bluuebunny/crossref_metadata_2025 huggingface dataset:
When Do Voters Punish Politicians Who Violate Democratic Norms?
Authors: Fang Albert H. , Thal Adam
Published: December 2023

Democracy requires voters to hold politicians accountable for violating democratic norms. Events surrounding Donald Trump have shown how partisanship can interfere with this process. While Trump has been accused of violating democratic norms, Republicans have opposed efforts to hold him accountable. Using a survey experiment, we explore the conditions under which Republican voters might become more willing to hold Trump accountable for violating democratic norms. We focus on whether Republicans can be convinced by members of their own party that Trump should be held accountable. Our research thus speaks to whether Republican voters might be receptive to appeals from Republican elites like Liz Cheney and Mitt Romney who have criticized Trump. We find more evidence than prior work that Republicans are receptive to appeals from co-partisans who are critical of Trump’s behavior. However, our overall finding is that co-partisan appeals are not highly effective at changing Republicans’ views of Trump.
Experimental investigation of the frictional behavior of single glass fiber filament
Authors: Liu Yang
Published: December 2023

Fiber friction behaviors are crucial for understanding the ubiquitous frictional damage phenomena in the manufacturing and service processes of multiscale textile reinforcements. This paper investigates the influence of relative velocity and applied load on the frictional behavior between a solitary glass fiber filament and a metal roller. The results of piecewise regression analysis indicate that the apparent coefficient of friction initially decreases with relative velocity, followed by an increase, and subsequently decreases again until stabilizing at higher velocity. Specifically, the maximum values of the coefficient of static friction are observed within the relative velocity range of 1.26–1.68 mm/s, while that of dynamic friction occurs within the range of 0.84–3.94 mm/s; the coefficient of friction reaches stable values within the relative velocity range of 7.87–15.71 mm/s. Under four different tension conditions, the stable values for the coefficient of static friction are 0.336, 0.308, 0.321, and 0.281, while the coefficient of dynamic friction are 0.291, 0.269, 0.273, and 0.232 respectively. Furthermore, the relationship between the coefficient of friction and the applied load reveals that the coefficient of friction decreases as the load increases. Finally, quantitative investigation reveals a strong coupling characteristic between the velocity dependency and load dependency of the apparent coefficient of friction.
Predictors of Patient Engagement With an Interprofessional Lifestyle Medicine Program
Authors: Cheng Abby L , Dwivedi Mollie E , Martin Adriana , Leslie Christina G , Pashos Madeline M , Donahue Viola B , Huecker Julia B , Salerno Elizabeth A , Steger-May Karen , Hunt Devyani M
Published: December 2023

Background

Changes in lifestyle habits can reduce morbidity and mortality, but not everyone who can benefit from lifestyle intervention is ready to do so.

Purpose

To describe characteristics of patients who did and did not engage with a lifestyle medicine program, and to identify predictors of engagement.

Methods

This was a single-center, retrospective cohort study of 276 adult patients who presented for consultation to a goal-directed, individualized, interprofessional lifestyle medicine program. The primary outcome was patients’ extent of engagement. Candidate predictors considered in multivariable multinomial logistic regression models included baseline sociodemographic, psychological, and health-related variables.

Results

A predictor of full engagement over no engagement was having private or Medicare insurance (rather than Medicaid, other, or no insurance) (OR 4.2 [95% CI 1.3-14.2], P = .021). A predictor of partial engagement over no engagement was having a primary goal to lose weight (OR 3.1 [1.1-8.4], P = .026).

Conclusions

System-level efforts to support coverage of lifestyle medicine services by all insurers may improve equitable engagement with lifestyle medicine programs. Furthermore, when assessing patients’ readiness to engage with a lifestyle medicine program, clinicians should consider and address their goals of participation.
RSF-based model for predicting pump failure trends in tunnels
Authors: Wu Xin , Chen Qianru , Hu Min , Gan Lining , Teng Li
Published: December 2023

The water pump is a piece of crucial electromechanical equipment to ensure the safety of tunnels. Therefore, it’s essential to master the performance trend of pumps to prevent the occurrence of failure. In this paper, essential information and failure records of pumps in 15 operating tunnels for many years were collected. According to the data characteristics, a data-filling model based on XGBoost is developed to address the issue of the censored data. Considering that most pumps are still in operation, a failure prediction model based on Random Survival Forest (RSF) is designed by incorporating survival analysis principles. The proposed Pump Failure Trend Prediction Model (PFTPM) overcomes difficulties caused by the lack of previous data and the small number of old pumps. We identify two phases of failure: the first phase exhibits a bathtub-shaped failure rate curve, while the second phase is characterized by a lower failure risk. The importance of considering rainfall, pump operating time, and performance changes for effective maintenance planning is emphasized. Furthermore, we summarize the failure evolution law of various types of pumps to amend maintenance cycle in the existing specification. Overall, this paper integrates innovative big-data technologies into the traditional maintenance data of tunnel pumps.
An innovative deep active learning approach for improving unlabeled audio classification by selectively querying informative instance
Authors: Salama Mohamed
Published: December 2023

