bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the Impact of Partial Discharge Locations on Ultra-High Frequency Signal Propagation Characteristics
Authors: Li Duan-Jiao , Sun Wen-Xing , Chen Yi-Long , Chen Yu-Hui , Hu Yi-Dan
Published: December 2024

Transformers are critical devices for the functioning of power grids. Partial discharge, the leading cause of insulation failure, has consistently been a central focus in transformer fault detection and the assurance of safe operation. Among the various methods for detecting partial
discharges, ultra-high frequency (UHF) is widely employed as measured quantities due to its outstanding sensitivity and strong resistance to interference. However, as UHF signals propagate within the transformer, internal components can easily obstruct them, leading to alterations in their
propagation characteristics. These changes can hinder effective fault detection. Therefore, it is crucial to consider how the placement of the discharge source influences UHF signal transmission. In this study, an optimized model based on a real 110 kV device is developed through the Finite-Difference
Time-Domain (FDTD) method to examine the dissemination of UHF waves generated by partial discharges. To evaluate the impact of different discharge source locations, simulations are conducted with examples of partial discharges occurring between the winding and the tank wall, as well as between
windings. Drawing from the findings, the research investigates the propagation dynamics of UHF electromagnetic signals and analyzes how the discharge source location influences these characteristics.
AlGan/GaN Based Dual-Cavity Structure for DNA Detection
Authors: Ravikumar M. , Madheswaran M.
Published: December 2024

In this study, the effect of sensitivity on the performance of dielectric modulated AlGaN/GaN is reported in to determine the device’s viability as a precise biosensor to detect both charged biomolecules based on the charge variations at the interface. This device utilizes the
charge plasma effect, and the behavior is analyzed using variations in the threshold voltage and drain current for the improved performance. The device is simulated using the Sentaurus technology computer aided design (TCAD) simulator and specifically used to determine the biomolecules associated
with DNA. The presence of HfAlO2 as the oxide provides unique insight for sensitivity improvement by reducing the leakage current with a high Ion/Ioff ratio. Moreover, the threshold voltage is shifted to positive for normally OFF behavior. The results imply
a significant drain current (IDS) increase, up to 335 mA/mm. Finally, optimizing the device parameters increases sensitivity, making it an able candidate for future biosensing applications.
Mixed Convection Magnetohydrodynamics Flow of Micro Polar Nanofluid Over Stretching Cylinder with Cattaneo-Christov Theory and Chemical Reaction
Authors: Abera Jima Seyoum , Firdi Mitiku Daba , Rikitu Ebba Hindebu
Published: December 2024

In this article,the present study examined the two-dimensional flow of micropolar nanofluid over a stretching cylinder with chemical reaction and the Cattaneo-Christov heat flux model. The Buongiorno’s nanofluid flow model is utilized to study the effects of thermophoresis and
Brownian motion. The governing partial differential equations are modeled and reduced to ordinary differential equations by applying suitable similarity transformation, thereafter solved numerically through bvp4c technique in the MATLAB R2017b software. Accordingly, the numerical results reveal
that velocity profile increases due to enhancement of solutal buoyancy, magnetic parameters, chemical reaction, thermophoresis, and thermal relaxation time. In a similar manner, micropolar fluid, curvature, Brownian motion chemical reaction and solutal relaxation time increases of causes on
velocity profile to rise. The cylinder curvature (λ), micro-polar fluid effect (Κ), and micro-polar at the surface (n) parameters are enhanced that all contribute to the angular velocity profile’s rate of growth. The temperature profile of the nanofluid
shows an increasing pattern in the following parameters: viscous dissipation, Brownian motion, micropolar factor, cylinder curvature, Prandtl number, and biot number. Moreover, the concentration profile decreases with increasing Prandtl number,relaxation time parameters, dissipation viscous
factor, Schmidt number, magnetic, chemical reaction, and thermophoresis components other parameters effects on concentration are increases. The pair stress and skin friction coefficient decrease as a result of the impacts of the micropolar factor (K). The opposite result on Nusselt and Sherwood
numbers as the cylinder curvature rises becomes of engineering interest. Finally, the results show an excellent degree of agreement when compared with the existing literature.
Regression Model Featuring Nanofluid in Interconnected Domain: An Innovative Way of Thermal Enhancement
Authors: Nasrin Rehena , Hasan Shariful , Alatawi Eid S. , Biswas Chaity
Published: December 2024

