bluuebunny/crossref_metadata_2025 huggingface dataset:
Car and train platoon simulations
Authors: Wu Qing , Ge Xiaohua , Cole Colin , Spiryagin Maksym
Published: November 2022

Detailed simulations of car and train platoons are critical steps towards successful implementations of the platooning technologies. This paper developed a simulation method that can be used for both car and train platoon simulations. The method includes three main parts: (1) a scalable adaptive longitudinal space controller, (2) 2D multibody dynamics simulations that consider wheel-rail contact (Polach model), tyre-road contact (Magic Formula), suspensions and in-train forces, and (3) a scalable parallel computing method that processes the dynamics simulation of each individual vehicle (one car or one carriage) by using one independent computer core. Two case studies were conducted to simulate a 6-car platoon and a 3-train platoon on real-world road and track. The maximum space errors for the car platoon and the train platoon results were about 0.32 and 0.23 m, respectively. When the platoons were running at a steady speed, space errors were well controlled within ±0.05 m for both car and train platoons. Example dynamics results were presented including wheel-rail contact forces, tyre-road contact forces, and carbody vibrations. This information can be used to conduct a wide range of related studies such as passenger ride comfort and system damage assessments.
Race and the Use of Force by Police Revisited: Post-Ferguson Findings From a Large County Police Agency
Authors: Smith Michael R. , Tillyer Rob , Engel Robin S.
Published: November 2022

This study examines racial and ethnic disparities in the use of force by the Fairfax County, VA Police Department using post-Ferguson data and after the adoption of modern training and use of force policies on de-escalation. White civilians were overrepresented as subjects of force compared to a variety of benchmarks, while Hispanics were underrepresented. Black and Asian civilians also were overrepresented using some benchmarks but not others. Multivariate models revealed that Black civilians experienced more severe force, higher average force levels, and more total force than Whites. We discuss possible reasons for the overrepresentation of Blacks and Whites as subjects of force, as well as the disparities in force levels and the totality of force experienced by Black civilians. We conclude with suggestions for policy change, training, and deployment changes to help reduce the potential influence of unconscious bias in the application of force by the FCPD and other law enforcement agencies.
HLA-DRB1*1501 influences long-term disability progression and tissue damage on MRI in relapse-onset multiple sclerosis
Authors: Brownlee Wallace J , Tur Carmen , Manole Andreea , Eshaghi Arman , Prados Ferran , Miszkiel Katherine A , Wheeler-Kingshott Claudia AM Gandini , Houlden Henry , Ciccarelli Olga
Published: November 2022

Background:

Whether genetic factors influence the long-term course of multiple sclerosis (MS) is unresolved.

Objective:

To determine the influence of HLA-DRB1*1501 on long-term disease course in a homogeneous cohort of clinically isolated syndrome (CIS) patients.

Methods:

One hundred seven patients underwent clinical and MRI assessment at the time of CIS and after 1, 3, 5 and 15 years. HLA-DRB1*1501 status was determined using Sanger sequencing and tagging of the rs3135388 polymorphism. Linear/Poisson mixed-effects models were used to investigate rates of change in EDSS and MRI measures based on HLA-DRB1*1501 status.

Results:

HLA-DRB1*1501 -positive ( n = 52) patients showed a faster rate of disability worsening compared with the HLA-DRB1*1501 -negative ( n = 55) patients (annualised change in EDSS 0.14/year vs. 0.08/year, p < 0.025), and a greater annualised change in T2 lesion volume (adjusted difference 0.45 mL/year, p < 0.025), a higher number of gadolinium-enhancing lesions, and a faster rate of brain (adjusted difference −0.12%/year, p < 0.05) and spinal cord atrophy (adjusted difference −0.22 mm2/year, p < 0.05).

Interpretation:

These findings provide evidence that the HLA-DRB1*1501 allele plays a role in MS severity, as measured by long-term disability worsening and a greater extent of inflammatory disease activity and tissue loss. HLA-DRB1*1501 may provide useful information when considering prognosis and treatment decisions in early relapse-onset MS.
Party soldiers on personal platforms? Politicians’ personalized use of social media
Authors: Pedersen Helene H
Published: November 2022

Social media are seen as a catalyst for personalized politics, and social media activity has, therefore, been used as an indicator of personalized representation. However, this may lead to an overestimation because politicians can behave as party soldiers even on their personal social media platforms. This article proposes that we need to examine the content of politicians’ social media communication to evaluate levels of personalized representation and understand the drivers behind it. Based on a full year’s Facebook activity of Danish members of Parliament including 28,000 updates, this study documents two main results. First, politicians do use Facebook to manage their personal image, but they also attend to their party duties. Attending to content suggests that activity measures overestimate personalized representation by at least 20 percentage points. Second, in contrast to expectations, mainly electorally secure politicians personalize communication on social media, which suggests that vote getters may enjoy more party duty leeway.
Longitudinal assessment of COVID-19 fear and psychological wellbeing in the United Kingdom
Authors: Quigley Martyn , Whiteford Seb , Cameron Gemma , Zuj Daniel V , Dymond Simon
Published: November 2022

