bluuebunny/crossref_metadata_2025 huggingface dataset:
The problem of art teaching based on interactive multimedia assisted instruction platform
Authors: He XiangPeng , Cao Yanling
Published: March 2021

When digital technology reproduces and simulates real scenes, it can realistically multi-dimensionally present and simulate real-life situations. This solves the problem that the design methods that are difficult to avoid in art design teaching are out of touch with the real space environment, and the design concept and function are out of touch. The openness of the teaching knowledge of art design in interactive teaching platform is reflected in the informationization of resources and the development of diverse knowledge. This paper proposes an architecture scheme of multimedia remote interactive teaching system composed of network multimedia teaching platform, general network teaching platform, digital resource management platform, streaming media resource recording platform and interactive distance learning platform. The system architecture has the characteristics that the underlying data are mutually integrated and the platforms complement each other. The essential characteristics of e-Learning are provided in the interaction characteristics, the dynamic resource scheduling function is enabled, and the multimedia-assisted remote interactive teaching in the future m-Learning and u-learning eras The system proposes a vision.
Safeguarding women at work? Lessons from Aotearoa New Zealand on effectively implementing domestic violence policies
Authors: Weatherall Ruth , Gavin Mihajla , Thorburn Natalie
Published: March 2021

Although domestic violence is increasingly acknowledged as a workplace issue and a gender equality issue, a gap remains in the effective implementation of domestic violence policies in workplaces. The Domestic Violence – Victims Protection Act passed in 2018 in Aotearoa New Zealand was a global landmark for holding workplaces accountable for safeguarding victims through a codification of employer responsibility. While the legislation is a milestone, such moves are nascent compared with other workplace gender equality initiatives. In this article, we assess ‘where we are now’ in relation to domestic violence policy initiatives, arguing that knowledge necessary for successful policy implementation is limited by the historical ‘gender blindness’ of industrial relations scholarship. For successful implementation, scholars and practitioners must understand domestic violence as a public issue embedded in broader patterns of gender inequality, reinforced by a gendered labour market. Drawing upon vignettes of victims’ experiences from empirical data on intimate partner stalking in Aotearoa New Zealand, a research and practice agenda is proposed to consider ‘where to next’ for implementing domestic violence policies. Our agenda proposes recognising domestic violence as a gendered, public issue which blurs boundaries between work, home and society in order to truly safeguard women at work.
Dismembering media diversity: A tryst with two press commissions
Authors: Parthasarathi Vibodh
Published: March 2021

How does the governance of the newspaper business in mid-20th century India enrich our understanding of contests over media diversity? This essay examines the anxieties of media diversity in regulatory debates in India during the decades between the two Press Commissions of 1954 and 1982. I argue the contests spawned during these debates being driven as much by normative standpoints on the press as a modern institution as by enumerations of the actual dynamics in the newspaper business. My purpose is twofold: to highlight the anxieties about media diversity expressed by both press commissions and related policy debates in the interim; and to reveal the desires to mitigate the risks to media diversity being undermined by mobilising unqualified notions of media freedom.
Level of Knowledge, Understanding, and Impact of the COVID-19 Pandemic on Continuing Fixed Orthodontic Treatment in Adults: A Questionnaire Study
Authors: Ram RSVM Raghu , Ranganayakulu I , Viswanadh K Anand , Kumar TSS Manikanta , Chaitanya C Viswa , Sunil G.
Published: March 2021

Objectives:

To evaluate the level of knowledge, understanding, and impact of the coronavirus disease 2019 (COVID-19) pandemic on adult patients regarding their ongoing fixed orthodontic treatment.

Subjects and Methods:

A cross-sectional and descriptive survey was conducted on 108 adult patients undergoing fixed orthodontic treatment at GSL Dental College (GSLDC), India. All the candidates were aged 18 years and above, who were in lockdown due to the COVID-19 pandemic and devoid of treatment.

Results:

Among the patients 43.5% were male and 56.5% were female; 22.3% were not at all aware that the COVID-19 virus spreads quickly in a dental setup; 64.8% were definitely willing for their status disclosure and to undergo pretreatment screening; 71.3% were definitely willing to adhere to strict appointment timings for adequate sanitization of the clinical area; 60.2% thought that missed appointments during the COVID-19 pandemic would prolong their overall orthodontic treatment and affect their treatment outcome; and 51.9% were financially affected due to the pandemic.

