bluuebunny/crossref_metadata_2025 huggingface dataset:
Increasing expertise to a novel script modulates the visual N1 ERP in healthy adults
Authors: Brem Silvia , Hunkeler Eliane , Mächler Markus , Kronschnabel Jens , Karipidis Iliana Irini , Pleisch Georgette , Brandeis Daniel
Published: September 2017

Neural tuning to print develops when children learn to read and is reflected by a more pronounced left occipito-temporal negativity to orthographic stimuli as compared to non-orthographic false fonts or symbols after around 150–250 ms in their N1, a visual event-related potential (ERP). In adults, initial expertise for a novel script can emerge in less than 2 hours through repeated exposure or training. Here, we aimed to assess changes in the visual N1 related to the process of learning associations between unknown written characters and familiar, spoken syllables or words. Thirty-two healthy literate adults learned to associate a set of foreign characters with either syllables or German words within a single experimental session. EEG was recorded during a visual one-back character repetition detection task in which trained characters, untrained characters and familiar letters were presented before and after the training. A bilateral occipito-temporal increase in the N1 negativity with training was only found for the newly learned characters, but not for the control characters. In conclusion, the present data indicate that expertise to novel characters can be induced by a short character–sound association training and is reflected by a bilateral modulation of the visual N1 amplitude. However, no differentiation was found regarding the comparison of word or syllable training, indicating that the visual N1 most likely reflects gaining expertise driven by phonological associations common to both training types.
“A jungle that is continually encroaching”: The time of disaster management
Authors: Hu Cameron
Published: September 2017

This essay examines the temporal logics of contemporary disaster management. I discuss episodes from the expansion of the global disaster management complex—in the United States after WWII, and in Indonesia after the New Order—to characterize the form of futurity established through the technocratic administration of systematically-envisioned catastrophe. Disaster management projects a shallow future whose indeterminacy does not stimulate aspiration toward transcendence of the given, but rather motivates an endless procedural loop of anticipation and pre-emption in order to delay the destruction of the present order. Disaster management thus refashions “action” as the postponement of the future, and in doing so explicates a basic but neglected temporality of liberalism—that of vigilance toward continually-renewed danger.
Living and dying with advanced dementia: A prospective cohort study of symptoms, service use and care at the end of life
Authors: Sampson Elizabeth L , Candy Bridget , Davis Sarah , Gola Anna Buylova , Harrington Jane , King Michael , Kupeli Nuriye , Leavey Gerry , Moore Kirsten , Nazareth Irwin , Omar Rumana Z , Vickerstaff Victoria , Jones Louise
Published: September 2017

Background:

Increasing number of people are dying with advanced dementia. Comfort and quality of life are key goals of care.

Aims:

To describe (1) physical and psychological symptoms, (2) health and social care service utilisation and (3) care at end of life in people with advanced dementia.

Design:

9-month prospective cohort study.

Setting and participants:

Greater London, England, people with advanced dementia (Functional Assessment Staging Scale 6e and above) from 14 nursing homes or their own homes.

Main outcome measures:

At study entry and monthly: prescriptions, Charlson Comorbidity Index, pressure sore risk/severity (Waterlow Scale/Stirling Scale, respectively), acute medical events, pain (Pain Assessment in Advanced Dementia), neuropsychiatric symptoms (Neuropsychiatric Inventory), quality of life (Quality of Life in Late-Stage Dementia Scale), resource use (Resource Utilization in Dementia Questionnaire and Client Services Receipt Inventory), presence/type of advance care plans, interventions, mortality, place of death and comfort (Symptom Management at End of Life in Dementia Scale).

Results:

Of 159 potential participants, 85 were recruited (62% alive at end of follow-up). Pain (11% at rest, 61% on movement) and significant agitation (54%) were common and persistent. Aspiration, dyspnoea, septicaemia and pneumonia were more frequent in those who died. In total, 76% had ‘do not resuscitate’ statements, less than 40% advance care plans. Most received primary care visits, there was little input from geriatrics or mental health but contact with emergency paramedics was common.

Conclusion:

People with advanced dementia lived with distressing symptoms. Service provision was not tailored to their needs. Longitudinal multidisciplinary input could optimise symptom control and quality of life.
The Springfield Project service: evaluation of a Solihull Approach course for foster carers
Authors: Madigan Sarah , Paton Kate , Mackett Naomi
Published: September 2017

