bluuebunny/crossref_metadata_2025 huggingface dataset:
Weight-bearing Allowed Following Internal Fixation of Ankle Fractures, a Systematic Literature Review and Meta-Analysis
Authors: Khojaly Ramy , Rowan Fiachra E. , Hassan Mekki , Hanna Sammy , Mac Niocail Ruairí
Published: July 2022

Background:

Postoperative management regimes vary following open reduction and internal fixation of unstable ankle fractures. Traditional postoperative nonweightbearing cast immobilization may prevent loss of fixation and protect the soft tissue envelope but may also be associated with poorer functional outcomes. This systematic review and meta-analysis aimed to compare the complication rate and functional outcomes of early weightbearing (EWB) vs late weightbearing (LWB) following open reduction and internal fixation of ankle fractures.

Methods:

We performed a systematic review with a meta-analysis of controlled trials and comparative cohort studies using 3 databases. We included all studies that investigated the effect of weightbearing following internal fixation of ankle fractures in adult patients by any means. Studies that investigated mobilization but not weightbearing, non–English-language publications, and tibial Plafond fractures were excluded from this systematic review. We assessed the risk of bias using ROB 2 tools for randomized controlled trials and ROBINS-1 for cohort studies. Data extraction was performed using Covidence online software and meta-analysis by using RevMan 5.3.

Results:

This systematic review included 10 randomized controlled trials and 4 comparative cohort studies. Most of the included studies were rated as having some concern with regard to the risk of bias. There was no significant difference in the complication rate between the protected EWB and LWB groups (the risk ratio [RR] for infection was 1.30, 95% CI 0.74, 2.30; I² = 0%; P = .36), but better functional outcome scores were detected in the EWB group only at 6 weeks postoperatively (MD =10.08, 95% CI 5.13, 15.02; I² = 0%; P ≤ .0001), with no significant difference seen at 6 or 12 months postoperatively.

Conclusion:

Based on the studies reviewed, it appears that early protected weightbearing following open reduction and internal fixation of ankle fractures does not affect surgical incision or fracture healing and is associated with better early functional outcomes at 6 weeks, but not 6 or 12 months, postoperatively.
The Return: Research-Based Theater With and for Ex-Military Personnel Experiencing Posttraumatic Stress
Authors: Balfour Michael , Hassall Linda
Published: July 2022

This article discusses The Return, a research-based theater project about posttraumatic stress, performed by actors and ex-military personnel. The objective of the project was to address the stigma of mental health in the military and encourage psychological help-seeking in the veteran and military population. The play combined verbatim text and dramaturgical re-authoring of material to explore the lived realities of mental health experiences of posttraumatic stress (PTS) in the military. Part of the ethical entanglements encountered lay in calibrating the risk–safety nexus, specifically in relation to questions of authenticity, narrative structure, decisions relating to casting actors and ex-military personnel, and how to negotiate the performance of a personal story of trauma. The article argues that performance is innately a process governed by “edgework” as much as safety, and therefore part of the ethical entanglement lies in the negotiations between risky aesthetics, “safe” spaces, and frameworks that enable critical vulnerability.
Preparing for the Research Ceremony: Indigenist Researcher Training
Authors: Hughes Margaret , Wilson Shawn , Barlo Stuart
Published: July 2022

Preparing ourselves for the ceremony of research is akin to preparing ourselves to be in good relationship with Knowledge, and with whoever else participates in the research, including other human beings, more than human beings, and Country. In this article, I talk about the practice of cultivating the values and skills that make for good relationships, both as a researcher in training and through the mentoring relationships with my PhD supervisors. It is my hope that sharing my experience as a PhD student traversing this training and mentoring journey may support others preparing for research within a relational methodology. Throughout the conversation, I come back to the importance of cultivating and practicing the principles of respect, receptivity, generosity, humility, compassion, and care, and building the skills of attention, deep listening, and service.
Comparing Treatment Outcomes in Children and Adolescents With ADHD to Other Disorders Within an Australian and Dutch Outpatient Cohort
Authors: Payne Leanne , Roest Sanna L. , Lu Zhen Qi , Zendarski Nardia , Bisset Matthew , Sciberras Emma , Stathis Stephen , Siebelink Bart M. , Vermeiren Robert R. J. M. , Bellgrove Mark A. , Coghill David , Middeldorp Christel M.
Published: July 2022

Objective:

Previous studies at child and youth mental health services (CYMHS) suggest that children with ADHD have poorer outcomes compared to those with other diagnoses. This study investigates this in more detail.

Methods:

Children with ADHD were compared to those with ASD and those with emotional disorders, on routinely collected outcomes at CYMHS in Australia ( N = 2,513) and the Netherlands ( N = 844).

Results:

Where the emotional disorders group reached a similar level of emotional symptoms at the end-of-treatment as the ADHD and ASD groups, the latter two groups still had higher scores on ADHD and ASD symptoms (attention and peer problems). The poorer outcomes were mainly explained by higher severity at baseline. In Australia, an ADHD and/or ASD diagnosis also independently contributed to worse outcomes.