Audio classification tasks like speech recognition and acoustic scene analysis require substantial labeled data, which is expensive. This work explores active learning to reduce annotation costs for a sound classification problem with rare target classes where existing datasets are insufficient. A deep convolutional recurrent neural network extracts spectro-temporal features and makes predictions. An uncertainty sampling strategy queries the most uncertain samples for manual labeling by experts and non-experts. A new alternating confidence sampling strategy and two other certainty-based strategies are proposed and evaluated. Experiments show significantly higher accuracy than passive learning baselines with the same labeling budget. Active learning generalizes well in a qualitative analysis of 20,000 unlabeled recordings. Overall, active learning with a novel sampling strategy minimizes the need for expensive labeled data in audio classification, successfully leveraging unlabeled data to improve accuracy with minimal supervision.
The Knowledge Analysis of Panel Vector Autoregression: A Systematic Review
Authors: Yang Rui , An Xin , Chen Yingwen , Yang Xiuli
Published: December 2023

The panel vector autoregression (PVAR) model preserves the advantages of the vector autoregression model while expanding its time series to the spatial direction, which can effectively solve the problem of individual heterogeneity using panel data. It is derived from econometrics but has been applied interdisciplinarily because of its advantages in metrology. Given its increasingly important role in econometrics and interdisciplinary applications, a systematic review based on the bibliometric tool was conducted by screening 292 articles related to PVAR from the Web of Science. First, a descriptive analysis of the related articles was conducted to identify the current research status of PVAR. It reveals that macroeconomic effects, economic growth and environmental protection, and model adaptation are the primary topics in PVAR-related research. Then, the study classifies PVAR models into three categories and summarizes the four estimation methods within the knowledge domain. Having clarity on the different categories and estimation methods enhances the practical utility of the PVAR model. Finally, to gain insight into the knowledge evolution of PVAR, this study discusses how research hotspots in the field have evolved over time. This analysis provides a historical perspective and allows researchers to anticipate future trends and emerging areas of interest within PVAR. Based on these findings, this study identifies three research opportunities that can guide future investigations in the field of PVAR. This study aims to foster extension applications of the model in econometric research and highlight its potential for interdisciplinary applications.
Chinese Multinationals’ Dynamic Integrations in the Developed Market: From a Resource Dependence Perspective
Authors: Yang Yanan , Lütge Christoph
Published: December 2023

Integrating the developed-market resources after acquisitions is a crucial tool for Chinese multinational enterprises (CMNEs) to accelerate industrial high-quality development. However, existing theories have scarce thorough explanations of the dynamic mechanism of CMNEs’ post-merger integrating resources. Our research aims at disclosing CMNEs’ post-merger integration (PMI) long-term dynamics under resource relatedness changes. We applied a multiple-case study with four typical CMNEs’ German-market PMI cases and proposed a theoretical framework based on a coding analysis of 38 interviews. Our findings highlight that: CMNEs change initial gentle integrations (partnering/preservation) to balance dependence when pre-merger resources complementary decreases with similarity increasing, or to extreme dependence when pre-merger resources similarity continually increases to extremely high. Pre-merger resource relatedness basics and later changes and CMNEs’ dynamic capability (threat and development potentials’ perception capabilities and utilization capability) are crucial factors in promoting CMNEs’ PMI changes. Our originality lies in that we consider the interactions resource relatedness changes and CMNEs’ PMI dynamics, strongly replenishing the deficiency of current PMI dynamic studies that lack considerations of resource relatedness changing; also, we simultaneously consider the two facets of dependence asymmetry and joint dependence such that broadened the application of resource dependence theory (RDT) in PMI studies. Our study offers managerial insights into CMNEs’ development leapfrog through acquisitions in developed markets that CMNEs should focus on the vital role of inter-firm resource relatedness changing. Initial gentle integration can be deepened when original resource backgrounds become more similar but should be cautious of the effect of power imbalance and selfish actions.
Work Connectivity Behavior After-Hours and Turnover Intention: A Configuration Perspective
Authors: Tao Aihua , Xu Qian , Zhou Chencui , Wang Wei , Yu Feng
Published: December 2023