Many young people in care have experienced trauma. The emotional and behavioural issues that often ensue, along with foster carers’ varying levels of confidence and skills, are cited as the main reasons for placement disruption. Placement breakdown can represent a further trauma for young people and is also highly costly for local authorities. The need for interventions to develop foster carers’ competence and confidence in understanding and managing foster children’s behaviour is therefore significant. The Solihull Approach (SA) promotes the parent and child relationship by emphasising the need for emotional containment and a reciprocal relationship so as to form a framework for thinking about, understanding and effectively managing behaviour. The ‘Solihull Approach course for foster carers: understanding your foster child’s behaviour’ is a 12-week programme tailored to the demands of this task. It has been run within the Springfield Project in Fife, Scotland for the past four years. In the reported study 83 participants completed evaluation forms. A thematic analysis of their replies revealed that the most important things learned were: taking a step back; understanding the effects of trauma; reciprocity; communication and play; containment (of my child); understanding my child; and the ability to offload when full up. The course helped participants to better understand their foster child by clarifying the nature of the relationship and their role, understanding the impact of the child’s early experiences and appreciating that she or he is not to blame. Participants took from the course: increased understanding; being part of the group; staying calm and thinking before they act; feeling more confident; and looking after themselves and seeking containment. Pre- and post-Child Behaviour Checklist (CBCL) questionnaires were collected from 34 carers with children in the six to 18 age group and 13 looking after children aged one-and-a-half to five years. Paired samples t-tests revealed no statistically significant difference in pre- and post-scores in either the six- to 18-year-olds (t(33) = 1.6, p = 0.114) or the one-and-a-half- to five-year-olds (t(12) = 2, p = 0.069). Possible reasons for this and its implications are explored. However, the identified qualitative themes suggest that the aims of the training are being met. There was a strong overall sense that foster carers found the course helpful and informative, suggesting that it could represent a valuable intervention for promoting placement security.
Experimental study of a ducted contra-rotating lift fan for vertical/short takeoff and landing unmanned aerial vehicle application
Authors: Deng Shuanghou , Ren Zongliang
Published: September 2017

This study explores the aerodynamic characteristics of a ducted contra-rotating lift fan for vertical/short takeoff and landing application by means of force, pressure, and flow field measurements. The effect of rotating frequency and contra-locomotion on the force generation was examined using a miniature six-component force sensor. Additionally, for the sake of considering the ground effect, the flow field at the exit was investigated using high-response pressure measurement. Results revealed that the lift shows a quadratic generation trend on increasing the r/min where the inherent unsteady flow contradicts the conventional quasi-steady model of propeller. The contra-rotating mechanism can significantly augment the lift while still being lower than double single rotors. The unsteadiness of the contra-rotating rotors is quite obvious where two high-pressure regions are revealed and rotate. When the lift fan approaches the ground, the lift will be augmented significantly due to the surplus of the wake jet.
Brief manual-based single-session Motivational Interviewing for reducing high-risk sexual behaviour in women – an evaluation
Authors: Boman Jens , Lindqvist Helena , Forsberg Lars , Janlert Urban , Granåsen Gabriel , Nylander Elisabet
Published: September 2017

The objective of this study was to develop and evaluate brief Motivational Interviewing (MI) to facilitate behaviour change in women at high risk of contracting sexually transmitted infections (STIs). One hundred and seventy-three women (mean age 24.7) at high risk of contracting STIs were randomized to a brief risk-reducing MI counselling intervention (n = 74) or assigned to the control group (n = 99). MI skill was assessed using the Motivational Interviewing Treatment Integrity (MITI) Coding System. Seventeen of 74 (23%) women tested for Chlamydia trachomatis (CT) in the MI intervention group and 22 of 99 (22%) in the control group had a genital CT infection 0–24 months before baseline. All additional CT testing was monitored up to 24 months for all 173 women in the study. None of the 49 CT-retested women in the MI group was CT infected, as compared to 3 of 72 (4%) women in the control group. A generalized estimating equations model with sexual high-risk behaviour measured at baseline and at six-month follow-up produced an adjusted estimated odds ratio of 0.38 (95% confidence interval = 0.158, 0.909), indicating efficacy. Brief manual-based single-session MI counselling seems to be effective in reducing high-risk sexual behaviour in women at high risk of acquiring STIs.
The impact of debt and financial stress on health in Northern Irish households
Authors: French Declan , McKillop Donal
Published: September 2017

We analyse data collected from a survey of Northern Irish low-income households experiencing varying degrees of financial hardship and examine how debt affects health and health-related behaviours. Our results indicate that the subjective experience of feeling financially stressed has a robust relationship with most aspects of health, including ability to self-care, problems performing usual activities, pain problems and psychological health. In contrast, the size of the debt, the type of debt or the number of different lenders does not add any extra explanatory power. Additionally, our results indicate that the pathway from financial difficulties to worse health runs through worse diets and increased consumption of cigarettes and drugs. This research is timely as household debt burdens will soon surpass the high levels seen at the time of the financial crisis and the introduction of welfare reform in Northern Ireland will put additional strain on low-income households.
Big Data: A case study of disruption and government power
Authors: Galloway Kate
Published: September 2017

Although it is part of core government business to collect information about its citizens, ‘big data’ has increased the scale, speed and complexity of data collection and use to such an extent that it is arguably qualitatively different from the record-keeping that has gone before it. Big data represents a radical shift in the balance of power between State and citizen. This article argues that embedding big data in government operations masks its deployment as enhancing government power, rather than simply facilitating execution of government activities. In other words, big data is ‘disruptive’ technology that calls for the examination of the limits of government power. To illustrate this argument, this article examines a selection of recent case studies of attempts by the Australian government to deploy big data as a tool of governance. It identifies the risk to the citizen inherent in the use of big data, to justify review of the bounds of government power in the face of rapid technological change.
Contract cheating: Will students pay for serious criminal consequences?
Authors: Steel Alex
Published: September 2017