Conclusions:

Not all adult orthodontic patients were in knowledge of COVID-19 cross infection. The majority were in a state of understanding and willing to follow infection-eradicating protocols. Patients’ view on overall orthodontic treatment was altered due to the psychological and financial impact of COVID-19.
Cell-Free Book-Shaped Decellularized Tendon Matrix Graft Capable of Controlled Release of BMP-12 to Improve Tendon Healing in a Rat Model
Authors: Xiao Han , Chen Yang , Li Muzhi , Shi Qiang , Xu Yan , Hu Jianzhong , Li Xing , Chen Can , Lu Hongbin
Published: March 2021

Background:

Achilles tendon (AT) defects often occur in traumatic and chronic injuries. Currently, no graft can satisfactorily regenerate parallel tendinous tissue at the defect site to completely restore AT function.

Purpose:

To develop a cell-free functional graft by tethering bone morphogenetic protein 12 (BMP-12) on a book-shaped decellularized tendon matrix (BDTM) and to determine whether this graft is more beneficial for AT defect healing than an autograft.

Study Design:

Controlled laboratory study.

Methods:

Canine patellar tendon was sectioned into a book shape and decellularized to fabricate a BDTM. The collagen-binding domain (CBD) was fused into the N-terminus of BMP-12 to synthesize a recombinant BMP-12 (CBD-BMP-12), which was tethered to the BDTM to prepare a cell-free functional graft (CBD-BMP-12/BDTM). After its tensile resistance, tenogenic inducibility, and BMP-12 release dynamics were evaluated, the efficacy of the graft for tendon regeneration was determined in a rat model. A total of 140 mature male Sprague-Dawley rats underwent AT tenotomy. The defect was reconstructed with reversed AT (autograft group), native BMP-12 tethered to an intact decellularized tendon matrix (IDTM; NAT-BMP-12/IDTM group), native BMP-12 tethered to a BDTM (NAT-BMP-12/BDTM group), CBD-BMP-12 tethered on an IDTM (CBD-BMP-12/IDTM group), and CBD-BMP-12 tethered on a BDTM (CBD-BMP-12/BDTM group). The rats were sacrificed 4 or 8 weeks after surgery to harvest AT specimens. Six specimens from each group at each time point were used for histological evaluation; the remaining 8 specimens were used for biomechanical testing.

Results:

In vitro CBD-BMP-12/BDTM was noncytotoxic, showed high biomimetics with native tendons, was suitable for cell adhesion and growth, and had superior tenogenic inducibility. In vivo the defective AT in the CBD-BMP-12/BDTM group regenerated more naturally than in the other groups, as indicated by more spindle-shaped fibroblasts embedded in a matrix of parallel fibers. The biomechanical properties of the regenerated AT in the CBD-BMP-12/BDTM group also increased more significantly than in the other groups.

Conclusion:

CBD-BMP-12/BDTM is more beneficial than autograft for healing AT defects in a rat model.

Clinical Relevance:

The findings of this study demonstrate that CBD-BMP-12/BDTM can serve as a practical graft for reconstructing AT defects.
Simultaneously Improving Computational Thinking and Foreign Language Learning: Interdisciplinary Media With Plugged and Unplugged Approaches
Authors: Hsu Ting-Chia , Liang Yi-Sian
Published: March 2021

This study proposed plugged and unplugged approaches for young students to simultaneously improve their interdisciplinary learning performance in English and Computational Thinking (CT). The plugged approach involved adopting educational robots to enhance CT and to provide English vocabulary and sentence practice via a board game. The unplugged version of the educational board game involved using a conventional board game without a computer, although it was designed for practicing CT as well as some foreign language vocabulary and conversational sentences. The results show that both approaches were helpful for simultaneously improving the students’ English proficiency of the target vocabulary and sentences, and their CT competence. The students’ foreign language learning anxiety during the English conversation in the plugged game was significantly lower than that of the students playing the unplugged game. On one hand, the cooperation tendency of the CT scale improved significantly for the students playing the unplugged game. On the other hand, the critical thinking of the CT scale improved significantly for those using the plugged approach. This research provides an innovation development and evaluation for plugged and unplugged approaches.
Structural Gendered Racism Revealed in Pandemic Times: Intersectional Approaches to Understanding Race and Gender Health Inequities in COVID-19
Authors: Laster Pirtle Whitney N. , Wright Tashelle
Published: March 2021