The COVID-19 pandemic continues to impact global psychological wellbeing. To investigate the sustained impact of COVID-19 on wellbeing, the current study longitudinally assessed fear of COVID-19, anxiety, depression, intolerance of uncertainty, worry, sleep quality, loneliness and alcohol use during the pandemic in the United Kingdom. Timepoint 1 (T1; N = 445) took place in February 2021 following the highest number of pandemic-related deaths in the UK. Timepoint 2 (T2, N = 198) took place in June 2021 when pandemic-related deaths had declined considerably, and many had been vaccinated. At T1, COVID-19 fear predicted elevated levels of anxiety, depression, intolerance of uncertainty, worry, sleep quality and loneliness. At T2, we observed that levels of COVID-19 fear, depression, loneliness and sleep quality decreased. However, COVID-19 fear continued to predict elevated intolerance of uncertainty, worry and impaired sleep quality. These findings demonstrate the longitudinal impact of COVID-19 fear on psychological wellbeing.
Learner Profile Attributes in IB Teaching: Insights from a Continuum School in Turkey
Authors: Keser Özlem , Altan Servet , Lane Jennie F
Published: November 2022

This article presents findings from a case study of a K-12 school in Turkey where teachers shared perceptions of how the International Baccalaureate Learner Profile attributes related to their own practice. While discussing the interdependency of the attributes, teachers considered that being an inquirer is the most valuable attribute for effective International Baccalaureate teachers. Participants at all grade levels believed that being open-minded and r eflective were important attributes. Despite the importance of inquiry, participants shared that they feel most capable of implementing the attribute of being knowledgeable. The conceptual framework developed for this study may be used by schools and teacher educators to develop attributes of teachers who can help students become global citizens with intercultural understandings.
Alcohol’s Role in Campus Sexual Assault Bystander Behavior: A Systematic Review
Authors: Rizzo Andrew J. , Klein L. B. , Scaglione Nichole M.
Published: November 2022

Between 50% and 70% of campus sexual assaults (SA) involve alcohol and campuses frequently promote bystander intervention strategies to prevent SA in student party contexts. This systematic review evaluates the measurement and outcomes of quantitative studies on how alcohol affects campus SA bystander outcomes. Using four search strategies and rigorous systematic review methods, we conducted a review of 36 studies. We included studies published after 2,000 conducted with college students in the United States, its territories, and Canada which contained information on alcohol use and SA bystander outcomes (behaviors and upstream proxies). Only a third of included studies measured bystander behavior directly, the majority measured upstream proxies (e.g., intentions, self-efficacy). Most studies considered the influence of victim intoxication on bystander outcomes. No studies assessed the pharmacological or physiological effects of alcohol on bystander outcomes. A single study examined hypothetical bystander responses when intoxicated, one-third examined bystander’s typical alcohol use in relation to bystander outcomes. Many findings are contradictory, including fundamental details such as how often students encounter SA involving alcohol or whether bystanders’ alcohol use predicts outcomes. Findings suggest that students are less likely help intoxicated victims compared to sober victims, but there are clear moderating factors. Perpetrator intoxication was not studied in relation to bystander behavior and did not influence any upstream proxies. Evaluations of interventions on alcohol and bystander topics are promising yet more research is required. This review illuminates key gaps in the literature, including the need for validated measures and scenarios, event-level studies, and alcohol administration trials.
Improvement of mechanical property for BNNSs/PAN composite films via electro-spinning with high filtration performance
Authors: Zhou Yingying , Sun Runjun , Wang Ruining
Published: November 2022

People increasingly need air filters with ultra-high efficiency due to air pollution. In this work, BNNSs (boron nitride nanosheets) were prepared by chemical method using potassium permanganate and sulphuric acid. This functionalization induced the exfoliation of the layered structure of h-BN into monolayer or few-layer sheets. Infrared spectrum analysis shows that the oxidation functional group was introduced into hexagonal boron nitride. Further investigation of the crystallization property was accomplished by XRD analysis in conclusion that the crystal structure was not changed for the introduction of oxidation functional group. The polyacrylonitrile (PAN) and BNNSs/PAN nanofiber films were constructed by electrospinning. It is found that the electrospun nanofiber films had good filtration effect and could capture the most particles in the air because of electrostatic adsorption. The removal rate of particle by the filters reached 99.8% for BNNSs/PAN nanofiber films. Addition of BNNSs increaed the mechanical property of the nanofiber films.
The Importance of Transformational Leadership to Support Faculty Diversity in Our Nation’s Predominantly White Institutions of Higher Learning
Authors: Carlson Jadwiga A. , LaVenia Kristina N.
Published: November 2022