Efficient thermal management is essential in applications ranging from electronics cooling to industrial heat exchangers, where even incremental enhancements in heat transfer can significantly boost reliability and performance. This study presents an innovative approach to enhancing
thermal performance by developing a regression model for water (W)-propylene glycol (PG) mixture-based multi-walled carbon nanotube (MWCNT) nanofluid in interconnected oblique triangles aiming to leverage Nanofluids’ higher thermal conductivity for more efficient heat transfer. Using
the finite element method (FEM) to solve partial differential equations (PDEs), combined with simulations of computational fluid dynamics (CFD), this research analyzes the buoyancy effects across Rayleigh numbers (103 Ra ≤ 106), solid concentrations (0.1% ≤ φ
≤ 3%) of MWCNT nanoparticles, Prandtl numbers (3.5 ≤ Pr ≤ 150), and various ratios of base fluid W-PG mixtures. The regression model derived from CFD data provides robust predictive capabilities, validated by residual error, ANOVA table, line fit, and normal probability plots, revealing
key sensitivities in transfer rates to changes in response variables. Results indicate that the incorporation of a 3% concentrated W-PG-MWCNT nanofluid results in an enhancement in heat transfer by 3.45% for the base fluid mixture ratio of 40:60%, by 9.52% for a ratio of 80:20%, and by 7.75%
for a ratio of 60:40%. Also, the W-PG-MWCNT nanofluid composition achieves an 11.11% increase in heat transport compared to W-PG alone, with the highest transfer rate observed at an 80:20% mixture ratio. The regression equation for the mean Nusselt number has about a 95% correlation coefficient,
making it an extraordinary new approach to improving thermal performance. This research offers an effective solution for enhancing heat performance, particularly for applications like electronic cooling systems and automotive radiators, where stable thermal management is crucial.
The Effects of Communication Accommodation on Hispanic Immigrants’ Willingness to Cooperate With U.S. Police
Authors: Maguire Edward R. , Hill Shawn L. , Brimbal Laure
Published: December 2024

Communication accommodation theory (CAT) focuses on the communicative adjustments (accommodations) people make when interacting with others, as well as the causes and consequences of those adjustments. Research shows that these accommodations play a powerful role in shaping interpersonal and intergroup relations. One domain in which research has found these accommodations to be especially meaningful is in the relationships between police and the public. Based on theory and research on CAT, we examine the role of communication accommodation in shaping immigrants’ willingness to cooperate with police using data from a national survey of immigrants in the United States. Our findings are useful for understanding how immigrants view U.S. police, as well as the role of communication accommodation in shaping those views.
Application of Keystone Design Perforator Island Flap in the Reconstruction of Maxillofacial Defect: A Case Series
Authors: Li Dongpo , Wang Lin , Wei Yubo , Wang Shuangyi
Published: December 2024

Objective: To investigate the effect of Keystone Design Perforator Island Flap (KDPIF) in the repair of maxillofacial soft tissue defect. Methods: From June 2021 to June 2023, 16 patients with soft tissue defects caused by resection of maxillofacial tumor repaired by KDPIF were selected. Variants of KDPIF were designed according to the area of the defect, and the incision was parallel to the wrinkle as far as possible in the same facial cosmetic subunit. Postoperative follow-up was 3 months to 1 year. Results: One (6.3%) case of flap had dark red congestion and peripheral epidermal necrosis within 1 week. 1 week later, the skin flap blood flow was recovered, and the wound healed after 3 weeks. The other 15 (93.7%) cases of skin flap survived in the first stage. The postoperative follow-up showed that all flaps had good color and shape. There was no obvious scar contracture, the patient was satisfied with the facial shape and had no obvious facial function disorder. Conclusion: KDPIF is easy to operate, with a short operation time, a high survival rate of flap, and a good aesthetic effect, which is especially suitable for the repair of small and medium-sized maxillofacial soft tissue defects in the elderly.
Transitioning From Pediatric to Adult Psychiatric Care for ADHD in Sweden: A Nationwide Study
Authors: Giacobini MaiBritt , Zhao Jingcheng , Freilich Jonatan , Malmgren Carolina , Wallin Bernhardsson Niklas , Ahnemark Ewa
Published: December 2024

Objective:

To evaluate care transition and medication use in young adults with ADHD in Sweden.

Method:

Observational retrospective study of patients with ADHD from the Swedish National Patient Register, Prescribed Drug Register, and Cause of Death Register (2018–2020). Last contact with pediatric psychiatric care, first contact with adult psychiatric care, and medication use were described for ages 18 to 21 years, inclusive.

Results:

Of 19,233 patients who had dispensed ADHD treatment, 85.8% had received adult psychiatric care by 21 years of age. The proportion of patients on medication was highest at age 18 years (80.1%), decreasing to 36.1% by age 21 years. By 21 years, there were significantly more patients on versus off ADHD medication who had received healthcare for autism, been prescribed selective serotonin re-uptake inhibitors, and received adult psychiatric outpatient visits (all p < .0001).

Conclusion:

This study demonstrates declining ADHD medication use during the pediatric-to-adult care transition for patients in Sweden.
In feature story reporting, curiosity is a personality trait, a motivation, and a skill
Authors: Flammia Christine
Published: December 2024

