bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal
Authors: Sandilos Georgianna , Zhu Clara , Giugliano Danica N. , Kwiatt Michael , Wang Yize R. , Hunter Krystal , McClane Steven J.
Published: January 2022

Background

Anastomotic strictures represent a major source of morbidity in colorectal surgery with an incidence reported up to 30%. Despite this, the mechanism by which strictures develop remains unclear. This study aims to determine the incidence of colorectal anastomotic strictures and associated risk factors among a series of diverted patients.

Materials and Methods

A retrospective chart review was conducted of 142 patients over a 7-year period at a single institution after colorectal resection with anastomosis and diverting ileostomy creation re-examined with postoperative endoscopy. One patient was removed due to anastomotic tumor recurrence. Patient and technical factors were examined for significance using chi-square analysis. Logistic regression was used to perform multivariate analysis to estimate odds ratio (OR) and 95% confidence intervals (CI).

Results

Among 141 patients, 14.1% (20 patients) developed strictures detected on endoscopy. Strictures were observed in a greater percentage of women than men (21.2% vs 8%, P = .025). 30.6% of patients who underwent resections for diverticulitis developed strictures while those with neoplastic lesions and other indications had stricture rates of 6.8% and 17.6%, respectively ( P = .002). Anastomoses performed during a colostomy reversal were associated with a higher stricture rate (OR 4.23, 95% CI 1.37-13.40, P = .012). Anastomoses performed with a 28/29 mm EEA circular stapler demonstrated a significantly higher stricture rate versus a 31/33 mm stapler (OR 7.21, 95% CI 1.23-155.58, P = .045).

Discussion

Our data reveal that female sex, history of diverticulitis, anastomoses performed in the setting of colostomy reversal, and smaller stapler size are associated with a higher rate of anastomotic stricture.
The role of social work in the healthcare settings during the COVID-19 pandemic in Africa
Authors: Kodom Richard Baffo
Published: January 2022

Globally, the social work profession seeks to empower and support vulnerable groups during the COVID-19 pandemic. These roles and responsibilities seem to be lagging in Africa as the potentials of social workers are underutilized in many areas of practice including the hospital setting. Given the contributions of medical social work, this article highlights the roles of social workers in healthcare delivery amid the COVID-19 pandemic. In addition, it emphasizes the challenges of medical social work. Since healthcare delivery requires collaboration, suggestions are made regarding ways to incorporate medical social work in healthcare settings for optimal healthcare delivery.
Sleep-deprived electroencephalography, a forgotten investigation in psychiatry; a case series
Authors: Najand Babak , Christensen Andrew , Martin Michael , Spelman Mark
Published: January 2022

Objectives

Many patients with psychiatric disorders may have epileptic disorders; however, clinical diagnosis without imaging investigation may result in misdiagnosis and thus resistance to treatment. We investigated electroencephalography (EEG) abnormalities in the patients with psychiatric disorders referred to us with treatment resistance.

Methods

In this case series study, nine patients with mood and psychotic symptoms who were referred to us at Belmont Private Hospital, Australia, from August 2018 to July 2020, were evaluated.

Results

Complete examination showed the presence of undiagnosed temporal lobe epilepsy. Notably, the seizure symptoms had been assumed as part of other psychiatric co-morbidities.

Conclusions

This study suggests the necessity of paying attention to the biological etiologies of mental illnesses in the initial assessments in psychiatric and neurological practice. Performing electroencephalogram and treating such patients with mood stabilizers, which have antiepileptic properties, can change the course of the mental illness decisively.
Adaptive consensus control for a class of nonlinear multi-agent systems with unknown time delays and external disturbances
Authors: Liu Shaoning , Feng Jian , Wang Qiangde , Song Weizhao
Published: January 2022

This paper investigates a class of unknown nonlinear multi-agent systems with unknown time delays and external disturbances. The external disturbance considered in this paper is completely unknown, and the accurate mathematical expression cannot be obtained. To eliminate the external disturbance, a disturbance observer is constructed by the Disturbance-Observer-Based-Control (DOBC) method. By utilizing Young’s inequality scaling technique, the problem of time delay is solved. By assuming that the communication graph among the agents is directed and connected, a novel distributed adaptive consensus control protocol is established based on the relative output information to achieve the goal of consensus control. Furthermore, the stability of the multi-agent system is analyzed by selecting an appropriate Lyapunov function; it is certified that with the proposed control protocol, all signals are guaranteed to be globally uniformly bounded, and the considered multi-agent systems can reach consensus even in the presence of time delay and external disturbance. Finally, two simulation examples are given to support the proposed control strategy.
Recommendations for Refined Preventive Maintenance Management of Concrete Bridges in China Based on Environmental Risk Zoning
Authors: Liu Yisheng , Su Dan , Duan Qingxu , Cao Zhicheng
Published: January 2022

