bluuebunny/crossref_metadata_2025 huggingface dataset:
A theoretical analysis of friction and vibration characteristics of wiper reversal process
Authors: Yang Xue , Wang Yansong , Guo Hui , Yuan Tao , Zheng Lihui , Sun Pei
Published: April 2022

This paper is concerned with the friction and vibration characteristics of a vehicle wiper-windscreen contact. The dynamics and friction models of the wiper-windscreen system are established to study the frictional vibration and noise of the wiper-windscreen system. The dynamic model of the wiper-windscreen system is established and the analytical formulas are derived. Based on the negative slope formula of friction coefficient with respect to relative velocity, the Coulomb’s friction law, and the fluid lubrication characteristics, the friction models of the system are built in dry and wet operating conditions, respectively. Meanwhile, the formulas of friction coefficient and relative velocity in time domain are presented. The changes of blade angle and friction with time in different working conditions are investigated. The Runge-Kutta method is used to analyze the nonlinear dynamic response and friction characteristics of the friction models. The simulations successfully reproduce the vibrations of the wiper blade in actual motion. The effectiveness of the dynamic model and the friction models is verified by comparing the simulation results under different working conditions. The dynamics and friction models presented in this paper can provide theoretical references for structural optimization of the wiper blade, and thereby the vibration and noise control of the wiper-windscreen system.
Political alliance with COVID-19: Macedonian politics and the strategic use of the pandemic
Authors: Takovski Aleksandar
Published: April 2022

The emergence of COVID-19 in Macedonia in March 2020 overlapped with a period in which the country was run by a technical Government tasked to organize premature elections. In circumstances of highlighted inter-party conflict predating the health crisis, the newly emerged health emergency has only added to the political confrontation and the existing political crisis. COVID-19 and the resulting discourses on health crisis in this respect, I argue, have been used strategically by the political actors to make a populist advancement in the struggle over state power. Moreover, the strategic use of the COVID-19 by the two major political parties in a discourse marked by blame casting and (inter)dependence on past political misconduct indexes, and at the same time perpetuates, a larger ongoing political crisis in the country. To demonstrate the strategic use of the COVID-19 health discourse within the interparty conflict and its diagnostic potential to witness a prolonged political crisis, I will use internet data collected from the websites of the two largest Macedonian political parties in order to analyze the discursive strategies of predication and argumentation employed by the political parties.
Adaptive integral backstepping control of a reconfigurable quadrotor with variable parameters’ estimation
Authors: Derrouaoui Saddam Hocine , Bouzid Yasser , Guiatni Mohamed
Published: April 2022

This work presents the control of a quadrotor capable of changing its configuration while flying. The designed controller should handle several arising issues since the drone geometric parameters are varying over time. This variation has a great influence on the quadrotor control, which prompts us to propose an efficient nonlinear adaptive integral backstepping controller. The control architecture includes an estimator of the inertia and other specific blocks to calculate the center of gravity and the mixing matrix. The performance of the proposed control approach has been compared with the conventional integral backstepping controller in two cases, with and without disturbances. The obtained results of the inertias and the center of gravity are also compared and confirmed with those calculated using Computer-Assisted Design–based model.
Physicians’ Attitudes Against Clinical Practice Guidelines on the Use of Guidelines: A Scale Development Study
Authors: Akyüz Selahattin , Çelik Yusuf
Published: April 2022

This study aims at developing scale measuring attitudes of physicians against clinical practice guidelines (CPGs) and investigate whether the attitude of physicians against CPGs has an effect on the use of CPGs. ‘The Physicians’ Attitudes Against CPGs and The Use of CPGs’ was developed and used to collect data from the physicians working in a public education and research hospital. Physicians’ attitudes that were constructed as an upper latent variable were significant, positive and highly effective on the use of CPGs. Furthermore, the attitude upper latent variable explained 30% of the variance in the observed variable for the use of CPGs. The attitude upper latent variable was affected significantly, positively and at a remarkably high level by positive attitude latent variable while it was affected significantly, negatively and at a remarkably high level by negative attitude latent variable. Physicians’ attitudes against CPGs were found to be a highly important factor in the use of CPGs. And it was also observed that physicians’ positive attitudes against CPGs affected the use of CPGs in a positive way while negative attitudes had negative effect on use of CPGs.
Private Sector Engagement for Infectious Disease Surveillance in Mixed Health Systems: Lessons from a Model Dengue Reporting Network in India
Authors: Furtado Kheya Melo , Kar Anita
Published: April 2022