Journalism instruction has long assumed curiosity is integral to the work, but there has not been a systematic study that engages psychological or sociological curiosity theory in the journalistic process. Instead, it’s assumed that curiosity means the same thing to all people, that all journalists engage curiosity in similar ways. Journalism instruction and practice therefore suffers from a shallow understanding of how curiosity affects the stories produced. Drawing on 18 semi-structured interviews with U.S. feature journalists and editors, I found feature journalists use their sense of curiosity to explore possible story ideas on multiple levels. Through a qualitative analysis of these interviews, three themes emerged: curiosity as a personality trait, curiosity as a motivational force, and curiosity as a skill. The journalists self-identified as curious people and knew they used curiosity to find stories. However, the way they conceptualized curiosity, how and when they explored it, and with how much intensity differed per person and per story. Still, a throughline remained. Feature story reporting demands a specific kind of curiosity: a tool that can be articulated, practiced, and taught.
A multi-stage method for defect detection of underwater structures based on deep learning
Authors: Wu Zhihua , Liu Airong , Teng Shuai , Ng Ching-Tai , Wang Jialin , Fu Jiyang , Zhou Haoxiang
Published: December 2024

Underwater defect detection faces challenges such as difficulty in image acquisition, low precision in detection and inaccurate defect localization. This article presents a multi-stage method to address these issues. A custom-built remotely operated vehicle (ROV) with advanced path planning was used to collect images of underwater defects. An improved YOLOv8 network, integrating deformable convolution and a multi-head self-attention mechanism, significantly enhanced defect detection accuracy. Furthermore, an upgraded Deeplabv3+ semantic segmentation network with a densely connected atrous spatial pyramid pooling module was proposed for precise pixel-level mapping of defects, particularly elongated ones. A 3D reconstruction method based on structure from motion was developed to generate accurate 3D point clouds for precise defect localization. The experimental results demonstrated that the developed ROV, equipped with a high-resolution camera and a multi-source heterogeneous vision enhancement module, efficiently captured defect images and improved image quality in turbid water. The improved YOLOv8 achieved a 6.61% increase in mAP50, while the upgraded Deeplabv3+ showed a 4.19% increase in mean intersections over union. These enhancements enabled the integrated method to achieve pixel-level defect detection and segmentation, demonstrating significant advancements across all performance metrics and competitive frames per second for real-time applications. The successful visualization of defects in the 3D model validated the effectiveness and feasibility of the proposed multi-stage method.
A method for detecting cracks on the trailing edge of wind turbine blades based on aeroacoustic noise analysis
Authors: Zhang Yang , Radzieński Maciej , Xue Sidney , Wang Ziping , Ostachowicz Wiesław
Published: December 2024

This study uses aeroacoustic noise to identify cracking and debonding faults on the trailing edge (TE) of wind turbine blades, which is very meaningful because it can monitor early faults without affecting the normal operation of the wind turbine, thereby improving the safety and reliability of the wind turbines and extending the service life of the blades. First, the semi-empirical model called NAFNOISE is used to analyze the factors that influence the noise from the TE, such as chord length, angle of attack, and TE thickness. Computational aeroacoustics (CAA) as a more precise finite element method is further employed to calculate the areoacoustics noise (AAN) of the blade with TE cracking. Based on the vortex shedding diagram of the calculation results, a preliminary explanation is provided for the main reason high-frequency energy appears in the sound power spectrum when the blades have a TE cracking failure. Next, the semi-empirical model is compared with the noise waveforms obtained by CAA, the differences between different models in identifying TE cracking are analyzed, and the theoretical acoustic characteristics of AAN changes when blades fail are drawn. Finally, a noise detection experiment and corresponding signal processing technology are discussed. The results demonstrate that the method proposed in this article is not only capable of detecting debonding and cracking faults at the TE but also improves the theoretical research on active and noncontact damage monitoring of the blades.
An open-source SQL database schema for integrated clinical and translational data management in clinical trials
Authors: Niazi Umar , Stuart Charlotte , Soares Patricia , Foure Vincent , Griffiths Gareth
Published: December 2024

Unlocking the power of personalised medicine in oncology hinges on the integration of clinical trial data with translational data (i.e. biospecimen-derived molecular information). This combined analysis allows researchers to tailor treatments to a patient’s unique biological makeup. However, current practices within UK Clinical Trials Units present challenges. While clinical data are held in standardised formats, translational data are complex, diverse, and requires specialised storage. This disparity in format creates significant hurdles for researchers aiming to curate, integrate and analyse these datasets effectively. This article proposes a novel solution: an open-source SQL database schema designed specifically for the needs of academic trial units. Inspired by Cancer Research UK’s commitment to open data sharing and exemplified by the Southampton Clinical Trials Unit’s CONFIRM trial (with over 150,000 clinical data points), this schema offers a cost-effective and practical ‘middle ground’ between raw data and expensive Secure Data Environments/Trusted Research Environments. By acting as a central hub for both clinical and translational data, the schema facilitates seamless data sharing and analysis. Researchers gain a holistic view of trials, enabling exploration of connections between clinical observations and the molecular underpinnings of treatment response. Detailed instructions for setting up the database are provided. The open-source nature and straightforward design ensure ease of implementation and affordability, while robust security measures safeguard sensitive data. We further showcase how researchers can leverage popular statistical software like R to directly query the database. This approach fosters collaboration within the academic discovery community, ultimately accelerating progress towards personalised cancer therapies.
Association between number of medications and indicators of potentially inappropriate polypharmacy: a population-based cohort of older adults in Quebec, Canada
Authors: Campeau Calfat Alexandre , Turner Justin P. , Simard Marc , Boiteau Véronique , Sirois Caroline
Published: December 2024

Background:

As the number of medications increases, the appropriateness of polypharmacy may become questionable due to the heightened risk of medication-related harm.