Service environment has an important influence on the durability of concrete bridges. Environmental factors are often considered in the design stage, however, they tend to be ignored in the process of maintenance management. It is of great significance in prolonging the service life of a bridge to pay attention to the influence of the environment on the deterioration of the bridge during the preventive maintenance process. Concrete carbonation, chloride ion corrosion, sulfate corrosion, concrete cracking, concrete abrasion, and freeze–thaw damage are the main causes of decline of bridge durability. Based on these six kinds of distress, indexes of environmental zoning are proposed. For this purpose, variable weight theory is introduced into the matter-element extension model, and the comprehensive environmental risk values of various regions are calculated. The environmental risk zoning map of the concrete bridge’s location is then drawn using data visualization software (Tubiaoxiu). These maps show that the east, south, and southwest of China are the most high-risk areas for the deterioration of concrete bridges, and the validity of the results is proved by the distribution of collected bridge collapse accidents. Through the environmental risk zoning map, managers can intuitively grasp the degree of environmental risk in each region in real time. This approach could help bridge management department to implement differential management of concrete bridges in different regions, adjust bridge maintenance intervals dynamically, predict the state of bridges scientifically, and realize refined preventive maintenance management.
Evaluation of the Operational Effects of Autonomous and Connected Vehicles through Microsimulation
Authors: Manjunatha Pruthvi , Roy Somdut , Elefteriadou Lily , Guin Angshuman , Hunter Michael
Published: January 2022

Proper evaluation of traffic operations integrating connected and autonomous vehicles (CAVs) requires accurate representation of these emerging technologies in microscopic simulation. This paper evaluates the ability of microscopic simulator PTV-VISSIM (Version 10.0) to simulate CAVs, and presents a comprehensive CAV model extension. In addition, emissions modeling is integrated with VISSIM to calculate real-time energy and emission estimates. The evaluation of VISSIM revealed that its internal CAV modeling has several limitations, such as modeling connectivity and complex vehicle behavior. For external modeling, there are two available VISSIM interfaces. The Component Object Model (COM) Application Programming Interface (API) is the superior approach for fetching data and modeling connectivity, whereas the External Driver Model (EDM) is a better tool for lateral and longitudinal control. The simulation extension developed leveraged both interfaces. An isolated signalized intersection was simulated to demonstrate the impact of connected vehicle (CV), autonomous vehicle (AV), and CAV traffic on speed, delay, and travel time. In addition, trajectory data, combined with the Motor Vehicle Emission Simulator (MOVES) method, were utilized to obtain energy, fuel consumption, and greenhouse gas emissions. The results show that CAVs result in net improvement in travel time and speed. However, emissions did not follow the same trend. While increasing AV penetration rates resulted in emissions reductions, increasing CV and CAV penetration rates resulted in higher emissions. While the CV logic chosen for testing seeks to maximize the likelihood of vehicle arrival-on-green, the algorithm likely results in increased variations in second-by-second accelerations, leading to overall higher emissions.
Evaluation of Hexagonal Multi-Shape, Multi-Axial Geogrids in Unsurfaced Road Applications
Authors: Robinson William Jeremy , Wayne Mark H. , Tamrakar Prajwol
Published: January 2022

A full-scale unsurfaced test section was constructed to evaluate the performance of two recently developed innovative geogrids, referred to as NX-1 and NX-2, having a unique combination of hexagonal, trapezoidal, and triangular aperture shapes, rib aspect ratios greater than 1.0, and a coextruded, composite polymer sheet designed to improve aggregate and geogrid interaction. The test section consisted of a 25-cm-thick crushed aggregate surface layer placed over a weak clay subgrade. Simulated truck traffic was applied using a load cart outfitted with a single-axle dual-wheel truck gear. Rutting performance and instrumentation response data gathered from earth pressure cells and single-depth deflectometers were monitored at multiple traffic intervals. It was found that the geogrids improved rutting performance when compared with an unstabilized test item, and NX-1 was found to be the best performer of the two geogrids. Calculated traffic benefit ratios ranged from approximately 1.2 at low levels of rutting up to approximately 13.0 at higher levels of rutting. Instrumentation response data indicated that the geogrids reduced measured pressure and deflection near the surface of the subgrade layer. Pressure response data in the aggregate layer suggested that the geogrids redistributed applied pressure higher in the aggregate layer, effectively changing the measured stress profile with depth.
Modeling Injury Severity of Unconventional Vehicle Occupants: Hybrid of Latent Segments and Random Parameters Logit Models
Authors: Saha Bijoy , Fatmi Mahmudur Rahman , Rahman Md. Mizanur
Published: January 2022