There are increasing reports of university students contracting with third parties to write their essays and assignments. While getting caught is likely to mean the student faces disciplinary action within the university, the students and those offering the service may also be exposing themselves to criminal prosecution. This article looks at the range of offences that students and the contract cheating services could be committing – including fraud, forgery and conspiracy. The article also recommends specific statutory offences be introduced. Far from an entrepreneurial innovation, the activities can be construed as serious crimes.
Serotonin Syndrome Complicating Treatment of Ifosfamide Neurotoxicity With Methylene Blue
Authors: Snyder Matthew , Gangadhara Suhas , Brohl Andrew S. , Ludlow Steven , Nanjappa Sowmya
Published: September 2017

Methylene blue is a widely used treatment for ifosfamide neurotoxicity. We present a case of severe encephalopathy complicating ifosfamide-based therapy for recurrent retroperitoneal leiomyosarcoma. After treatment with methylene blue, the patient experienced clinical decompensation and was diagnosed with serotonin syndrome based on a constellation of clinical findings. Withdrawal of methylene blue and other serotonergic medications led to clinical stabilization and ultimately neurological recovery. Our case highlights the challenge of diagnosing serotonin syndrome in the face of preexisting ifosfamide neurotoxicity, as there is significant clinical overlap between these 2 syndromes. Practitioners must remain vigilant of this potential life-threatening complication in this vulnerable population.
Technology: The Dark Side of Using Technology
Authors: Siegle Del
Published: September 2017

Technology offers gifted children opportunities to explore advanced content and express their creativity. However, parents and educators must guide gifted children to avoid negative consequences of technology such as plagiarism, cyberbullying, viewing inappropriate content, and technology addiction.
Child Sexual Abuse Prevention Opportunities: Parenting, Programs, and the Reduction of Risk
Authors: Rudolph Julia , Zimmer-Gembeck Melanie J. , Shanley Dianne C. , Hawkins Russell
Published: September 2017

To date, child sexual abuse (CSA) prevention has relied largely on child-focused education, teaching children how to identify, avoid, and disclose sexual abuse. The purpose of this article is to explore how prevention opportunities can include parents in new and innovative ways. We propose that parents can play a significant role as protectors of their children via two pathways: (i) directly, through the strong external barriers afforded by parent supervision, monitoring, and involvement; and (ii) indirectly, by promoting their children’s self-efficacy, competence, well-being, and self-esteem, which the balance of evidence suggests will help them become less likely targets for abuse and more able to respond appropriately and disclose abuse if it occurs. In this article, we first describe why teaching young children about CSA protective behaviors might not be sufficient for prevention. We then narratively review the existing research on parents and prevention and the parenting and family circumstances that may increase a child’s risk of experiencing sexual abuse. Finally, we make a number of recommendations for future approaches to prevention that may better inform and involve parents and other adult protectors in preventing CSA.
Karen Barad’s Quantum Ontology and Posthuman Ethics: Rethinking the Concept of Relationality
Authors: de Freitas Elizabeth
Published: September 2017

This article focuses on Karen Barad’s quantum ontology and her attempts to reformulate the concept of relationality. The aim is to show how Barad’s work articulates a new kind of empiricism for the social sciences, by reclaiming the creative and speculative force of experimental practice and by recentering the philosophical problem as a source of inquiry. Relationality is redefined through discussions of diffractive apparatus, more-than-human performativity, and the “polymorphous perversity” of the matter-meaning mixture.
Executive Functions and Attachment Relationships in Children With ADHD: Links to Externalizing/Internalizing Problems, Social Skills, and Negative Mood Regulation
Authors: Al-Yagon Michal , Forte Dovrat , Avrahami Lital
Published: September 2017

Objective: Theoretical models suggest multiple underlying pathways for ADHD and multiple risk factors’ co-occurrence as impairing this population’s affective, interpersonal, and behavioral adjustment. After comparing groups’ executive functioning (EF) difficulties and attachment security with each parent, this study primarily aimed to examine four risk factors (ADHD, child-father attachment, child-mother attachment, EF) as possibly explaining children’s socioemotional/behavioral measures (externalizing/internalizing behavior, social skills, negative mood regulation). Method: Participants were 100 children in Grades 5-6 (ages 11-12 years; M=11.45 years, SD=.50): 50 with formally diagnosed ADHD, and 50 with typical development (TD). Instruments were children’s self-report measures and teachers’ evaluation. Results: Significant group differences emerged on all EF measures and attachment relationships, and most socioemotional/behavioral measures. Findings demonstrated the significant contribution of children’s ADHD, parental attachments, and, partially, EF difficulties in explaining children’s socioemotional/behavioral adjustment. Conclusion: Children with ADHD, compared to children with TD, reported significantly larger EF deficits and a significantly higher incidence of insecure attachment to the father as well as a lower sense of trust and closeness to the mother. Outcomes highlighted the role of children’s four risk factors (ADHD, child-father attachment, child-mother attachment, EF) in explaining their socioemotional/behavioral adjustment. The EF deficits contributed only to intrapersonal maladjustment.
Evaluation of incubation time for Microsporum canis dermatophyte cultures
Authors: Stuntebeck Rebecca , Moriello Karen A , Verbrugge Maria
Published: September 2017

Objectives

The goal of this study was to determine how frequently Microsporum canis was isolated after 1, 2 and 3 weeks of incubation on dermatophyte culture medium either from untreated cats or cats during treatment.