Predominantly white institutions (PWIs) struggle to attract and retain underrepresented faculty. Despite aspirations for diversity, the reality remains that underrepresented faculty are not hired and retained in numbers sufficient to change the institution’s demographics. The leadership of PWIs strives for solutions to ameliorate the trend in recruitment, retention, and climate. The issue has gained even more significance recently due to the global coronavirus pandemic when layoffs, non-renewals, and hiring freezes have been widely imposed. This case examines how systemic leadership problems, mindsets, and climates keep PWIs at the status quo, and invites application of leadership and adult learning theories to develop a strategy for improving faculty diversity at PWIs.
Principal leadership typologies and their relationship with teacher self-efficacy and commitment: A latent profile mediation analysis
Authors: Bellibaş Mehmet Şükrü , Polatcan Mahmut , Akyürek Muhammet İbrahim
Published: November 2022

This study investigated the heterogeneous nature of teachers’ perceptions of distinct leadership practices and explored the predictors of teacher- and school-level leadership typologies on teacher self-efficacy and commitment by using a multilevel latent profile mediation analysis of a dataset of 890 teachers from K-12 schools in Turkey. The results revealed three distinct leadership profiles ( limiting, transitioning, and integrating) at the teacher level and two profiles ( transitioned and integrated) at the school level, providing evidence that integrating teachers and integrated school profiles were associated with greater teacher self-efficacy and commitment. Additionally, both levels of integrated leadership profiles were indirectly related to teacher commitment through teacher self-efficacy vis-a-vis other profile groups. The study concluded that different leadership styles are related and that the impact of leadership on teachers is maximized when multiple leadership types are integrated.
Engaging key stakeholders to overcome barriers to studying the quality of research ethics oversight
Authors: Anderson Emily E , Hurley Elisa A , Serpico Kimberley , Johnson Ann , Rowe Jessica , Singleton Megan , Bierer Barbara E , Cholka Brooke , Chaudhari Swapnali , Fernandez Lynch Holly
Published: November 2022

The primary purpose of Institutional Review Boards (IRBs) is to protect the rights and welfare of human research participants. Evaluation and measurement of how IRBs satisfy this purpose and other important goals are open questions that demand empirical research. Research on IRBs, and the Human Research Protection Programs (HRPPs) of which they are often a part, is necessary to inform evidence-based practices, policies, and approaches to quality improvement in human research protections. However, to date, HRPP and IRB engagement in empirical research about their own activities and performance has been limited. To promote engagement of HRPPs and IRBs in self-reflective research on HRPP and IRB quality and effectiveness, barriers to their participation need to be addressed. These include: extensive workloads, limited information technology systems, and few universally accepted or consistently measured metrics for HRPP/IRB quality and effectiveness. Additionally, institutional leaders may have concerns about confidentiality. Professional norms around the value of participating in this type of research are lacking. Lastly, obtaining external funding for research on IRBs and HRPPs is challenging. As a group of HRPP professionals and researchers actively involved in a research consortium focused on IRB quality and effectiveness, we identify potential levers for supporting and encouraging HRPP and IRB engagement in research on quality and effectiveness. We maintain that this research should be informed by the core principles of patient- and community-engaged research, in which members and key stakeholders of the community to be studied are included as key informants and members of the research team. This ensures that relevant questions are asked and that data are interpreted to produce meaningful recommendations. As such, we offer several ways to increase the participation of HRPP professionals in research as participants, as data sharers, and as investigators.
Beyond the Leader: An Ideational-Political Logics Approach to Redshirt Movement Populism in Thailand
Authors: Connors Michael K.
Published: November 2022

By twinning the ideational and political logic approaches to populism, this article offers an original interpretation of the Redshirt movement in Thailand. The article extensively uses pro-Thaksin media sources and booklets to demonstrate how the Redshirt movement in Thailand appropriated the formerly authoritarian Thaksin as an empty signifier. This article fills a significant gap by exploring how ideational elements of the Redshirt movement fostered the emergence of a populist subject that struggled for a liberal constitutional re-foundation of Thai politics.
Perinatal Tissue–Derived Allografts and Stromal Cells for the Treatment of Knee Osteoarthritis: A Review of Preclinical and Clinical Evidence
Authors: Sawvell Emily , Wright Noah , Ode Gabriella , Mercuri Jeremy
Published: November 2022

Objective

The use of perinatal-derived tissues and mesenchymal stromal cells (MSCs) as alternative treatment options to corticosteroid and hyaluronic acid injections has been gaining popularity. However, their ability to attenuate osteoarthritic (OA) symptoms while also slowing the progression of the disease remains controversial. Thus, the objective of this article is to summarize the results from both preclinical and clinical studies evaluating the efficacy of perinatal-derived tissue allografts and MSCs for the treatment of OA.

Design

A comprehensive literature search was conducted on databases including Pubmed, ScienceDirect, and Google Scholar beginning in March 2020 for both preclinical and clinical studies evaluating perinatal-derived tissues and MSCs in OA. Eighteen studies met the inclusion criteria and were used for this review.