The use of Internet tools virtually increases the work connectivity behavior after-hours (WCBA), is becoming increasingly common. Previous studies have found that WCBA has a double-edged sword effect on turnover intention (TI), but the configuration effect had been ignored. To investigate the configuration effect of WCBA, internal factors (i.e., psychological capital and mindfulness), and external factors (i.e., family-to-work conflict and social support), on TI. A total of 305 participants have been collected using convenience sampling. A questionnaire that covers six personal and contextual scales of the WCBA, psychological capital (PsyCap), mindfulness, family-to-work conflict (FWC), social support (SS), and TI, was used to gather data. Adhering to configurational theory, the study was conducted using fuzzy-set qualitative comparative analysis (fsQCA). it was revealed that seven antecedent configurations could achieve high TI, among them, WCBA existed in S4 and S6 but was absent in S5 and S7. Moreover, WCBA can exist and be absent in S1-S3 simultaneously; and for the 13 configurations that achieve low level of TI, WCBA can exist or not. Therefore, although the achievement of low level of TI is to some extent influenced by WCBA, it relies more on the influence of other factors (i.e., PsyCap, mindfulness, ∼ FWC, and SS). The study proves that WCBA has a double-edged effect on TI. The absence of FWC and existence of SS, PsyCap, and mindfulness are critical variables to buffer the loss of psychological resources caused by WCBA and recover psychological resources in time. These results may be helpful to recognize the negative effect of WCBA existence, accompanied with the absence of mindfulness on TI; also, the absence of SS was as crucial as the existence of FWC in the process of achieving high level of TI.
Global Research on International Students’ Intercultural Adaptation in a Foreign Context: A Visualized Bibliometric Analysis of the Scientific Landscape
Authors: Tang Lingjie , Zhang Chang’an
Published: December 2023

As the volume of research on intercultural adaptation of international students (IAIS) increases significantly over the past decades, a systematic review of the diverse literature on a global scale and its development process becomes essential. This study conducted a thorough bibliometric analysis for the knowledge domain of IAIS research using relevant articles ( N = 1,126) from 1990 to 2022 in Thompson Reuter’s Web of Science (WoS) database-Core Collection. This work aims to analyze the advances and trends on the subject using a set of bibliometric analytical tools, including Bibliometrix, VOSviewer, and BibExcel. The research findings demonstrate that the number of published articles projects an ostensible upward trend in terms of temporal distribution, especially since 2007. The USA occupies a leading position in terms of the largest publication output and a greater influence therewith. The most productive journal, author(s), and institution(s) are International Journal of Intercultural Relations, Brown L and Wang KT, and the University of Hong Kong and the University of Queensland, respectively. Collaboration in this field has become mainstream but still needs to be enhanced among researchers and at national and institutional levels. The frequency and co-occurrence analysis of keywords reveals that the main keywords for discussion include international students, adjustment, acculturation, adaptation, acculturative stress, identity, social support, stress, experiences, and depression, while cultural intelligence and intercultural sensitivity, culture shock and intercultural challenges, and integration and migration serve as the emerging themes. The study would aid academic researchers and policymakers in understanding the intricacies of IAIS and identifying areas that require further investigation.
The Influencing Factors of the Helpfulness of User-Generated Product Q&As
Authors: Liang Jing , Li Ming , Wang Jie , Ma Yating
Published: December 2023

User-generated product questions and answers (Q&As) are a new way for consumers to exchange product knowledge that can provide important support for consumer decisions. Research on the influencing factors of consumers’ judgment of the helpfulness of user-generated product Q&As can help optimize Q&A systems. Although research has extensively examined the impacts of answers and answerers on user-generated Q&As, the underlying mechanism of how the characteristics of questions and Q&As affect the helpfulness of user-generated Q&As has rarely been explored. Based on the elaboration likelihood model (ELM), a research model reflecting the impacts of the characteristics of questions and Q&As on the helpfulness of user-generated product Q&As is developed and empirically examined by using data collected from 4,814 product questions and 10,573 corresponding answers on Amazon.com. Specifically, the moderating effects of the question type and product type on the relationship between Q&A cues and the helpfulness of user-generated product Q&As are investigated. The results show that the helpfulness of user-generated product Q&As is positively affected by answer professionalism, Q&A topic consistency, answer opinion consistency, and answer valence, while it is negatively influenced by answer knowledge stickiness. As expected, the relationship between answer knowledge stickiness, answer opinion consistency, and the helpfulness of user-generated product Q&As is weakened when products are experiential. The relationship between answer knowledge stickiness, Q&A topic consistency, and the helpfulness of user-generated product Q&As is weakened when consumers’ questions are correlated with product attributes.
Brand, Quality, and CSR: Which Management Strategy Achieves High Financial Performance for Agricultural Small-Medium Enterprises?
Authors: Fan Fan
Published: December 2023

This study aims to investigate the mechanism for the combined influence of brand, quality, and corporate social responsibility management strategy on financial performance. These management concepts are positively used in agricultural small-medium enterprises as three research streams. However, because of resource limitations, the cost of brand management would be a burden or corporate social responsibility activities may lead to harmful performance. There are many conflicting findings in the existing research. This study analyzed data from 371 agricultural small-medium enterprises in China using fsQCA 3.0. The result reveals four solution pathways for achieving high financial performance and highlights the attributes of each solution pathway. The findings suggest that integrating brand, quality, and corporate social responsibility management, or combining brand and quality management are effective options for achieving high financial performance in agricultural small-medium enterprises. These results have significant implications for managers seeking to improve their firm’s financial performance by optimizing their management strategies.