Methods

This was an observational retrospective study. Toothbrush fungal culture results were examined from two data pools: untreated cats with suspect skin lesions and weekly fungal cultures from cats being treated for dermatophytosis.

Results

Results from 13,772 fungal cultures were reviewed and 2876 (20.9%) were positive for M canis. Of these, 2800 were confirmed as positive within 14 days of incubation and only 76 (2.6%) required >14 days for confirmation of M canis. In pretreatment specimens, 98.2% (1057/1076) of M canis isolates were recovered within 14 days of incubation in specimens from cats not known to have received prior antifungal treatment. For cats receiving treatment, 96.8% (1743/1800) of M canis isolates were recovered within 14 days of incubation. Of the 57 cultures that required >14 days for finalization, 21 required extra incubation time because cultures were grossly abnormal, 12 had concurrent contaminant growth delaying microscopic confirmation and 24 had no growth in the first 14 days. Of these 24, 19 had 1–2 colony-forming units (cfu)/plate and the remaining five plates had 5 to >10 cfu/plate, all with abnormal morphology.

Conclusions and relevance

The findings of this study show that it is not necessary to hold pretreatment or post-treatment fungal cultures for 21 days before finalizing cultures for no growth. Growth requiring >14 days had grossly abnormal morphology.
Treatment With Tafamidis Slows Disease Progression in Early-Stage Transthyretin Cardiomyopathy
Authors: Sultan Marla B , Gundapaneni Balarama , Schumacher Jennifer , Schwartz Jeffrey H
Published: September 2017

Background:

Transthyretin cardiomyopathy (TTR-CM) is a progressive, fatal disease caused by the accumulation of misfolded transthyretin (TTR) amyloid fibrils in the heart. Tafamidis is a kinetic stabilizer of TTR that inhibits misfolding and amyloid formation.

Methods:

In this post hoc analysis, data from an observational study (Transthyretin Amyloidosis Cardiac Study; n = 29) were compared with an open-label study of tafamidis in patients with TTR-CM (Fx1B-201; n = 35). To ensure comparable baseline disease severity, patients with New York Heart Association (NYHA) functional classification ≥III were excluded in this time-to-mortality analysis.

Results:

Patients with either wild-type or Val122Ile genotypes treated with tafamidis have a significantly longer time to death compared with untreated patients ( P = .0004). Similar results were obtained when limiting the analysis to wild-type patients only, without restricting NYHA functional classification ( P = .0262).

Conclusions:

These results support earlier conclusions suggesting that tafamidis slows disease progression compared with no treatment outside of standard of care and warrant further investigation.

Trial Registration:

ClinicalTrials.gov, NCT00694161.
Taking out the garbage: Migrant women’s unseen environmental work
Authors: Bonatti Valeria
Published: September 2017

In recent years, feminist scholars have criticized various European governments for placing the burden of environmentalist practices on women’s unpaid work. While denouncing how environmentalist regimes reinforce gender inequalities, this literature has overlooked migrant domestic workers’ contributions to sustainable practices, such as managing household recyclables and waste. This article addresses the intersection of gender, race and immigration in urban recycling schemes in the city of Naples, Italy, a growing destination for labor migrants and an area with a long history of waste management crises. Through in-depth interviews, the author examines how migrant domestic workers sustain recycling efforts, in their homes and workplaces. These narratives show how precarious immigration and employment statuses push migrant workers to take on burdensome recycling work for their employers. Despite concerns of street harassment and xenophobia, findings further show how contributing to neighborhood recycling efforts are also important ways in which migrant women express their commitment to the local community. These findings broaden existing notions of gender inequalities in environmental governance through an intersectional framework focusing on precarious migrant labor.
Assessing the ideological extremism of American party activists
Authors: Birkhead Nathaniel A , Hershey Marjorie Randon
Published: September 2017

In this article, we investigate whether it is appropriate to generalize about the ideological and demographic characteristics of American party activists. Many studies on party polarization emphasize the role of activists in encouraging the divisions within the parties, and in so doing, commonly treat activists as a homogeneous group. Here, we show that different forms of political activity attract systematically different types of individuals. Similarly, we show that ideological extremism is more strongly associated with some forms of activism than others. Importantly, we find that extremism is most strongly associated with the forms of activity that are most likely to influence elected officials through the provision of resources, information or support in a nomination. Thus, while our findings broadly support the notion that extremists are more engaged than moderates, we challenge the consensus that the various forms of activism are interchangeable.
Investigation on three-directional dynamic interaction between a heavy-duty vehicle and a curved bridge
Authors: Li Shaohua , Ren Jianying
Published: September 2017