Conclusion:

Those with neurodevelopmental disorders within both countries had poorer outcomes than those with emotional disorders. Services should aim to optimize treatment to ensure best possible outcomes.
The Impact of Suspect Race and Precipitating Incident on Community Members’ Assessments of Deadly Force Reasonableness
Authors: Fridell Lorie A. , Marier Christopher J.
Published: July 2022

The contrast between many community members’ views about the extent to which force used by police is excessive and the criminal justice system’s determination of same suggests a “reasonableness divide.” Using survey data from 3,600 nationally representative adults, this study assessed one possible reason for this divide—that community members evaluate the reasonableness of deadly force using factors that are not considered in legal assessments. The results affirmed this divide—finding that community members’ evaluations of deadly force incidents are impacted by the race of the subject and by the precipitating event. Policy and research implications are presented.
Evaluating Canadian Legal Changes in Context: Homicide Investigator Insights
Authors: Witt Christina , Hak Jonathan W. , Gibbs Van Brunschot Erin , Abela Graham
Published: July 2022

In 2020, a research study was conducted surveying homicide investigators and managers within the province of Alberta (Canada). This study provided investigator insight and knowledge of current issues impacting investigations, focusing on issues related to the law and prosecutions. Specifically, two key Supreme Court of Canada decisions were identified as having significant impact on homicide investigations. Limiting factors regarding the law and prosecutions included case law developments impacting privacy issues, warrant requirements, disclosure, and prosecution timelines, which continue to challenge homicide investigators. Recommendations are made to assist investigators and managers in navigating these legal changes.
Malignancy Rates by Bethesda Subcategory in the Pediatric Population
Authors: Park Soyun , Osterbauer Beth , Sahyouni Grace , Paik Connie , Austin Juliana , Gomez Gabriel , Shillingford Nick , Kwon Daniel
Published: July 2022

Introduction

While the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is the most widely used method for categorizing thyroid nodules, its applicability to children is often debated. We describe our institution’s experience utilizing the TBSRTC and examine the rates of malignancy in our population.

Methods

We conducted a retrospective chart review of eligible patients undergoing primary thyroidectomy at a high-volume tertiary care pediatric hospital. All patients had pre-operative fine needle aspiration

Results

Of the 112 patients in our cohort, 85 (76%) were female. The median age was 15.1 years. The patients were divided into groups based on the Bethesda categorization of the fine needle aspirations of their nodules. The percentages of patients whose resection specimens showed evidence of malignancy on the surgical pathology reports were recorded as follows: category I (n = 5): 20%, category II (n = 11): 0%, category III (n = 30): 17%, category IV (n = 13): 31%, category V (n = 17): 94% and category VI (n = 36): 100%.

Conclusion

Our findings indicate that the malignancy rates at our institution are comparable to those reported by other high-volume studies. When compared with the 2017 TBSRTC data, we found that our results were similar in many categories, with the exception of categories I and V.
Legacy and Rupture: The Political Learning of Young Left-wing Basque Nationalists in the Post-ETA Period
Authors: Larrinaga Ane , Amurrio Mila
Published: July 2022

The article examines ways in which the left-wing nationalist movement in the Basque Country has offered a framework of opportunity for the construction of activist youth agency. It also identifies transformations in youth activist practices over the last decade, following the cessation of ETA´s armed activity. Based on in-depth interviews, we set out to reconstruct the evolution of the political learning and trajectories of youth from the Basque Nationalist left during this period. The analysis of these young peoples’ narratives allows us to understand some of the meanings that they attach to their current political practices. With respect to inherited political traditions, continuity was manifest in the existence of enduring dispositions favourable to counter-hegemonic activism. Changes were manifest in the adaptation of these dispositions to new political conditions through progressively more individualized forms of political action, connected to emerging contemporary agendas.
A tragic ethics for the Anthropocene: On the unmanageable and impossible in management learning
Authors: Arruda Fontenelle Isleide
Published: July 2022

This essay offers a reflection on which ethics can critically guide the field of management learning in the Anthropocene. Based on a negative ontology of humankind and nature, I understand the Anthropocene as being unmanageable and imposing an ethical dimension of the impossible on the field of management learning. Inspired by the Lacanian concept of tragic ethics, which is based on certain categories – radical contingency, indeterminacy and the impossible – I propose a tragic ethics for the Anthropocene. Such ethics, articulated to an indigenous ontology and ethics, presents the possibility of an open way of knowing and learning in the context of management learning, which is necessary not only for the radical contingency of the Anthropocene but also for the inclusion of other voices and knowledge, both human and nonhuman.
Teachers as new speakers of a minority language: Identity, speakerness, and ideologies on variation in Irish
Authors: Ó Murchadha Noel , Flynn Colin J.
Published: July 2022

Aims and objectives:

This article reports the ideologies on linguistic variation among a cohort of new speaker teachers (NSTs) of Irish. It investigates responses to the three main traditional dialects of Irish and a post-traditional variety common among new speakers.