The pandemic reveals; the novel coronavirus (COVID-19) pandemic has brought the historically rooted inequities of our society to the forefront. We argue that an intersectional analysis is needed to further help peel back the veil that the pandemic has begun to reveal. We identify structural gendered racism—the totality of interconnectedness between structural racism and structural sexism in shaping race and gender inequities—as a root cause of health problems among Black women and other women of color, which has been amplified during the pandemic. We show that women of color occupy disadvantaged positions within households, occupations, and health care institutions, and therefore face heightened risk for COVID-19 and lowered resources for mitigating the impact of the deadly virus. Intersectional analyses and solutions must be centered to also reveal, we hope, a new way forward.
Development of arc welding technique to preclude microsegregation in the dissimilar joint of Alloy C-2000 and C-276
Authors: Arulmurugan B , Sathishkumar M , Balaji D , Muralikrishnan K , Pranesh S , Praveen V , Praveen Kumar K , Arivazhagan N , Manikandan M
Published: March 2021

Hastelloy C-2000 and C-276 are widely used in Flue Gas Desulphurization (FGD) system and Chemical Processing Industries (CPI). Current work is focused on weld microstructure, and mechanical properties (structure-property relationship) of the dissimilar combination of alloy C-2000 and C-276. Multi-pass Pulsed Current Gas Tungsten Arc (PCGTA) welding was adopted for joining the dissimilar alloys using the filler ERNiCrMo-17. Microstructural characteristics of the weld joint were assessed by Optical and Scanning Electron Microscope (SEM). Weld interface microstructure examination revealed the presence of grain coarsening near the Heat Affecting Zone (HAZ) of the alloy C-276 side. SEM analysis shows the absence of secondary Topologically Closed Packed (TCP) phases in the Inter-Dendritic (ID) regions of the dissimilar weld. Micro-segregation of alloying elements in the weldment was assessed by Energy-Dispersive X-ray Spectroscopy (EDS). X-Ray Diffraction (XRD) analysis had been carried out to identify the phase constitution and average grain size. Strength, toughness, and hardness of the dissimilar weld were evaluated with the support of the tensile test, Charpy impact test, and Vicker’s hardness test. Tensile study showed that all the tensile fracture occurred at the base metal side of alloy C-276. The average toughness of the dissimilar alloy joint was noted about 84 J. Hardness test results indicated that fusion zone (FZ) hardness value was 6.19% and 2.27% superior to the candidates’ material (C-276 and C-2000) employed in this study. The refined grain structure and absence of microsegregation resulted in the highest hardness in the dissimilar weld FZ. Results revealed the substantiated use of PCGTA welding for the effective joining of dissimilar alloys of C-2000 and C-276 through the evaluation of metallurgical and mechanical characteristics.
Google search volume trends for cancer screening terms during the COVID-19 pandemic
Authors: Snyder Austin , Jang Sean , Nazari Ilana S , Som Avik , Flores Efren J , Succi Marc D , Little Brent P
Published: March 2021

The COVID-19 pandemic has led to delays in cancer diagnosis, in part due to postponement of cancer screening. We used Google Trends data to assess public attention to cancer screening during the first peak of the COVID-19 pandemic. Search volume for terms related to established cancer screening tests (“colonoscopy,” “mammogram,” “lung cancer screening,” and “pap smear”) showed a marked decrease of up to 76% compared to the pre-pandemic period, a significantly greater drop than for search volume for terms denoting common chronic diseases. Maintaining awareness of cancer screening during future public health crises may decrease delays in cancer diagnosis.
Evaluation of a 20-Month Physical Activity Intervention to Improve Motivational and Affective Outcomes Among Disadvantaged Adult Women
Authors: Sanz-Remacha María , Aibar Alberto , Sevil-Serrano Javier , García-González Luis
Published: March 2021