Road safety research in developing countries has evolved in two categories: (a) crash frequency prediction modeling and (b) injury severity analysis. In injury severity analysis, the focus is to identify the influential factors for different injury severity categories. However, limited research has been undertaken in this domain, especially to assess the injury severity of the occupants of unconventional vehicles (UVOs) (including both human-pulled and engine-operated vehicles). This study investigates the injury severity of UVOs in Dhaka, Bangladesh adopting a hybrid of latent segments and random parameters logit (LSRPL) models. The model is developed utilizing police-reported collision records for the years 2011–2015. The LSRPL model captures multi-dimensional heterogeneity by allocating victims into discrete latent segments (i.e., inter-segment heterogeneity) and allowing a continuous distribution of parameters within the segments (i.e., intra-segment heterogeneity). The model is estimated for two segments using victim and crash attributes, where segment one is lower risk and segment two is higher risk. The model results suggest that victim and driver profiles, crash attributes, environmental factors, road network attributes, transportation infrastructure, and land use attributes influence the injury severity of UVOs. The model confirms the existence of significant inter-segment heterogeneity. For example, mid-block crashes are more likely to result in severe injury in higher-risk segments, and less likely to result in severe injury in lower-risk segments. The model further confirms intra-segment heterogeneity for areas with higher levels of mixed land use. For example, for mid-block crashes, higher mixed land use shows a significantly lower mean in high-risk segments, revealing lower likelihood of sustaining severe injury.
Exploratory Investigation of Gender Differences in School Psychology Publishing Before and During the Initial Phase of COVID-19
Authors: Harris Bryn , Sullivan Amanda L. , Embleton Paul , Shaver Elizabeth , Nguyen Thuy , Kim Jiwon , St. Clair Koryn , Williams Shayna
Published: January 2022

Although many disciplines saw increases in manuscript submissions coinciding with lockdown measures, numerous studies have documented widening gender gaps in academic productivity. Chi-squared analyses of gendered trends in first author manuscript submission in three school psychology journals during the initial phase of COVID-19 compared to the same time frame in the preceding 3 years did not reveal any significant associations. There was a significant increase over time in the gender gap, with a trend of more female authors than male authors. Women school psychology researchers may not have experienced similar detriments to productivity as in other disciplines, or such detriments were not reflected in submission patterns during this time frame. Limitations of the study and implications for school psychology are provided.
Modelling, design and control of a new seat-cushion for pressure ulcers prevention
Authors: Mannella Daniele , Bellusci Marco , Graziani Francesco , Ferraresi Carlo , Muscolo Giovanni Gerardo
Published: January 2022

Pressure ulcers are a frequent complication in patients having limited activity and mobility (e.g., elderly people, spinal cord injury patients, people with disabilities, etc.). The aim of this work is the conceptual design, modelling and control of a new seat cushion for pressure ulcers prevention. The whole system (constituted by the seat cushion equipped with a real-time pressure mapping with closed-loop control) is designed to identify the critical points on the human skin, before pressure ulcers creation, and to be able to distribute the contact pressure between the human and cushion avoiding wound creation. The seat cushion is constituted by soft air-cells actuated by air flow. To define the shape and size of the soft air-cells, finite element simulations are carried out, analysing the internal volume reduction with external loads application to reproduce the variable stiffness. The data obtained by finite element analysis are used to simulate inflation and deflation of the soft bubble air-cells. Finally, the control systems of a single air-cell and of the whole cushion are designed and simulated. The novelty of our work consists in the conception of a seat cushion able to recognise higher and lower risk zones of pressure ulcer generation on the human skin and to provide compensation automatically. This work can therefore be considered in line with the sustainable development goals recently launched by the EU Commission.
Management of COPD in a Hospital-at-Home Setting at a Peripheral Spanish Hospital: 8-Year Experience
Authors: Garcia-Carretero Rafael , Vazquez-Gomez Oscar , Luna-Heredia Esther , Vargas-Rojo Borja , Fernandez-Cotarelo Maria-Jose , Naranjo-Mansilla Gema
Published: January 2022

We performed exploratory and descriptive analyses of data from our 8 years of experience in hospital-at-home (HaH) treatment to characterize the clinical profile of patients with exacerbated underlying chronic obstructive pulmonary disease (COPD). Our study had a retrospective research design, using historical electronic health records from patients admitted to the HaH setting between 2012 and 2019. We collected demographic, administrative, and clinical data from patients diagnosed with exacerbated COPD. Between 2012 and 2019, 420 patients diagnosed with acute respiratory infectious disease related to COPD were treated in our HaH setting (18% of all admissions to HaH). Most patients were referred from the Internal Medicine Department. The median length of the hospital stay was 10 days. Most patients (78.8%) presented acute exacerbation with no pneumonia. One-third of the patients required domiciliary oxygen therapy, and half required ventilatory devices for nebulized bronchodilator therapy. All patients were successfully discharged as clinically stable. Our HaH experience in managing patients with exacerbated COPD indicates a means of obtaining cost savings and increased quality of life for patients in which antibiotic and ventilatory therapy is not compromised.
Cut Them Loose? Firms’ Response Strategies to Environmental Misconduct by Supplying Firms
Authors: Comyns Breeda , Meschi Pierre-Xavier , Norheim-Hansen Anne
Published: January 2022