Considering the nonlinear property of suspension damping and tire stiffness, a full-vehicle model is built for a heavy-duty truck. A modified preview driver model with nonlinear time delay is inserted into the vehicle model to compute the suitable steering angle of the front wheel and to make the vehicle follow the required route. Next, the finite element model of a five-span continuous curved highway bridge is established, and the bridge’s inherent frequencies and modes are obtained. The curved bridge and the vehicle are coupled by three-directional tire forces, and a three-directional driver–vehicle–bridge interaction model is presented. The presented vehicle model and bridge model are verified by comparing with the published works. The dynamic impact factors of vertical, lateral, and torsional displacements of the bridge are calculated when a vehicle is traversing through the bridge, and the impact factors’ distributions along the bridge are analyzed. The effects of vehicle driving conditions on impact factors are also researched. It is found that the impact factor calculated from the present specification for a straight bridge is smaller than that from the three-directional driver–vehicle–bridge interaction model, and the vertical and torsional impact effects at the third span midpoint are greater than the lateral impact effect.
#refugeesnotwelcome: Anti-refugee discourse on Twitter
Authors: Kreis Ramona
Published: September 2017

In this study, I examine the online discourse of the European refugee crisis on the micro-blogging platform, Twitter. Specifically, I analyze 100 tweets that include #refugeesnotwelcome, and explore how this hashtag is used to express negative feelings, beliefs and ideologies toward refugees and (im)migrants in Europe. Guided by critical discourse studies, I focus on Twitter users’ discursive strategies as well as form and function of semiotic resources and multimodality. Twitter users who include this particular hashtag use a rhetoric of inclusion and exclusion to depict refugees as unwanted, criminal outsiders. These tendencies align with current trends in Europe where nationalist-conservative and xenophobic right-wing groups gain power and establish a socially accepted discourse of racism.
Charcot Collapse: Does Collapse Pattern Dictate Osseous Metabolism?
Authors: Grant Lisa , Yoho Robert , Halaharvi Chandana , Grant William
Published: September 2017

Charcot fracture pattern (FP) and Charcot dislocation pattern (DP) are 2 distinct collapse patterns identified in Charcot neuroarthropathy of the foot and ankle. These patterns are believed to demonstrate relative differences in central bone mineral density (BMD), which has been theoretically extrapolated to describe local BMD. To assess variation in local bone composition of FP and DP patients, 10 patients, 5 DP and 5 FP were recruited. The patient’s age, body mass index (BMI), radiographs, central BMD, local BMD, sRANKL (soluble receptor activator nuclear factor kappa-beta ligand), sRAGE (soluble receptors of advanced glycated end-products), and osteocalcin were measured to determined bone metabolic status and density. Central BMD was determined using DEXA (dual-energy X-ray absorptiometry) scans of the hip. peripheral BMD was determined using scans at the level of the ankle mortise and Chopart’s joint, depending on the location of collapse. These scans were then compared with controls. Central and peripheral DEXA scans were significantly reduced in the FP ( P = .002 and P < .0001) when compared with healthy controls. Additionally, FP patients demonstrated statistically significant elevations in sRANKL ( P = .05) and sRAGE ( P = .002) when compared with DP. No significant difference was seen in osteocalcin ( P = 0.22); however, elevated values compared with normal reference ranges suggest increase bone production. These elevations combined with an osteoporotic profile may indicate difficulty of FP patients in repairing micro fracture. Results from this study emphasize the increased risk of nonunion during FP reconstruction, and highlight the variation in bone composition in these 2 Charcot subtypes.

Levels of Evidence: Level III
Habitual pelvic posture and time spent sitting: Measurement test–retest reliability for the LUMOback device and preliminary evidence for slouched posture in individuals with low back pain
Authors: Takasaki Hiroshi
Published: September 2017

Objectives:

It has been difficult to monitor the pelvic position during actual daily life. However, recent developments in wearable device technologies, such as the LUMOback device, provide the possibility to evaluate habitual pelvic posture and time spent sitting during daily life. The current study aimed (1) to investigate test–retest reliability for habitual pelvic posture and time spent sitting with the LUMOback in individuals with prolonged low back pain (low back pain group) and without low back pain (control group), and (2) to preliminarily investigate differences in those measures between groups.

Methods:

Fifteen individuals in each group wore the LUMOback daily for 2 weeks. Intraclass correlation coefficients were calculated in each group by comparing the mean from the first week with the mean from the second week: (1) for the posture score, which is a proportion of time with neutral posture, and (2) for time spent sitting. The two measures for the first week were compared between the low back pain and control groups.

Results:

The intraclass correlation coefficients for the posture score were .82 in the low back pain group and .91 in the control group. The intraclass correlation coefficients for time spent sitting were .75 in the low back pain group and .85 in the control group. The posture score in the low back pain group (mean ± SD: 37.5% ± 10.3%) was less than that in the control group (49.6% ± 6.0%; p < .001), but there was no difference in time spent sitting between the groups (p > .05).