Design and methodology:

An experimental design was employed. Participants responded to 15-second samples of four speakers, first on adjective items referring to speakers’ characteristics (speaker phase) and second on statements referring specifically to the type of Irish in the samples (speech phase). Background information was also gathered, for example, school type, place of origin, and type of Irish spoken.

Data and analysis:

We present the responses of a subset of 88 NSTs of Irish, focusing specifically on participants’ responses in the speech phase where they evaluated the type of Irish in the samples. Data were analysed to determine whether there were significant differences in the ratings of samples within different respondent subgroups.

Findings and conclusions:

Some significant differences were found among subgroups. Teachers working in Irish-medium schools align more closely with established native speaker language ideologies than those in English-medium institutions. Participants did not distinguish significantly between their local Gaeltacht variety and other Gaeltacht areas, but did rate all three Gaeltacht samples more positively than the new speaker variety. Finally, participants who self-identify as speakers of ‘standard’ Irish and those who describe themselves as practising a Gaeltacht variety rated the Gaeltacht samples more positively.

Originality:

While experimental investigations of linguistic ideologies are central to sociolinguistics, this article is original in its focus on the ideologies of NSTs of Irish.

Significance and implications:

This research illustrates the robustness of established ideologies in the responses of some participants but shows that others challenge these ideologies. Results speak to the complexities and contradictions of identity and speakerness among NSTs of a minority language.
Pad cultures: An ethnography of continence care and its consequences for people living with dementia during a hospital admission
Authors: Northcott Andy , Boddington Paula , Featherstone Katie
Published: July 2022

Background

There is little research examining how continence care is organised and delivered to people living with dementia across an acute hospital admission, despite the prevalence of this patient population and their vulnerability within these settings.

Objective

To explore how continence care is delivered to people living with dementia during an acute hospital admission.

Design

Ethnographic.

Setting(s)

Acute medical units and wards within three hospitals across England and Wales.

Participants

People living with dementia and ward staff (registered nurses and care assistants) on participating wards.

Methods

Ethnographic fieldwork collected over a period of 12 months (180 days of non-participant observation) focussing on the organisation and delivery of continence care to people living with dementia. Observations were supported with in situ ethnographic interviews ( n = 562) with patients, visitors and staff within the six observed wards. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory.

Results

The findings comprised of five overall themes: (1) visibility of continence; (2) rationales of continence care; (3) containment and contagion; (4) consequences of continence care and (5) supporting continence.

Conclusions

We introduce the term ‘pad cultures’ to refer to the established routine use of continence pads in the care of a wider group of people living with dementia (regardless of continence status and independence), with the rationale to provide safeguards, ensure containment and prevent ‘accidents’ or incontinent episodes. There was an expectation within acute wards that people living with dementia not only wear continence pads but that they also use them.
Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection
Authors: Massmann Alexander , Giebels Christian , Buecker Arno , Schäfers Hans-Joachim , Fries Peter
Published: July 2022

Purpose:

Unintended false-lumen thoracic endovascular aortic repair (TEVAR) is under-reported and often fatal. We present percutaneous endovascular rescue techniques for true-lumen reperfusion with strategies to address the peripheral artery perfusion needs unique to each case.

Case Report:

Two patients deteriorated 24 hours after uncomplicated and complicated acute aortic type-B dissection TEVAR treatment at a tertiary community hospital. Reevaluation of index and repeated imaging studies revealed inadvertent false-lumen TEVAR with severe visceral and peripheral ischemia. Stepwise subtraction angiography was used to confirm continuous true-lumen catheterization from femoral puncture into the thoracic aorta. Retrograde fenestration distal to the misplaced TEVAR from the true- into the false-lumen allowed for snorkeling by distal stent-extension across the dissection membrane. In one case, TEVAR stent graft extension resulted in true-lumen re-expansion and in the other case, bare-metal stent-extension for stabilization of the dissection membrane resulted in true-lumen re-expansion in addition to preservation of visceral and peripheral perfusion via the false-lumen. Despite excellent acute hemodynamic results and initial signs of recovery, both patients eventually died (multiorgan failure; cerebral hemorrhagic infarction).

Conclusion:

Correct indication and prompt recognition of potential inadvertent false-lumen stenting is critical to avoid disastrous sequelae, for example, malperfusion. Endovascular salvage is feasible for restoration of correct perfusion and must be performed in a timely manner.

Clinical Impact

Clinically apparent, complicated type-B dissection necessitates instantaneous treatment. Prerequisite for an endovascular approach is a true-lumen guidewire continuously from access to the ascending aorta. DSA after TEVAR and prompt clinical re-evaluation are to verify effective visceral and peripheral restoration of blood flow. Despite these measures, inadvertent false-lumen TEVAR may occur rarely. Immediate recognition may allow for timely true-lumen re-expansion using percutaneous endovascular salvage techniques e.g. retrograde fenestration from the true- into the false-lumen for distal snorkeling of the misplaced TEVAR across the dissection membrane. However, morbidity and mortality are very high, if erroneous stent graft placement is not identified early.
Mental Activity as the Bridge between Neural Biomarkers and Symptoms of Psychiatric Illness
Authors: Riddle Justin , Frohlich Flavio
Published: July 2022