Disease estimates from surveillance in mixed health systems is affected by lack of data from the private sector. We aimed to characterize private sector engagement and reporting to a disease surveillance network, and determine the implications on dengue case detection. We developed and set up a public–private network (CODREN—Community Disease Detection and Response Network) with recruitment of eligible health resources ( n = 462) in a municipal ward of Pune city, India (population 209,331). Dengue cases reported through CODREN were compared with reports of the local dengue surveillance (LDS) over 1 year. Private clinics constituted the majority of eligible providers (60%, 276). Retention of participants was 81.7% with 13.9% reporting dengue cases. Phone call was the preferred reporting method (85.5%, 564 reports). CODREN captured a higher number of cases than LDS (78.9%, 251 vs 50.6%, 161), increasing case detection by 18% due to increased private reporting points. A twofold lower number of cases was reported by LDS from shared reporting points with CODREN, due to discrepancies in case definitions and diagnostic test preferences among private providers. We conclude that private sector engagement can improve dengue case detection with the selective inclusion of providers, sustained contact, feedback and simple reporting methods. Testing guidelines and case definitions adopted by the LDS need to address heterogeneity of private practice in mixed health systems, in order to improve dengue estimates in India.
An Index to Measure Progress Towards Universal Social Protection with Application to India
Authors: Chaurasia Aalok Ranjan
Published: April 2022

This article develops an index to measure the progress towards universal social protection which is based on the three core dimensions of social protection—household income security; household resilience to external shocks; and social inclusion. The index is based on the concept of social protection space. Application of the index to India suggests that the country will have to go a long way to achieve the goal of universal social protection. The article also reveals significant diversity in the progress towards universal social protection across states/union territories. The analysis suggests that a decentralised, state/union territory-specific approach is needed to achieve universal social protection in the country.
Black-White incentive inequality for college persistence
Authors: Witteveen Dirk , Attewell Paul
Published: April 2022

Despite similar educational aspirations, black students persist in higher education at much lower rates than white undergraduates. This paper advances a theoretical explanation for the racial gap in persistence by examining whether the differential attrition in college reflects contrasting incentives for educational persistence. To account for the highly unequal hurdles faced by black men and women in college and in the labor market, we propose a method that addresses race-gender-specific opportunity structures in both institutions simultaneously. This approach is based on forward-looking estimates of outcomes where students draw information from their race-gender reference group ahead of them. The model estimates the earnings payoffs of persistence separately for each race-gender group at three consecutive educational decision nodes: at high school graduation, college entry, and after one year in college. We subsequently apply one version of this model to data from the American Community Surveys (2001–2017), calculating the absolute and relative incentives for educational persistence across racial groups. In addition to large dollar earnings differentials, the analyses reveal striking racial gaps of the relative incentives to stay enrolled: “incentive inequality.” This incentive race gap is largest at the earliest stages of the higher education career—high school graduation and college entry—where the black undergraduate dropout rate is highest. Our findings have substantive and methodological implications for situations where returns to investments are unequal across groups affected by discrimination.
‘Exploring the Influence of Social Media Influencers on Intention to Attend Cervical Screening in the UK: Utilising the Theory of Planned Behaviour’
Authors: Fielden Naomi , Holch Patricia
Published: April 2022

Objectives

Cervical cancer is 99.8% preventable when detected early; however, uptake of screening in the United Kingdom is at a 20-year low. Recently, a number of social media influencers have video logged about their experiences of cervical screening through narrative communication with their audience. Here we aimed to explore if accessing cervical screening information from a social media influencer can impact the theory of planned behaviour variables and predict intention to attend cervical screening appointments.

Design

Utilising a cross-sectional design a volunteer sample of 102 UK women (mean age = 28; SD = 3.10; range = 25–35) took part in an online questionnaire study.

Results

Hierarchical regression modelling revealed attitude as a significant predictor of intention to attend a cervical screening appointment and that social media influencers affect attitudes of their audience, indirectly influencing intention to attend.

Conclusion

Health messages communicated by social media influencers are effective in promoting positive attitudes but not directly influence intention to attend towards cervical screening. Further research should explore influencer impact on attitudes towards this health behaviour with the ultimate aim of increasing attendance and consequently saving lives.
Knowledge, Attitude, and Practice Toward Cervical Cancer Screening and Associated Factors Among College and University Female Students in Dire Dawa City, Eastern Ethiopia
Authors: Bekele Henok Tesfaye , Nuri Aliya , Abera Legesse
Published: April 2022

Introduction:

Cervical cancer is preventable and, in most cases, curable if identified at an early stage. Cervical cancer is the second leading cause of cancer-related mortality Ethiopia with screening accounting for only 0.8%. Furthermore, female students and young adults in colleges and universities’ have a high prevalence of genital HPV infection because of their risky sexual behavior, lack of knowledge on screening and very few students receive screening services. This study aimed to assess the Knowledge, attitudes, and practice toward cervical cancer screening and its associated factors among female college students in Dire Dawa City, Ethiopia.

Methods:

An institutional-based cross-sectional study was conducted using a multistage sampling technique from November to December 2020, among 730 female college students in Dire Dawa. Descriptive statistics and binary logistic regression were used to describe each variable and identify associations between the dependent and independent variables respectively. Adjusted odds ratio with 95% confidence interval and P-value <.05 used to determine the association.

Results:

The results showed, only 64 (9.3%) participants were knowledgeable, 413 (60.1%) had positive attitudes and 17 (2.5%) were screened in their lifetime. Age group, years of study, and history of cervical cancer practice were significantly associated with knowledge of cervical cancer screening. The year of study was based on cervical cancer smears and the number of screenings was significantly associated with attitude.

