bluuebunny/crossref_metadata_2025 huggingface dataset:
Mediators and Moderators of Active Music Engagement to Reduce Traumatic Stress Symptoms and Improve Well-being in Parents of Young Children With Cancer
Authors: Robb Sheri L. , Stegenga Kristin , Perkins Susan M. , Stump Timothy E. , Moody Karen M. , Henley Amanda K. , MacLean Jessica , Jacob Seethal A. , Delgado David , Haut Paul R.
Published: December 2023

Objective:

This trial examined the effects of proximal/distal mediators and moderators of an Active Music Engagement (AME) intervention on young child/parent distress, quality of life, and family function outcomes.

Methods:

Child/parent dyads (n = 125) were randomized to AME or Audio-storybooks attention control condition. Each group received 3 sessions with a credentialed music therapist for 3 consecutive days with data collection at baseline, post-intervention (T2), and 30-days later (T3). Potential proximal mediators included within session child and parent engagement. Potential distal mediators included changes in perceived family normalcy, parent self-efficacy, and independent use of play materials. Potential moderators included parent/child distress with prior hospitalizations, parent traumatic stress screener (PCL-6), and child age. Outcomes included child emotional distress and quality of life; parent emotion, traumatic stress symptoms (IES-R), well-being; and family function. Mediation effects were estimated using ANCOVA, with indirect effects estimated using the percentile bootstrap approach. Moderation effects were tested by including appropriate interaction terms in models.

Results:

No significant mediation effects were observed. Child distress with prior hospitalizations moderated AME effects for IES-R intrusion subscale scores at T2 ( P = .01) and avoidance subscale scores at T3 ( P = .007). Traumatic stress screener scores (PCL-6) moderated intervention effects for IES-R hyperarousal subscale scores at T2 ( P = .01). There were no moderation effects for child age.

Conclusions:

AME is a promising intervention for mitigating traumatic stress symptoms and supporting well-being in parents of children with cancer, particularly for parents who screen high for traumatic stress and whose children are more highly distressed with hospitalization.
Dihydroartemisinin and zerumbone esters of ataluren and its analogs as anticancer agents and EGFR inhibitors
Authors: Tran Duc Quan , Truong Ngoc Hung , Nguyen Thi Hoang Anh , Trinh Thi Thuy , Ba Thi Cham , Nguyen Thi Thuy Linh , Ngo Van Tu , Cam Thi Inh , Pham Minh Quan , Luu Van Chinh
Published: December 2023

In a five-step procedure, 18 new esters (20a–i and 21a–i) of ataluren and its analogs with dihydroartemisinin and zerumbone were synthesized from methyl 3-cyanobenzoate. The screening for their cytotoxic activity against two cancer cell lines, HepG2 and MCF-7, showed that most esters exhibit activity against the tested cell lines, with IC50 values in the range of 1.61–36.52 µM. Among the tested compounds, ester 21f containing 4-methoxy in structure R did not show cytotoxic activity. The interactions of these new derivatives with the epidermal growth factor receptor protein were also investigated by molecular docking studies. The obtained binding conformation revealed several notable results, demonstrating similarities between molecular modeling theory and experiment. These results contributed to interpreting the in vitro cytotoxicity of esters and proposed the basis for predicting the mechanism of their cytotoxic action.
Evaluation of the effect of polyesters containing a curcumin ring system on Bemisia tabaci
Authors: Mehdi Hayat MR , Abdulhassan Hala A , Almayyahi Baqer A , Saleh Basil A , Hewitt Natalie L , El-Hiti Gamal A
Published: December 2023

The whitefly Bemisia tabaci is a destructive insect pest that infects many plants. Finding solutions to reduce the damage associated with whiteflies and their widespread use is of great interest. Therefore, the current research aims to synthesize four polyesters containing a curcumin ring system and investigate their effects against B. tabaci. The synthesized polyesters killed whitefly eggs and their nymphs. Polyester containing a methoxy group (P3) showed the best performance (80.3%) toward the mortality of insect eggs among all the tested polymers. Polyester containing a 4-hydroxybenzaldehyde moiety (P2) showed the lowest mortality efficiency (50.9%) against whitefly eggs after 72 h of treatment. The effect of polyester concentration on the mortality of insect nymphs varied during the treatment period. The mortality rate of nymphs after P3 treatment was the highest (78.0%), whereas that after P2 treatment was the lowest (46.9%). The polyester type, concentration, and treatment duration significantly affected the insect nymph mortality rate. Polyester containing a methoxy group for 72 h resulted in the highest mortality rate (90.0%) against whitefly nymphs.
An investigation into the variability of rugby union small-sided game demands and the effect of pitch size and player number manipulation
Authors: Dudley Charles , Johnston Rich , Jones Ben , Hacking Trent , McCafferty Robert , Weakley Jonathon
Published: December 2023