JEL Classification: M14, M31, Q13
Does Child-friendly Gram Panchayats Mean Good Governance? An Analysis of 10 Gram Panchayats in Karnataka
Authors: Rao Madhusudhan B. V. , Prasad Sridhar R. , J. Sowmya , U. C. Abida
Published: December 2023

A ‘Gram Panchayat (GP)’ is the lowest tier of self-government within the Panchayati Raj Institutions and is entrusted with critical responsibilities such as poverty alleviation, delivery of welfare measures, primary education, empowerment of marginalised communities, etc. Apart from these, GPs are also endowed with responsibilities with respect to the empowerment of women and welfare of children. The article proposes to develop a comprehensive framework that can help in analysing the underpinnings of what makes a GP child friendly. The framework is further extended to the overall governance of a GP as well. The institutional capability and governance of 10 GPs of Karnataka have been examined in detail using this framework.
MIBA Osteotomy vs Open Technique in Hallux Valgus Surgery: Results of a Randomized Prospective Study
Authors: Escudero Mario I. , Escobar Francisco , Chaparro Felipe , Albarran Carlos , Payá Andrés I. Medina , Pellegrini Manuel J.
Published: December 2023

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

In Hallux Valgus (HV) surgery, the open technique has traditionally been used, which implies aggressive and extensive approaches, not without complications. The goal of surgical treatment of HV is to correct the anatomical deformity and achieve a satisfactory long-term result, without interrupting the biomechanics and weight-bearing function of the first metatarsophalangeal joint complex. In recent years, the use of minimally invasive techniques (MIS) has been a valid alternative due to less soft tissue trauma. The purpose of this study is to compare short-medium term clinical results of the MIBA technique versus the traditional open technique in patients with mild-moderate HV.

Methods:

A randomized, multicenter clinical trial of patients with HV, operated between January 2019 - January 2022, with a minimum of 1-year follow-up. A total of 39 patients were included; 20 MIBA and 19 with the open technique (Chevron osteotomy). It was evaluated if there were statistically significant differences between: demographic variables; radiologic measurements: Intermetatarsal Angle (IMA); Metatarsal Length (ML); visual analog scale (VAS); Foot and Ankle Ability Measure (FAAM), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal- interphalangeal (MTP-IP) and operative wound healing through Photographic Wound Assessment Tool (PWAT) and ASEPSIS score were analyzed. The radiologic measurements and functional scores were collected preoperatively, at 2-6 weeks and 1-year follow-up, while wound scores were at 3 weeks, 3 months, and 1-year follow-up.

Results:

There were no significant differences concerning age, hypertension, diabetes mellitus, or smoking between both groups. The average follow-up time of the MIBA group was 14 months and the open technique group 12.9 months. In relation of postoperative soft tissue, MIBA group showed significant differences at 6 weeks in PWAT score (0.06 ± 0.24) but no statistically significant differences at 3 weeks and 1 year of follow-up. There were no significant differences in IMA and ML values at 6 months (p=0.57 vs 0.40) and 1 year (p=0.35 vs 0.11). Regarding functional scores, no significant differences were found preoperatively, at 6 months, and 1-year follow-up. Complications in both groups did not have significant differences either.

Conclusion:

The MIBA technique is a reliable alternative to the classical technique, with significant differences at 6 weeks in a better evolution of postoperative soft tissue according to the PWAT score, but correcting in the medium term. Concerning radiological, functional outcomes and complications, no significant differences were found at 1-year follow-up. Further follow-up and casuistry are necessary to obtain definitive results.
Outcomes after Total Ankle Arthroplasty with A Minimum Average Follow-Up of 10 Years: A Systematic Review and Meta-Analysis
Authors: Bagheri Kian , Anastasio Albert T. , Cantor Nicole , Aitchison Alexandra Hunter , Poehlein Emily , Green Cynthia , Adams Samuel
Published: December 2023

Category:

Ankle Arthritis

Introduction/Purpose:

End-stage ankle osteoarthritis (OA) is a debilitating condition that adversely affects quality of life and causes considerable functional impairment. Total ankle arthroplasty (TAA) is growing in popularity as a motion-preserving option for ankle OA. A previously published meta-analysis evaluated the mid-term outcomes of TAA with a minimum average follow-up of 5 years, demonstrating excellent survivorship. To our knowledge, there is no such manuscript that evaluates the outcomes of TAA at the long-term, with a minimum follow-up of ten years or greater. Due to a lack of long-term follow-up of TAA implants in the current literature, the aim of this review was to aggregate findings from the most up-to-date analyses of the long-term outcomes of TAA via meta-analysis.

Methods:

We conducted a systematic review and meta-analysis according to the PRISMA guidelines. Electronic databases were searched from the date of inception to September 12, 2022. These databases included Medline, Embase, and Scopus. We included all studies that 1) involved patients that underwent uncemented TAA, and 2) all patients who had an average follow-up period of at least ten years. We excluded abstracts, as well as manuscripts written in languages other than English. We collected American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) scores from the included studies for pooled meta- analysis. Due to the varying definition of survivability between studies, this metric was not assessed in our final evaluation.