The Research Domain Criteria (RDoC) initiative challenges researchers to build neurobehavioral models of psychiatric illness with the hope that such models identify better targets that will yield more effective treatment. However, a guide for building such models was not provided and symptom heterogeneity within Diagnostic Statistical Manual categories has hampered progress in identifying endophenotypes that underlie mental illness. We propose that the best chance to discover viable biomarkers and treatment targets for psychiatric illness is to investigate a triangle of relationships: severity of a specific psychiatric symptom that correlates to mental activity that correlates to a neural activity signature. We propose that this is the minimal model complexity required to advance the field of psychiatry. With an understanding of how neural activity relates to the experience of the patient, a genuine understanding for how treatment imparts its therapeutic effect is possible. After the discovery of this three-fold relationship, causal testing is required in which the neural activity pattern is directly enhanced or suppressed to provide causal, instead of just correlational, evidence for the biomarker. We suggest using non-invasive brain stimulation (NIBS) as these techniques provide tools to precisely manipulate spatial and temporal activity patterns. We detail how this approach enabled the discovery of two orthogonal electroencephalography (EEG) activity patterns associated with anhedonia and anxiosomatic symptoms in depression that can serve as future treatment targets. Altogether, we propose a systematic approach for building neurobehavioral models for dimensional psychiatry.
Hormesis Research in China Is More Prevalent than Previously Thought
Authors: Agathokleous Evgenios , Geng Caiyu , Zhou Boya , Sun Haoyu , Guo Jiahua , Zhang Jing , Zhu Fuxing
Published: July 2022

An analysis of China’s domestic publications revealed that China’s hormesis-related research was enormously underestimated. China’s documented hormesis-related research spans at least four decades, covers a broad spectrum of research areas, and is more abundant than previously thought. These findings should be considered in historical assessments of the concept of hormesis. Moreover, similar to the international literature, different terms have been used to describe the same phenomenon (hormesis), which hampers communication, generalization of findings and accumulation of knowledge. Hence, we advocate that ‘hormesis’ should be cited as a keyword in all the relevant publications written in Chinese language.
Accuracy and reliability of college athletes’ scoring of artificial urine color samples to determine hydration status
Authors: Wardenaar Floris C , Seltzer Ryan GN , Kavouras Stavros A
Published: July 2022

There is potential for error when athletes self-assess urine color when attempting to distinguish between high and low urine concentration. This study investigates student athletes’ ability to score artificial urine color samples (Uc) using an 8-color Uc chart. A total of 35 student-athletes ( n = 30 women) scored 51 samples on two days 2–5 days apart. Artificial urine color samples were designed to match urine colors 4–7 from an 8-color Uc chart. The color rating took place using a scoring box with LED lights providing an illuminance of 1660 lux. The data were used to design random effect models to test the contrast between the athletes' color ratings and the actual color of the reference, with significance set at P ≤ 0.05. Results showed that as a group, participants scored samples similarly between days (4.4 ± 1.2 vs. 4.5 ± 1.2, P = 0.52), but on an individual level, samples were rated inconsistently (intraclass correlation coefficient: 0.30, 95% CI: 0.13–0.56), with correlations between reported scores and the reference colors ranging from r = −0.74 to + 0.64. Samples were scored significantly lighter than their actual color shade (odds ratio: 2.64, 95% CI 1.55–4.52, P < 0.001). In conclusion, athletes scored the color of artificial urine color samples inconsistently between days. Further, the odds are 2.6 to 1 that athletes report urine samples one shade lighter than their actual color, which in practice may affect the correct classification of urine samples with a color close to the selected Uc cut-off value to detect a high versus low urine concentration.
UK victim-survivor experiences of intimate partner spiritual abuse and religious coercive control and implications for practice
Authors: Mulvihill Natasha , Aghtaie Nadia , Matolcsi Andrea , Hester Marianne
Published: July 2022

This study extends existing scholarship on coercive control within an intimate relationship by exploring how some perpetrators use spiritual abuse as part of their control repertoire and how others harness belief and doctrine to exercise a totalising ‘religious coercive control’ over their victims. The analysis in this article draws on two multi-faith datasets: secondary data analysis of 27 semi-structured interviews and primary data collected through an online anonymous survey eliciting 24 qualitative responses, supplemented by 4 follow-up interviews with victim-survivors. Thematic analysis demonstrates the experience and longer-term impact of coercive control on victim-survivors and the barriers to help-seeking, including complicity at familial, community and leadership levels. We articulate their recommendations for change within places of worship and the implications for criminal justice practitioners.
‘We may have bad days . . . that doesn’t make us killers’: How military veterans perceive contemporary British media representations of military and post-military life
Authors: Parry Katy , Pitchford-Hyde Jenna
Published: July 2022

Over the last two decades of long wars in Afghanistan and Iraq, the media’s attention on military veterans in the UK has been characterized by a series of shifts: from a focus on combat operations; to initiatives to support transition to civilian life; and finally to a largely invisible presence of veteran issues in the mediated public sphere. This article presents findings from an online qualitative survey conducted with British veterans in 2020. The authors’ primary focus is on how veterans express their concerns when asked about varied televised representations of military and post-military experience. How did the respondents perceive differences across television genres (drama, news, reality TV), and how did this affect their engagement? How do they see their veteran identity reflected back at them through popular media culture?