Results

Both animal models and early human clinical trials demonstrated that perinatal tissues could reduce joint inflammation and pain as well as improve range of motion and function in OA. Perinatal tissue–derived MSCs in animal studies have shown the potential to support chondrocyte proliferation while also decreasing inflammatory gene and protein expression. Limited clinical results suggest perinatal tissue–derived MSC sources may also be a viable alternative or adjunct to hyaluronic acid in reducing pain and symptoms in an arthritic joint.

Conclusions

Perinatal tissue–derived allografts and MSCs have promise as potential therapeutics for mitigating OA progression. However, further research is warranted to fully define the therapeutic mechanism(s) of action and safety of these biological therapies.
EU Asset Recovery and Confiscation Regime – Quo Vadis? A First Assessment of the Commission’s Proposal to Further Harmonise the EU Asset Recovery and Confiscation Laws. A Step in the Right Direction?
Authors: Sakellaraki Anna
Published: November 2022

This article aims to explore the key novelties of the proposal recently published by the Commission for a new Directive on asset recovery and confiscation and to offer critical reflection on certain issues. The proposed Directive intends to replace the previous Directive 2014/42/EU on freezing and confiscation and the Council Decision 2007/845/JHA on Asset Recovery Offices. The present article first clarifies the legal bases chosen for the adoption of this new EU legal instrument and shortly addresses some issues of compliance with the subsidiarity and proportionality principle. Then offers an overall analysis of the most important provisions (a) on the different asset recovery stages (asset tracing and identification, management, freezing and confiscation) (b) on the safeguards for the persons affected by such measures and (c) on the newly introduced obligation for the Member States to create a national asset recovery strategy. The article sheds also some light on the relationship between the proposed Directive and the violation of EU restrictive measures and finally concludes with some critical remarks, in order to contribute to the legal dialogue ahead of the final adoption of the new Directive.
Early activation of artificial urinary sphincter for stress incontinence is safe: A pilot study
Authors: David Rowan V , Kahokehr Arman A
Published: November 2022

Background:

Artificial urinary sphincter (AUS) activation is usually deferred until 6 weeks following insertion. However, this timeframe for activation is based on traditional dogma. This study aims to assess the feasibility, efficacy and safety of earlier activation of AUS.

Methods:

A prospective database was established on consecutive patients undergoing AUS implantation (AMS-800 Boston Scientific) from March 2019 to March 2022 by a single fellowship-trained urologist. Early activation was defined as <30 days from the date of implantation.

Results:

Twenty-one patients were included in the study with a median follow-up of 34 (range: 3–96) months. The most common indication for AUS insertion was post-prostatectomy stress urinary incontinence ( n = 19, 90%). All 21 patients had their AUS successfully activated and used before 30 days, with a median of 14 (range: 9–28) days. Median (range) pre-operative continence pad numbers were 3 (2–6) and 0 (0–1) at 4 weeks post-operatively. Median (range) pad weight per day was 600 g (190–1310 g) pre-operatively and 6 g (0–6 g) at 4 weeks post-operatively. There were no adverse events associated with early activation.

Conclusion:

To our knowledge, this is the first description of the early activation of the AMS-800 AUS device. Our preliminary experience indicates early activation is safe and acceptable for patients.

Level of evidence:

II
Is the Way I was Raised Linked to How I Love? Perceived Parenting and Implicit Theories of Relationships
Authors: Wang Ziying , Chen Wei-Wen
Published: November 2022

The current study was aimed at exploring (a) the links between perceived parenting styles (i.e., authoritarian parenting and authoritative parenting) and implicit theories of relationships (i.e., destiny belief and growth belief) and (b) the potential differences in such links based on romantic relationship status among emerging adults. A total of 578 participants aged 18–25 from Taiwan were included in the present study. By utilizing structural equation modeling (SEM), results indicated that perceived authoritative parenting linked to growth beliefs about romantic relationships, whereas perceived authoritarian parenting linked to both growth and destiny beliefs about romantic relationships. Additionally, according to the multigroup analysis of SEM, we found the associations between perceived parenting and implicit theories of relationships significantly varied by romantic relationship status. This study identified the critical relation between perceived parenting and youths’ romantic relationship beliefs and further revealed how these relations varied across young people with different relationship statuses.
“I Just want to be Happy”: An Exploration of the Aspirations, Values, and Psychological Wellbeing of Australian Young People
Authors: Humphrey Ashley , Forbes-Mewett Helen , Bliuc Ana-Maria
Published: November 2022

Western cultural environments present an increasingly challenging landscape for young people’s mental health. To better understand how this cultural environment may be influencing the lives of young people, we conducted 50 semi-structured interviews with young Australians, discussing participants’ values, life goals, social attitudes and behaviours, and life stressors. We find that while participants tended to see factors such as maintaining strong relationships and personal growth as important to them, their ambitions, attitudes, and social behaviours were often driven by self-centred and materialistic aims. Participants also perceived outcomes specific to these drivers, including poor social support, feelings of competitiveness, and uncertainties around their future, as significant contributors to the stress they experienced in their lives. These findings help us better understand how prevailing Western cultural norms, including individualistic and materialistic practices, may influence young people’s psychological wellbeing.
Training Background and Characteristics of NFL, MLB, and NBA Team Physicians
Authors: Young Matthew W. , Plummer Hillary A. , Fleisig Glenn S.
Published: November 2022

Background:

An analysis of the demographics and training of head team physicians (HTPs) in professional sports would be valuable for evaluating training programs and as a resource for aspirant HTPs.