Grounded in self-determination theory, this study aimed to qualitatively examine women’s perception of a set of motivational and affective consequences during and immediately after a physical activity intervention. In total, 11 disadvantaged adult women participated in this 20-month intervention. A total of 102 physical activity sessions based on need-supportive strategies were performed. Six discussion groups, 14 semi-structured interviews, and field notes were used to collect data. A thematic analysis was conducted based on self-determination theory. Findings highlighted that it might be advisable among these disadvantaged women to begin with relatedness-support strategies to increase group cohesion, followed by competence support strategies to increase self-confidence, and, finally, autonomy support strategies to empower women to be physically active. The development of a need-supportive environment in a physical activity intervention may have the potential to achieve motivational and affective consequences, which might promote the empowerment of these disadvantaged women to be physically active.
Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program
Authors: Cipriano-Steffens Toni , Cursio John F. , Hlubocky Fay , Sumner Marsha , Garnigan-Peters Deborah , Powell Judy , Arndt Nicole , Phillips Lee , Lassiter Rev. Herbert , Gilliam Marie , Petty Lou Ester , Pastor Rev. Scott Onque , Malec Monica , Fitchett George , Polite Blase
Published: March 2021

Background:

Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population.

Design:

Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status.

Measurement:

Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record.

Result:

Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life.

Conclusion:

The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients’ quality of life, spiritual wellbeing, and decreased aggressive EOL care.
New PAX2 Mutation Associated with Polycystic Kidney Disease: A Case Report
Authors: Forero-Delgadillo Jessica Maria , Ochoa Vanessa , Duque Natalia , Restrepo Jaime Manuel , Londoño Hernando , Nastasi-Catanese Jose Antonio , Pachajoa Harry
Published: March 2021

Background:

Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage renal disease in children. Diagnosis by genetic testing has proven challenging due to its genetic and phenotypic heterogeneity, as well as incomplete penetrance. We report a case on a 16-months old female with a history of renal cysts and a PAX2 mutation.

Case presentation:

The patient presented with a prenatal diagnosis of Potter sequence and a postnatal diagnosis of renal cysts. An ultrasound at 20 weeks gestation revealed right renal agenesis and possible left renal dysplasia. Post natal genetic analyses identified a novel mutation in PAX2.

Conclusion:

Cystic kidney disease is often underdiagnosed due to its variable expressivity and wide range of clinical manifestations; PAX2 genetic screening should be considered for all patients with CAKUT.
Wild, stressful, or stupid: Que es Bandersnatch? Exploring user outcomes of Netflix’s interactive Black Mirror episode
Authors: Nee Rebecca C
Published: March 2021

Prior scholarship related to interactive digital narratives (IDNs) typically has analyzed this emerging genre of storytelling on web-based platforms. The Bandersnatch episode of the Black Mirror series on Netflix offers a unique opportunity to explore the affordances and audience effects of IDNs appearing within a popular streamed TV program. This case study combines updated models of the uses and gratifications theory of media use with human–computer interaction frameworks to identify cognitive themes and emotional valences among Bandersnatch users, as expressed through tweets related to their experience. Findings show positive emotions were associated with perceived degree of control, as well as immersion or sense of flow. Gratifications associated with binge-type behavior on streaming services were also present. However, perceived realism, parasocial identification with the character, a need for a sense of completion, and the burden of choice created stress among many users. Social media served as a valuable ancillary vehicle for users to participate with others around the program, thus elevating the interactive narrative elements of the experience, which were otherwise limited and controlled.
Conformity and reactions to deviance in the time of COVID-19
Authors: Packer Dominic J. , Ungson Nick D. , Marsh Jessecae K.
Published: March 2021