Objectives:

(1) To investigate the relationship between the number of current medications used by older adults and three indicators of potentially inappropriate polypharmacy: (a) the mean number of potentially inappropriate medications (PIMs), (b) the average count of drug–drug interactions, and (c) the anticholinergic burden; (2) To characterize the population-based burden of potentially inappropriate polypharmacy by calculating the proportion of individuals with these indicators.

Design:

We conducted a population-based observational study using the Quebec Integrated Chronic Disease Surveillance System.

Methods:

We included all individuals over 65 years insured by the public drug plan on April 1st, 2022. For each individual, we calculated the number of current medications and the number of (a) PIMs (Beers 2019), (b) drug–drug interactions (Beers 2019), and (c) anticholinergic burden (Anticholinergic Cognitive Burden (ACB) scale). The association between the number of medications and these indicators was quantified using linear regression. Prevalence with 99% confidence intervals (CIs) was calculated.

Results:

A total of 1,437,558 individuals (mean age: 75; 55% female) were included, taking an average of 4.9 medications (±4.1). For each additional medication, the mean number of PIMs, drug–drug interactions, and anticholinergic burden increased by 0.11, 0.04, and 0.17, respectively ( p-trend <0.0001). Nearly half the population (45.5%; 99% CI: 45.5–45.5) had a regimen containing ⩾1 PIMs, ⩾1 drug–drug interaction, or an ACB ⩾3.

Conclusion:

The strong association between the increasing number of medications and reduced polypharmacy quality underscores the importance of medication count beyond therapeutic indications. With widespread medication use, many older adults face quality issues.
Finite Element Analyses of Three Minimally Invasive Fixation Techniques for Treating Sanders Type II Intra‑Articular Calcaneal Fractures
Authors: Shi Zhongmin , Gu Wenqi
Published: December 2024

Category:

Hindfoot; Trauma

Introduction/Purpose:

Calcaneal Sanders type II or III fractures are highly disabling with significant burden. Surgical treatment modalities include open reduction and internal fixation (ORIF) techniques and a variety of minimally invasive surgical (MIS) approaches. ORIF techniques are associated with complications and traditional MIS techniques need extensive intraoperative fluoroscopic procedures. The present study aims to investigate the effects of three different minimally invasive internal fixation (MIIF) techniques used to treat Sanders type II intra-articular calcaneal fractures using finite element analyses.

Methods:

A 64-row spiral computed tomography scan was used to observe the calcaneus of a healthy adult. The scanning data were imported into Mimics in a DICOM format. Using a new model of a Sanders type II-B intra-articular calcaneal fracture, three minimally invasive techniques were simulated. Technique A involved fixation using an isolated minimally invasive locking plate; Technique B used a minimally invasive locking plate with one medial support screw; and Technique C simulated a screw fixation technique using four 4.0-mm screws. After simulating a 640-N load on the subtalar facet, the maximum displacement and von Mises stress of fragments and implants were recorded to evaluate the biomechanical stability of different fixation techniques using finite element analyses.

Results:

After stress loading, the maximum displacements of the fragments and implants were located at the sustentaculum tali and the tip of sustentaculum tali screw, respectively, in the three techniques; however, among the three techniques, Technique B had better results for displacement of both. The maximum von Mises stress on the fragments was < 56 Mpa, and stress on the implants using the three techniques was less than the yield strength, with Technique C having the least stress.

Conclusion:

All three techniques were successful in providing a stable fixation for Sanders type II intra-articular calcaneal fractures, while the minimally invasive calcaneal locking plate with medial support screw fixation approach exhibited greater stability, leading to improved enhancement for the facet fragment; however, screw fixation dispersed the stress more effectively than the other two techniques.
Foot and Ankle Biomechanics During Gait of Patients with an Osteochondral Lesion of the Talus
Authors: Emanuel Kaj , Schallig Wouter , Piech Maciej , Dahmen Jari , van der Krogt Marjolein , M.M.J. Kerkhoffs Gino M , Stufkens Sjoerd
Published: December 2024

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

An osteochondral lesion of the talus (OLT) is a defect of talar cartilage and subchondral bone, primarily linked to a history of ankle trauma. Mechanical overload is considered one of the reasons for the development of osteochondral lesions of the talus. However, no gait analysis of this patient group exists to date. We hypothesize that altered gait patterns lead to increased load at the side of the lesion compared to healthy controls. The primary aim of the study was to compare the foot and ankle biomechanics during gait between individuals with OLT and healthy controls. The secondary aim was to compare these parameters between individuals with a medial and lateral OLT.

Methods:

Ten patients diagnosed with symptomatic OLT (5 medial and 5 lateral lesions) underwent gait analysis. 3D kinematics according to the Amsterdam Foot Model, ground reaction force, and plantar pressure data were collected to quantify the motions and forces within the foot. OLT data were compared to a reference dataset of healthy controls (n=13) using statistical parametric mapping and one-way ANOVA.