This study aimed to quantify the variability of physical, technical, and subjective task-load demands in small-sided games (SSGs), and the effect of manipulating of pitch size and player numbers in SSG in adolescent rugby union (RU) players. Twenty-six subjects completed six conditions in a crossover study design. In each condition subjects played 4 × 3-min periods of an SSG. Games were completed with either 4 × 4, 6 × 6 or 12 × 12 players on either a small (W: 25 m, L: 30 m), medium (W: 30 m, L: 40 m), or large (W: 35 m, L: 50 m) sized pitch. Match demands were assessed using global navigation satellite systems, heart rate (HR) monitors, ratings of perceived exertion, National Aeronautical Space Association task-load index and video analysis. Statistical analysis comprised of typical error, coefficient of variation (CV) and intra-class correlations to assess variability, and the use of linear mixed effects modelling to assess differences between conditions. A range of variability was observed in technical (CV = 25.00% to 52.38%), physical (CV = 4.12% to 51.18%) and subjective task-loads (CV = 7.65% to 17.14%) between identical games. Reducing player numbers increased physical demands such as m/min (ES range = 0.45 to 1.45), technical exposures such as total involvements (ES range = 0.04 to 0.63) and effort, physical and temporal task-loads. Increasing pitch size caused greater movement demands such as m/min (ES range = 0.11 to 0.79), but did not change the technical demands.
School Nurses’ Emotional Wellbeing: May the Schwartz Be With you!
Authors: Gavin Eileen , Pleus Donna
Published: December 2023

The purpose of this article is to introduce Schwartz Rounds as a means for school nurses to foster their personal wellbeing by sharing their experiences. Nurse panelists openly discuss their journeys, followed by facilitated small-group conversations led by mental health professionals. To address the unique challenges of school nurses during the COVID-19 pandemic, the New Jersey Nursing Emotional Well-Being Institute initiated virtual Schwartz Rounds. New Jersey State School Nurses Association leaders joined as panelists to discuss the theme of hope for the upcoming school year. Schwartz Rounds prove highly effective in preserving and enhancing school nurses’ mental health and wellbeing, allowing them to maintain their vital work while caring for themselves and their school communities. This approach builds community among school nursing professionals, fostering connections, and providing mutual support to combat isolation.
Fatal outcome of dengue fever with multi-organ failure and hemorrhage: A case report
Authors: Uzair Hafsa , Waseem Radeyah , Kumar Naresh , Hussain Muhammad Sheheryar , Shah Hussain Haider
Published: December 2023

Dengue fever is a prevalent viral disease caused by a single-stranded positive RNA virus belonging to the Flaviviridae family, genus flavivirus. It is characterized by fever, headache, myalgias, leukopenia, rash, and plasma leakage, which may progress to compensated or uncompensated shock and multi-organ failure. Liver involvement is a common feature of Dengue fever and is usually manifested by nausea, vomiting, abdominal discomfort, anorexia, hepatomegaly, and elevated serum transaminase levels. Severe disease is associated with laboratory parameters such as mean Platelet count < 20,000/mm, Aspartate Transaminase Levels >45 IU, and lymphocytes <1500. The Expanded Dengue Syndrome (EDS), a term coined by World Health Organization in 2012, refers to an atypical presentation of Dengue fever that manifests with generalized impacts on normal physiology. This case report presents a 29-year-old male with EDS who presented at a Tertiary Care Hospital in Karachi and died a week later due to liver failure.
Internal auditory canal duplication with facial and cochlear nerve dysfunction: A case report
Authors: Ghising Roshan , Dongol Kripa , Suwal Sundar
Published: December 2023

Internal auditory canal duplication is a rare anomaly of the temporal bone. The condition is diagnosed on performing High-Resolution Computed Tomography of the temporal bone and magnetic resonance imaging for sensorineural hearing loss. A bony septum divides the internal auditory canal into dual compartments. Duplication may be either unilateral or bilateral and vestibulocochlear nerve may be aplastic or hypoplastic. Rarely, patient may present with facial nerve palsy. A 26-year-old female presented with right grade IV lower motor neuron facial nerve palsy for 12 years and right-sided hearing loss for 9 years. Pure tone audiogram revealed 45 dB of moderate degree sensorineural hearing loss on the right ear. On High-Resolution Computed Tomography of the temporal bone, an incomplete bony septum was visualized in the right internal auditory canal, dividing it into two compartments. Internal auditory canal on the left side was normal. Other inner and middle ear structures were normal. On magnetic resonance imaging, both the vestibulocochlear and facial nerves were well visualized with normal calibers.
Ecology under the falling sky: Nature, ecology and entropy in Yanomami cosmology
Authors: Porto Renan Nery
Published: December 2023

This article is a theoretical engagement with the book The Falling Sky, written by anthropologist Bruce Albert and Yanomami shaman Davi Kopenawa. It presents how the concepts of nature and ecology in Yanomami cosmology, as developed by Kopenawa, break with stereotypes of indigenous people living in harmonic and stable relationships with nature. Instead, this ecology is a way of dealing with an unstable nature that can derail into chaos, disarranging the cosmic arrangement of humans, non-humans and spirits that shamans should work to keep in place. Kopenawa named this cosmic entropy the fall of the sky, which now is an imminent risk caused by the destruction of the forests. His conception of ecology shows that maintaining forests in indigenous land is not merely a spontaneous fact. Rather, it is also a consequence of the intellectual engagement of indigenous people and their collaboration with other living beings.
Perceived Pressures and Motivations for Environmental Disclosures: Role of Certification
Authors: Chowdhury Md Ali Arshad , Rahman Mohammad Morshedur , Dey Mouri , Moudud-Ul-Huq Syed , Hossain Sk Alamgir
Published: December 2023