Conclusion:

This study showed that students’ knowledge of cervical cancer screening is low. Overall attitudes toward cervical cancer screening among female students were good, but only a small proportion of students had undergone cervical cancer screening. The most common reasons for the low screening practice were lack of information and undecided. There is a need to promote different campaigns for cervical cancer screening programs, in order to increase awareness.
The Use of SGLT-2 Inhibitors Coupled With a Strict Low-Carbohydrate Diet: A Set-Up for Inducing Severe Diabetic Ketoacidosis
Authors: Guirguis Helpees , Beroukhim Afrahimi Shiela , Pham Charles
Published: April 2022

A 58-year-old male with a history of hypertension and non-insulin dependent type 2 diabetes mellitus (DM) was brought in by ambulance and admitted to the intensive care unit for weakness, lethargy, and altered mental status and was found to be hypotensive and subsequently diagnosed with severe diabetic ketoacidosis (DKA). A thorough investigation into precipitating factors for his DKA was largely unrevealing; an extensive infectious work- up was negative and the patient’s history was otherwise only significant for starting a ketogenic diet 1 month prior while simultaneously being on a sodium-glucose transport protein 2 (SGLT-2) inhibitor, namely empagliflozin. Literature investigation revealed that a strict low carbohydrate diet can rarely lead to DKA in the setting of SLGT-2 inhibitor use.
Sinus Node Dysfunction, Atrial Arrhythmias, and the Sinus Node Microcirculation
Authors: Fellner Susan K
Published: April 2022

A patient with sinus node dysfunction (SND) developed atrial arrhythmias that were abolished after avoidance of nonsteroidal anti-inflammatory medication and by the institution of a deliberate, modest increase in blood pressure, suggesting that there was a vascular component to the rhythm disturbance. Published anatomical evidence for a unique sinus node microcirculation substantiates the premise that SND may be sensitive to arterial flow. Because physicians have been unaware of the presence of a unique sinus node microcirculation, recognition of its presence may alter the approach to treatment of patients with SND and atrial arrhythmias, particularly in the elderly and those with diabetes.
Extracellular vesicles in gestational diabetes mellitus: A scoping review
Authors: Bathla Tanvi , Abolbaghaei Akram , Reyes Agafe Bless , Burger Dylan
Published: April 2022

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy worldwide. Despite extensive study, the molecular mechanisms leading to GDM and associated perinatal complications are not well understood. The condition is also associated with an increased risk of future cardiometabolic disease in both mothers and their offspring. Thus, there is a pressing need for the development of effective screening tools and to identify novel molecular mechanisms responsible for the short and long-term risks associated with GDM. In this regard, extracellular vesicles (EVs) offer promise as novel biomarkers of GDM-mediated changes to both mother and fetus. The purpose of this scoping review is to provide an overview of studies examining EVs in the context of GDM. EMBASE and Ovid Medline were searched for articles published from inception to December 2020. We update current knowledge in this area and identify key knowledge gaps with recommendations for future research.
Tongbixiao Pills Improve Gout by Reducing Uric Acid Levels and Inhibiting Inflammation
Authors: Xi Shijun , ZhiguoShao  , Li Lu , Gui Zhuang , Liu Peng , Jiang Qi , Yu Yuan , Zhou Wen , Zhou Ziqi , Zhang Shuo , Peng Xiao Chun , Su Bo
Published: April 2022

Gout is a chronic disease. Gout symptoms are often experienced in the middle of the night. The onset of gout in the middle of the night is closely related to abnormal liver and gallbladder meridian. The purpose of this study was to investigate the clinical efficacy and possible mechanism of action of Tongbixiao pills in the treatment of hyperuricemia and gouty arthritis. The Tongbixiao pills we used included several traditional Chinese medicines, most of which tonify the spleen; strengthen the liver; benefit the kidney; and reduce heat, dampness, and blood stasis. In this randomized clinical study of 105 patients, we found that Tongbixiao pills can reduce uric acid levels in hyperuricemia patients. Additionally, the efficacy was similar to that of allopurinol and the level of uric acid did not increase significantly at eight weeks after withdrawal. In the absence of notable adverse reactions, Tongbixiao pills can also increase uric acid excretion, reduce serum creatinine and lipid levels, and reduce inflammation and relieve gout symptoms. In addition, we used SD rats to simulate gout and arthritis and divided them into five groups: normal group, model group, low-dose group, medium-dose group, and high-dose group. The inflammatory indices of the 40 SD rats were observed. After seven days, ankle swelling in rats in the treatment group was significantly reduced. The indices of uric acid, creatinine, and urea nitrogen in the treatment group were significantly lower than those in the model group, which proved that Tongbixiao pills could inhibit hyperuricemia in rats, thus treating gout. This study demonstrates that Tongbixiao pills can treat gout, provide more treatment options for gouty arthritis, and improve the quality of life of patients.
Effect of Adenosine Receptor Antagonists on Adenosine-Pretreated PC12 Cells Exposed to Paraquat
Authors: Shang Liangcheng , Huang Yaobiao , Xie Xin , Ye Sudan , Chen Chun
Published: April 2022