There is a growing research interest in ‘veteran studies’ from a range of disciplines, but the relationship between veteran identity and perceptions of (post)-military representations remains largely under-researched, at least in the UK context. One concern is that negative or misleading stereotypes of veterans among publics could hinder their successful reintegration into society, but the authors are interested in how veterans make sense of such representations across popular media culture, how they imagine the ‘general public’ audience in their reflections, and the nature of veteran identity they project within the survey responses. This study finds that anxieties about ‘mad, bad or sad’ stereotypical representations of veterans continue, but the diversity within its findings also reaffirms the importance of not treating veterans as a homogeneous group in research.
The effect of pre-operative shoulder injections on post-operative opioid use, infection and revision following shoulder arthroplasty
Authors: Lemme Nicholas J , Yang Daniel , Lama Christopher , Testa Edward J , Dworkin Myles , Modest Jacob M , Owens Brett D , Daniels Alan H , DeFroda Steven F
Published: July 2022

Background

Treatment of glenohumeral osteoarthritis (GHOA) may include conservative management with use of intraarticular injections, prior to considering total shoulder arthroplasty (TSA). The purpose of this study was to assess trends in the use of preoperative cortisone (CO) and hyaluronic acid (HA) injections, as well as investigate the relationship between injection use and infection or revision arthroplasty following TSA.

Methods

Pearl Driver was used to identify all patients undergoing TSA for GHOA between 2010 and 2018. Patients were categorized based on the type and number of injections they received. Outcomes of interest included post-operative opioid use, post-operative infection, and risk of revision surgery within 1 year of the index procedure.

Results

The incidence of patients receiving a CO or HA injections within 1 year of their TSA decreased by 83% and 54%, respectively. Patients who had received 1 or more steroid injections had higher odds of prolonged opiate use following surgery. Patients that received 1 or 2 CO injection prior to TSA had an increased risk of needing revision surgery.

Discussion

Use of intraarticular injections for the management of GHOA has declined. Patients receiving preoperative injections had increased odds of prolonged opiate use and the need for revision surgery.
Subscapularis management in anatomic total shoulder arthroplasty: A systematic review and network meta-analysis
Authors: Ahmed Abdulaziz F , T Kreulen Randall , Mikula Jacob , Nayar Suresh K , Miller Andrew S , McFarland Edward G , Srikumaran Uma
Published: July 2022

Background

This systematic review and network meta-analysis compare clinical outcomes of three different subscapularis management techniques in anatomic total shoulder arthroplasty: lesser tuberosity osteotomy, subscapularis peel, and subscapularis tenotomy.

Methods

PubMed, Web of Science, Embase, and Cochrane's trial registry were searched in July 2021. Comparative studies and case series evaluating the outcomes of these three techniques were included. The network meta-analysis was performed only on comparative studies.

Results

Twenty-three studies were included. Both lesser tuberosity osteotomy and subscapularis peel had significantly higher Western Ontario Osteoarthritis Scores compared to subscapularis tenotomy, but no difference in American Shoulder and Elbow Society Scores. Subscapularis peel had superior external rotation compared to lesser tuberosity osteotomy. However, no difference was found in external rotation between subscapularis peel and subscapularis tenotomy or between subscapularis tenotomy and lesser tuberosity osteotomy. The overall weighted average for lesser tuberosity osteotomy bony union was 93.6%, whereas the overall weighted average for subscapularis tendon healing was 79.4% and 87% for subscapularis tenotomy and subscapularis peel, respectively.

Discussion

This network meta-analysis demonstrated that lesser tuberosity osteotomy and subscapularis peel were associated with the high union and subscapularis healing rates and may be associated with improved shoulder function and quality of life, compared to subscapularis tenotomy. Lesser tuberosity osteotomy and subscapularis peel demonstrate a trend of superior outcomes compared to subscapularis tenotomy during anatomic total shoulder arthroplasty.
Unstable Rotational Ankle Fractures Treated With Anatomic Mortise Repair and Direct Posterior Malleolus Fixation
Authors: Littlefield Connor P. , Drake Jack H. , Egol Kenneth A.
Published: July 2022