In light of the gravity of environmental issues, this study investigates the influence of competitive advantage and stakeholder pressure on voluntary environmental disclosures, together with the “certification” mediating variable. The research questions and hypotheses were developed based on the essence of stakeholder and legitimacy theory, within the compass of the resource-based view. Data were collected from numerous listed manufacturing organizations and analyzed following the deductive approach. Structural equation modeling was used to test the hypotheses. The results show that competitive advantage influences and smoothens the attainment of environmental certificates, leading to an impression on voluntary environmental disclosures. The evidence from the study also demystifies the dominance of competitive advantage over environmental disclosures. Furthermore, the associated effect of certification upon environmental disclosure is also established and found worthy. Other factors were not found to be significant. Finally, the study also provides various insightful policy suggestions to the wide range of stakeholders.
Fiscal Sustainability and Its Implications for Economic Growth in Egypt: An Empirical Analysis
Authors: Alshaib Bayan Mohamad , Al khatib Abdullah Mohammad Ghazi , Nuta Alina Cristina , Hamra Mohamad , Mishra Pradeep , Gautam Rajani , Hussain Sarfraz , Zamfir Cristina Gabriela
Published: December 2023

This study examines the association between fiscal sustainability indicators and Egypt’s economic growth from 1980 to 2018. Fiscal sustainability refers to a government’s ability to generate sufficient revenue to cover its costs and debt obligations in the long run without excessive borrowing or money creation. Egypt’s economic growth has slowed, raising questions about fiscal sustainability. This study aimed to analyze the dynamic relationship between fiscal sustainability indicators (government revenue, expenditure, external debt) and economic growth in Egypt. The autoregressive distributed lag (ARDL) bounds testing approach and unrestricted error correction model were applied to annual data from 1980 to 2018. A dynamic link was found between fiscal sustainability indicators and economic growth. Government expenditure and external debt significantly impacted economic expansion in the long term, while government revenue did not. Fiscal sustainability, measured by growth in total government expenses, external debt obligations, and revenue, significantly influences Egypt’s economic growth. Prudent fiscal management is crucial for sustained economic development. Policymakers should focus on controlling government spending, limiting external debt, and improving revenue generation to promote long-term economic growth in Egypt. Fiscal sustainability must balance critical investments in public services. Carefully managing fiscal deficits is key to unleashing Egypt’s economic potential. This study provides valuable insights into the connection between fiscal policy and economic growth in Egypt, informing policymakers’ decisions.
Pesticide Choice and Use Patterns Among Vegetable Farmers on Idjwi Island, Eastern Democratic Republic of Congo
Authors: Mushagalusa Balasha Arsene , Mulume Dominique Aganze , Mwisha Sage Weremubi , Mukonde Shadya Sharufa , Zirhumana Mugisho Janvier
Published: December 2023

The move towards reducing environmental and health risks related to pesticide application in smallholder agriculture requires a more detailed understanding of farmers’ awareness and pesticide use practices. Drawing on field observations and interviews with 90 randomly selected farmers, this study assesses the choice of pesticide, use patterns and the level of awareness of pesticide risks among male and female farmers growing vegetables on Idjwi Island, eastern Democratic Republic of Congo. The main crops grown are tomatoes, eggplants, and cabbages, which are vulnerable to pest attacks, leading to fruit rot (70%), leaf holes, and spots (17%), resulting in significant economic losses. To protect crops, farmers use various pesticides, including fungicides (e.g., Metalaxyl, Mancozeb) and insecticides (e.g., profenofos, Cypermethrin), based on their availability on local market, perceived effectiveness, and relatively affordable prices. Although the results did not reveal significant differences in pesticide use patterns between male and female farmers, men (41%) make decisions about pesticide purchase and use within households either alone or jointly with their spouses (31%). Regrettably, farmers disregard safety instructions and hygiene practices following pesticide application, leading to concerns about public health and the environmental impact of using these products. While we highlight the factors influencing farmers’ willingness to wear protective equipment, findings also show that 75% of the participants are willing to pay $US 5 for any alternative method to pesticide use. This study emphasizes the need for improving awareness and recommends field farmers’ schools to train farmers on pesticides’ proper usage and management. The results suggest further research on farmers’ exposure to pesticide and the exploration of existing alternative methods based on integrated pest management to advance sustainable agriculture.
The Relationship Between Administrative Empowerment and Organizational Commitment: The Mediating Role of Job Satisfaction Amongst Academic Staff in Higher Education
Authors: Harb Husameddin Khalil , Eyupoglu Serife Zihni , Tashtoush Laith
Published: December 2023