We have seen massive global behavioral change as billions of people radically altered their ways of life in response to COVID-19. Here, we review how research on conformity and deviance can inform understanding of and effective responses to the pandemic. Group identities are critical for understanding who is influenced by whom, as well as how partisan divisions can obstruct cohesive and coordinated action. We identify several questions highlighted by the pandemic, including when people will react more harshly to ingroup members who violate health-protective norms (black sheep effect) or to outgroup members violating the same norms (intergroup hypocrisy). As a working hypothesis, we propose a goal-based approach, positing that differentially negative reactions to ingroup and outgroup deviants are likely influenced by the relative salience of goals to protect ingroup image, enforce group norms, maintain intergroup boundaries, and seek justice for potential victims put at risk by norm-violating behavior.
Coping with COVID-19-induced threats to self
Authors: Kruglanski Arie W. , Molinario Erica , Lemay Edward P.
Published: March 2021

Whereas the COVID-19 pandemic induces in people both uncertainty and angst, the latter may not be a direct consequence of uncertainty as such, but rather of the possible negative outcomes whose subjective certainty increased under the pandemic. From this perspective, we discuss the psychological determinants of people’s reactions to the pandemic and their modes of self-affirmation in response to pandemic-implied threats. Those reactions are guided by value-oriented narratives that may variously drive people’s pro- and anti-social behaviors during the pandemic.
Culture and global societal threats: COVID-19 as a pathogen threat to humanity
Authors: Kashima Yoshihisa , Dennis Simon , Perfors Andrew , Laham Simon M.
Published: March 2021

The COVID-19 global pandemic has brought into sharp focus the urgency of tackling the question of how globalized humanity responds to a global societal threat, which can adversely affect a large portion of the human population. Changing geospatial distribution of COVID-19 morbidity paints a gloomy picture of cross-national differences in human vulnerabilities across the globe. We describe the dynamic nexus among societal – particularly pathogen – threat, social institutions, and culture, and discuss collectivism (ingroup favouritism and outgroup avoidance) and tightness (narrow prescription of behaviours and severe punishment of norm violations) as potential cultural adaptations to prevalent pathogen threats. We then sketch out a theoretical framework for cultural dynamics of collective adaptation to pathogen threats, outline a large number of theory- and policy-relevant research questions and what answers we have at present, and end with a call for renewed efforts to investigate collective human responses to societal threats.
Xenophobia and anti-immigrant attitudes in the time of COVID-19
Authors: Esses Victoria M. , Hamilton Leah K.
Published: March 2021

The devastating impact of the COVID-19 pandemic on nations and individuals has almost certainly led to increased feelings of threat and competition, heightened uncertainty, lack of control, and a rise in authoritarianism. In this paper we use social psychological and sociological theories to explore the anticipated effects on xenophobia and anti-immigrant attitudes worldwide. Based on our analysis, we discuss recommendations for further research required during the ups and downs of the pandemic, as well as during recovery. We also discuss the need for research to address how to best counteract this expected surge in xenophobia and anti-immigrant attitudes. As the pandemic persists, it will be important to systematically examine its effects on xenophobia and anti-immigrant attitudes, and to develop and implement strategies that keep these negative attitudes at bay.
Activism in the time of COVID-19
Authors: Grant Peter R. , Smith Heather J.
Published: March 2021

In many countries, COVID-19 has amplified the health, economic and social inequities that motivate group-based collective action. We draw upon the SIRDE/IDEAS model of social change to explore how the pandemic might have affected complex reactions to social injustices. We argue that the virus elicits widespread negative emotions which are spread contagiously through social media due to increased social isolation caused by shelter-in-place directives. When an incident occurs which highlights systemic injustices, the prevailing negative emotional climate intensifies anger at these injustices as well as other emotions, which motivates participation in protest actions despite the obvious risk. We discuss how the pandemic might shape both normative and non-normative protests, including radical violent and destructive collective actions. We also discuss how separatism is being encouraged in some countries due to a lack of effective national leadership and speculate that this is partially the result of different patterns of social identification.
Assessing and assisting prospective adoptive parents: Social workers’ communicative strategies in adoption assessment interviews
Authors: Wirzén Madeleine , Čekaitė Asta
Published: March 2021