Firms are increasingly held accountable for their suppliers’ environmental misconduct and often face significant stakeholder pressure to respond or even end their affiliations with misbehaving suppliers. Despite the importance of the subject, we know little about antecedents to supplier exclusion. In this article, we build on the assumption of stakeholder expectations being a core mechanism—and adopt an expectancy-violation theory lens. Drawing also on complementary insights into signaling theory, we argue that the severity of the misconduct affects the decision to cut ties. Furthermore, we argue that the engagement in environmental partnerships of client firms as well as suppliers moderates this relationship. To test our hypotheses, we use a unique sample of 434 client firm–supplier dyads, including 27 focal firms pressured by Greenpeace to remove “dirty” palm oil suppliers, accused of illegal deforestation. The study’s findings provide contributions to several literature streams related to inter-organizational dynamics and environmental sustainability.
Initiating a Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy Program Based on a Single Center Experience in Lebanon
Authors: Osman Bassam , Bou Akel Imad , Tulimat Tamam , Sfeir Pierre , Borgi Jamil
Published: January 2022

Purpose

In 2018, the American University of Beirut Medical Center established the first multidisciplinary Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy program in Lebanon. The study describes the challenges faced in establishing the program and in improving patient referral, evaluation, and perioperative care.

Methods

The program establishment including the preparation phase, clinical evaluation, and team education is discussed. The implementation of the flow of patients referred to the program was established. Education regarding diagnosis and referral were provided to physicians in the community. The initial experience is described in a retrospective analysis of 4 consecutive patients who were diagnosed with CTEPH and underwent PEA.

Results

Four patients were diagnosed with CTEPH had PEA performed. The mean age of patients was 64 years. The average CPB and total circulatory arrest times were 244 and 23.9 minutes per side, respectively. No mortalities were encountered perio-operatively. All patients reported significant improvement in functional capacity from NYHA III and IV to a NYHA class of I with an average PASP decrease of 59.5 ± 19.7 mmHg and mPAP drop by 30.2 ± 16.3 mmHg.

Conclusion

The launch of the first CTEPH and PEA program in Lebanon, with a clear framework, coupled with good surgical outcomes is very encouraging. The program offers a curative solution for CTEPH patients in the region. A clear referral process and an increase in disease and treatment awareness in the community are crucial to the future success of the program, offering a definitive treatment, and avoiding delays to surgery.
Effects of Abnormal Weather Conditions on the Performance of Hotel Firms
Authors: Mun Sung Gyun , Park Sangwon
Published: January 2022

Weather is one of the critical factors that influence tourists’ destination choices and activities. Apart from ambient temperature anomaly, rain anomaly is also an important factor considered by tourists when they plan and modify their vacation and holiday trips. This study confirms the important role of abnormal weather conditions in explaining hotel performance, such as occupancy, average daily rate, and revenue per available room. Moreover, operational performance indicators are observed to exhibit dynamic patterns in response to abnormal weather conditions in accordance with different types/classes of hotels. Evidence indicates that tourists prefer to stay at full-service hotels with complete facilities rather than at hotels with limited facilities and services during an abnormally heavy rain situation. Therefore, the findings of this research suggest a useful determinant (i.e., weather changes) of revenue management practices for hotel firms to maximize their operating performance.
Analyzing the influence of short-term rental platforms on housing affordability in global urban destination neighborhoods
Authors: Garay-Tamajón Lluís , Lladós-Masllorens Josep , Meseguer-Artola Antoni , Morales-Pérez Soledad
Published: January 2022

In the last decade, global urban destinations have witnessed an unprecedented wave of tourism growth based on the development of short-term rental platforms (STAP) and of a particular platform, Airbnb. Literature has demonstrated this growth’s influence in different contexts, highlighting its impact on housing markets, mostly at the city level and through correlation or regression analyses. This study goes a step further, focusing on the neighborhood level for the case of Barcelona (Spain) and using k-means clustering. Results show how the concentration of Airbnb listings in “highly touristified” and “trendy” neighborhoods has been associated with an increase in rental prices in these areas. Moreover, the subsequent increase in the demand for tourism-related services in these neighborhoods has led to a displacement of residents to peripheral neighborhoods, which has also put pressure on these areas’ housing prices. These processes have been accompanied by an increasing reaction from local anti-tourism movements. Based on these findings, we suggest that global urban destinations managers need to manage STAP and tourism-related service development not only in relation to the tourism industry but also regarding its impact on the conditions of residents and should consider the neighborhood as a primary management unit when designing the necessary regulations.
What Can We Learn About the Others Present During Incidents of Child Abuse?: Key Lessons and Future Directions Based on a Scoping Review
Authors: Klebanov Bella , Tener Dafna , Katz Carmit
Published: January 2022