The aim of the study is to examine whether job satisfaction mediates and strengthens the relationship between administrative empowerment and organizational commitment among academic staff in Higher Education - Palestinian universities. A questionnaire was implemented during the data collection process. The study sample consisted of academic staff in Higher Education. Two hundred eighty-seven academic staff from seven different universities participated in the study. Data analysis involved calculating descriptive statistics, t-test, (ANOVA) test, correlation, and regression analysis. The results of the study indicated that administrative empowerment, Organizational commitment, and job satisfaction were statistically significant; moreover, it was found that administrative empowerment through job satisfaction impacts Organizational commitment. Management of universities should appreciate these results as good empowerment practices can increase employee job satisfaction. The current study model that has been developed provides that administrative empowerment through job satisfaction helps universities positively influence the organizational commitment of academic staff in universities.
More than Meets the Eye? Using Text Analytic Techniques to Unpack School Mission Statements
Authors: Bali Valentina A. , Higgins Devin
Published: December 2023

Schools develop mission statements in part to communicate their purposes of schooling to internal and external audiences. The goal of this study is to employ text analytic techniques to analyze school mission statements. Focusing on Arizona and New Jersey’s schools, we seek to understand: 1) what themes (topics) emerge from their mission statements, 2) whether local context (politics) and institutional factors (being a charter) mediate topic prevalence, and 3) how similar school mission statements are to one another overall and across select factors. Using structural topic modeling we find that five topics emerge as particularly prevalent, and they address key purposes within the US context related to social, academic, and civic development with an emphasis on a safe environment and a sense of community. Local political leanings have a minor impact on the prevalence of topics but being a charter has a distinct influence. Compared to regular schools, charters are more likely to include themes related to preparing for college, academic approaches, and character and family ties, but they place lower emphasis on community and citizenship themes. School missions display moderate levels of similarity, indicating that a common set vocabulary has permeated schools’ missions, though differences remain, including between states. Overall, this study deepens our understanding of the varieties of schools’ missions and reveals text analytic techniques are well suited for uncovering them.
Bitcoin Cryptocurrency and Electronic Commerce in Saudi Arabia
Authors: Hajr Layla , Katamoura Suzan , Mirza Abdulrahman
Published: December 2023

Bitcoin, a well-known cryptocurrency, has attracted much attention worldwide and is becoming more widely used. This study develops a hypothesis to investigate and test the impact of Bitcoin on E-Commerce use in Saudi Arabia using a survey research approach. Analyzing factors such as Bitcoin awareness and usage among Saudi Arabian consumers can increase online transactions, increase payment efficiency, a larger degree of financial inclusion, and a higher level of trust and security. The online-based survey was used to collect responses, and descriptive-analytical and standard results. Assessment criteria approaches were implemented to interpret the results. Responses were collected from individuals and employees of various companies working in different occupations in Saudi Arabia. In addition, statistical tools SPSS and SmartPLS were used to test the study’s hypotheses. The findings indicated a rapid growth in e-commerce transactions and some knowledge of Bitcoin. Also, it shows a positive correlation between digital currencies (Bitcoin) and e-commerce in Saudi Arabia. The study’s conclusions are expected to be valuable for those involved in Saudi Arabia’s e-commerce sector, helping them to decide how to adopt and use Bitcoin in their digital business strategy. The study also opens the way for future investigations into topics including Saudi Arabia’s regulations for Bitcoin, consumer attitudes toward Bitcoin, and the potential of blockchain technology for enhancing the nation's e-commerce processes.
The Identity Development of Onscreen Legendary Heroes: A Visual Affect Analysis of Mulan in Three Movie Adaptions
Authors: Zhong Zenan , Tu Binglan , Yang Shu
Published: December 2023

This study examines the visual emotive meanings involved in three films, that is, Mulan (1998), Mulan (2009), and Mulan (2020), which are adapted from The Ballad of Mulan. By adopting the theoretical framework of visual affect, this research conducts quantitative and qualitative analyses on the emotional episodes of Mulan in the three films. The study reveals that these films construct Mulan as a personality rich in emotions. However, there are distinctively different distributions of visual affect. In Mulan (1998), Mulan is built as a tomboy disrupting the masculine tradition, while in Mulan (2009) and Mulan (2020), Mulan is constructed as a filial and dutiful woman and an inherent legendary heroine respectively. The identity development revealed in this paper could be seen as a crucial way to transforming traditional figures in adapted films, contributing to the field of adaptation study from a semiotic perspective.
Income Quality and Organic Food Purchase Intention: The Chain Mediating Role of Environmental Value, Perceived Consumer Effectiveness
Authors: Zheng Qiuqin , Wen Xiaoting , Xiu Xintian , Chen Qiuhua
Published: December 2023