Results:

Our data included a total of 2,562 patients and 2,895 ankles with an average follow-up of 10 years. Of the 25 studies included in the systematic review, 7 provided pre- and post-operative AOFAS means and 5 provided pre- and post-operative VAS means with associated measures of variability and were included in our meta-analysis. The weighted mean difference between pre- and post-operative AOFAS scores was -41.98 (95% CI: -48.28 to -35.69) (Fig. 1A), indicating that patients improved by almost 42 points between pre-and post-surgery. The weighted mean difference between pre-and postoperative VAS scores was 4.52 (95% CI: 2.26-6.43) (Fig. 1B), indicating patients improved by about 4.5 points on average between pre-and post-surgery. Survivability was not assessed due to the heterogeneity in survivability definition between studies.

Conclusion:

Outcomes following TAA are favorable and indicate patient-reported outcomes improve over long-term follow-up. Future, prospective, randomized research should be conducted to better assess TAA, and authors should work towards standardization of survivorship and complication reporting methodologies to allow for pooled metanalysis of these important outcome metrics.
Participant Satisfaction and Investigator Assessment of Collagenase Clostridium Histolyticum Injection as a Nonsurgical Intralesional Treatment Option for Plantar Fibromatosis
Authors: Anderson C. James , Pollak Richard , Dalton Shannon , Xiang Qinfang , Vijayan Saji , Ortega Luis A. , Caporusso Joseph
Published: December 2023

Category:

Midfoot/Forefoot; Basic Sciences/Biologics

Introduction/Purpose:

Currently, there is no safe and efficacious injectable therapy for symptomatic plantar fibromatosis (PFi) that addresses its pathophysiology. Patients with PFi nodules experience symptoms that reduce quality of life, causing functional disability leading to severe impairment in some patients. Collagenase clostridium histolyticum (CCH) is approved for Dupuytren’s and Peyronie’s disease treatment, which are both fibroproliferative disorders that may coexist in patients with PFi. This first study of CCH treatment for PFi evaluated participant satisfaction and investigator assessment of improvement.

Methods:

Participants were randomly allocated (1:1:1) in this Phase 1, multicenter study to receive 0.6, 1.2, or 2.25 mg/mL CCH. All participants underwent the initial treatment period (ITP) and received 1–2 intralesional injections per nodule on Day 1 with follow-up assessments at specified intervals. Participants with palpable treated nodules could enter the retreatment period (RP) and receive additional CCH doses (at 2.25 mg/mL), with follow-up at specified intervals. Assessments included the Subject Satisfaction with Treatment Rating Scale (+2: very satisfied; to -2: very dissatisfied), and the Investigator Assessment of Improvement Scale (+3: very much improvement; to -3: very much worse).

Results:

After ITP, ≥75% of participants reported “very” or “quite” satisfied across all treatment groups, with 2.25 mg/mL group reporting 100% satisfaction. For ≥72.7% of nodules, participants reported satisfaction with outcome. Investigators reported improvement (“minimal”, “much”, or “very much”) in ≥75% of participants and ≥80% of treated nodules. After RP, 63.6% of participants reported treatment satisfaction; participants were satisfied with 66.7% of treated nodules, indicating continued improvement from the ITP. Almost all participants (90.9%) were deemed by investigators to have shown improvement, with 86.7% of treated nodules being assessed as having improvement.

Conclusion:

CCH-treated PFi participants were satisfied with their improvement; physicians assessed improvement in >90% of participants. Results indicate CCH as a potential nonsurgical intralesional option for PFi treatment.
Patient Reported Outcomes Following Surgical Intervention of Isolated Lisfranc Injury: Minimum Two- year Follow-up
Authors: Scheinberg Mila , Sanchez Thomas , Shah Ashish
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

This is the largest cohort to date of patients who completed the patient reported outcome measurement information systems (PROMIS) along with the foot function index (FFI) following operative fixation for Lisfranc injury. The patient outcomes were compared against the mean population with inter-analysis comparing varying operative procedures used, basic demographic information, and patient comorbidities and their individual impact on PROMIS, FFI and VAS scores.

Methods:

131 patients between 2010 and 2020 met inclusion criteria and were selected for this study. Utilizing the electronic medical record (EMR), patient charts were reviewed to obtain basic patient demographic information and comorbidities. Operative reports were reviewed to determine which procedure or combination of procedures was performed for definitive fixation. VAS scores were obtained from patients preoperatively and at two, six, and twelve weeks post-operatively. PROMIS and FFI scores were obtained via phone calls and when reviewing patient charts. The impact of categorical variables on complications was compared using Chi-Squared tests. Variables were analyzed with a type 3 SS ANOVA test to stratify independent risk factors on PROMIS, FFI and VAS scores and to account for confounding variables.

Results:

Arthrodesis procedure (p=.025) was associated with a significant decrease in complication rates. Males, HR screw placement, and arthrodesis were independent risk factors for significantly higher reports of PROMIS pain interference, FFI disability, and FFI activity limitation. Males, alcohol consumption, and those treated with arthrodesis had higher FFI pain scores (p=0.0193, p=.0498, and p=0.0351). ORIF was found to be an independent risk factor for significantly increased PROMIS physical function (p=0.046), whereas bone grafting during the procedure was associated with lower PROMIS depression scores (p=0.0096). Tobacco use at the time of operation and arthrodesis were independent risk factors for higher FFI total scores (p=0.0153 and p- 0.0273). Patient’s preoperative VAS score averaged 5.13. Postoperative VAS scores averaged 3.89, 2.65 and 2.04 for two, six and twelve respectively (p < 0.001).

