1 ± 5 days. At a mean follow-up of 2 years (range, 3-90 months), clinical varus stress examination at 30° demonstrated a significant reduction in lateral compartment opening, from 9 ± 3 mm preoperatively to 0 ± 3 mm ( P < .0001). The failure rate was calculated to be 10.7% (3/28), which was significantly lower than the failure rate from a 2016 systematic review (38%, 17/45; P = .015). Of the 28 patients, 21 (75%) had PROM scores. Patients who underwent staged bi-cruciate reconstructions (n = 5) had significantly higher subjective International Knee Documentation Committee (IKDC) (87.2 vs 65.5; P = .014) and Lysholm (90.5 vs 75.2; P = .029) scores compared to patients with untreated bi-cruciate injuries (n = 9). Patients with peroneal nerve injury (n = 4) had significantly lower IKDC (58.2 vs 80.8; P = .0045) and Tegner (3.2 vs 5.4; P = .047) scores than those without peroneal nerve injury (n = 17). The mean IKDC and Lysholm scores at final follow-up were 73.4 ± 24.0 and 80.8 ± 23.1 at 7.1 years (range, 2.3-10.6 years) of follow-up.

Conclusion:

Repair of acute grade 3 combined PLC avulsion injuries using a transosseous Krackow suture pull-through technique demonstrated a failure rate of 10.7%. Patients who underwent a staged cruciate reconstruction(s) had higher subjective outcome scores than those who had cruciate injuries left untreated. Peroneal nerve injury was associated with lower outcome scores.
Differences in Outcomes Between Tendon Transfer Treatments of Congenital Clubfoot in Cerebral Palsy
Authors: Chu Alice , Hanna Aedan , Hanna Adeeb J. , McGrath Aleksandra , Kaushal Neil , Edobor-Osula Folorunsho
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Cerebral palsy (CP) provides challenges when treating congenital clubfoot (CF) due to the presence of aberrant muscle tone and motor dysfunction. Split anterior tendon transfer (SPATT) and split posterior tendon transfer (SPOTT) are two ubiquitous treatments in the surgical repair of CP CF. Kling et. al. developed a three-tier grading system for documenting SPOTT outcomes; assigning excellent, good, or poor based on postoperative ambulation and functional dorsiflexion, this system has also been applied to SPATT recovery. The purpose of this study is to elucidate any difference in the outcomes of CP CF patients who receive SPOTT vs SPATT treatment.

Methods:

Following PRISMA guidelines a comprehensive search was conducted of PubMed, Cochrane, CINAHL, Scopus, and Web of Science. Collected publications represent all available literature on clubfoot. Articles were then screened by two independent reviewers at the title, abstract, and full-text level; only articles that detailed tendon-transfer treatment of pediatric patients with CF, CP, and contained three or more human subjects were included. Publications were excluded from screening if found to be duplicate articles, historical reviews, professional opinions, case reports, or contained non-human subjects. Two independent reviewers verified that each article met predetermined inclusion criteria at each level of screening. SAS statistical software was used to determine the relationship between positive and negative interventions outcomes, as well as patent demographics.

Results:

An initial search yielded 6,469 articles; after review 17 articles remained which described surgical tendon transfer: 12 (70.59%) split posterior tendon transfer (SPOTT) articles (mean-age 9.30 +- 2.57 years, mean follow-up length 60.03 +- 37.64 months), 5 (29.41%) split anterior tendon transfer (SPATT) articles (mean-age 10.12 +- 3.40 years mean follow-up length 64.16 +- 34.35 months). SPOTT papers included a total of 391 patients and 446 feet with a post-operative excellent & good rate of 90.48% and failure rate of 8.70%. SPATT papers included a total of 136 patients and 151 feet with a post-operative excellent & good rate of 71.22% and failure rate of 9.73%.

Conclusion:

These results show that the publication frequency of CP CF treatment by split posterior tendon transfer is higher than that of split anterior tendon transfer. Additionally, results of this systematic review indicate that there is a greater predicted positive outcome in SPOTT vs SPATT while there is no significant difference in predicted negative outcomes between procedures.
Evidence for Graft Materials Used in Hindfoot and Ankle Arthrodesis: A Systematic Literature Review
Authors: Covell Donald J. , Knight Ashley , Fitch David
Published: November 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

There is a wide range of graft materials available to supplement hindfoot and ankle arthrodesis procedures. These include autograft, allografts, and bone graft substitutes. While these various materials are commonly used, the level of evidence to support each has not been widely explored. The purpose of this study was to conduct a systematic literature review to evaluate the level of evidence that exists for each of these materials to inform clinical decision making towards optimal patient outcomes.