Conclusions:

The current study found (1) acceptable test–retest reliability for the posture score and time spent sitting evaluated by the LUMOback device, and (2) preliminary evidence of a difference in the posture score, indicating a more slouched lumbopelvic posture in individuals with prolonged low back pain than those without low back pain.
Effect of Hypoalbuminemia on Perioperative Complications and Hospital Outcomes in Ankle Fracture Fixation
Authors: Barber Collin , Chung Andrew , Jones Clifford , Russell George , Karr Sean
Published: September 2017

Category:

Trauma

Introduction/Purpose:

Pre-operative serum albumin levels have routinely been utilized to assess nutritional status. Malnutrition, as defined by serum albumin levels < 3.5 g/dL, has been associated with worse post-operative outcomes in multiple surgical settings. The effect of hypo-albuminemia on 30-day post-operative outcomes after operative fixation of ankle fractures has not been well delineated.

Methods:

Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 1,526 patients who had undergone surgical fixation of ankle fractures were identified using Current Procedural Terminology (CPT) codes. Perioperative complications and length of hospital stay were compared between patients with and without hypoalbuminemia (serum albumin concentration <3.5 g/dL) with adjustment for patient and procedural factors. Complications were divided into major and minor. Major complications included death, myocardial infarction, sepsis, and return to operating room.

Results:

Preoperative diagnosis of hypoalbuminemia was present in 324 patients (21%). Multivariate analysis confirmed hypoalbuminemia as an independent risk factor for major complications following surgical fixation of ankle fractures (2.3% vs 7.7%; odds ratio [OR], 2.35; 95% confidence interval [CI], 1.29 to 4.27; p=0.05). Patients with a preoperative diagnosis of hypoalbuminemia had an increased length of stay (p<0.001) and increased risk of rehospitalization (1.9% vs 7.1%; OR 4.072; 2.03 to 8.19, p<0.001) compared to those with normal albumin levels.

Conclusion:

The presence of hypoalbuminemia upon admission for ankle fracture fixation increases risk of major perioperative complications as well as hospital length of stay. Nutritional optimization of malnourished patients is important in patients undergoing operative fixation of ankle fractures.
Posterior Tibial Tendon Dysfunction
Authors: Bariteau Jason , Robertson Douglas , Carpenter William
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

Stage 1 posterior tibial tendon dysfunction (PTTD) may be present without intra-substance tendon pathology. We hypothesize that in individuals with the clinical diagnosis of Stage 1 PTTD, with no MRI-detectable intra-substance tendon pathology, that sheath fluid amount is a confirmatory finding of PTTD. This purpose of this study was to quantify the amount of PTT sheath fluid in 1) individuals with the clinical diagnosis of Stage 1 PTTD and no MRI-detectable intra-substance tendon pathology and compare to controls with medial ankle pain (causes other) also without MRI-detectable intra-substance PTT pathology, and 2) test if there was a sheath fluid measurement predictive of the clinical diagnosis of PTTD.

Methods:

326 individuals with medial ankle pain, no intra-substance PTT pathology, were studied, 48 with the clinical diagnosis of Stage 1 PTT dysfunction and 278 with medial ankle pain, causes other. Geometric methods defined MRI-based sheath fluid volume, maximum cross-sectional fluid area, and maximum fluid width. Fluid measurements were compared between groups and a predictive measurement calculated to identify individuals with PTTD. Measurement reliability was tested.

Results:

Individuals with PTT dysfunction had larger PTT sheath fluid volume, area, and width than controls (p’s < 0.001). An 9 mm threshold maximum fluid width was associated with PTTD (sensitivity 84%, specificity 85%). Measurements were reliable (p’s <0.03).

Conclusion:

The amount of PTT sheath fluid, in individuals with medial ankle pain and no intra-substance PTT pathology, was associated with Stage 1 PTTD and a maximum PTT sheath fluid width of > 9 mm predicted PTTD. This is clinically significance as MRI-detected sheath fluid can now be used as a confirmatory finding in individuals with the clinical diagnosis of Stage 1 PTTD who do not have MRI-detectable intra-substance pathology
Does Foot Position and Local of Measurement Influence on Ankle Medial Clear Space?
Authors: Baumfeld Tiago , Baumfeld Daniel , Cangussú João , Macedo Benjamim , Silva Thiago , Raduan Fernando , Nery Caio
Published: September 2017

Category:

Ankle, Sports, Trauma

Introduction/Purpose:

The ankle Medial Clear Space (MCS) is frequently used in foot and ankle surgery for determining the competence of the deltoid ligament in Weber B ankle fractures. A widened MCS indicates deltoid ligament incompetence, requiring surgery to prevent lateral talar shift. Controversy still exists regarding Medial Clear Space (MCS) normal and abnormal values, and its possible variation in previously uncontrolled biases. Sex, height, foot position, and type of radiograph were all described as possible influencing factors. The objective of this study was to access how much different degrees of plantar flexion, all performed with and without stress, influence on MCS width.