Previous studies evaluated the adenosine receptor antagonists alone to determine their effects on oxidative stress, but little is known about adenosine’s protective efficacy when oxidative injury occurs in vivo. Adenosine is a crucial signaling molecule recognized by four distinct G-protein-coupled receptors (GPCRs) (i.e., A1R, A2AR, A2BR, and A3R) and protects cells against pathological conditions. The present study was performed to evaluate the role of antagonist modulation in the setting of paraquat toxicity with adenosine pretreatment. First, PC12 cells were exposed to paraquat (850 μM) and adenosine (30 μM) to develop an in vitro model for the antagonist effect assay. Second, we found that the A1R antagonist DPCPX enhanced the viability of paraquat-induced PC12 cells that underwent adenosine pretreatment. Moreover, the A2AR antagonist ZM241385 decreased the viability of paraquat-induced PC12 cells that underwent adenosine pretreatment. Our findings indicate that adenosine protection requires a dual blockade of A1R and activation of A2AR to work at its full potential, and the A2B and A3 adenosine receptor antagonists increased paraquat-induced oxidative damage. This represents a novel pharmacological strategy based on A1/A2A interactions and can assist in clarifying the role played by AR antagonists in the treatment of neurodegenerative diseases.
Trajectory tracking of in-wheel motor electric vehicles based on preview time adaptive and torque difference control
Authors: Han Wenyao , Li Aijuan , Huang Xin , Li Wei , Cao Jiaping , Bu Haixiang
Published: April 2022

In order to improve the accuracy of trajectory tracking of in-wheel motor electric vehicles, a preview time adaptive trajectory tracking method based on iterative algorithm and fuzzy control is proposed. Firstly, based on the vehicle’s three-degree-of-freedom model, the vehicle is controlled to track trajectory based on model predictive control (MPC). The preview step size and sampling period of MPC are adjusted by iterative function and fuzzy controller, respectively. Then, In order to optimize MPC active steering control, a differential torque controller is established to realize the trajectory tracking control of differential torque steering. Finally, Carsim/Simulink co-simulation analysis and real vehicle verification are done. The simulation results show that the controller can complete the trajectory tracking control of the in-wheel motor intelligent vehicle, and the stability and steering performance are good. The controller has good robustness and adaptability according to road adhesion conditions and vehicle speed changes. At the same time, the trajectory tracking accuracy of the MPC controller is better than sliding mode variable structure control (SMC). The real vehicle verification results show that when the real vehicle tracking under different speeds, the adaptive preview time controller designed in this paper has good trajectory tracking performance and stability.
Natal philopatry is associated with smaller nest size in a cavity-nesting bird with consequences for nest box temperature
Authors: Reed Angelica N , McRae Susan B
Published: April 2022

Considerable within-population variation in nest size exists among cavity nesters. We sought to explain this by studying a multi-brooded population of Eastern Bluebirds (Sialia sialis) breeding in nest boxes. We examined seasonal change in nest weights and compared the weights of nests built by immigrant and resident females. We further investigated whether nest weight correlated with maternal condition or breeding success. Nest weight measured after broods fledged was correlated with nest height at the start of incubation. Breeders spent fewer days building and built successively smaller, lighter nests in later nesting attempts. Female bluebirds performed the majority of nest construction. Nests built by immigrant females were significantly larger on average than those built by female recruits hatched on site, and the seasonal decline in nest weight was more pronounced for natally philopatric females. For the first time, we present evidence that the weights of philopatric females’ first nests were significantly positively correlated with the weights of the nests they were raised in, suggesting an effect of natal memory. Contrary to expectation, neither maternal condition nor reproductive success (clutch size, hatching success, brood size, and fledging success) was related to nest weight. To investigate whether smaller nests provided a thermal advantage in summer nest attempts when afternoon box temperatures can exceed 41°C, we measured the temperature within nest boxes using programmable data loggers. Mean daily maximum box temperatures during incubation were significantly positively related to nest weight and significantly negatively related to the volume of free space above the nest. Increased air circulation above the nest likely contributed to cooling the boxes when ambient temperatures were high. Reducing nest size was therefore advantageous, especially in later nesting attempts when ambient temperatures were warmest. Seasonal decline in nest weights and differences between immigrant and natally philopatric females merits further investigation.
Mitigation of blast effects through novel energy-dissipating connectors
Authors: Seica Michael V , Packer Jeffrey A , Walker Martin G , Gow Matthew I
Published: April 2022

Explosions generate overpressures that can cause irreparable damage to structures. For many buildings, especially critical infrastructure, continued operation after an explosive attack is essential. The use of energy-dissipating methods will enable the protection of a structure and occupants from a blast and permit the timely repair and re-occupation of the building after an event.

The concept behind the system presented is the creation of panels that can be used as cladding for structures. The panels are connected to the main structure using energy-dissipating component assemblies around the panel edge. When subjected to a blast load the panels transfer the blast pressure through the assemblies, thereby reducing the forces transmitted to the underlying structure. After an event, the panels and energy-dissipating component assemblies can be replaced quickly and easily, allowing the building to be reoccupied in a short time after an attack.