Child abuse (CA) is a global problem that has received attention from policymakers, researchers, and practitioners. The majority of studies have focused on the phenomenon’s epidemiology and consequences, alongside groundbreaking writing on victims and perpetrators. The concept of others who are present during the abuse is understudied and underdeveloped, despite its vital importance in better understanding children’s experiences as well as their disclosure. The current study was designed to spotlight the phenomenon of others' presence, beyond the victims and perpetrators, during child abuse incidents. The current literature review was guided by a scoping review strategy. The results revealed scant empirical data, with only 15 studies meeting the inclusion criteria of the study. The articles that met the inclusion criteria addressed other people’s presence during CA incidents, were published in peer-reviewed journals, and were written in the English language. These articles’ analyses addressed the relations of the survivors with these others, pointing mainly to two identities: accidental bystanders who are not familiar with the child and family members of the child. The results provided a glance into the process that accidental bystanders go through during the abuse and the meaning of their presence for those who are family members. The perceptions and experiences of the children themselves with respect to the presence of the others during the abuse are noticeably lacking. The key conclusion from the current scoping review pinpoints the urgent need to advance the empirical knowledge on the presence of others during incidents of child abuse, especially others who are familiar to the children and are a significant part of their lives. The conceptualization of this phenomenon has the potential to better adapt prevention and intervention efforts in the field of child abuse.
An exploratory study: The effects of sleep systems on sleep quality, pain and carer goals for non-ambulant children and young people with cerebral palsy
Authors: Wood Nicola , Brown Sarah
Published: January 2022

Introduction

Sleep systems are supports used in lying, forming part of 24 h posture management programmes, for children and adults with severe motor disorders. Improved posture reduces likelihood of secondary complications such as pain and poor sleep quality, thus improving quality of life. The study aims are to investigate the effect of sleep systems on sleep quality and quantity, pain for young people with Cerebral Palsy and outcomes for carers.

Methods

Baseline data were gathered for 1 month prior to sleep system provision. Comparative data with the sleep system in place, were gathered for 5 months. The sample comprised four children with Cerebral Palsy, GMFCS level V, average age of 11.5, who did not have a sleep system. Data on sleep quality and quantity was gathered using the Chailey Sleep Questionnaire and sleep diaries and pain levels using the Paediatric Pain Profile. GAS Light verbal outcome measure was used to measure carer goals.

Results

Descriptive statistics and paired sample t-tests were used, demonstrating pain levels remained static, improvements in sleep quality and quantity were found and carer goals achieved.

Conclusion

A small sample size and subjective data collection methods were used; further research is required to obtain more conclusive results.
Primary Care Providers’ Perceptions of the Acceptability, Appropriateness, and Feasibility of a Mammography Decision Aid for Women Aged 75 and Older
Authors: Schonberg Mara A. , Hamel Mary Beth , Davis Roger B. , Karamourtopoulos Maria , Pinheiro Adlin , Hayes Michelle C. , Wee Christina C. , Kistler Christine
Published: January 2022

Background. Clinicians need to find decision aids (DAs) useful for their successful implementation. Therefore, we aimed to conduct an exploratory study to learn primary care clinicians’ (PCPs) perspectives on a mammography DA for women ≥75 to inform its implementation. Methods. We sent a cross-sectional survey to 135 PCPs whose patients had participated in a randomized trial of the DA. These PCPs practiced at 1 of 11 practices in Massachusetts or North Carolina. PCPs were asked closed-ended and open-ended questions on shared decision making (SDM) around mammography with women ≥75 and on the DA’s acceptability, appropriateness, and feasibility. Results. Eighty PCPs participated (24 [30%] from North Carolina). Most ( n = 69, 86%) thought that SDM about mammography with women ≥75 was extremely/very important and that they engaged women ≥75 in SDM around mammography frequently/always ( n = 49, 61%). Regarding DA acceptability, 60% felt the DA was too long. Regarding appropriateness, 70 (89%) thought it was somewhat/very helpful and that it would help patients make more informed decisions; 55 (70%) would recommend it. Few ( n = 6, 8%) felt they had other resources to support this decision. Regarding feasibility, 53 ( n = 67%) thought it would be most feasible for patients to receive the DA before a visit from medical assistants rather than during or after a visit or from health educators. Most ( n = 62, 78%) wanted some training to use the DA. Limitations. Sixty-nine percent of PCPs in this small study practiced in academic settings. Conclusions. Although PCPs were concerned about the DA’s length, most found it helpful and informative and felt it would be feasible for medical assistants to deliver the DA before a visit. Implications. Study findings may inform implementation of this and other DAs.
A Retrospective Comparison of Above- vs Below-the-Knee Cast Treatment for Salter Harris-II Distal Tibia Fractures
Authors: Dasari Suhas P. , Kukushliev Vasil V. , Graf Alexander R. , Liu Xue-Cheng , Van Valin Scott E.
Published: January 2022

Background:

Distal tibia fractures are common in the pediatric patient population. Recent reports suggest that patients with closed low-energy distal tibial fractures treated with short leg casts (SLCs) have similar radiographic outcomes with improved functional outcomes compared to those treated with long leg casts (LLCs). However, to date there has not been a study comparing these treatment modalities for Salter-Harris (SH) II distal tibia fractures. The purpose of this study was to compare the radiographic and time to weightbearing outcomes between patients with SH-II tibial ankle fractures treated with an SLC vs an LLC.