Concerns about income inequality and environmental pollution have been important aspects of achieving sustainable development goals. Promotion and use of organic food is one important way to reduce resource consumption and waste. In this study, the structural equation model (SEM) was used to analyze 450 questionnaire data, and the environmental values and perceived consumer effectiveness were used as mediating variables to explore the influence mechanism of income quality on the organic food purchase intention. An extended Value—Attitude—Behavior (VAB) theory was used as the research framework, and the results showed that: (1) income quality had a significant positive effect on environmental values, perceived consumer effectiveness, and organic food purchase intention; (2) perceived consumer effectiveness had a significant positive effect on organic food purchase intention and played a partial mediating role; and (3) environmental values and perceived consumer effectiveness played a chain mediating role between income quality and organic food purchase intention.
Smartphone Addiction and Subjective Withdrawal Effects: A Three-Day Experimental Study
Authors: Aarestad Sarah Helene , Flaa Tine Almenning , Griffiths Mark D. , Pallesen Ståle
Published: December 2023

Smartphones have arguably become a common necessity in modern society. While they can be used for many practical purposes, their many features increase the risk of overuse, a key element in behavioral addiction. The present study examined withdrawal-related scores on the Smartphone Withdrawal Scale, the Fear of Missing Out Scale, and the Positive and Negative Affect Schedule during a smartphone restriction period, lasting 72 h. In total, 127 participants were randomly assigned either to a condition without smartphone access or to a control condition. The scales were administered three times a day during the restriction period and smartphone addiction scores were assessed on Day 1. The results showed that participants with the highest scores on smartphone addiction in the restricted condition were significantly more negatively affected by the restriction (compared to those with lower scores). This appears to indicate that being restricted from using smartphones can generate significant withdrawal symptoms, especially for those at risk of smartphone addiction.
Green-Smart University Campuses: The Mediating Role of Student Engagement in Enhancing Corporate Image
Authors: Al-Dmour Hani
Published: December 2023

This study investigates the motivating factors influencing university students’ participation in the Green-Smart Campus initiative. The model examines variables from the student’s perspective, with a green-smart campus as the exogenous variable, encompassing energy efficiency sustainable buildings, sustainable transportation, waste management, and water management. Data was collected via an online questionnaire from 1,000 participants, undergraduate and graduate students at the University of Jordan, using random sampling. After excluding 56 incomplete responses, regression analysis was conducted on 745 valid responses to explore the relationships between variables. The research reveals a significant positive impact of the Green-Smart Campus initiative on student engagement and the university’s corporate image. Institutions promoting green practices, like recycling programs and eco-friendly transportation options, experienced higher student engagement levels. Engaged students felt connected to the institution and actively participated in sustainability-related activities, enhancing the university’s corporate image. Student engagement was found to mediate the relationship between the Green-Smart Campus initiative and the university’s corporate image. Engaged students played a crucial role in translating sustainability initiatives into an enhanced institutional reputation by sharing positive experiences and advocating for the institution.
How DMOS Respond to the COVID-19 Pandemic: The Case of Los Angeles
Authors: Leung Xi Y. , Zhang Huiying , Bai Billy
Published: December 2023

Destination marketing organizations (DMOs) are key players in destination crisis management. This case study applies the theoretical background regarding destination crisis management in exploring the role of DMO in managing Los Angeles as a destination. Based on an interview and documentation, the case explicates the recovery efforts led by Los Angeles Tourism & Convention Board (LATCB) in response to the COVID-19 pandemic. The case offers valuable information and important insights for destinations to manage future crises and disasters.
Climate Change and the Textile Industry: The Carbon Footprint of Dyes
Authors: Li Xin , Zhu Lisha , Ding Xuemei , Wu Xiongying , Wang Laili
Published: December 2023

Dyes play an important role in textile production, but their contribution to air pollution and harming human health have raised concerns and remain an international problem. The key to overcoming this challenge is to assess how much greenhouse gases are being generated and the hotspots which guide decision-making process toward more sustainable options. This article established a carbon footprint calculation method for disperse dyes. First, the system boundary description and the functional unit were discussed. Second, the carbon footprint inventory analysis was determined. What’s more, the calculation method, allocation method and emission factors were proposed. It was intended to be practical and effective based on three typical disperse dyes in China. The results showed that the carbon footprints of Disperse Blue 79, Disperse Red 167, and Disperse Orange 61 corresponded to 8.28 t CO2 eq/t, 8.07 t CO2 eq/t, and 7.48 t CO2 eq/t, respectively. For the three disperse dyes, the carbon emissions of dispersing agent melamine-formaldehyde resin and liquid ammonia consumption were the dominant emission sources. The steam and electricity were the two major sources of carbon emissions caused by energy usage. The homogenization and the wastewater treatment process were the two largest emission emitters. The sensitivity analysis showed that the total product carbon footprint was mostly sensitive to dispersing agent melamine-formaldehyde resin changes, followed by steam, liquid ammonia, and electricity. The results show that disperse dye production have great potential for improvement. The reduction options for the emissions of the disperse dyes production can be concluded by the optimization of the production process and technology for dispersing agent melamine-formaldehyde resin, liquid ammonia, electricity, and steam. Through the calculation, the influencing factors for the carbon footprint can be analyzed and highlighted. The method provides a comprehensive understanding of environmental impacts with dyes, driving the adoption of sustainable dyeing practices.
A Novel Ultrasonographic Method to Detect Intra-Operative Syndesmotic Malreduction – the “Gap Penetrance” Sign
Authors: Ghandour Samir , Taseh Atta , Ashkani-Esfahani Soheil , Waryasz Gregory , Guss Daniel , Sharma Siddhartha , DiGiovanni Christopher W.
Published: December 2023