The assessment of prospective adoptive parents is a complex task for professional social workers. In this study, we examine the structure and function of professional social workers’ follow-up questions in assessment talk with adoption applicants. The analysis shows that adoption assessment through interviews involved a delicate and complex task that was accomplished by using a particular genre of institutional talk. This both invited the applicants’ extended and ‘open-ended’ responses and steered these responses and their development towards the institutionally relevant topics. Detailed interaction analysis demonstrates that social workers used a broad range of question types to steer and guide applicants’ responses, organising talk about specific assessment topics. On the basis of initial open-ended topic initiations and applicants’ responses, the social workers steered topic development by using follow-up moves such as polar questions and clarifying questions that asked for specification, challenged applicants’ ideas, confirmed their knowledge and encouraged self-reflection. These follow-up moves allowed social workers to achieve the progression of talk into relevant areas of investigation and constituted a central and characteristic feature of assessment interviews. We suggest that they allow social workers to accomplish two hybrid institutional goals: i) the assessment of applicants’ suitability and ii) applicants’ preparation for future parenthood.
Combined machine learning–wave propagation approach for monitoring timber mechanical properties under UV aging
Authors: Nasir Vahid , Fathi Hamidreza , Kazemirad Siavash
Published: March 2021

This study proposes a combined machine learning–wave propagation approach for nondestructive prediction of the modulus of elasticity (MOE) and rupture (MOR) of timber subjected to ultraviolet (UV) radiation. Fir, poplar, alder, and oak wood specimens were subjected to artificial UV aging and assessed using the Lamb wave propagation. Different features including the wave characteristics and the viscoelastic properties of the specimens were obtained from the Lamb wave propagation tests. The extracted features trained a decision tree model for MOE and MOR prediction. The UV radiation caused a decrease in the elastic properties of wood but increased its viscoelasticity. The results also showed a decrease in the wave velocity and an increase in the wave amplitude decay with the UV exposure time. It was revealed that compared with the wave velocity, the wave amplitude decay was better correlated to the MOE of MOR of UV-degraded wood. The MOE and MOR of UV-degraded wood were accurately predicted by the machine learning models fed by the features extracted from the Lamb wave propagation tests, where the shear storage modulus was found as the most important feature for training the models. It was concluded that the proposed approach offers a great tool for in-situ monitoring of wood structures under weathering and photodegradation conditions.
A Chronic Care Management Framework Bridging Clinic, Home, and Community Care in a Mexican American Population
Authors: Zolezzi Maria , Lopez Juliana , Mitchell-Bennet Lisa , Payne Lisa Y. , McCormick Joseph B. , Reininger Belinda
Published: March 2021

Despite evidence that chronic care management improves outcomes, a framework designed for low income, uninsured populations is still needed to improve health disparities and guide further replication. We describe the Innovative Care for Chronic Conditions framework implemented by a coalition of clinics and agencies to address chronic care management for Mexican Americans with Type 2 diabetes mellitus who have low income and primarily uninsured. The core elements of the framework are described by clinic, home and community settings with community health workers playing an essential role in the delivery of community-based services that address the social determinants of health. Promising results are described. This framework expands the understanding of chronic care management approaches and contributes to further replication of the framework in diverse settings.
Design and evaluation of the target spray platform
Authors: Zhou Mingchuan , Jiang Huanyu , Bing Zhenshan , Su Hang , Knoll Alois
Published: March 2021

The target-oriented spraying is an effective way to minimize chemical input in agricultural production and it is important to actualizing sustainable agriculture. This article focused on the design and optimization of the target spray platform. The spray platform consists of three parts: the vision system, the spray system, and the moving platform. All components were effectively connected and preliminarily evaluated especially regarding the response time and target spray accuracy. A simulation system was built considering the real crop geometric shape and nozzle spray pattern using the Monte Carlo method. The spray simulator was used to optimize the spray height objective function of spray deposition rate and coefficient of variance for the spray deposition. The spray process can be easily visualized and compared for different spray parameters. The indoor experiment setup was built to test and optimize the parameters of the overall system, which is flexible to verify the system. Afterward, the outdoor tractor-based equipment was designed to test the system for the field environment. The experimental result showed that 80% of the crop had a spray deviation from 0 mm to 28 mm and the proposed spraying system can reduce 46.8% usage of the chemical compared to the uniform spray method.
The Effects of Collaborative Writing on Students’ Writing Fluency: An Efficient Framework for Collaborative Writing
Authors: Pham Vu Phi Ho
Published: March 2021