Methods:

A retrospective review on SH-II distal tibia fractures was performed at a Level I pediatric trauma center from 2013 to 2020. Primary outcomes included final coronal angulation, sagittal angulation, and time to weightbearing.

Results:

A total of 59 patients with SH-II distal tibia fractures were treated with an SLC (22 patients, median age 11.79 years) or an LLC (37 patients, median age 12.17 years). There was no statistically significant difference between the 2 treatment groups for coronal angulation at final follow-up, sagittal angulation at final follow-up, or percentage of patients fully weightbearing at 6 weeks ( P > .05). No patients required subsequent remanipulation or operative treatment in either treatment group.

Conclusion:

In this retrospective review with relatively short-term follow-up, SLCs were found to be noninferior to LLCs for treatment of reduced SH-II distal tibia fractures. This casting option may still be considered by surgeons who are nonoperatively managing pediatric distal tibia fractures.

Level of Evidence:

Level III, retrospective comparative study.
The Effect of Single vs Serial Platelet-Rich Plasma Injection in Osteochondral Lesions Treated with Microfracture: An in Vivo Rabbit Model
Authors: Dankert John , Yasui Youichi , Tonogai Ichiro , Mercer Nathaniel P. , Goodale Margaret B. , Fortier Lisa A. , Kennedy John G.
Published: January 2022

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

Platelet-rich plasma (PRP) has gained increasing interest as a potential therapeutic augment for decreasing inflammation and enhancing healing after cartilage injury. However, it remains unknown whether osteochondral repair outcomes benefit from multiple PRP injections. We performed this animal study to investigate the effects of serial PRP injections on cartilage repair tissue, subchondral bone remodeling, and joint inflammation.

Methods:

Forty-eight adult New Zealand White rabbits were randomly assigned to receive either one (1P), two (2P), or three (3P) PRP injections. Cylindrical full-thickness cartilage defects with subsequent microdrilling were created on the central medial femoral condyle of both knees. PRP injections were provided on the day of surgery and every 2 weeks thereafter until the assigned number of injections was achieved for each group. Rabbits in each group were euthanized at 3, 6, or 12 weeks postoperatively. Cartilage repair tissue was assessed using the International Cartilage Repair Society (ICRS) macroscopic and modified ICRS histological scoring systems. Subchondral bone remodeling was evaluated by micro-computer tomography (µCT) analysis. Joint inflammatory cytokines including IL-1, IL-1ra, IL-6, IL-8, TNFα, and TGFβ were assessed by quantitative polymerase chain reaction.

Results:

Macroscopic assessment at 3 and 6 weeks demonstrated improved mean ICRS macroscopic scores in the PRP groups compared with the control group, although this difference was not significant. The mean ICRS macroscopic score at 12 weeks in Group 3P was significantly lower than the control, but there was no significant difference compared with Group 1P and Group 2P (Control: 6.1+-3.3, Group 1P: 3.4+-2.7, Group 2P: 4.2+-2.9, Group 3P: 0.7+-1.5). The mean modified ICRS histological score was significantly higher at each time point for the PRP groups compared with the control group, but there was no significant difference in the scores among PRP groups. There were no significant differences in outcomes for the characteristics evaluated by µCT nor inflammatory cytokine levels among each group at each time point.

Conclusion:

Serial PRP injections, as compared to a single PRP injection, do not have a significant impact on cartilage repair tissue nor inflammatory cytokine levels at 12 weeks after surgery in an in vivo animal model. Further work is necessary to determine the effect of single versus serial PRP injections on cartilage repair tissue in humans.
Suture Pullout in Human Cadaveric Skin: Evaluation of HEMIGARD® Augmentation vs Suture Alone
Authors: Lin Jason S. , Pearson Jacob , Pipitone Olivia
Published: January 2022

Category:

Other; Ankle; Midfoot/Forefoot

Introduction/Purpose:

Closure of high-tension surgical wounds is a challenge frequently encountered during surgical procedures. The use of a novel adhesive augmentation device, HEMIGARD, has been proposed to decrease tension on wound closure and thereby increase the amount of force needed for suture pullout. In principle, this may help prevent wound dehiscence, skin edge necrosis and the sequelae thereof. We hypothesized that HEMIGARD augmentation of suture placement would require more force for suture pullout from human cadaveric lower extremity skin when compared to suture alone.

Methods:

In this study, HEMIGARD with suture was compared to suture alone on leg and foot measurements from four cadavers. One side of the incision was used to test the HEMIGARD according to the manufacturer's instructions. The other side of the same incision was used to test the same suture material, passed without HEMIGARD, to allow for direct comparison. A force gauge was used to measure the Newtons of force required for suture pullout. A total of 30 measurements were recorded per cadaver; 15 using HEMIGARD and 15 using suture alone.

Results:

No difference was observed between HEMIGARD and suture alone in the amount of force required for suture pullout. When excluding instances of HEMIGARD adhesive failure, which occurred in 67% of measurements, the HEMIGARD was found to be superior to suture alone in the cadaveric foot, but not in the leg.