Purpose:

To outline common characteristics among professional sport HTPs.

Study Design:

Cross-sectional study.

Methods:

In June 2021, publicly available directories and news articles were used to identify the head orthopaedic HTPs and primary care HTPs for every team in Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL). Data regarding HTP characteristics were collected via internet-based sources. Age, sex, years from fellowship completion to current team role, and years in current team role were compared across sports with chi-square analyses and analyses of variance; comparisons between orthopaedic and primary care HTPs were performed with Fisher exact tests and Student t tests. The most frequently attended residency and fellowship training programs were also calculated. The productivity of fellowship programs was calculated as the number of current HTPs from that institution divided by the number of fellowship positions currently offered.

Results:

We identified 181 HTPs: 171 (94%) men and 10 (6%) women. The mean age was 55.4 years (range, 33-79 years); the mean time from fellowship training completion to first year in current team role was 9.8 years (range, 0-29 years); and the mean time spent in current team role was 14.1 years (range, 0-39 years). There were 94 orthopaedic HTPs and 87 primary care HTPs. The rate of fellowship training was significantly higher in orthopaedic HTPs (95%) than in primary care HTPs (67%; P < .001). The fellowship programs that produced the largest number of current HTPs were the Hospital for Special Surgery (n = 16; productivity = 2.3), the American Sports Medicine Institute (11; 1.8), and the Kerlan-Jobe Orthopaedic Clinic (11; 1.2). The years from fellowship to HTP varied significantly by sport: 7.2 for MLB, 10.0 for the NFL, and 11.7 for the NBA ( P = .048).

Conclusion:

Almost all orthopaedic HTPs were fellowship trained, as compared with two-thirds of primary care HTPs. Of the 94 orthopaedic HTPs, 62% were trained at 6 specific fellowship programs. Men accounted for a majority of HTPs.
Indication and Consideration of Minimally Invasive Bosh Akin (MIBA) for Salvage in Recurrence of Hallux Valgus
Authors: Redlich Alex , Ortiz Cristian A. , Chaparro Felipe R. , Mombello Franco L.
Published: November 2022

Category:

Bunion

Introduction/Purpose:

Hallux valgus recurrence is a common complication to consider, depending on the different series it has an incidence of between 5-15%, being one of the most frequent complications reported after surgical surgery, however, not all of them require surgical treatment. This has a multifactorial origin with factors depending on the surgeon, the chosen surgical technique and some components of the deformity not completely corrected during the initial surgery. In cases where this recurrence requires surgical correction, it is a challenge for both the patient and the surgical team, and the success of the treatment depends on correct identification of the cause of failure after primary surgery and correct surgical planning. We present some technical considerations for choosing a minimally invasive osteotomy in this cases.

Methods:

The inappropriate selection of the technique in a patient with a recurrence of hallux valgus has a high rate of failure. In this sense, we must carry out a precise preoperative evaluation of the patients, both clinical and radiological, using weight-bearing X-rays or even a Weight-bearing CT scan that allows Adequate planning to evaluate rotation and pronation of the metatarsal more reliably, associated with an evaluation of sesamoid subluxation, possible signs of cuneometatarsal instability, such as plantar gap, articular facet obliquity, cortical thickening of the 2nd metatarsal. This also allows us to confirm the presence of metatarsophalangeal arthrosis, or sesamoid metatarsal arthritis that could influence our decision algorithm.

Results:

Similar to a primary hallux valgus, an asymptomatic deformity should only be observed and if it becomes symptomatic or has a considerable rate of progression, it should be treated surgically. In cases of symptomatic deformities we should always consider the presence of metatarsophalangeal osteoarthritis, medial column instability, if these are not present as indicated by Raikin in his algorithm proposed in 2014, we consider an osteotomy as a revision procedure in a recurrent hallux. In this scenario, we have considered this alternative for selected cases, using the minimally invasive Bosh Akin (MIBA) technique, as a salvage alternative in surgery for recurrences of Hallux valgus. We present a series of 4 feet successfully treated with MIBA osteotomy

Conclusion:

The application of the miba osteotomy is an effective alternative for the treatment of recurrence of Hallux valgus, which achieves results similar to other open rescue techniques with less aggression of soft tissue
Syndesmotic Reduction Landmarks in Healthy Ankle Patients, Comparative Analysis of Weight- Bearing Computed Tomography
Authors: Redlich Alex , Pellegrini Manuel J. , Carcuro Giovanni M. , Chaparro Felipe R. , Ortiz Cristian A. , Escudero Mario I. , Espinoza Carolina Avilés
Published: November 2022