This study focuses on the characterization of energy-dissipating component assemblies using static and dynamic laboratory testing. A predictive theory, supported by a single degree of freedom model, is developed and a general evaluation method proposed. Further laboratory testing expands the characterization of behaviour of the assemblies through experiments, with a blast generator in tension tests and in simulated blast panel tests. The time histories developed from tension tests are then compared to examine the effect of loading rate. The investigations on blast panels also include a comparison with predictions to determine whether the latter can describe the global behaviour of the system. Lastly, the response of the energy-dissipating component assemblies is evaluated in full-scale field blast tests on cladding panels.
A Meta-Analysis on the Safety and Immunogenicity of Covid-19 Vaccines
Authors: Ashmawy Rasha , Hamdy Noha A. , Elhadi Yasir Ahmed Mohammed , Alqutub Sulafa T , Esmail Ola Fahmy , Abdou Marwa Shawky Mohammed , Reyad Omar Ahmed , El-ganainy Samar O. , Gad Basma Khairy , Nour El-Deen Ahmed El-Sayed , Kamal Ahmed , ElSaieh Haider , Elrewiny Ehab , Shaaban Ramy , Ghazy Ramy Mohamed
Published: April 2022

Objective:

The presented meta-analysis (MA) aims at identifying the vaccine safety and immunogenicity in published trials about SARS-CoV-2 vaccines.

Methods:

All relevant publications were systematically searched and collected from different databases (Embase, Scopus, EBSCO, MEDLINE central/PubMed, Science Direct, Cochrane Central Register for Clinical Trials (CENTRAL), Clinical Trials.gov, WHO International Clinical Trials Registry Platform (ICTRP), COVID Trial, COVID Inato, Web of Science, ProQuest Thesis, ProQuest Coronavirus Database, SAGE Thesis, Google Scholar, Research Square, and Medxriv) up to January 10, 2021. The pooled vaccine safety and immunogenicity following vaccination in phase 1 and 2 vaccine clinical trials, as well as their 95% confidence intervals (CI), were estimated using the random-effects model.

Results:

The predefined inclusion criteria were met in 22 out of 8592 articles. The proportion of anti-severe acute respiratory distress coronavirus 2 (SARS-CoV-2) antibody responses after 7 days among 72 vaccinated persons included in 1 study was 81% (95% CI: 70-89), after 14 days among 888 vaccinated persons included in 6 studies was 80% (95% CI: 58-92), after 28 days among 1589 vaccinated persons included in 6 studies was 63% (95% CI: 59-67), after 42 days among 478 vaccinated persons included in 5 studies was 93% (95% CI: 80-98), and after 56 days among 432 vaccinated persons included in 2 studies was 93% (95% CI: 83-97). Meta regression explains more than 80% of this heterogeneity, where the main predictors were; the inactivated vaccine type (β = 2.027, P = 0.0007), measurement of antibodies at week 1 (β = −4.327, P < 0.0001) and at week 3 of the first dose (β = −2.02, P = 0.0025). Furthermore, the pooled proportion adverse effects 7 days after vaccination was 0.01 (0.08-0.14) for fever, headache 0.23 (0.19-0.27), fatigue 0.10 (0.07-0.13), and 0.18 (0.14-0.23) for muscle pain.

Conclusion:

Immunogenicity following vaccination ranged from 63% to 93% depending on the time at which the antibody levels were measured.
Effect of Founder Control on Equity Financing and Corporate Performance-Based on Moderation of Radical Strategy
Authors: Lyu Bei , Chen Hui
Published: April 2022

The founder is the cornerstone of the establishment of a company, and plays a vital role in the decision-making and cohesion of the company, as well as the operation of the company, and thus has a positive impact on the growth and performance of the company. This study takes founder control as the starting point, analyzes the correlation between founder control, equity financing, corporate radical strategy, and corporate performance, and selects 2010 to 2019 listed companies in China as the research sample. Based on literature review and theoretical analysis, four main hypotheses of this research are put forward. After descriptive statistical analysis, correlation statistical analysis, and empirical model testing of sample data, the following research conclusions are obtained. First, there is a negative correlation between founder control and equity financing. Second, there is a negative correlation between equity financing and corporate performance. Third, a corporate radical strategy has a negative moderating effect on the relevance between founder control and corporate performance. Fourth, equity financing has an enhanced mediating effect on the relevance between founder control and corporate performance. Fifth, the degree of corporate strategy of non-state-owned enterprises has a negative moderating effect on the correlation between founder control and corporate performance. Furthermore, based on the research conclusions above, this research puts forward the following recommendations: First, according to the different stages of enterprise development, reasonably restrict the control of the founder of the enterprise. Second, focus on long-term benefits and adopt strategic changes at the right time.
Implant-Related Complications after Spinal Fusion: A Multicenter Study
Authors: Koshimizu Hiroyuki , Nakashima Hiroaki , Ohara Tetsuya , Tauchi Ryoji , Kanemura Tokumi , Shinjo Ryuichi , Machino Masaaki , Ito Sadayuki , Ando Kei , Imagama Shiro
Published: April 2022

Study Design

Retrospective analysis of prospectively database

Objective

Implant-related complications are an extremely important issue because they pose a burden to patients who underwent surgery. An understanding of these complications can help improve the postoperative management of patients undergoing spinal surgery. The current large-scale multicenter study aimed to identify postoperative implant-related complications that may require revision surgery.