Conclusion:

The amount of force required for suture pullout from human cadaveric lower extremity skin did not significantly differ when using HEMIGARD augmentation of suture placement versus using suture alone. However, when excluding instances of HEMIGARD adhesive failure, the HEMIGARD may be superior to suture alone in the cadaveric foot, but not in the cadaveric leg.
Gender and Geographic Trends Amongst Foot & Ankle Surgeons: Where Are We and Where Do We Need to Improve?
Authors: Okereke Robyn , Janney Cory , Rezvani Aryan , Safavi Kiya Shazadeh
Published: January 2022

Category:

Other

Introduction/Purpose:

Clinical and elective experiences as well as the guidance of mentors are all critical factors in the pursuance of orthopedic residencies and fellowships. Women have historically been underrepresented in orthopedics. Some propose that the root cause lies in the lack of availability in the aforementioned factors. Previous studies demonstrated geographic differences in sex representation in orthopedic residency programs. Studies over geographic distributions of orthopedic foot and ankle (OFA) surgeons showed high variation in geographic density of OFA surgeons throughout the U.S. This study seeks to determine both the gender and geographic distributions of OFA surgeons as well as to determine geographic patterns between their training locations and current practices.

Methods:

AOFAS data regarding fellowship completion from 1988 through 2021 was analyzed with regards to gender and fellowship location. Internet searches were performed for all those identified within the database for their medical school, residency, and current practice location. This biographical data was obtained from their front-facing biographical webpage or hospital affiliation. States were placed into regions and subsequent divisions as defined according to the US Census Bureau definition: Northeast (New England and Middle Atlantic), Midwest (East North Central and West North Central), South (South Atlantic, East South Central, and West South Central) and West (Mountain and Pacific).

Results:

1,088 OFA surgeons were analyzed. 168 (15.3%) were female and 922 (84.7%) were male. Female-held OFA fellowship positions increased over time, currently sitting at 13 (22% of all fellowship positions), with a maximum of 15 (25%) in 2017. Geographically, the Pacific had most females (n=26, 15.6% of females), while East South Central had least (n=10, 6.0%). The South Atlantic had most males (n=193, 20.9% of males) while East South Central had least (n=59, 5.3%). The region with the most OFA surgeons in total was the South Atlantic (n=218, 20.0% of the total) whereas the regions with the least were East South Central and New England (n=59, 5.4% in each).

Conclusion:

Although the amount of female OFA surgeons has increased, the numbers are still low. Geographically, the East South Central division of the U.S consistently had the least number of OFA surgeons whereas the South Atlantic division had the highest.
Red Blood Cell Distribution Width: A Novel Predictor of Mortality Following Amputation in Diabetic Foot
Authors: Park Jae Han , Park Kwang Hwan , Yoon Yeo Kwon , Han Seung Hwan , Lee Jin Woo
Published: January 2022

Category:

Diabetes

Introduction/Purpose:

Red blood cell distribution width (RDW), reflects the degree of heterogeneity of erythrocyte volume, has been found to be a significant prognostic factor in various human disorders. Herein, we assessed the value of RDW as a prognostic factor in diabetic foot amputation.

Methods:

Data of 415 patients with diabetic foot underwent amputation between January 2009 and January 2019 were analyzed retrospectively. After establishing a cut-off point of preoperative RDW for all-cause mortality, Cox proportional hazard model for mortality and logistic regression analysis for length of hospital stay more than 1 month were performed with other variable

Results:

RDW >14.5% was a significant risk factor for mortality (hazard ratio, 2.55; 95% confidence interval [CI], 1.55 to 4.19) on multivariable-adjusted regression analysis. Other significant factors associated with mortality were age and kidney disease. High RDW was also associated with longer hospitalization over 30 days (odds ratio, 2.17; 95% CI, 1.29 -3.66).

Conclusion:

High preoperative RDW over 14.5% is an independent prognostic factor with increased mortality and longer hospitalization, implying that RDW may be a simple and inexpensive laboratory parameter for risk stratification in diabetic foot amputation.
Delayed Surgery for Ankle Fractures is Associated with Poor Patient Reported Outcome
Authors: Pilskog Kristian , Inderhaug Eivind , Odland Heid Elin J. , Gote Teresa B. , Fjeldsgaard Knut , Dale Håvard , Fevang Jonas M.
Published: January 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Several studies discuss the relation between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait affects clinical outcomes. The present study, therefore, aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures.

Methods:

Patients treated operatively for low-energy ankle fractures which also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs and patient- reported outcome measures (SEFAS, RAND-36, VAS of Pain, VAS of Satisfaction). For analyses, patients were stratified based on time from injury to definitive surgery; Group 1: within the same day, Group 2: 1 to 7 days after injury, and Group 3: later than 7 days after injury.