Introduction: The purpose of this study was to evaluate patient outcomes following a standardized algorithmic approach to ankle mortise stabilization, following rotational fracture, utilizing direct repair of the posterior malleolus in the prone position. Methods: Eighty consecutive patients with unstable rotational ankle fractures that involved the posterior malleolus were analyzed. All underwent direct repair of the posterior malleolus regardless of size through a posterolateral approach. Electronic records were retrospectively reviewed for demographic information, initial injury and operation details, healing status, and complications. Preoperative and postoperative radiographs were obtained to assess the initial injury and healing was determined both by radiographic and clinical progress at follow-up visits. Results: Average posterior malleolus fragment width was 8.1 ± 3.7 mm (range = 2.1-19.9 mm) and percentage of the articular surface was 23.6% (range = 7.1%-56.7%) on the lateral radiograph. Overall, 80/80 (100%) patients healed their ankle fractures by a mean 2.9 ± 1.1 months. Only 1 (1.3%) patient required transsyndesmotic fixation following posterior malleolus repair. Mean range of ankle motion was as follows: dorsiflexion 20° ± 10°, plantarflexion 34° ± 10°, inversion 8° ± 4°, and eversion 7° ± 4°. Seventy-nine patients (98.8%) had an anatomic mortise reduction. Nine patients (11.3%) had a superficial wound complication, 3 patients (3.8%) had dysesthesia in the sural nerve distribution, and 1 patient (1.3%) lost reduction of the medial malleolus. Conclusion: Patients who undergo direct repair of the posterior malleolus in the prone position can expect a high rate of healing with superficial wound breakdown being the biggest problem, which was associated with an ankle fracture dislocation. Posterior malleolus fixation may obviate the need of transsyndesmotic stabilization.

Levels of Evidence: Retrospective Level IV
Human mini brains and spinal cords in a dish: Modeling strategies, current challenges, and prospective advances
Authors: Kofman Simeon , Mohan Neha , Sun Xiaohuan , Ibric Larisa , Piermarini Emanuela , Qiang Liang
Published: July 2022

Engineered three-dimensional (3D) in vitro and ex vivo neural tissues, also known as “mini brains and spinal cords in a dish,” can be derived from different types of human stem cells via several differentiation protocols. In general, human mini brains are micro-scale physiological systems consisting of mixed populations of neural progenitor cells, glial cells, and neurons that may represent key features of human brain anatomy and function. To date, these specialized 3D tissue structures can be characterized into spheroids, organoids, assembloids, organ-on-a-chip and their various combinations based on generation procedures and cellular components. These 3D CNS models incorporate complex cell-cell interactions and play an essential role in bridging the gap between two-dimensional human neuroglial cultures and animal models. Indeed, they provide an innovative platform for disease modeling and therapeutic cell replacement, especially shedding light on the potential to realize personalized medicine for neurological disorders when combined with the revolutionary human induced pluripotent stem cell technology. In this review, we highlight human 3D CNS models developed from a variety of experimental strategies, emphasize their advances and remaining challenges, evaluate their state-of-the-art applications in recapitulating crucial phenotypic aspects of many CNS diseases, and discuss the role of contemporary technologies in the prospective improvement of their composition, consistency, complexity, and maturation.
Medical students’ intention to integrate digital health into their medical practice: A pre-peri COVID-19 survey study in Canada
Authors: Paré Guy , Raymond Louis , Pomey Marie-Pascale , Grégoire Geneviève , Castonguay Alexandre , Ouimet Antoine Grenier
Published: July 2022

Objective

We aimed to explore the factors that influence medical students’ intention to integrate dHealth technologies in their practice and analyze the influence of the COVID-19 pandemic on their perceptions and intention.

Methods

We conducted a two-phased survey study at the University of Montreal's medical school in Canada. The study population consisted of 1367 medical students. The survey questionnaire was administered in two phases, that is, an initial survey (t0) in February 2020, before the Covid-19 pandemic, and a replication survey (t1) in January 2021, during the pandemic. Component-based structural equation modeling (SEM) was used to test seven research hypotheses.

Results

A total of 184 students responded to the survey at t0 (13%), whereas 138 responded to the survey at t1 (10%). Findings reveal that students, especially those who are in their preclinical years, had little occasion to experiment with dHealth technologies during their degree. This lack of exposure may explain why a vast majority felt that dHealth should be integrated into medical education. Most respondents declared an intention to integrate dHealth, including AI-based tools, into their future medical practice. One of the most salient differences observed between t0 and t1 brings telemedicine to the forefront of medical education. SEM results confirm the explanatory power of the proposed research model.

Conclusions

The present study unveils the specific dHealth technologies that could be integrated into existing medical curricula. Formal training would increase students’ competencies with these technologies which, in turn, could ease their adoption and effective use in their practice.
From Paragon to Peer: China's Shifting Perspective on German Education
Authors: Chen (陈洪捷) Hongjie
Published: July 2022

Highlights

Around 2000, China's view of German education began to change. The seemingly insurmountable education gap between the two countries began to close. China began viewing its education system as being equal to that of Germany. China still regards Germany as a role model and will continue using it as a reference.
Effect of Time After Injury on Tibiofemoral Joint Kinematics in Anterior Cruciate Ligament–Deficient Knees During Gait
Authors: Li Changzhao , Lin Yulin , Kernkamp Willem A. , Xia Hong , Lin Zefeng
Published: July 2022

Background:

Anterior cruciate ligament (ACL) injury can lead to changes in tibiofemoral kinematics during gait, but the detailed short-term kinematic changes after ACL injury are still unknown.

Purpose:

To measure tibiofemoral kinematics during gait in ACL-deficient (ACLD) knees over time after ACL injury.

Study Design:

Controlled laboratory study.