Category:

Ankle

Introduction/Purpose:

Introduction: The diagnosis of low-energy syndesmotic injuries continues to be a challenge, and there is no standard for it. Being the dynamic exams, the ones with the best performance. With the development of Weight-Bearing computerized tomography (WBCT), the understanding of their lesion patterns has improved, however, there is high variability in the syndesmotic anatomy between different individuals, with asymmetry parameters in up to 89% of healthy syndesmosis. therefore the best element to evaluate them is the healthy contralateral ankle and compare these parameters. However, what are the normal values in our population, or the possible anatomical differences according to different age groups, in the morphology of the syndesmal notch of our patients, nor that there is a real symmetry between both ankles.

Methods:

Retrospective analysis of comparative bilateral ankle WBCT in healthy patients from March 2018 to July 2021 according to the parameters: anterior, posterior and central syndesmal distance, fibular rotation, sagittal translation and area. All patients with comparative bilateral ankle weight-bearing CT taken since January 2018 to August 2021, patients without history of ankle injuries, were included in the analysis. That have required a comparative bilateral WBCT to study another pathology. Patients with a history of acute or chronic ankle or syndesmal injuries, patients with degenerative ankle joint injuries, with severe misalignments > 10° in varus or valgus, incomplete or non-comparative study were excluded.

Results:

150 patients with comparative bilateral WBCT were evaluated. Among the ankles evaluated with WB CT in a comparative manner, it is established that there were no significant differences between both ankles of subjects with healthy ankles (Wilcoxon Test) in anterior syndesmal distance (SD), posterior SD, central SD, syndesmal area (p > 0.05). While fibular rotation and sagittal translation showed significant differences between the measurements in healthy ankles, evaluated with comparative bilateral WB CT in independent evaluations (p < 0.05). Regarding the differences by age range established for the different syndesmotic reduction parameters, for the different subgroups of patients under 40 years of age, 40 and 60 years of age and over 60 years of age, no significant differences were generated between them (Wilcoxon test).

Conclusion:

We have established normal ranges for measurements in the syndesmal anatomy in axial slices during weight bearing CT, as well as that there are no differences between the right and left ankle in healthy ankles in anterior, posterior and central syndesmal distance, or syndesmal area. Being these parameters, the most suitable as internal control for patients with suspected syndesmotic injury regardless of the age of the patients.
Intermetatarsal Screw Fixation Reduced Intermetatarsal Angle Following Modified Lapidus Procedures
Authors: Reed Logan , Luque-Sanchez Kevin S. , Awad Shadi K. , Mihas Alexander K. , Young Sean M. , Patch David A. , Johnson Michael D.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

The Modified Lapidus arthrodesis is a historically established surgical technique for treatment of hallux valgus, providing quality patient outcomes and reproducible results. Addition of a transverse first to second intermetatarsal screw spanning the base of the metatarsals in this procedure can increase stability. However, no study evaluates the radiographical parameters following application of this intermetatarsal screw fixation to procedures without first to second intermetatarsal screw fixation. The purpose of this study was to assess the quality of radiographic parameters between individuals receiving a first to second intertarsal screw fixation to those that did not receive intermetatarsal screw fixation following a non-saw cut Modified Lapidus procedure.

Methods:

A retrospective review was performed on 74 patients that underwent a Modified Lapidus arthrodesis between 2016- 2020 at a single institution. Preoperative indications for the procedure included first ray instability, first ray hypermobility, hallux abductovalgus, and metatarsal primus elevatus. Inclusion criteria consisted of skeletally mature patients undergoing non sawcut Modified Lapidus procedure. Patients that received the procedure due to a traumatic event or patients with concomitant second metatarsal arthrodesis were excluded. Review of patient's charts was performed. Basic demographics data, implant type, and radiographic parameters including intermetatarsal angle (IMA) and first metatarsal length were obtained from preoperative as well as postoperative films.

Results:

A total of 74 patients who underwent a Modified Lapidus arthrodesis were included in the study. A group of 43 patients received the Modified Lapidus arthrodesis with the addition of a first to second intermetatarsal screw fixation compared to a group of 31 patients who only received the Modified Lapidus arthrodesis procedure. The average IMA in all patients prior to surgery was 13°. The patients who received intermetatarsal screw fixation had significantly higher IMA reductions between preoperative and postoperative films than those who did not receive the intermetatarsal screw (-8.41° vs. -5.78°, p=.005). The difference in first metatarsal length on preoperative and postoperative films was less in patients who received the screw fixation but this was not statistically significant.