Results:

Follow-up visits of 130 patients were performed at median 25 (Interquartile range (IQR), 19-34) months after surgery. Patient demographics and fracture characteristics were similar between groups. Median SEFAS was 40 in Group 1 (IQR 33-43), 41 (IQR 33-44) in Group 2, and 33 (IQR 27-42) in Group 3. The difference between Group 1 and 3 (p =.03), and between Group 2 and 3 (p =.04) was statistically significant. Group 1 had the highest rate of mechanical irritation and secondary surgery following malreduced fractures or missing syndesmotic fixation. Patients operated later than seven days from injury reported more pain than those treated earlier (p =.03).

Conclusion:

Time from injury to final surgery influenced clinical outcomes after these severe ankle fractures. Patients who waited more than seven days until definitive surgery had poorer clinical outcomes and more pain compared to those who had surgery within a week.
Quadrimalleolar Fractures of the Ankle: Principles and Medium-Term Results of Surgical Fixation
Authors: Rammelt Stefan , Kroker Livia , Neumann Annika P.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Over the last decade, much attention has been paid to the fractures of the posterior malleolus as it became obvious that the mere presence of a posterior tibial fragment is associated with a less favorable prognosis in malleolar fractures. It seems logical to pay the anterior restraints of the ankle joint a similar attention as to the posterior ones. The anteriolateral distal tibia may be considered a 'fourth' or anterior malleolus. Here, we present a technique of fixation of trimalleolar fractures with additional fracture of the anterior tibial tubercle ('quadrimalleolar') or anterior fibular rim ('quadrimalleolar equivalent').

Methods:

Twenty-four patients with a mean age of 60 years were treated with open reduction and internal fixation of all 4 malleoli. There were 17 quadrimalleolar and 6 quadrimalleolar equivalent fractures. One patient had both anterior tibial and fibular avulsion fractures in addition to a trimalleolar ankle fracture. Surgical approaches and internal fixation were tailored individually. Twenty patients were operated in prone position with direct fixation of the posterior malleolus and 4 patients in supine position with indirect anterior to posterior screw fixation of the posterior malleolus under transfibular control of reduction.

Results:

After fixation of al 4 malleoli, only one patient (4%) required a syndesmotic screw for residual syndesmotic instability on intraoperative testing. There were no infections, and no wound healing problems. All patients went on to solid union. No late fusions were needed. Nineteen patients (79%) could be reevaluated after a mean of 77 months (range, 15 to 156 months) follow- up. The Foot Function Index averaged 15 (range, 50 to 0), the Olerud and Molander Score averaged 79 (range, 45 to 100) and the AOFAS Ankle and Hindfoot Scale averaged 87 (range, 39 to 100).

Conclusion:

Fixation of the anterior and posterior tibial fragments increases syndesmotic stability by providing a bone-to-bone fixation. Reduction of displaced anterior and posterior tibial rim fractures restores the physiological shape of the tibial incisura and therefore facilitates fibular reduction. In the majority of cases, this also restores articular congruity of the lateral tibial plafond. Anatomic reduction of the anterior and posterior malleolus in addition to medial and lateral malleolar fixation leads to favourable functional results despite a complex (quadrimalleolar) fracture pattern.
Heterotopic Ossification Following Total Ankle Arthroplasty with Fourth- Generation Prostheses
Authors: Rushing Calvin J. , Malloy McCoy Antonio M. , Steriovski James M. , Hyer Christopher F. , Berlet Gregory C.
Published: January 2022

Category:

Arthroscopy; Hindfoot

Introduction/Purpose:

The purpose of the present study was to assess the radiographic incidence, location, and classification of heterotopic ossification (HO) in patients who underwent total ankle arthroplasty (TAA) with a 4th generation prostheses at a minimum of 1-year follow up. Baseline demographic, radiographic, and operative factors between patents with and without HO were compared.

Methods:

Ninety ankles that underwent TAA with a 4th generation protheses, INFINITY (n = 62) or CADENCE (n = 28) were followed for an average of 23.7 (range, 12-49) months. Incidence and location of HO was assessed on weight bearing radiographs, and severity graded according to the modified Brooker classification. Data was compared between patents with and without HO to identity any predisposing factors.

Results:

In 90 ankles that underwent 4th generation TAA, HO incidence was 55.6% (n = 50); 56.5% (n = 35) for INFINITY, and 53.6% (n = 15) for CADENCE. Twenty-five cases of HO were observed posteriorly, 16 anteriorly, and 9 combined. Severity was as follows; class I in 19 cases (38%), class II in 20 (40%), class III in 9 (18%) and class IV in 2 (4%). A single ankle required a non- revisional reoperation for HO debridement; reoperation rate of 2%.

Conclusion:

The present study suggests a similarly high incidence of HO after TAA with two different 4th generation prostheses (INFINITY 56.5%, CADENCE 53.6%). A trend for differences in location and severity between the prostheses may also be present. Given the paucity of literature, additional studies with longer follow-up are warranted to discern the significance of HO following TAA with 4th generation prostheses.