Methods

In total, 3447 patients who underwent spinal fusion surgery were included in the analysis. Data about age at surgery, sex, preoperative diagnosis, surgical level, type of implant-related complications, causes of reoperation, and time from the initial to revision surgery were reviewed. Moreover, the characteristics of reoperation in 3 periods (within 30, 31–90, and over 90 days) were assessed.

Result

The overall incidence of implant-related complications was 4.6%. Adult spinal deformity was the most common diagnosis (9.9%), and thoracic-lumbar-sacral (42.9%) was the most common surgical level among patients with implant-related complications. Further, screw malposition was the most frequent implant-related complication (42.8%). In total, 89 (2.6%) patients underwent reoperation due to implant-related complications. The main causes of reoperation within 30, 31–90, and over 90 days were screw malposition (72.2%), screw loosening or pull out (81.8%), and rod or screw fracture (60.9%), respectively.

Conclusion

To the best of our knowledge, this was the first large-scale multicenter study that assessed the characteristics of patients who underwent reoperation due to spinal implant-related complications. The study results could improve the preoperative informed consent procedure about spinal fusion.
Politics of Knowledge in Development: The Case of Sugar as an Artificial Sweetener
Authors: Singh Arun Kumar
Published: April 2022

The article aims to explicate the binary created between the two sweeteners, that is, gur (jaggery) and sugar. The focal point of this article is to understand with the analytical framework of politics of knowledge how a ‘traditional’ sweetener, that is, gur, is replaced from our diet by a ‘modern’ sweetener, that is, sugar. This framework replaces the term ‘traditional’ knowledge with ‘already existing knowledge system’ (AEKS, as spelt out by Banerjee [2021, Studies in Indian Politics, vol. 9, pp. 78–90]) and its transformation is examined in five different spaces: epistemology, political economy, historical context, state policy and collective action. In the first section, the epistemic hegemony of sugar is deconstructed through analytical understanding of technological processing; in the second, the changing political economy of sweeteners is explored. The third analyses post-colonial sugar policy showing the continuum from the colonial; and the fourth explores the politics of collective action to challenge and delegitimize the hegemony of sugar.
Increased Complication and Hardware Removal Rates with Headed Screws in Ankle or Subtalar Arthrodesis
Authors: Bailey Evan , Hoch Caroline P. , Goodloe Jonathan B. , Scott Daniel J. , Gross Christopher E.
Published: April 2022

Category:

Ankle; Hindfoot

Introduction/Purpose:

A large variety of hardware can be used for ankle or subtalar (ST) joint arthrodesis, with very little data available to guide which implants might be most effective for these indications. Hardware removal rates in the setting of calcaneal fixation have been shown to vary widely from 9-47%, which can impose an added economic and surgical burden on both the patient and the healthcare system. The purpose of this study was to determine if there was a difference in the outcomes between two different versions of cannulated screws (i.e., headless, variable-pitched; headed), as reflected by patient-reported outcome measures (PROMs), and postoperative complication and reoperation rates.

Methods:

A retrospective chart review identified 126 patients (135 feet) who underwent ankle or ST arthrodesis with a single fellowship-trained foot and ankle surgeon between December 2015 and February 2021. These patients met the following inclusion criteria: isolated tibiotalar or ST arthrodesis; receipt of a headless, variable-pitched screw made by Acutrak or headed screw made by Orthohelix; and minimum 3 months of postoperative radiographic follow-up. Overall, 76 procedures used headless, variable- pitched screws (ankle=13, ST=63) and 59 used headed (ankle=18, ST=41).

Results:

Overall, there was a significantly higher rate of complications among headed screws (54.2%), as compared to the headless, variable-pitched screws (35.5%; p=.030). There was no difference in any treatment duration or postoperative PROM between groups. There was a significant difference in reoperation rates between cohorts (headless, variable-pitched=11.8%, headed=32.2%; p=.004), but no difference in nonunion rate (headless, variable-pitched=22.4%, headed=35.6%; p=.090). There were also significantly more screw issues (i.e., break, movement, impingement) with headed screws (headless, variable- pitched=0.0%, headed=5.1%; p=.047). (Table 1) Of the nine patients who underwent a reoperation, headed screws were removed six (66.7%) times, with half attributable to nonunion, whereas headless, variable-pitched hardware was only removed once (1.11%) due to infection.