Category:

Ankle; Other

Introduction/Purpose:

Anatomical reduction of the distal syndesmosis can be challenging. There is ongoing debate and variability in the methods used for evaluating the accuracy of reduction, including radiography, intra-operative CT, arthroscopy, and direct visualization. Tornetta et al. have described a method called ‘the articular surface method’ that evaluates the relationship between the articular cartilage of the distal anteromedial fibula and the anterolateral tibia as being significantly more accurate for detecting malreduction. However, it entails an additional surgical incision over the distal aspect of the ankle. The aim of this study was to find a non-invasive method using ultrasound to assess the accuracy of reduction in syndesmotic injuries.

Methods:

A cadaveric syndesmotic instability model was created by dissecting the PITFL, IOL, and AITFL through a small posterior incision. The fibula was fixed in incremental degrees of rotational malreduction to achieve a malreduction of 3, 5, and 7 mm. A blinded observer assessed the syndesmosis using a portable ultrasound device. The probe was placed in its short axis at the level of the ankle joint then moved proximally until both the anteromedial fibular and anterolateral tibial articular surfaces were visualized simultaneously in one view. In a reduced syndesmosis, the distal articular surfaces of the tibia and fibula overlap. This relationship is altered in a malreduced syndesmosis, which allows ultrasonographic waves to ‘penetrate’ through the malreduced articular surfaces and be readily detected. This sign was graded positive if an acoustic signal penetrated between the distal articular surfaces of the tibia and fibula, and negative if no acoustic signal was detected.

Results:

The gap penetrance sign was positive in all 3 instances of malreduced syndesmoses, and negative in an anatomically reduced syndesmosis. Figure 1 illustrates the outcomes in a reduced syndesmosis and malreduced syndesmosis, respectively.

Conclusion:

We introduced a novel sign that can be used as a surrogate of the ‘articular surface method’ to detect syndesmotic malreduction. It is accurate, can obviate the need for a separate surgical incision for direct visualization, permits rapid point-of- care evaluation in the operating room, and minimizes radiation exposure
Clinical Outcomes and Complications of Peroneus Brevis Allograft Reconstruction
Authors: Mathew Smitha E. , Kuripla Casey , Coleman Michelle , Hembree Walter C. , Guyton Gregory P.
Published: December 2023

Category:

Ankle; Other

Introduction/Purpose:

Peroneus brevis (PB) tendon tears are an important cause of lateral ankle pain. When PB tears are irreparable, allograft reconstruction maintains native anatomy and avoids the morbidity of tenodesis and tendon transfer procedures. Current data on allograft PB reconstruction is limited to small case series. We sought to retrospectively determine the clinical outcomes and complications in a large series of patients who underwent PB tendon reconstruction with semitendinosus allograft.

Methods:

After institutional review board approval, patients with PB tears who underwent tendon reconstruction with semitendinosus allograft at a single tertiary center between March 2010 and January 2020 were retrospectively reviewed. Hospital records, preoperative and postoperative visual analog pain scale (VAS), and complications were evaluated. A phone survey was conducted to assess postoperative work status, use of assistive devices, satisfaction, and patient-reported outcomes (PROMIS scores).

Results:

Sixty-eight patients (69 feet) (24 men,44 women) were identified. Mean age at surgery was 51.7 years (range, 23.0-74.0) and mean follow-up was 20.4 months (range, 3.4-71.4). VAS pain scale improved postoperatively (4.0±2.7 vs 2.4±2.8, p=0.0012). Most common complication was sural neuralgia in 18 (26.1%) feet, but only 2 (11%) required surgery. The allograft failed in 7 (10.1%) feet (Table 1).Of 29 (42.6%) patients available for survey, 25 (86.2%) were employed preoperatively, of whom 23 (92.0%) returned to work. Of the 29 survey patients, 25 (86.2%) did not use an assistive device, 20 (69.0%) reported being satisfied, and average T-scores for physical function and pain interference were 49.5±9.7 and 50.8±9.7, respectively. Revision PB surgery (30 [43%] feet) was not associated with sural neuralgia or patient satisfaction.

Conclusion:

This study demonstrated a relatively high rate of postoperative transient sural neuralgia after PB reconstruction with semitendinosus allograft, but the rate of reoperation for this complication was low. Among the subgroup of patients who completed a phone survey, there was a high rate of return to work, low rate of assistive device use, and good patient satisfaction after the procedure. These findings suggest that allograft reconstruction is a clinically effective treatment for irreparable PB tendon tears when few other options exist.
Diabetes is a Potential Predictor of Failure following Total Ankle Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Butler James J. , Azam Mohammad T. , Stewart-Miller Annabella , McCourt Alexander , Thompson Conor , Randall Grace W. , Kennedy John G. , Walls Raymond J.
Published: December 2023

Category:

Ankle Arthritis; Other

Introduction/Purpose:

The purpose of this systematic review and meta-analysis was to evaluate potential predictors of failure following total ankle arthroplasty (TAA) for the management of end stage ankle arthritis.