Methods:

The authors categorized 76 patients with unilateral ACLD knees into 4 groups based on the time from injury: <3 months (group 1), 3 to 6 months (group 2), >6 to 12 months (group 3), and >12 months (group 4). The controls were 20 participants with ACL-intact knees. Changes in the knee kinematics and range of motion during gait were compared among ACLD groups and those with ACL-intact knees.

Results:

Compared with controls, the range of motion of flexion in group 1 was significantly lower (6°; P = .033), and the mean knee flexion was significantly increased (0.7°-3.4°) in groups 1 to 4 (all P ≤ .004). There was more internal tibial rotation (2.9°-4.3°) in group 1 and 2, and more anterior tibial translation (4.3 mm) in group 1 during the stance or swing phases than in controls ( P ≤ .049 for all). The mean internal tibial rotation and anterior tibial translation significantly decreased from group 1 to group 4 ( P < .001 for both). Compared with controls, the mean medial tibial translation was significantly greater (1.2-2.5 mm) in all groups, and more medial tibial translations (2.4-3.7 mm) were observed during the stance phase in groups 1, 3, and 4 ( P ≤ .047 for all).

Conclusion:

ACLD knees displayed a motion impairment walking strategy within 3 months, and a higher-flexion walking strategy increased with time after injury. Excessive anterior translation and internal rotation of the tibia tended to return to normal, while excessive medial translation of the tibia increased in ACLD knees after 6 months postinjury. These results may provide new insight into the compensatory mechanisms and risk factors for premature osteoarthritis in ACLD knees.
Treatment times, functional outcome, and hemorrhage rates after switching to tenecteplase for stroke thrombolysis: Insights from the TETRIS registry
Authors: Gerschenfeld Gaspard , Liegey Jean-Sébastien , Laborne François-Xavier , Yger Marion , Lyon Victoire , Checkouri Thomas , Tricard-Dessagne Bertille , Marnat Gaultier , Clarençon Frédéric , Chausson Nicolas , Turc Guillaume , Sibon Igor , Alamowitch Sonia , Olindo Stéphane
Published: July 2022

Introduction:

The encouraging efficacy and safety data on intravenous thrombolysis with tenecteplase in ischemic stroke and its practical advantages motivated our centers to switch from alteplase to tenecteplase. We report its impact on treatment times and clinical outcomes.

Methods:

We retrospectively analyzed clinical and procedural data of patients treated with alteplase or tenecteplase in a comprehensive (CSC) and a primary stroke center (PSC), which transitioned respectively in 2019 and 2018. Tenecteplase enabled in-imaging thrombolysis in the CSC. The main outcomes were the imaging-to-thrombolysis and thrombolysis-to-puncture times. We assessed the association of tenecteplase with 3-month functional independence and parenchymal hemorrhage (PH) with multivariable logistic models.

Results:

We included 795 patients, 387 (48.7%) received alteplase and 408 (51.3%) tenecteplase. Both groups (tenecteplase vs alteplase) were similar in terms of age (75 vs 76 years), baseline NIHSS score (7 vs 7.5) and proportion of patients treated with mechanical thrombectomy (24.1% vs 27.5%). Tenecteplase patients had shorter imaging-to-thrombolysis times (27 vs 36 min, p < 0.0001) mainly driven by patients treated in the CSC (22 vs 38 min, p < 0.001). In the PSC, tenecteplase patients had shorter thrombolysis-to-puncture times (84 vs 95 min, p = 0.02), reflecting faster interhospital transfer for MT. 3-month functional independence rate was higher in the tenecteplase group (62.8% vs 53.4%, p < 0.01). In the multivariable analysis, tenecteplase was significantly associated with functional independence (ORa 1.68, 95% CI 1.15–2.48, p < 0.01), but not with PH (ORa 0.68, 95% CI 0.41–1.12, p = 0.13).

Conclusion:

Switch from alteplase to tenecteplase reduced process times and may improve functional outcome, with similar safety profile.
Lively water infrastructure: Constructed wetlands in more-than-human waterscapes
Authors: Hurst Elliot , Ellis Rowan , Karippal Anu Babu
Published: July 2022

Water infrastructures are often living infrastructures, whose operation relies on processes involving other-than-human living beings. This article considers the materiality of waterscapes by attending to this liveliness. We argue that critical water research can benefit from situating social relations and water transformations within more-than-human worlds. Our conceptual framework brings hydrosocial scholarship into conversation with more-than-human geography. This opens avenues for interdisciplinary water research that weaves together ecology and qualitative social research. The analytical potential of such a framework is explored through an empirical account grounded in two constructed wetland projects in rural India. These infrastructural assemblages engage humans, other living beings and objects in webs of material-semiotic processes. We present three stories of intra-action that focus on particular plants, microbes and animals within these waterscapes. Our analysis highlights the crucial importance of other-than-human living beings in the production of waterscape knowledge and suggests a need to go beyond the problematisation of ‘uneven’ waterscapes. Approaching waterscapes as more-than-human collectives prompts us to consider the power relations that underpin waterscape knowledge and the politics of multispecies justice. A focus on more-than-human infrastructures opens up the possibility of interdisciplinary water research that is better attuned to the hybrid nature of social and ecological processes, as well as the politics embedded therein.
Safety and feasibility of neoadjuvant chemotherapy as a surgical bridge for acute left-sided malignant colorectal obstruction: a retrospective study
Authors: Zhang Jiawei , Deng Jiaxin , Hu Jiancong , Zhong Qinghua , Li Juan , Su Mingli , Liu Wei , Lv Miwei , Xu Tian , Lin Dezheng , Guo Xuefeng
Published: July 2022