Conclusion:

Patient reported outcomes following Lisfranc surgery reported via PROMIS, FFI and VAS scores are independently influenced by patient demographics, comorbidities, and surgical variables. Analysis of potential associations between these patient characteristics and PROMIS and FFI scores provides evidence for physicians to manage patient expectations prior to operative treatment of a non-polytraumatic Lisfranc injury.
Role of Insole Material in Treatment of Plantar Fasciitis: A Randomized Clinical Trial
Authors: Taseh Atta , Mathur Vasundhara , Weaver Bradley A. , Hashmi Mustafa , Skolnik Jennifer , Ashkani-Esfahani Soheil , Waryasz Gregory
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

Plantar fasciitis (PF), a leading cause of persistent heel pain, results in almost a million physician visits annually. Conservative treatment is often the first line of management with insoles being frequently prescribed. While multiple studies have compared insoles based on the degree of customization to foot contour, the literature is lacking in data comparing insoles based on their material. In this randomized clinical trial, we compared the early effects of foam, polyurethane, and carbon fiber insoles in the treatment of PF, using a robust set of PROMS.

Methods:

A randomized clinical trial was designed at the foot and ankle research center of a tertiary care hospital in Massachusetts. Adult patients diagnosed with PF who had not received injectable or surgical treatment for it were included. Participants who consented were randomly allocated one of the three prefabricated insoles – carbon fiber insole (Group 1, n=13), polyurethane insole (Group 2, n=13), or foam insole (Group 3, n=9) for regular use. Their response was recorded using PROMIS 3a (for pain intensity), PROMIS 4a (for pain interference), FAOS (Foot and Ankle Outcome Score), and VAS for pain at baseline (T0), two (T2), six (T6) and twelve weeks (T12). A per-proto analysis was undertaken using Kruskal Wallis and Friedman tests. P< 0.05 was set as the level of significance.

Results:

Among groups 1, 2 and 3, the mean age of participants was 51.9±13.2, 51±12.5, and 47.9±13.5 years respectively and baseline weight varied as 211.6±32.7 lbs, 193.6±59.3 lbs, and 180.7±33 lbs respectively (p>0.05 for both). The group-wise distribution of participants based on sex and laterality of the affected foot showed no difference. Participants in each group reported similar intensity of the pain (VAS) at baseline and at all follow-up time points (p>0.05). A comparison of outcomes between baseline and subsequent timepoints showed significant improvement in quality of life (FAOS) at T12 (p=0.047) for carbon fibre insole users (Figure 1), significant pain relief on PROMIS Pain intensity and Pain Interference questionnaires for foam insoles at T3 and T12 (p=0.0003, 0.036 respectively).

Conclusion:

Carbon fiber insoles offered slightly better pain relief as early as six weeks into treatment and improved quality of life after twelve weeks of use. A possible link between the material of insole used and effective treatment of PF may exist. Conducting further analyses on the position of the foot during gait while using insoles and designing the insoles based on patient-specific criteria should be considered for future research.
Syndesmosis Evaluation Under WBCT: 3rd Base to Get a Cut-Off Point to Diagnosis
Authors: Protasowicki Nicolas , Carcuro Giovanni , Chaparro Felipe , Ahumada Ximena , Pellegrini Manuel J. , Ortiz Cristian A.
Published: December 2023

Category:

Sports; Arthroscopy

Introduction/Purpose:

Evaluation of syndesmal injury remains challenging for Foot & Ankle Surgeons. As objective data to provide an accurate preoperative diagnosis of syndesmal instability is lacking, arthroscopy has remained the Gold Standard. However, the costs and risks associated with surgery make arthroscopy challenging to indicate in all cases. Therefore, significant interest exists in determining objective criteria to safely indicate surgery. Comparative WBCT is a valuable tool, allowing a precise evaluation of the healthy and injured joints. Specifically, the difference in the syndesmal area correlates with diastasis at the inferior tibiofibular joint, while the cut value for diagnostic instability remains undetermined.

Objective:

To compare the difference in syndesmal area between healthy patients and patients with syndesmal sprains under WBCT.

Methods:

IRB approval was obtained for a retrospective case-control study. Patients with suspected syndesmal injuries from April 2019 to August 2022 were included in the case group. Patients with chronic ankle instability, age over 55 years, or surgery of the inferior limb were excluded. The control group was obtained from a previous study of comparative WBCT of the ankle joint, obtained for reasons different than trauma or instability. All patients were evaluated under WBCT by a fellowship-trained MSK radiologist. After evaluating the syndesmal area at 1 cm from the ankle joint line in an axial WBCT slice, the percentage difference from the injured to the healthy side was recorded. Demographic data were obtained from the patient chart. For those patients undergoing surgical stabilization, the operative note was examined. Statistical evaluation was performed by an independent statistician using SPSSv27 using the ANOVA test.