Methods:

During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to evaluate potential predictors of failure following total ankle arthroplasty for the management of end stage ankle arthritis. Data regarding surgical characteristics, subjective clinical outcomes, radiographic outcomes, odds ratios, hazard ratios, correlation coefficients, failure rates and complications were extracted and analysed.

Results:

In total, 15117 patients (15198 ankles) underwent TAA at a weighted mean follow-up of 64.0 ± 21.8 months. Pooled Odds ratio found that diabetes was a statistically significant predictor of failures following TAA (OR: 2.1; [1.9861, 2.2284], p = 0.003). Other variables such as age, gender, body mass index, implant type and arthritis aetiology were not associated with failure.

Conclusion:

This systematic review and meta-analysis found that the presence of diabetes mellitus was a statistically significant predictor of failure following TAA. However, there was marked heterogeneity between the included studies with regards to statistical data collection which significantly limits the robustness of the conclusions of this study. Thus, further higher quality research with more consistent data collection is warranted to identify potential predictors of failure post TAA.
Do Arch Supports Alter Foot Alignment in Patients with Metatarsalgia? A Weightbearing CT and x-ray Study
Authors: Taseh Atta , Karaismailoglu Bedri , Ghandour Samir , Mirochnik Karina , Ashkani- Esfahani Soheil , Landsman Adam S.
Published: December 2023

Category:

Midfoot/Forefoot; Lesser Toes

Introduction/Purpose:

Arch-support insoles are frequently included in the treatment plans for common foot ailments including metatarsalgia. Literature has demonstrated that insoles with metatarsal and arch support could relieve walking pain and improve patient-reported measures of function in metatarsalgia. The purpose of this study was to examine alterations in foot alignment among metatarsalgia patients who used arch support insoles.

Methods:

A clinical trial was initiated after the approval by the institutional review board. Patients with metatarsalgia (age: 18-65 y/o) were included after they consented to participate. Individuals with open wounds, feet asymmetry, using assistive device or brace, and those with BMI more than 35 were excluded. Participants underwent weightbearing computed tomography (WBCT), and weight-bearing x-ray of their feet while standing barefoot or on the insoles (Good Feet™, Dr.’s Own, LLC). The radiological measurements on WBCT and X-rays conducted in these patients are shown in Table 1. The Wilcoxon-Signed Rank test was used for comparison of the continuous measurements, and the interobserver reliability was analyzed with Intraclass Correlation Coefficient (ICC).

Results:

Ten patients with a mean age of 46.9±13.06 years were included in the study. Observed changes on X-rays include decreased 4th-5th intermetatarsal angle (p=0.04), 2nd-4th/2nd-5th metatarsal tangent angles (p=0.003, p=0.001), and 1st metatarsal length on antroposterior (AP) view (p=0.02). Also, 1st metatarsal declination angle (p=0.002), and talo-first metatarsal angle on AP view (p=0.05) were increased. No significant changes on the WBCT were found, except for a decrease in the first metatarsal pronation angle (p=0.02).

Conclusion:

Arch support insoles can bring about anatomical changes especially in the forefoot area of patients with metatarsalgia. While the causal correlation between these changes and alleviation of the symptoms cannot be proven based on our data, these outcomes can guide future clinical trials comparing different treatment for metatarsalgia to determine contributing factors to the healing process of this condition.
Early Outcomes after Minimally Invasive Percutaneous Calcaneal Osteotomy in the Treatment of Cavovarus and Planovalgus Foot Deformities
Authors: Bakaes Yianni , Edelman David , Phillips Tammy , Encinas Rodrigo , Jackson J. Benjamin , Gonzalez Tyler
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

A calcaneal osteotomy is often included as part of the treatment in planovalgus and cavovarus foot deformities. Often this is done through an open approach where complications of wound infection and sural nerve injury are common. More recently, this strategy has been modified using minimally invasive techniques. A percutaneous approach, in comparison to the standard open calcaneal osteotomy, allows for reduced postoperative complication and decreased pain compared to an open procedure. This retrospective chart review aims to evaluate the postoperative outcomes of patients undergoing calcaneal osteotomy via a minimally invasive percutaneous approach in foot reconstructive surgery to assess early functional outcomes, complication rate and revision rates.

Methods:

One fellowship-trained foot and ankle orthopaedic surgeon at one academic institution performed minimally invasive calcaneal osteotomy on 20 patients. All cases were completed between March 2021 and March 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.