Background

For colorectal cancer, preoperative (neoadjuvant) chemotherapy is more effective than postoperative chemotherapy because it not only eradicates micrometastases more effectively but also reduces the risk of incomplete intraoperative resection and tumor cell shedding. For the treatment of acute left-sided malignant colorectal obstruction, colorectal stents as well as stoma are being used to relieve the obstructive colorectal cancer, and as a bridge to surgery, allowing easy mobilization and resection of the colon. Neoadjuvant chemotherapy combined with self-expandable metal stents (SEMS) or neoadjuvant chemotherapy combined with decompressing stoma (DS) can be used as a bridge to elective surgery (BTS) as an alternative to emergency surgery in patients with acute left-sided malignant colorectal obstruction, but its benefit is uncertain. The purpose of this study was to evaluate the safety and feasibility of neoadjuvant chemotherapy as a bridge to surgery in the treatment of acute left-sided malignant colorectal obstruction.

Methods

Data from patients who were admitted with acute left-sided malignant colorectal obstruction between January 2012 and December 2020 were retrospectively reviewed, and patients with gastrointestinal perforation or peritonitis were excluded. We performed one-to-two propensity score matching to compare the stoma requirement, postoperative complications, and other short-term oncological outcomes between the neoadjuvant chemotherapy group and surgery group.

Results

There were no differences in intraoperative blood loss, operative time, one-year postoperative mortality, and postoperative tumor markers between the two groups. The 1-year recurrence-free survival (RFS) rates of neoadjuvant chemotherapy group and surgery group were 96.8 and 91.3% (p = 0.562). The neoadjuvant chemotherapy group was able to reduce stoma rate 1 year after surgery (p = 0.047). Besides, the neoadjuvant group significantly reduced postoperative bowel function time (p < 0.001), postoperative hospital stay (p < 0.001), total hospital stay (p = 0.002), postoperative complications (p = 0.017), reduction in need to stay in the intensive care unit (ICU) (p = 0.042).

Conclusions

Neoadjuvant chemotherapy as a bridge to elective surgery in patients with acute left-sided malignant colorectal obstruction is safe and has many advantages. Prospective multicenter studies with large samples are needed to further evaluate the feasibility of neoadjuvant chemotherapy.
Determinants of accident and emergency attendances and emergency admissions in infants: birth cohort study
Authors: Nath Selina , Zylbersztejn Ania , Viner Russell M. , Cortina-Borja Mario , Lewis Kate Marie , Wijlaars Linda P. M. M. , Hardelid Pia
Published: July 2022

Background

There is limited understanding of the drivers of increasing infant accident and emergency (A&E) attendances and emergency hospital admissions across England. We examine variations in use of emergency hospital services among infants by local areas in England and investigate the extent to which infant and socio-economic factors explain these variations.

Methods

Birth cohort study using linked administrative Hospital Episode Statistics data in England. Singleton live births between 1-April-2012 and 31-March-2019 were followed up for 1 year; from 1-April-2013 (from the discharge date of their birth admission) until their first birthday, death or 31-March-2019.

Mixed effects negative binomial models were used to calculate incidence rate ratios for A&E attendances and emergency admissions and mixed effects logistic regression models estimated odds ratio of conversion (the proportion of infants subsequently admitted after attending A&E). Models were adjusted for individual-level factors and included a random effect for local authority (LA).

Results

The cohort comprised 3,665,414 births in 150 English LAs. Rates of A&E attendances and emergency admissions were highest amongst: infants born < 32 weeks gestation; with presence of congenital anomaly; and to mothers < 20-years-old. Area-level deprivation was positively associated with A&E attendance rates, but not associated with conversion probability. A&E attendance rates were highest in the North East (916 per 1000 child-years, 95%CI: 911 to 921) and London (876 per 1000, 95%CI: 874 to 879), yet London had the lowest emergency admission rates (232 per 1000, 95%CI: 231 to 234) and conversion probability (25% vs 39% in South West). Adjusting for individual-level factors did not significantly affect variability in A&E attendance and emergency admission rates by local authority.

Conclusions

Drivers of A&E attendances and emergency admissions include individual-level factors such being born premature, with congenital anomaly and from socio-economically disadvantaged young parent families. Support for such vulnerable infants and families should be provided alongside preventative health care in primary and community care settings. The impact of these services requires further investigation. Substantial geographical variations in rates were not explained by individual-level factors. This suggests more detailed understanding of local and underlying service-level factors would provide targets for further research on mechanisms and policy priority.