Conclusion:

The Modified Lapidus procedure is a commonly used procedure to treat hallux valgus. The results of this study found that the addition of a first to second intermetatarsal significantly reduced the IMA when compared to individuals who did not receive the screw construct. These findings will help surgeons further delineate if an intermetatarsal screw is required and how it will contribute to the radiographic parameters of interest.
The Effect of Diabetes on Ankle Fracture Outcomes in the UK: A National Collaborative Assessment of Current Guidelines, Management and Surgical Choices in Ankle Fractures
Authors: Reichert Ines , Ahluwalia Raju S. , Wek Cesar , Stringfellow Thomas , Coffeyy Duncan , Tan Sze Ping
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Objectives: Ankle fractures associated with diabetes experience more complications with standard Open-Reduction-Internal-Fixation (ORIF) following AO-principles than those without diabetes. It is unclear if augmented/extended fixation strategies can improve this. This aim of this study was to understand utilisation of extended/augmented/ORIF techniques (e.g., hind-foot-nail (HFN) and present outcomes of ankle fractures associated with diabetes. Secondarily the study aimed to evaluate compliance with national guidelines on early post-operative weight bearing.

Methods:

Research, Design & Methods: A national-multicentre retrospective cohort study was conducted between Jan - Jun 2019 of 56 UK centres (10 Major-Trauma-Units and 46 Trauma-Units). Institutional approval was obtained by all centres. 1360 complex-ankle-fractures were enrolled. Demographics, fixation choice and surgical outcomes were obtained. Statistical analysis was performed including propensity matching comparing patients with and without diabetes.

Results:

316pts (23.2%) had diabetes, 7.4% had neuropathy, with a mean age 63.9yrs (vs.49.3yrs in non-diabetes), with greater frailty >4 (24% vs.14% (non-diabetes) (p<0.03). 79.7% underwent standard AO-principles-ORIF; those with peripheral neuropathy were more likely to undergo extended/augmented-techniques. Overall wound complications were higher with diabetes (15.8% vs. 8.8% (p<0.02). 13% of patients with diabetes underwent augmented/extended techniques without a difference in complications to a matched control group without diabetes.

Conclusion:

Diabetic ankle fractures occur in older, frailer persons; whilst lower than expected neuropathy rates suggest a need for improved assessment. Contrary to current guidelines most patients remain non-weightbearing post-surgery. Extended/Augmented surgical techniques can allow earlier weight-bearing without increasing complications. MDT screening/management may improve surgical selection and under-utilisation of these techniques and promote early mobilisation.
End-Stage Tibiotalar Osteoarthritis and Chronic Strontium Toxicity
Authors: Ricci Gianni , Collier Watson B.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Metal toxicity due to environmental sources or orthopedic implants has been a primary focus in recent literature. Specifically, in orthopedics, total joint arthroplasty regarding metal-on-metal articulation with cobalt-chromium articulation has adverse local and systemic effects. In particular, strontium toxicity is less known metal toxicity that can cause many systemic effects such as severe osteoporosis.

Methods:

This is the first reported case of strontium toxicity and end-stage tibiotalar osteoarthritis.

Results:

We present a case of a 68-year-old female with bilateral ankle pain and deformity that were refractory to conservative measures, including physical therapy and anti-inflammatory medications. She was diagnosed with bilateral osteoarthritis and osteoporosis secondary to strontium toxicity by exclusion after extensive workup with a multi-disciplinary approach. The patient pursued conservative measures with ankle-foot orthosis, physical therapy, and anti-inflammatory medications. After the failure of conservative measures with over two years of follow-up, we recommended operative intervention to improve function and pain with staged bilateral tibiotalocalcaneal fusions utilizing an intramedullary device. Since she is moving out of state, she chose to pursue operative intervention at a different institution in order to establish long-term follow-up. The patient was placed on teriparatide for her osteoporosis secondary to strontium toxicity.

Conclusion:

Low doses of strontium can be beneficial to bone health and improve adverse events relating to osteoporosis. However, high doses of strontium can be detrimental leading to severe systemic complications. Although strontium toxicity is quite rare, this case demonstrates its deleterious effects on the quality of the bone leading to debilitating osteoarthritis and significant deformity in the foot and ankle.
The Efficacy and Safety of Tranexamic Acid in Foot and Ankle Surgery: A Systematic Review and Meta- Analysis
Authors: Salameh Motasem , Attia Ahmed K. , Hsu Raymond Y. , Blankenhorn Brad D.
Published: November 2022

Category:

Basic Sciences/Biologics; Other

Introduction/Purpose:

Tranexamic acid (TXA) use is increasing in Orthopedic practice specially among arthroplasty surgeons. It was proven to decrease the estimated blood loss and need for blood transfusion in hip, knee and shoulder arthroplasty as well as pelvis and acetabulum surgery. There was no reported increase risk of thromboembolic events with the use of TXA in orthopedic practice. This systematic review and meta analysis aimed on reporting on the available evidence on the use of TXA in foot and ankle surgery.

Methods:

The current meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic-based search on MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases to November 2021. Clinical studies on tranexamic acid use in foot and ankle surgeries reporting at least one of the desired outcomes; estimated blood loss (EBL), Hemoglobin difference between pre- and post-op, or complications were included. To assess risk of bias, the Joanna Briggs institute critical appraisal tool was used for case series and the Newcastle Ottawa scale for comparetive studies. The level of evidence was assigned according to the Cochrane Book Review Group.