Methods:

We submitted 30 volunteers to six different anteroposterior non-weight bearing digital radiographs of the ankle in the following positions: neutral, neutral with external rotation stress, physiologic plantar flexion (FPF), physiologic plantar flexion with external rotation stress, maximum plantar flexion (MPF) and maximum plantar flexion with external rotation stress. The medial clear space MCS oblique (MCSo) and perpendicular (MCSp) were measured in all images by an experienced foot and ankle surgeon.

Results:

The data analysis showed with statically significance that the position of the foot does influence in the value of both MCSp and MCSo (p<0,05), regardless of three exceptions. MCSo does not change statistically between FPF with stress and MPF with stress. On the other hand, MCSp did not change in two situations: between FPF and Neutral with stress and between MPF and FPF with stress. It is noteworthy that MCSo, on average, was 15% wider than MCSp in all positions tested. It is also noticeable that, from the neutral position, plantar flexing the ankle has a great impact on MCS than external rotation stress, increasing MCSp by 25% and 22% respectively. MCSo follows the same pattern, with 21% and 17% respectively.

Conclusion:

This study is unique on showing that many different ways of positioning the foot and making stress radiographs do result in completely different MCS values, and that these values differ depending on the anatomical site they are measured. All these data indicates that we need to establish a gold standard for measuring MCS, taking into account patient sex, height, local of measurement of MCS, position of the foot and type of radiograph (AP or Mortise). This study was not able to address all variables that influence directly on MCS and therefore did not intended to establish this new gold standard.
Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement
Authors: Deforth Manja , Krähenbühl Nicola , Zwicky Lukas , Knupp Markus , Hintermann Beat
Published: September 2017

Category:

Ankle

Introduction/Purpose:

A key for success in total ankle replacement is a balanced ankle joint. If the tibial component is misaligned, the ligamentous structures, the malleoli and the tendons may be overused, which, may lead to pain and impairment during gait. A misaligned tibial component can be revised using a corrective bone resection and re-insertion of a new component or using a corrective osteotomy of the distal tibia above the stable implant. The aim of this study was to review a series of patients, in whom a corrective supramalleolar osteotomy was performed to realign a misaligned tibial component in total ankle replacement.

Methods:

Twenty-two patients (nine male; 13 female; mean age, 62.6 years; range, 44.7 – 80.0) were treated with a supramalleolar osteotomy to correct a painful dysbalanced ankle, following a varus implanted tibial component. Following radiological and clinical outcomes were recorded preoperatively and at the follow-up examination within the first 24 months: the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), patient’s pain measured with the Visual Analogue Scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score, range of motion (ROM) of the ankle and patient’s satisfaction. Furthermore, postoperative complications were reviewed.

Results:

The TAS changed on average from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively (p < 0.0001), the AOFAS score increased from 46 ± 14 to 66 ± 16 points (p < .0001) and the VAS pain score decreased from 5.8 ± 1.9 to 3.3 ± 2.4 (p < .001). No statistical difference was found in the TLS and the range of motion. The osteotomy healed in 19 patients (86%), re-osteosynthesis was successful in the remaining three patients. In one of these three patients, a chronic infection of the ankle joint led to a below-knee amputation. Fifteen patients (68%) were (very) satisfied, four (18%) moderately satisfied and three (14 %) patients were not satisfied with the obtained postoperative result.

Conclusion:

The supramalleolar osteotomy was found to be an efficient alternative to correct the misaligned tibial component in total ankle replacement. Pain could be successfully addressed in the majority of the patients. The treatment of a malpositioned, well anchored tibial component with a supramalleolar osteotomy, instead of exchanging the tibial component, allows preservation of the bone stock. However, non-union should be mentioned as a possible complication of this surgery. Nonetheless, this method might be a feasible treatment option, especially for younger patients.
Comparison of Contact and Damage to Anatomic Structures in the Fixation of Zone II Fifth Metatarsal Fractures with an Intramedullary Screw or an Intramedullary Nail
Authors: Garras David , Adams Samuel , Burgess Brian
Published: September 2017

Category:

Sports, Trauma

Introduction/Purpose:

Percutaneous intramedullary screw fixation of Zone II fifth metatarsal fractures has become commonplace. The potential for injury to the important surrounding anatomy has not been well documented, though some authors have reported unexplained postoperative pain and paresthesia over the lateral aspect of the foot despite hardware removal. The purpose of this study was to determine the contact and injury rate of surrounding anatomic structures with either the use of the traditional intramedullary screw (IMS) inserted “high and inside” or a novel intramedullary nail (IMN) inserted “low and outside” through a relative “safe-zone.”

Methods:

Zone II fifth metatarsal fractures were created in ten cadaver matched-pairs using a 1 mm thick saw through a small incision. Fractures were randomized to receive either an IMS or an IMN. The surgical technique was performed in accordance with the manufacturer’s instructions. For the IMS group, the guide pin was inserted percutaneously according to the “high and inside” starting point on the base of the fifth metatarsal using fluoroscopy; followed by insertion of the 3.5 mm drill, tissue protector, tap, and screw. For the IMN group, the guide pin was inserted percutaneously “low and outside,” positioned slightly medial and dorsal to the tip of the tuberosity of the fifth metatarsal; followed by the 5.2 mm reamer, tissue protector, and IMN. Dissection was performed to identify damage or contact to the peroneus brevis tendon (PB), peroneus longus tendon (PL), sural nerve (SN), lateral insertion of the plantar fascia (PF) and cuboid-fifth metatarsal jointspace.