Methods:

A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted using the Embase, MEDLINE, and Cochrane Controlled Register of Trials databases in May 2019 for studies published in English since January 1, 2009. The review included all studies published with patients who were at least 18 years of age needing graft material for hindfoot or ankle arthrodesis. Two independent reviewers reviewed all abstracts for inclusion. Disagreements were resolved by a third reviewer for consensus.

Results:

The search returned 3,547 records, of which 35 were included. Autograft and allograft had the largest number of studies, most of which were retrospective case series. Recombinant human platelet-derived growth factor BB with beta-tricalcium phosphate (rhPDGF-BB/β-TCP) and autograft were supported by the highest levels of evidence, each having four randomized controlled trials (RCTs). B2A was the only other material in an RCT, but with only24 subjects. Allograft and off-label use of recombinant human bone morphogenetic protein (rhBMP) were supported mainly by retrospective case series. Another assessment of quality was the endpoints. Fusion status was assessed by computed tomography (CT) and/or radiographs, with CT considered superior. Seventeen (17) studies used CT, but the definition of fusion varied from a high barrier of 'at least 50% osseous bridging' in 6 autograft, 5 rhPDGF-BB/β-TCP, 1 rhBMP, 1 demineralized bone matrix, and 1 B2A studies to a lower or undefined criteria in other studies.

Conclusion:

This literature review reveals the use of grafting materials is supported by a wide range of evidence quality. Most are supported by Level IV evidence, with the exceptions of autograft and rhPDGF-BB/β-TCP. Both are supported by multiple Level I studies. When looking at the methods for assessing fusion status, less than half of studies used CT. Of these, autograft and rhPDGF-BB/β-TCP both had at least 5 studies using CT while other materials had at most 1 study. Surgeons may wish to consider the availability of high-quality evidence, or the lack of, when selecting grafting materials.
Tantalum Spacer Augmentation of Large Bony Defects in Hindfoot Arthrodesis
Authors: Delman Connor , Kazemi Soroush , Afzal Najiba , Haffner Max R. , Giza Eric , Kreulen Christopher D.
Published: November 2022

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

Tibiotalocalcaneal (TTC) arthrodesis is a common surgical technique used in the treatment of various hindfoot pathologies. Large osseus defects are particularly challenging with a high rate of graft collapse and nonunion when using autograft or allograft. Porous tantalum has emerged as a favorable osteoconductive material to address sizeable hindfoot defects. The purpose of this study was to review the radiographic outcomes and complications associated with tantalum spacer augmentation in hindfoot arthrodesis.

Methods:

A retrospective review was performed of all patients who underwent a hindfoot arthrodesis augmented with a metal spacer (Trabecular MetalTM) from 2012 to 2020 at a single institution. Patients [endif]–>18 years of age who had a large, hindfoot osseus defect were included in the study. Surgeries were performed by two fellowship-trained foot and ankle orthopaedic surgeons. The primary outcomes assessed were presence of radiographic union, post-operative complications, and return to the operating room.

Results:

Fourteen patients were identified who underwent hindfoot arthrodesis with the use of a Trabecular MetalTM augment. Two of the 14 patients were lost to follow-up resulting in a total of 12 patients with an average age of 59 years (range, 42 - 74). The average length of follow-up was 26 months (range, 4 - 56). Four patients had plain radiographs at final follow-up compared to 7 patients who had CT scans performed. Nine patients underwent TTC fusion with a retrograde intramedullary nail (MedShape DynaNail) and three patients underwent isolated subtalar (ST) fusion. Ten of 12 fusions were augmented using reamer irrigator aspirator (RIA) autograft and two patients received autograft from either the tibia or fibula. Of the 12 patients, 10 achieved radiographic evidence of union for a union rate of 83%. There were three patients who required reoperations: one hypertrophic nonunion, one surgical site infection, and one symptomatic hardware.

Conclusion:

Tantalum provides a great structural option for patients undergoing TTC or ST fusion in the setting of large hindfoot bony defects. This method combined with the use of autograft and adequate biomechanical stabilization can produce reliable results. Functional outcomes are needed to capture the utility of this technique in attaining longterm clinical results.
Opiate Free Multimodal Pain Pathway in Elective Foot and Ankle Surgery: A Prospective Study
Authors: Glenn Rachel L. , Ross Daniel J. , Jackson J. Benjamin , Gonzalez Tyler A.
Published: November 2022

Category:

Bunion; Other

Introduction/Purpose:

Orthopedic surgeons frequently prescribe and overprescribe narcotic pain medications during the postoperative period, despite our increased understanding of the opioid crisis. In an effort to minimize narcotic analgesia and its potential side effects, opiate free multimodal pain pathways have been developed with promising results. However, there is a lack of published literature looking at opiate free multimodal pain protocols for elective outpatient foot and ankle surgeries. At our institution we have been implementing a novel opiate free multimodal post-operative pain protocol for elective outpatient foot and ankle surgeries. The purpose of this study was to explore the efficacy, feasibility, outcomes and satisfaction of an opioid-free, multimodal postoperative pathway in patients undergoing elective outpatient foot and ankle surgery.