Results:

Participants included 15 females and 5 males, 4 of whom were smokers. Average age was 42.2 years. Average BMI was 32.3, and average follow up was 130.4 days. Complications included 1/20 patients had a postoperative wound breakdown of the screw site requiring incision and debridement with closure and 2/20 cases of sural neuritis. One resolved 6 months after treatment and the other was present but became less symptomatic. All participants achieved union, and there were no revisions. All shifts corrected hindfoot deformity either via medializing or lateralizing osteotomy. Average preoperative PROMIS scores in the domains of physical function, pain interference, and mobility were 36.8 (28.6-46), 67.1 (54.3-78), and 34.6 (25-40), respectively. Average postoperative PROMIS scores were 35.7 (21-76), 62.3 (39-76), and 33.4 (16-75), respectively.

Conclusion:

Minimally invasive calcaneal osteotomy appears to be an efficacious and safe treatment option for the correction of cavovarus and planovalgus hindfoot deformities with the ability to obtain appropriate hindfoot correction with low complication rates and high union rates. Early outcome measures show a favorable pain interference PROMIS score as well as a trend in improvements in PROMIS physical function scores. Longer term data will need to be done to assess long term functional outcome and revision rates.
Effect of BMI on Acute Postoperative Complications following Total Ankle Arthroplasty (TAA)
Authors: Bakaes Yianni , Gonzalez Tyler , Jackson J. Benjamin
Published: December 2023

Category:

Ankle

Introduction/Purpose:

Total ankle arthroplasty (TAA) is an effective treatment for various ankle pathologies, but some concern remains for the relatively high associated complication and failure rates relative to major joint arthroplasty of the hip and knee. Patient body mass index (BMI) is a modifiable and potentially important preoperative variable when evaluating postoperative complications. The purpose of this study is to evaluate the effect of BMI on the acute postoperative complication rate after TAA.

Methods:

We performed a retrospective review to identify a large cohort of adult patients who underwent TAA between 2006 - 2020 from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Using overweight patients as the reference BMI group, we estimated log-binomial models to estimate risk ratios on outcomes, while also adjusting for sex and age, in order to investigate whether there was a significant difference in complication rate between the BMI groups.

Results:

We found that, relative to overweight patients, there was no statistically significant difference in the risk of acute complications for underweight (p-value=0.062), healthy weight (p-value=0.800), obese (p-value=0.993), or morbidly obese (p- value=0.781) patients who underwent TAA. There was also no statistically significant difference in the risk of acute complications based on age (p-value=0.876) or sex (p-value=0.696) for TAA. Additionally, there was no significant difference between the BMI groups when comparing how many patients had a complication out of the total number of patients in their respective BMI group for either major complications (p-value=0.9835) or minor complications (p-value=0.0578).

Conclusion:

We found that BMI, age, and sex did not lead to a statistically significant difference in the risk of complications, even when stratified by major vs minor complications, within 30 days postoperatively for TAA.
Is there any Synergistic Effect of Perioperative Use of Pregabalin in Addition to Naproxen in Ankle Fractures? A Prospective, Randomized, Multicenter Study
Authors: Shim Dong Woo , Yoon Yeokwon , Han Seung Hwan , Lee Jin Woo , Park Kwang Hwan , Choi Gi-Won
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

Opioid-centric pain management strategies have created an epidemic of prescription opioid abuse in the United States. Multimodal opioid-sparing analgesic regimens have spotlighted as alternatives to decrease postoperative pain. However there has been little study of the synergistic effect between naproxen and pregabalin. We aimed to compare the analgesic efficacy, adverse effects, and long-term functional outcomes between perioperative uses of naproxen only and naproxen with pregabalin.

Methods:

This study was designed in 70 patients belonging to the 19 to 65 age group indicated for operative fixation of a rotatory ankle fracture under general anesthesia in 3 different hospitals. Group A received naproxen 500mg only, Group B received naproxen 500mg with pregabalin 75mg 2 hour before surgery and 12 hourly for 3 days thereafter. Minimal clinically important difference of visual analog scale (VAS) for pain was set 13 mm out of 100 mm. VAS for pain, opioid consumption, time for first use of escape injection, and any adverse effect were recorded at 6-, 12-, 24-, 48-, and 72-hour postoperatively. VAS for pain was checked at 2-, 6-week, 3-, and 6-month afterward and functional outcomes including Olerud and Molander score and ankle- fracture outcome of rehabilitation measure (A-FORM) were measured at 3-month and 6-month postoperatively.

Results:

Sixty-two patients (33 in Group A and 29 in Group B) completed follow-up until 6 months. Demographic data were similar between the 2 groups. VAS for pain scale was not significantly different between 2 groups at each time point until 6 months (P ≥ 0.520). Ninety-five percent confidential interval (CI) were within 13 mm at every time point except for at 6- and 12-hour postoperatively (95% CI -1.6 – 0.8, -1.4 – 1.0, each). There were no significant differences in opioid consumption, time for first use of escape injection, and functional outcomes between groups (P ≥ 0.163). Any adverse event at 48-hour postoperatively was significantly higher in Group B (P = 0.017).

Conclusion:

There was no clinically significant effect of perioperative use of pregabalin in addition to naproxen to reduce pain after operative fixation of rotatory ankle fractures. Rather it significantly raised adverse events after 48-hour postoperatively. Therefore additional use of perioperative pregabalin should be cautiously decided.