Results:

There were significantly more episodes of PB injury, PL contact, SN contact, and presence in the cuboid-fifth metatarsal jointspace for the IMS group. There were significantly more episodes of contact of the PF with the IMN group but no episodes of damage. The results are summarized in Table 1. Images of contact and damage are shown in Figure 1. Fluoroscopic images of the IMN inserted through the “low and outside” position are shown in Figure 2.

Conclusion:

We have demonstrated significant contact and injury to surrounding structures with the placement of a “high and inside” IMS for the fixation of Zone II fifth metatarsal fractures. We believe there is a relative safe zone at the “low and outside” position that affords less potential damage to the important surrounding structures. Consideration should be given to the development of implants inserted through the relative safe zone.
The Value of Motion
Authors: Hamid Kamran , Dekker Travis , Easley Mark , Nunley James , Adams Samuel
Published: September 2017

Category:

Ankle, Ankle Arthritis

Introduction/Purpose:

The onus has been placed on surgeons to prove the value of procedures to patients, payers, policymakers and other key stakeholders. Demonstration of patient reported outcome measures (PROMs) constitutes an integral component of success within the context of value-based healthcare. The proposed benefit of total ankle replacement (TAR) over ankle fusion is preserved ankle motion, thus we hypothesized that an increase in range of motion (ROM) is positively correlated with validated PROMs in individuals receiving TAR.

Methods:

Patients undergoing TAR at a single academic medical center between 2007-2013 were evaluated in this study. In addition to a minimum of two-year follow-up, complete preoperative and postoperative outcome measures for the Foot and Ankle Disability Index (FADI), Short Musculoskeletal Function Assessment (SMFA) Bother and Function Indices, Visual Analog Scale (VAS) and 36-Item Short Form Health Survey (SF-36) were requisite for inclusion. Standardized weightbearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained and previously described ankle and foot measurements were performed to determine ankle ROM.

Results:

Eighty-eight patients met inclusion criteria (33 INBONE, 18 Salto-Talaris, 37 STAR). Mean time to final ROM radiographs was 43.8 months (range: 24-89 months). All aforementioned PROMs improved between preoperative evaluation and most recent follow-up (p<0.01). Final ankle ROM was significantly correlated with postoperative FADI, SF-36 Mental Component Summary (MCS), SMFA Bother and Function Indices, and VAS. Additionally, dorsiflexion was positively associated with FADI, SF-36 MCS and SMFA Function (p<0.05) but plantarflexion had no such influence on outcomes. No differences were identified with subset stratification by prosthesis type, fixed versus mobile-bearing design or etiology.

Conclusion:

In this TAR cohort with prospectively collected outcomes data, radiographic sagittal plane ankle motion was positively correlated with multiple PROMs. Disease-specific and generic health-related quality of life PROMs demonstrated improvement postoperatively in all domains. TAR is a viable option for patients with end-stage ankle arthritis and increased ROM is associated with improved patient-centric metrics.
CT Arthrography Visualizes Joint Regeneration after Microfracture of OLT
Authors: Lee Dong-Oh , Jung Hong-Geun , Sun Mao Yuan , Kang Hwa Jun
Published: September 2017

Category:

Ankle, Arthroscopy, Sports

Introduction/Purpose:

Little is known about arthroscopic or radiographic outcome after arthroscopic microfracture for osteochondral lesions of the talus (OLTs). The purpose of this study was to investigate tissue growth after arthroscopic microfracture for OLT using computed tomography arthrography (CTA) and to correlate this defect filling with clinical outcomes. We hypothesized that the morphology of the repaired tissue would be similar to that of normal anatomy and related to the clinical outcome.

Methods:

Forty-two ankles treated using arthroscopic microfracture for OLT from 2009 to 2014 were monitored. CTA was performed postoperatively at 6 months, 1, and 2 years. The postoperative thickness of the repaired tissue associated with OLT (grade) and the volume of the subchondral cystic lesions were evaluated using CTA. Clinical outcomes, including a pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle functional score, were evaluated and correlated with CTA.

Results:

The proportion of fully grown tissue (grade 3) increased over time; specifically, the rates were 12/40 (33.3%) at postoperative 6 months, 11/18 (61.1%) at 1 year, and 8/10 (80%) at 2 years (p=0.005). VAS pain (p<0.001) and AOFAS scores (p<0.001) also improved at the final follow-up; however, they were not associated with repaired tissue thickness on CTA (p=.409 and .579, respectively).

Conclusion:

Tissue growth after arthroscopic microfracture for OLT was detected in 96% of patients using ankle CTA, with which joint congruency remodeling and subchondral bone formation were well visualized. However, CTA findings were not related to clinical outcomes.