Conclusion:

Overall, the use of headed screws in ankle or ST arthrodesis is associated with significantly higher rates of complication and hardware removal, as compared to headless, variable-pitched screws. Even in the examination of the few patients in this cohort who underwent two procedures, headed screws were removed more often. Surgeons should place emphasis on these results when selecting the best hardware to fuse the ankle and ST joints.
Impact of Weber B Fracture Displacement on Medial Clear Space Volume: How Much Displacement Matters?
Authors: Bhimani Rohan , Mullen Marguerite A. , Ashkani-Esfahani Soheil , Waryasz Gregory R. , Kerkhoffs Gino , DiGiovanni Christopher W. , Guss Daniel
Published: April 2022

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Numerous radiographic studies examining Weber B fibular fractures demonstrate no change in tibiotalar contact area until the deltoid ligament is disrupted. In contrast, more recent studies using weight-bearing CT scan (WBCT) and 3D volume analysis suggest that medial clear space (MCS) volume can in fact increase in the setting of a Weber B fibular fracture even if initial radiographs are reassuring, possibly due to a loss of fibular buttress. This study aims to evaluate the ability of WBCT to quantify the impact of isolated Weber B fractures on MCS volume (3D), as well as understand the implication of increasing fibular displacement among patients with symmetric MCS distance (1D) on initial radiographs.

Methods:

The study group included 18 patients with unilateral Weber B ankle fractures who underwent preoperative bilateral foot and ankle WBCT. The control group consisted of 60 patients without ankle injury who underwent similar imaging. Measurements on WBCT images included: 1) MCS distance, 2) syndesmotic area, 3) anterior, middle, and posterior distal tibiofibular distance, 4) fibular rotation, 5) distance from fibular tip to plafond, and 6) fibular fracture displacement. Additionally, volumetric measurements included: 1) MCS volume 2) syndesmotic joint volume from the tibial plafond extending to 3cm and 5 cm proximally, and 3) lateral clear space volume were calculated. Area under the receiver operating characteristic (ROC) curve analysis and Delong test were used, and optimal cutoff values to distinguish between stable and unstable Weber B fractures without syndesmotic instability and MCS widening were determined using Youden's J statistic.

Results:

Among patients with unilateral Weber B ankle fractures, all WBCT measurements showed no side-to-side difference in any parameter, except MCS volume (p-values <0.001). When compared to the uninjured side, fibular displacement up to 2cm and up to 4cm increased lateral MCS volume by 37.1% (0.23cm3) and 51.8% (0.3cm3), respectively. Based on ROC analysis and Youden's J statistic, the optimal threshold for differentiating stable from an unstable Weber B fracture was 2.3 mm of displacement (AUC 0.81; sensitivity 77.8%; specificity 80%). The control group showed no difference in any of the measurements between the two sides.

Conclusion:

When using WBCT, 3D MCS volume increases significantly with Weber B fibular fractures, even if 1D distance measurements at the medial clear space are reassuring. This is especially true with fibular displacement greater than 2.3mm and may have an important role in the management of SER II ankle fractures.
Osteochondral and Ligament Injury Patterns in Ankle Fractures: A Prospective Multi-Center Study
Authors: Carreira Dominic S. , Shaw Daniel B. , Harris Thomas G. , McCullough Kirk A. , Kreulen Christopher D. , Martin RobRoy , Acevedo Jorge I.
Published: April 2022

Category:

Ankle; Arthroscopy; Sports; Trauma; Other

Introduction/Purpose:

When treating ankle fractures, the presence of talar osteochondral lesions and the extent of ligamentous injury are associated with the severity of injury. The Danis-Weber classification system has been used to predict potential ligament damage. The purpose of this study is to validate the ligament injury patterns that have been proposed to occur with the Danis-Weber Classification and identify the cartilage injury pattern that occurs on the talus with each fracture type.

Methods:

A prospective, multi-center foot and ankle arthroscopy registry was queried for patients who underwent arthroscopic treatment of ankle fractures. Preoperative and intraoperative findings were noted, including the Danis-Weber fracture classification, presence and location of osteochondral damage, and unstable deltoid, and/or syndesmotic ligaments. Kendall's tau-b, a nonparametric correlation coefficient for ordinal variables, was used to measure the strength and direction of association between Weber fracture type and the presence of a syndesmotic injury, deltoid ligament tear, medial malleolus fracture, or osteochondral lesion. The locations of osteochondral damage were compared as percentages.

Results:

73 subjects were prospectively collected as part of a multicenter ankle arthroscopy database. Average subject age was 43 years (SD = 17) with 59% female and 41% male. A significant association between the presence of a syndesmotic injury and fracture type was identified, with syndesmotic injuries more likely occurring with a Weber C fracture (p < 0.0005). A significant association was not identified between Weber classification and a deltoid tear or medial malleolus fracture (p = 0.47, p = 0.79). Location of the talar osteochondral lesions were as follows: 22% medial-anterior, 22% lateral-anterior, 22% lateral-central, 17% central-anterior, 9% medial-central, 4% later-posterior, 4% central. There was no significant association identified between Weber classification and the location of the osteochondral injury (p = 0.99).