Results:

The ankle joint was significantly rotated towards valgus in both the OLT groups compared to the control group during most of the gait cycle. Moreover, the medial OLT group showed decreased plantarflexion in the Lisfranc joint, and lateral OLT group showed higher peak pressures in the midfoot zone compared to the control group.

Conclusion:

The valgus rotation reduces medial loading, but was present in both OLT groups. Decreased Lisfranc plantarflexion and increased midfoot pressures indicate a tendency towards flat feet. The observed alterations in the OLT group could be adaptations to, or causes of, osteochondral damage in the ankle joint.
From Jargon to Clarity. Improving the Readability of Foot and Ankle Radiology Reports with An Artificial Intelligence Large Language Model
Authors: Butler James J. , Harrington Michael , Tong Yixuan , Rosenbaum Andrew , Samsonov Alan P. , Walls Raymond J. , Kennedy John G.
Published: December 2024

Category:

Other; Ankle

Introduction/Purpose:

The purpose of this study was to evaluate the efficacy of an Artificial Intelligence Large Language Model (AI-LLM) at improving the readability foot and ankle orthopedic radiology reports.

Methods:

The radiology reports from 100 foot or ankle X-Rays, 100 computed tomography (CT) scans and 100 magnetic resonance imaging (MRI) scans were randomly sampled from the institution’s database. The following prompt command was inserted into the AI-LLM. “Explain this radiology report to a patient in layman's terms in the second person. [Report Text]”. The mean report length, Flesch reading ease score (FRES) and Flesch-Kincaid reading level (FKRL) were evaluated for both the original radiology report and the AI-LLM generated report. The accuracy of the information contained within the AI-LLM report was assessed via a 5-point Likert scale. Additionally, any “hallucinations” generated by the AI-LLM report were recorded.

Results:

There was a statistically significant improvement in mean FRES scores in the AI-LLM generated X-Ray report (33.8±6.8 to 72.7±5.4), CT report (27.8±4.6 to 67.5±4.9) and MRI report (20.3±7.2 to 66.9±3.9), p< 0.001. There was also a statistically significant improvement in mean FKRL scores in the AI-LLM generated X-Ray report (12.2±1.1 to 8.5±0.4), CT report (15.4±2.0 to 8.4±0.6) and MRI report (14.1±1.6 to 8.5±0.5), p< 0.001. Superior FRES scores were observed in the AI-LLM generated X-Ray report compared to the AI-LLM generated CT report and MRI report, p< 0.001. The mean Likert score for the AI-LLM generated X-Ray, CT and MRI report was 4.0±0.3, 3.9±0.4, and 3.9±0.4, respectively. The hallucination rate in the AI-LLM generated X-Ray report, CT report and MRI report was 4%, 7% and 6%, respectively.

Conclusion:

AI-LLM was an efficacious tool for improving the readability of foot and ankle radiological reports across multiple imaging modalities. Superior FRES scores together with superior Likert scores were observed in the X-Ray AI-LLM reports compared to the CT and MRI AI-LLM reports. This study demonstrates the potential use of AI-LLMs as a new patient-centric approach for enhancing patient understanding of their foot and ankle radiology reports.
Gait in Controlled Ankle Movement (CAM) Walker Boot Using a Contralateral Shoe Lift
Authors: Fanfan Dino , Orellana Sergio Lemus , Lopez Kyra E. , Travascio Francesco , Murray Daniel , Chapman Cary B.
Published: December 2024

Category:

Basic Sciences/Biologics; Other

Introduction/Purpose:

Walking mechanics play a fundamental role in daily mobility and are significantly influenced by footwear choices, particularly in individuals with lower limb conditions. Among the interventions commonly used in rehabilitation settings are controlled ankle movement (CAM) boots and shoe lifts, which aim to provide support and improve gait dynamics. The purpose of this outcome study was to test how different a person walks when wearing the controlled ankle movement (CAM) boot and the shoe lift compared to walking with your running shoes.

Methods:

We conducted a prospective cohort study comprised of 30 participants, 15 men and women, who underwent three-level walking trials under the following conditions: athletic shoes, tall CAM boot, and tall CAM boot with a balancer added to the contralateral foot. Sixteen anatomical markers were placed on participants according to Vicon’s Plug-in Gait Full Body (PIGFB) model. Kinematic data and ground reaction forces were collected at 500 Hz and processed with the PIGFB biomechanical model and Vicon’s gait cycle parameters. Data post-processing provided spatiotemporal gait parameters (contact times, stride length, speed, time spent in stance/swing phases, cadence) and lower limb kinematics and kinetics (knee and hip joint angles, movement, and forces). A Two-Way ANOVA, using walking condition and gender as factors, followed by a Tukey Pairwise comparison identified significant effects of walking conditions on various gait characteristics.