Methods:

This study was approved by our IRB and was a prospective study. Data was collected from December 1st, 2020 through February 9th, 2022 for patients who underwent a primary elective outpatient foot and ankle surgery including bunion correction surgery with or without a lesser toe procedure(s). These patients completed a comprehensive opioid-free, multimodal pain management protocol and a follow up with one of two fellowship trained orthopedic foot and ankle surgeons. The multimodal treatment protocol included oral Lyrica, Tylenol, Toradol and flexeril to begin POD#0. Mobic was given to POD #4 once Toradol was completed. All data was collected in a prospective manner. At POD#1, #3, and #8, patients were contacted to collect VAS scores, complications, ED and Urgent care visits, and pain medication needs. At two week follow up these were again collected in addition to overall satisfaction rates.

Results:

33 patients enrolled with a mean age of 55 (19-81) years old. The average follow up was 11.5 weeks. On POD#1, #3, #8, and at 2 week follow up our patients’ average VAS pain score was a 4.0, 2.5, 1.6, and 1.4 out of 10, respectively. 18% of patients required narcotics within the first 2 weeks, but by 2 weeks no patients were taking narcotics. No patients visited an ED or urgent care during the first 2 weeks post operatively. Common side effects were drowsiness/tiredness and constipation. Only 4 reported nausea or GI upset at 2 week follow up. Overall, 91% were satisfied with their pain control, 78% would follow the same protocol again, and 82% would recommend this pain management regimen to others.

Conclusion:

An opioid-free, multimodal pain management pathway is a safe and effective option in properly selected patients undergoing elective outpatient foot and ankle surgery with a very low risk of requiring rescue opioids, having significant side effects, and/or needing an ED or urgent care evaluation within the first 2 week post operative period.
Biological Evaluation of a Native Amniotic Membrane Allograft
Authors: Godwin Lisa A. , Sukumar Divya , Moreno Sarah , Giedd Matthew , Chung Connie , Massee Michelle , Bara Heather , Koob Thomas J. , Harper John
Published: November 2022

Category:

Basic Sciences/Biologics; Other

Introduction/Purpose:

Placental tissue allografts have long been used as effective wound dressings for hard to heal wounds and are demonstrating increasing utility in the field of foot and ankle surgeries. Previous observations of the PURION-processed dehydrated amnion/chorion membrane (dHACM) demonstrated retention of regulatory proteins inherent to amniotic tissues and preservation of the bioactivity to stimulate cellular activities. Novel and patent-pending processing techniques have been developed to introduce a thicker and more robust allograft, as compared to dHACM. Lyophilized human amnion chorion membrane (LHACM) will confer versatility to clinicians with improved handling while maintaining the natural tissue composition and intrinsic biological activities. This study characterizes the biological properties of LHACM which may support the healing cascade.

Methods:

LHACM was processed using a modified PURION process which incorporates an optimized cleansing process, enabling retention of the intermediate layer, and lyophilization. Tissue architecture was visualized with hematoxylin and eosin staining. The hygroscopic contribution of the intermediate layer was appraised with absorbency measurements. Cleansing efficiency was determined through quantification of residual hemin remaining in the tissue. Regulatory proteins were quantified using a multiplex ELISA. The cellular response to LHACM treatment was assessed using multiple in vitro assays targeting cellular proliferation and analysis of signaling pathways. Adult dermal fibroblasts (HDFs) cultured over a 3-day period in LHACM eluates were assessed for cellular proliferation. In vitro models were developed to assess the regulation of relevant signaling pathways, including TGF-β1 and Wnt/β-catenin for fibrotic and proliferative processes, respectively. Cellular responses were evaluated through quantitative PCR and cell reporter lines.

Results:

Histological evaluation showed that processing maintains the tissue structure. Absorption testing demonstrated LHACM is more hygroscopic than dHACM. Hemin analysis demonstrated low levels of residual hemin which were comparable for LHACM and dHACM allografts. Screening for regulatory proteins indicate that LHACM contains a diverse array of regulatory proteins, inherent to amniotic membranes. In vitro treatment of primary cells with LHACM eluates promoted dermal fibroblast proliferation as well as regulation of elevated TGFβ- and Wnt/β-catenin signaling.

Conclusion:

The processing method of LHACM maintains the intrinsic properties of amniotic membranes with similar levels of biological activity as compared to dHACM, while providing an option for a thicker allograft with alternative handling characteristics. LHACM represents a novel product concept which increases versatility of amniotic membrane application in varied outpatient and surgical uses.