Results:

Thirty-nine patients were recruited for the study group, and a control group of 25 patients with healthy ankles was obtained. Demographics data for both groups were comparable Arthroscopy was indicated in 7/39 patients (17,9%), which confirmed diagnosis and warranted stabilization of the joint. The mean percentage area difference of the confirmed injured syndesmosis was 15,14% (IC 4,89-25,39), suspected injured syndesmosis was 9,25% (IC 3,11-15,39), and the healthy syndesmosis was 1,54 (IC 1,08-2,01). Statistically significant differences were obtained for healthy, operated, and non-operated patients with a p=0,021.

Conclusion:

A comparative WBCT scan and the percentage difference in the syndesmal area between the healthy, confirmed, and suspected syndesmal injury demonstrated a handy diagnostic tool. Although the limitations of this study, our results suggest that a 15% difference in the syndesmal area between healthy and injured sides might be used as the cut-off point to indicate diagnostic arthroscopy.
Tibialis Posterior Tendon Entrapment in Posterior Malleolar and Pilon Injuries of the Ankle: A Retrospective Analysis
Authors: Mason Lyndon W. , Aamir Junaid , Syziu Anxhela , Andritsos Loukas , Caldwell Robyn
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

The Tibialis Posterior tendon (TPT) is the only tendon to come into contact with the distal tibia and is therefore at greatest risk of injury in fractures of the distal tibia. Although TPT injury has been reported rarely with injuries around the ankle they often have been missed and present late.

Aim

Our aim was to analyse the rate to TPT entrapment in fractures involving the posterior tibia i.e. Pilon (PLM) and posterior malleolar fractures (PMF).

Methods:

A retrospective analysis of PMF and Pilon fractures over an 8-year period was undertaken. Patients who had undergone surgical fixation of their PMF or PLM were identified from 2014 to 2022, using our prospectively collected database. Any fracture which had undergone a preoperative CT was included. Analysis of their pre-operative CT imaging was utilised to identify TPT entrapment, where if < 50% of the tendon cross section was present in the fracture site this was denoted as a minor entrapment and if ≥50% of the tendon was present in the fracture site was denoted as major.

Results:

A total of 363 patients were identified for further analysis, 220 who had a PMF and posterior 143 with Pilon injury. The incidence of TPT entrapment was 22% (n = 79) with 64 minor and 15 major entrapments. If the fracture entered the TPT sheath, there was a 45% (72/172) of entrapment as compared to 3.7% (7/190) in fractures not entering the sheath p <.001). There was no significant difference in TPT entrapment in PMF as compared to PML (p=0.353).

Conclusion:

In our assessment, there was a significant risk of TPT entrapment when the CT images display the fracture line entering the tendon sheath. We recommend that surgeons consider care pre-operative imaging and seek to identify the TPT intraoperatively where entrapment does occur.
UK Foot and Ankle Thrombo-Embolism Audit (UK-FATE): A Multicentre Prospective Study of Venous Thromboembolism in Foot and Ankle Surgery
Authors: Mangwani Jitendra , Mason Lyndon W. , Malhotra Karan , Houchen-Wolloff Linzy
Published: December 2023

Category:

Other

Introduction/Purpose:

There is wide variation in the threshold and provision of thromboprophylaxis in the treatment of foot and ankle conditions. One of the difficulties in affecting change in practice in this area is the low incidence of postoperative, symptomatic VTE. Therefore, a large number of patients need to be included in any series for meaningful conclusions to be drawn. Primary objective To observe the UK-wide variation in post-operative thromboprophylaxis, and to analyse the 90-day incidence of symptomatic venous thrombo-embolism related to: -Elective foot and ankle surgery -Trauma foot and ankle surgery -Treatment of Achilles tendon ruptures (operative and non-operative)

Methods:

This was a multi-centre prospective audit spanning a collection duration of 9 months. Primary outcomes included symptomatic VTE up to 90 days following foot & ankle surgery and Achilles tendon rupture and VTE related mortality up to 90 days following treatment. Secondary outcomes included methods of thromboprophylaxis used, and possible confounding variables and influencing factors for VTE.

Results:

A total of 10,983 patients were included from 56 sites in the UK. This was split into 51.72% trauma (n=5571), 3.78% diabetic surgery (n=415) and 45.18% elective surgery (n=4962). There was 95 VTE events across the whole cohort (0.86%). Diabetic foot disease surgery had the highest rate of VTE (Below knee amputation 5.3% and acute foot debridement 2.6%). The trauma diagnosis with the highest rate of VTE was Achilles tendon rupture (3.7%). All elective foot procedures had a VTE rate < 1% except elective tendon procedure (1.1%). Factors with statistically significant association with VTE included trauma surgery where prophylaxis stopped greater than 1day pre surgery (p=.027), non-compliance with prophylaxis (p=.001), post-surgical infection (p=.005), and the comorbidities asthma (p=.014), cancer (p=.014), dementia (p=.001), diabetes (p=.005), stroke (p < 0.001) and recent long-distance travel (p=.048).