Results:

A total of 718 foot and ankle procedures were included. Out of those, 491 (68.38%) procedures received tranexamic acid while 221 (31.64%) served as controls and did not receive tranexamic acid. In the TXA group, 34 (6.92%) procedures received local TXA injection in one study, while the remaining majority of 457 (93.08%) procedures received intravenous (IV) TXA. Among the control group, saline was used a placebo in 113 (51.13%) controls in 3 studies, while no placebo was used in the remaining 108 (48.87%) controls. The pooled mean EBL for the TXA group was 57.75 mL [95% CI: 44.80 to 70.70, I2 = 98.31%] while the pooled mean EBL for the control group was 299.26 mL [95% CI: 212.43 to 386.09, I2= 98.96%] with statistical significance Figure 1. No significant difference was found between the two groups in terms of change of hemoglobin and risk of thromboembolic events and other complications. Figure 2,3

Conclusion:

This systematic review and metaanalysis showed that the use of TXA in foot and ankle surgery was safe with no increased risk in thromboembolic events. The lower risk of bleeding using TXA despite being stastically significant, did not reach clinical significance and did not affect the post operative hemoglobin level. TXA can be considered in foot and ankle surgery in special cases with higher risk of bleeding or in cases where the use of tourniquet is contraindicated.
Vitamin D Status and Fracture Healing: A Systematic Review of 63 Studies
Authors: Singh Priya K. , O'Sullivan Lucy , Vankara Ashish , Raad Micheal , Aiyer Amiethab A.
Published: November 2022

Category:

Other

Introduction/Purpose:

There is little consensus on the effects of vitamin D on fracture healing. This review aims to clarify that effect in addition to determining trends in the classification of deficiency and supplementation.

Methods:

This systematic review searched Pubmed, Embase, and Web of Science for manuscripts related to vitamin D status/deficiency and fracture healing. Two independent reviewers screened articles, graded evidence quality, and extracted data. A total of 38 human studies, 11 in vivo studies and 14 systematic reviews were analyzed.

Results:

The median vitamin D deficiency prevalence reported amongst the human studies was 41.2% which is comparable to subset of patients with deficiency defined as <20 ng/mL, 43.3%. Amongst the 9 human studies reporting vitamin D supplementation, the exact dosage varied greatly. No RCTs reported any radiographic evidence of increased fracture union with any form of supplementation. Several RCTs reported reduction in pain with smaller daily supplementation compared to placebo or single large boluses. Animal studies reported mixed results, with some showing no significant effects of vitamin D status on the biomechanical properties of bone, while others demonstrated a correlation between supplementation improved biomechanical stiffness. Furthermore, the metabolite 24,25D may be a mediator in Vitamin D's probable osteoprotective effects.

Conclusion:

While the role of vitamin D in fracture healing appears to be osteoprotective in animal models, the degree and significance of its effects on human fracture healing and prevention remains inconclusive. We recommend standardizing the definitions for vitamin D deficiency to be <20 ng/mL for deficiency and >30 ng/mL for sufficiency. Although there is no radiographic evidence, daily smaller doses of vitamin D supplementation seem to have a stronger impact on clinical fracture healing than large boluses.
Long-Term Use of a Temporary Keratoprosthesis and Perfluorocarbon in Traumatic Retinal Detachment Repair
Authors: Govindaraju Viren K. , Trese Matthew G.J. , Gupta Chirag , Williams George A.
Published: November 2022

Purpose:

To present a technique for optimizing repair of traumatic retinal detachments (RDs).

Methods:

A patient was followed in an outpatient setting with clinical examinations, optical coherence tomography, widefield fundus photography, and anterior segment imaging.

Results:

The patient presented with a total RD after ruptured globe repair. The patient had combined corneal and retinal surgery with placement of a temporary keratoprosthesis (TKP) and vitrectomy with perfluorocarbon liquid (PFCL) to reattach the retina. The TKP and PFCL were left in the eye for 2 weeks before a planned silicone oil exchange and penetrating keratoplasty were performed. Four months postoperatively, the patient presented with a partially attached retina and improved vision.

Conclusions:

In this case, a ruptured globe decompensated several months after primary repair. The prolonged use of the TKP allowed for optimal surgical visualization, enhanced office-based assessment, and limited endothelial cell loss of the donor corneal tissue.
How I Do It: Pneumatic Dilation
Authors: Clarke John O. , Boeckxstaens Guy E.
Published: November 2022

Large-caliber dilation is an important therapeutic approach in the management of achalasia, but there is significant variability in how this is performed and taught worldwide. This article reviews the personal approaches to large-caliber of 2 experienced esophagologists—focusing on how they were personally taught to do the procedure, how their technique has evolved over the decades since, and how they current perform dilation.