Results:

In both limbs, cadence (p = 0.002) and step width (p < 0.001) were significantly different in NB compared to CAM and CAMB. Specific to contralateral limb, stride time (p = 0.025), step time (p = 0.007), and limb index (p ≤ 0.001) were also affected. Regarding kinematics, the walking condition significantly affected contralateral hip abduction angle (p = 0.027). In addition, the walking condition had significant effect on the ipsilateral limb for both knee internal rotation (p = 0.024), and knee varus/adduction angle (p = 0.024). Regarding kinetics, the walking condition affected hip medial/lateral force (p =0.002), knee compression force (p =0.029), and knee varus/adduction moment (p = 0.024). The boot condition had the greatest hip force (5.7 N/kg) compared with the NB and CAMB conditions.

Conclusion:

Our study demonstrates significant changes in gait patterns and lower limb biomechanics when individuals wear a controlled ankle movement (CAM) boot and a shoe lift compared to athletic shoes. These results underscore the importance of considering footwear interventions in clinical and rehabilitation settings, as they can substantially influence gait patterns and biomechanical dynamics, highlighting the need for careful consideration in clinical and rehabilitation settings.
Impact of Body Mass Index on Complication Rates Following Primary Total Ankle Arthroplasty
Authors: McDonald Weston E. , Kulkarni Ronit , Morningstar Joshua L. , Friedman Richard J. , Scott Daniel J. , Gross Christopher E.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Recent literature has indicated higher body mass index (BMI) to be of concern for poorer outcomes following total ankle arthroplasty. The purpose of this study is to evaluate the impact of implementing BMI cutoff points on 6-month postoperative outcomes following total ankle arthroplasty (TAA).

Methods:

The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 5,865 patients undergoing primary elective TAA with a reported BMI range via ICD-10 diagnosis. Our cohort consisted of patients with BMI ≥30 kg/m2, stratified into groups by 5 BMI point intervals. Preoperative demographics, comorbidities, postoperative outcomes, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to control for predictors of adverse postoperative outcomes other than BMI.

Results:

When stratifying by preoperative BMI, higher BMI was associated with significantly lower age (p <.001) and rate of smoking (p <.001), and higher rate of female sex (p <.001), Medicaid insurance (p <.001), higher CCI score (p <.001), among other comorbidities. Multivariate regression analysis of 180-day postoperative outcomes, controlling for demographic and comorbidity differences, found that preoperative BMI 40-44.9 and ≥45 kg/m2 was significantly predictive of increased risk of any complication (44-44.9: OR=1.843; p<.001)(45+: OR=1.960; p<.001), adverse discharge (44-44.9: OR=1.217 p=.015)(45+: OR=2.030; p<.001), and extended stay greater than 4 days (44-44.9: OR=1.653; p<.001)(45+: OR=2.171; p<.001), with BMI ≥45 kg/m2 also being significantly predictive of 65% increased risk of readmission (OR=1.655; p=.004).

Conclusion:

Higher BMI in TAA is associated with an increased risk of any postoperative complication, adverse discharge, and extended LOS. Specifically, a BMI cutoff of 40kg/m2 would serve to prevent 38.6% of the 963 obese patients experiencing complications following TAA. While our results suggest that implementing a strict BMI cutoff would serve to reduce complications substantially, it will also prevent a large number of patients from undergoing a complication-free surgery that will ultimately serve to reduce pain and increase function. Instead, we suggest physicians consider a BMI cutoff in concert with other comorbidity factors that may affect surgical outcomes following TAA.
Impact of Socioeconomic Factors on Patient Reported Outcomes Following Operative Treatment for Ankle Fractures
Authors: Cantrell William A. , Teplensky Jason , Mueller James , Pasqualini Ignacio , Chawla Sagar
Published: December 2024

Category:

Ankle

Introduction/Purpose:

The impact of socioeconomic status on outcomes following operative treatment of ankle fractures is an emerging area of research. Recent studies have shown that lower socioeconomic status is associated with failure to return to work, increased risk of infection and amputation, and receiving care at higher cost locations. The Area Deprivation Index (ADI) is an effective measure of socioeconomic status that has been correlated with poorer outcomes in various orthopedic procedures, such as arthroscopic rotator cuff repair and total joint arthroplasty. However, the relationship between ADI and outcomes following operative treatment of ankle fractures has not been well-studied. Therefore, the purpose of this study was to evaluate the relationship between ADI and patient-reported outcomes following operative treatment of ankle fractures.

Methods:

This single-institution study utilized the OrthoMidas Episode of Care prospective database to identify 281 patients who underwent operative fixation for ankle fractures between January 1, 2021 and October 7, 2022. The primary outcomes were differences in FAAM, VR-12, PEG, and Patient Acceptable Symptom State (PASS) scores between patients from the least deprived (ADI tertile 1, range 1-33) and most deprived (ADI tertile 3, range 66-100) neighborhoods.

Results:

Of the available 281 patients, 12 did not have ADI information available. Of the remaining 270, 107 (40%) had completed 1-year patient-reported-outcomes. 130/270 (48%) of patients with ADI information available were in the most deprived neighborhoods (tertile 3, ADI range 66-100), whereas 45/270 (17%) were in the least deprived neighborhoods (tertile 1, ADI 1-33).