Conclusion:

This is a large-scale multicentre study which recorded multiple possible confounding variables. There were 12 different chemical prophylaxis used across the study, with the highest rate of VTE in patients administered Apixaban (4.9%). The most common chemical prophylaxis used in the study was Enoxaparin (27.19%) followed by Dalteparin (20.38%). There was no evidence of a decrease in VTE if mechanical prophylaxis was used. The study identified specific diagnosis with increased risk of VTE and comorbidities.
Changes in Coronal and Sagittal Alignment of the Ankle Joint After High Tibial Osteotomy: Evaluation Using Low Extremity Scanogram and EOS Imaging System
Authors: Song Jaehwang
Published: December 2023

Category:

Ankle; Hindfoot

Introduction/Purpose:

High tibial osteotomy (HTO) is a useful treatment option for symptomatic knee patients with varus knee alignment and medial compartment arthritis. Changes in coronal and sagittal alignment of the knee joint have been reported in several previous studies. However, no study have investigated the changes of both coronal and sagittal alignment of the ankle joint after HTO. The purpose of this study was to investigate changes in coronal and sagittal alignment of the ankle joint after HTO. Our hypothesis was that alignment of ankle joint, as well as knee joint, change significantly after HTO.

Methods:

Total 46 patients (49 cases) were retrospectively analyzed after HTO for varus knee osteoarthritis. Preoperative and follow-up of low extremity scanogram and EOS imaging system were taken. The hip–knee–ankle (HKA) angle, medial proximal tibial angle (MPTA), knee tibia plafond angle (KTPA), were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), Tibial plafond inclination (TPI), talar tilt (TT), and ankle joint axis point on the weight-bearing- line (AAWBL) were measured by scanogram to investigate coronal alignment of the ankle. Tibial lateral surface angle (TLS) and lateral knee tibial plafond angle (LKTPA) were measured by EOS to evaluate sagittal alignment of the ankle. Radiologic outcomes of the knee and ankle were evaluated pre- and postoperatively.

Results:

Varus alignment of the knee was corrected by significant coronal change of the HKA angle, MPTA, KTPA after HTO (P < 0.05). There was significant coronal change in TPI and AAWBL in ankle alignment (P < 0.05). The ankle joint axis point on the weightbearing axis moved laterally which was demonstrated by AAWBL. However, there was no significant difference between preoperative and follow up TAS and TT (P > 0.05). In sagittal alignment of ankle by EOS, LKTPA significantly increased after HTO (P > 0.05), but TLS showed no significant difference postoperatively (P > 0.05).

Conclusion:

Coronal and sagittal alignment of ankle joint was significantly changed after HTO by lateral shift of ankle joint axis and LKTPA increase after HTO. Further study is necessary to investigate the effects of the present radiologic results on clinical symptoms of the patients.
Comparison of Radiographic and Clinical Outcomes between Distal and Proximal Minimally Invasive Chevron and Akin Osteotomy for Severe Hallux Valgus Deformity
Authors: Choi Seung-Myung , Cho Byung-Ki
Published: December 2023

Category:

Midfoot/Forefoot; Midfoot/Forefoot

Introduction/Purpose:

The surgical treatment of severe hallux valgus (HV) deformity is challenging due to the difficulty in achieving sufficient reduction and the increased risk of complications such as recurrence, delayed or non-union. Minimally invasive surgery (MIS) has been increasingly used to treat HV deformity, with the third-generation minimally invasive Chevron and Akin osteotomies (MICA) technique being widely accepted. This retrospective cohort study aimed to compare the radiographic and clinical outcomes between the distal and proximal MICA techniques for severe hallux valgus deformity. It was hypothesized that the proximal MICA technique would provide better radiographic results due to the stronger deformity correction achieved by the proximal metatarsal osteotomy.

Methods:

Seventy-four feet with severe HV (defined as HVA [≥40 degrees] and/or IMA [≥20 degrees]) treated with distal MICA (40 feet) or proximal MICA (34 feet) were included in this study after at least one year of follow-up. Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), patient satisfaction rating, and complications. Radiographic assessments included HV angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA).

Results:

There were no differences in the mean AOFAS score, pain VAS score, and patient satisfaction rate at the final follow-up between the two groups (all p > .05). The mean postoperative HVA, IMA, and DMAA significantly improved at the final follow-up in both groups (all p < .001). There was no significant difference in the improvement of radiographic values after surgery between the two groups (all p > 0.05). Although not statistically significant, there was a trend toward a higher recurrence and delayed or nonunion rate in the distal MICA group (7.5% vs. 2.9%, P =.218 and 10% vs. 2.9%, P =.072).

Conclusion:

Both types of minimally invasive techniques resulted in satisfactory outcomes in terms of significant improvement in clinical values, large deformity correction, and reasonable complication rates. However, the proximal MICA technique appears to provide more stable maintenance of deformity correction than the distal technique.