Conclusion:

Concurrent injuries with syndesmotic disruption, deltoid ligament tears, medial malleolus fractures, and osteochondral lesions have been proposed to be associated with Weber C ankle fractures. However, in this multicenter study, only syndesmotic injuries were associated with the Weber C classification. This study found similar rates of medial malleolus fractures and osteochondral lesions in Weber B and C type fractures.
Role of the Lateral Ankle Ligaments in the Vertical Stability of the Fibula
Authors: Filippi Jorge , Gutierrez Paulina , Silvestre Rony A. , Bastias Gonzalo F. , Morales Jose Ignacio Quezada , Melo Rodrigo , Munoz Gerardo , Cuchacovich Mikenberg Natalio R.
Published: April 2022

Category:

Basic Sciences/Biologics; Ankle; Trauma

Introduction/Purpose:

In unstable ankle fractures, syndesmosis and the deltoid ligament have been widely studied, and their importance in their pathophysiology and treatment is recognized. This is not the case of the ankle lateral ligaments, and in particular, their role in the vertical stability of the fibula is unknown. Given their anatomical position, they should avoid proximal translation of the distal fragment of the fibula fracture. Purpose: To quantify the superior translation of the fibula by applying a constant proximal traction force as the syndesmosis and lateral ankle ligaments are sectioned sequentially.

Methods:

Eleven human ankle cadaveric specimens were used (6 female, 5 male). Removal of the skin and muscles was performed down to the ankle level, preserving the interosseous membrane (IOM). A deep dissection was performed to identify the inferior tibiofibular ligaments and the lateral ligaments of the ankle. Each piece was mounted on a platform specially designed for this work (fig 1), fixing the foot with an axial load of 25 kg, and a proximal traction force of 50 N was applied to the fibula. The syndesmotic ligaments, IOM, anterior talofibular ligaments (ATFL), and calcaneofibular ligament (CFL) were sequentially sectioned. The proximal displacement of the fibula was measured after each sequential section. Normality analysis was performed with the Kolmogorov-Smirnov and Shapiro-Wilkins tests. Differences between groups were evaluated with the ANOVA test with Dunnett and Newman-Keuls post-test.

Results:

When applying 50 N of proximal traction, the proximal and vertical displacement of the fibula was as follows; no sectioning 1.96 +- 1.19 mm, syndesmosis/IOM sectioning 3.96 +- 1.33 mm, ATFL sectioning 5.9 +- 1.73 mm and 10.2 +- 2.76 mm after sectioning the CFL. Normal distribution was observed in all groups. All measurements had a statistically significant difference between each group (p <0.05).

Conclusion:

In this model, a complete syndesmosis/IOM lesion produces a mean fibular proximal displacement of 3.96 mm. By adding the ATFL and CFL complete injury, it reaches 10.2 mm. Clinical relevance: In an unstable ankle dislocation with a significant fibular proximal displacement, there is probably a severe compromise of the lateral ligament complex, which could have clinical relevance as it is part of the bone and ligamentary stability ring of the ankle. This is the first study that describes the role of the lateral ligament complex in fibular vertical stability.
Early outcomes of Minimally Invasive Percutaneous Chevron/Akin Osteotomy for Symptomatic Hallux Valgus Deformity
Authors: Madi Naji S. , Braunstein Jacob R. , Fletcher Amanda N. , Doumat George , Parekh Selene G
Published: April 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

Hallux Valgus (HV) is a common progressive forefoot deformity. Although traditional open techniques have shown good outcomes, no technique has been shown to be superior to other techniques and 15% of patients have procedure related complications. This has significant functional restrictions, pain, and reduced quality of life. Minimally Invasive (MIS) percutaneous techniques became more popular in Orthopaedics. The current third generation of hallux valgus MIS technique developed by Vernois and Redfern features a percutaneous procedure with a stable internal fixation. The purpose of this study is to review the early outcomes of MIS hallux valgus operation by a single surgeon.

Methods:

Electronic health records were queried from January 1, 2015, through February 01, 2021, for patients who underwent MIS to treat HV deformity. Patients were treated by a single surgeon. The primary clinical outcomes assessed were visual analog pain score (VAS), rate of revision surgery, and recurrence. Additionally, radiographic outcomes were assessed including pre-and postoperative hallux valgus angle (HVA), inter-metatarsal angle (IMA), and foot width. The secondary outcomes included postoperative complications: infection, scar hypersensitivity, hardware irritation, hardware loosening, removal of hardware, and metatarsal fracture.

Results:

A total of 91 feet underwent MIS to correct symptomatic HV deformity. The mean age of this cohort was 53.63 +- 15.42 years, mean BMI of 26.81 +- 6.21, mean follow-up of 6.33 +- 6.39 months and 87 feet belonged to female patients. Patients showed a statistically significant (P < 0.001) improvement in VAS score after surgery. The radiographic outcomes showed significant (P < 0.001) improvement for all three variables at final follow up, with a mean improvement of 10.70° +- 6.42, 2.39° +- 3.55, and 5.30 mm +- 4.23 for the HVA, IMA, and foot width respectively. Two patients (2.2%) required revision surgery, one due to nonunion and one due to persistent pain. One patient had a hardware irritation that did not require hardware removal and one patient had a second metatarsal fracture. No feet had HV recurrence, hardware loosening, infection, or scar hypersensitivity.

Conclusion:

The current study showed that minimally invasive percutaneous Chevron/Akin for symptomatic hallux valgus correction is an effective and safe technique. In addition to a low complication rate, significant improvement in pain score and radiographic parameters at final follow up were demonstrated. Future randomized trials with long term follow up are needed to validate the outcomes of minimally invasive techniques.