Conclusion:

This study demonstrates a clear association between neighborhood-based socioeconomic deprivation and patient reported outcomes following operative treatment for ankle fractures. The true etiology could be a function of geography or potentially modifiable patient factors. Further investigation is essential to identify areas to target interventions and improve outcomes for low socioeconomic status patients.
In-Office Needle Arthroscopy Is a Cost-Effective Alternative for Operating Room Diversion for Anterior Ankle Arthroscopy a Financial Analysis
Authors: Butler James J. , Gianakos Arianna , Savage-Elliott Ian , Kennedy John G.
Published: December 2024

Category:

Ankle; Other

Introduction/Purpose:

The purpose of this study was to evaluate the impact on cost effectives with in-office needle arthroscopy (IONA) for the management of anterior ankle pathologies in comparison to anterior ankle arthroscopy performed in a traditional formal operating suite.

Methods:

Data regarding costs was obtained from the local institution in the following areas: . A Monte Carlo simulation combined with DuPont analysis running 10,000 simulations was conducted to calculate the revenue, expenses and profits between the 2 cohorts. Sensitivity analyses examined the influence of patient preference and revision rates on profit and throughput. Two-sample Student's t test was performed (p < .05).

Results:

There was a 91.4% reduction in costs in favor of anterior ankle IONA. Sensitivity analysis revealed 4.3% of patients need to select IONA over traditional arthroscopy in an operating suite with the revision rate remaining below 42% for the proposed state profit to be higher than the current state.

Conclusion:

IONA is a cost-effective alternative to traditional OR arthroscopy in patients undergoing anterior ankle arthroscopy. The next steps are to assess patients' perceptions of IONA as an alternative to traditional OR arthroscopy, and to carry out clinical trials to determine the efficacy, patient-reported outcome metrics, and complications of IONA.
Inter-Rater Reliability & Value of the Hawkins Sign
Authors: Lake Logan , Kurkowski Sarah , Roca Augusto , Kuechly Henry Albert , Huertas Andres Mor , Thimmesch Michael , Spencer Peter , McMillan Paul , Laughlin Richard T.
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Hawkins III talus neck fractures are associated with elevated rates of complications, notably avascular necrosis, which range between 40% to 70%. The Hawkins sign, characterized by subchondral lucency of the talar dome observed on post-injury ankle x-rays at 6-8 weeks post-injury, has traditionally served as a predictive factor for avascular necrosis development within a year. Nevertheless, we propose that the presence of the Hawkins sign exhibits considerable inter-observer variability and may not predict clinically relevant avascular necrosis development as reliably as previously assumed.

Methods:

A retrospective study was conducted on patients who experienced Hawkins III fractures between 2018 and 2022 at a Level 1 trauma center. Electronic medical records were thoroughly reviewed to ascertain the occurrence of avascular necrosis. An assessment of six-week postoperative ankle x-rays was conducted by a fellowship-trained foot and ankle orthopaedic surgeon to ascertain the presence or absence of the Hawkins sign. Subsequently, five orthopaedic surgeons independently assessed the x-rays to determine the presence of the Hawkins sign. Statistical analysis was then employed to assess the inter-rater reliability of the Hawkins sign and its association with the future development of avascular necrosis over a one-year follow-up period.

Results:

Seventeen patients with Hawkins III talus neck fractures were identified. Fleiss' kappa was run to determine if there was agreement between five orthopaedic trauma surgeons’ judgement on whether 17 individuals with Hawkins III talar neck fractures had a Hawkins sign present or not on 6-week postoperative x-rays. There was poor agreement between the surgeons’ judgements, κ = .040 (95% CI, -.035 to .115), but was not statistically significant, p = .294. There was complete agreement between surgeons on only 5/17 (29.4%) cases. Of the 6 patients that went on to develop avascular necrosis at 1 year, only 1 had a Hawkins sign (determined by fellowship-trained foot and ankle surgeon) present on their 6-week postoperative x-ray (Table 1).

Conclusion:

The reliability of the Hawkins sign among orthopaedic surgeons is notably low due to significant inter-observer variability. This variability introduces subjectivity to the interpretation of the Hawkins sign, rendering it an unreliable objective measure. Furthermore, its inability to correlate with the presence of avascular necrosis at the one-year mark raises doubts about its validity as a predictive marker for talar neck fracture outcomes.
Median Age of Patients Undergoing Total Ankle Replacement Has Not Significantly Changed Between 1999 and 2023: A Systematic Review of Prospective Studies
Authors: Bernasconi Alessio , Izzo Antonio , D'Agostino Martina , Sgadari Arianna , Mariconda Massimo , Goldberg Andrew J. J.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers.

Methods:

This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR.

Results:

Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6364 ankles, 6284 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 33 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p=0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p=0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p=0.12).

Conclusion:

According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time.
Medicare Reimbursement in Orthopaedic Foot and Ankle Surgery: A Continued Decline
Authors: Miskiel Sandra A. , Bye Matthew , Pagliaro Ava F. , Pagliaro Andre J.
Published: December 2024

Category:

Other

Introduction/Purpose:

The absence of an annual inflationary update for physician reimbursement from the Centers for Medicare & Medicaid Services threatens the financial stability of orthopaedic practices nationwide. Inflation-adjusted Medicare physician reimbursement for foot and ankle procedures has decreased by over 30% from 2000 to 2020. The effects of recent inflationary trends on orthopaedic foot and ankle reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2024 for orthopaedic foot and ankle surgical procedures.

Methods:

The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology (CPT) codes most frequently utilized in orthopaedic foot and ankle care. Next, the Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the Consumer Price Index and reported in 2024 US dollars. The average annual and total percent change in reimbursement were calculated for included procedures. The compound annual growth rate (CAGR) was calculated using 2024 and 2000 inflation-adjusted monetary data.

Results:

Prior to adjusting for inflation, the average physician reimbursement decreased by 7.9% from 2000 to 2024 for all included foot and ankle CPT codes. After adjusting for inflation, the average physician reimbursement decreased by 48.0% for included CPT codes, with all 30 CPT codes decreasing by more than 40.8%. The greatest decrease in reimbursement observed from 2000 to 2024 was for open reduction internal fixation of calcaneal fracture at 58.9% ($2,697.69 to $1,109.05) followed by repair of flexor tendon at 58.5% ($886.82 to $368.05) and ankle arthroscopy at 55.4% ($1,031.07 to $459.40). The average CAGR was -2.83%.

Conclusion:

Our study demonstrates that Medicare physician reimbursement for common orthopaedic foot and ankle procedures continues to decrease at an unsustainable rate. It is imperative that policy-makers understand these untenable trends to ensure continued access to quality foot and ankle care, especially for Medicare beneficiaries.
Midterm Functional Outcomes of Synthetic Cartilage Implant (SCI) Arthroplasty for Hallux Rigidus
Authors: Rajeev Aysha , Koshy George , Devalia Kailash
Published: December 2024

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Hallux rigidus is a degenerative condition of first metatarso-phalangeal joint, affecting people at all ages, but more commonly above 50 years of age. Multiple options are available to alleviate pain and improve movements of big toe. These include cheilectomy with Moberg osteotomy, silastic implants, ceramic and metal arthroplasties, hemiarthroplasties with Co-Cr and titanium implants with varying success. The aim of our study is to evaluate the midterm outcome of synthetic cartilage implant (SCI - Cartiva) arthroplasty for hallux rigidus.

Methods:

There were a total of 70 patients who underwent SCI interpositional arthroplasty. The five-year functional scores for all patients were collected and analysed. The functional evaluation was done using Manchester-Oxford Foot Questionnaire (MOxFQ). The general health was assessed by EQ-5D which included EQVAS. The data was obtained from hospital digital database Medway and Amplitude clinical outcomes. This was analysed by an independent assessor who was not involved in the patients’ care. The complications and revision rates were also documented.

Results:

Mean age at the time of operation was 63.4 years (range 42–84 years). The mean follow-up was 62.6 months. At five years follow up, 90% of the patients were satisfied with the outcome. The average preoperative MOxFQ score improved from 36.8 to 19.3 at one year after surgery. The EQ-5D scores improved from preoperative average of 9.4 to 4.4 at one year. The preoperative EQVAS was 75 and 85 at one year. At five years follow up the average MOxFQ score was 17.6, EQ-5D - 4.8 and EQVAS - 80. None of the patients had any infection. Three patients out of 70 had revision to first MTP fusion due to ongoing pain. Figure 1 shows the survival curve of the SCI implant at five years.

Conclusion:

Long term outcomes of Cartiva demonstrate clinical efficacy of this synthetic implant. The implant is durable, safe and is a viable treatment option to decrease pain, improve function and maintain motion for advanced hallux rigidus.
Identification of a suitable matching procedure in health services research: Insights into a study for stroke patients
Authors: Elkenkamp Svenja , Düvel Juliane , Gensorowsky Daniel , Greiner Wolfgang
Published: December 2024

Background

STROKE OWL is a quasi-experimental study using claims data from statutory health insurances in Germany to calculate the effect of case managers for stroke. Since there is no recruited control group, a suitable procedure needed to be identified to make the intervention effect measurable. Hence, the objective of this paper is to present an approach for comparing matching procedures before final data analyses take place.

Methods

We followed a four-step approach to identify an appropriate procedure on a partial dataset. First, we conducted a systematic review for identifying potential confounders of the study’s outcome. Afterwards we checked whether a matching procedure was able to balance the dataset with respect to the outcome, under the assumption that all relevant covariates including the intervention variable were balanced. Within the two last steps we checked covariate balances and remaining group sizes. Three matching procedures – coarsened exact matching, optimal full matching and propensity score matching – were tested.

Results

The coarsened exact matching was able to balance variables perfectly but on average lost >50% of the observations. Although optimal full and propensity score matching revealed some weaknesses concerning the variable balance, considerably more observations remained in the dataset. Based on the described approach and the external framework conditions of STROKE OWL the optimal full matching was chosen as matching procedure most suitable.

Conclusion

In summary, it was challenging to identify a suitable matching procedure for this study, since the detailed results of the different balance and group size checks varied.