Collaborative writing is widely researched for its effects on students’ writing accuracy; however, previous research studies fail to prove its effects on students’ writing fluency. Also, none of the previous studies have investigated the framework for students to compose argumentative essays collaboratively. The purpose of this article is to fill these gaps. Sixty-two sophomore English-major students at a university in Ho Chi Minh city, Vietnam, participated in the study. One difference in the treatment between the two groups was the composing stage. Twenty-seven students from the control group composed essays individually after they worked together for idea development to make an outline, whereas 35 students from the experimental group composed essays collaboratively. Data collection was from students’ pretests, posttests of both individually and collaboratively written papers, and from the semi-structured interviews. The study reveals that collaborative writing had great effects on students’ writing fluency in both collaboratively written papers and individually written papers. Also, the study invented an efficient framework for collaborative writing activities so that writing instructors could employ to their writing classrooms if they wish to.
Economic Analysis and Surgical Outcomes of Outpatient Versus Inpatient Total Ankle Replacement Surgery
Authors: Akoh Craig C. , Chen Jie , Kadakia Rishin J. , Fletcher Amanda N. , Easley Mark E. , Adams Samuel B. , Nunley James A. , DeOrio James K. , Park Young-uk , Kim Hyong Nyun , Wang Juntao
Published: March 2021

Category:

Ankle Arthritis; Ankle; Other

Introduction/Purpose:

The utilization of total ankle replacement (TAR) for end-stage ankle osteoarthritis continues to increase in the United States. From 2011-2012, 47.5% of all TAR were covered by Medicare insurance, which represents a large insurance market share for inpatient ankle surgeries. However, there is a growing trend in orthopedics toward performing outpatient surgery. There have been studies that demonstrate the cost benefits and safety of outpatient TAR surgery. However, previous cost studies involve a single implant, small sample size, and lack clinical outcomes. Thus, we aim to compare the costs and clinical outcomes associated with TAR in the outpatient versus inpatient settings.

Methods:

We performed a retrospective study on 178 consecutive patients undergoing primary inpatient versus short-stay designation TAR during the 2016 and 2017 fiscal years. Patient demographics, concomitant procedures, perioperative complications, patient reported outcomes, and perioperative costs were collected.

Results:

The mean age of our cohort was 62.5 yo. The implant types were: Infinity (39.3%), Salto (38.2%), INBONE (15.2%), Vantage (7.3%), and STAR (3.4%). 47.8% of patients were covered under managed care and 42.1% under Medicare. There were no significant differences in medical comorbidities (p > 0.05) or concomitant surgeries (p=0.4574) between inpatient and outpatient groups. There was no difference in complications between inpatient and outpatient groups (p= 0.9652). Inpatients had a greater improvement in their SMFA function score compared to outpatients (p=0.0442). Both inpatient and outpatient cohorts significantly improved in all other reported patient reported outcomes at final follow-up (<0.0001) without a difference between groups (p >0.05). The total direct cost was higher for the inpatient group ($15,340.1) versus outpatient group ($13,002.6) (p<0.0001).

Conclusion:

While inpatient designation TAR were more comorbid, short-stay designation TAR were associated with a 15.5% reduction in perioperative costs, comparable complication rates, and similar final postoperative patient reported outcome scores compared to inpatient TAR. [Table: see text]
2020 Roger A. Mann Award Winner: Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure
Authors: O’Neil Joseph T. , Plummer Otho R. , Raikin Steven M.
Published: March 2021

Category:

Other

Introduction/Purpose:

Patient-reported outcome measures (PROMs) are an increasingly important tool for assessing the impact of treatments orthopaedic surgeons render to patients. They provide information directly reported by the patient pertaining to the perception of their own outcome, functional status, and quality of life. Despite their importance, they can present a burden for patients as well as for a busy outpatient clinic. The Foot and Ankle Ability Measure (FAAM) is a freely available validated anatomy-specific outcome measure consisting of 32 questions, and has been found to be reliable for patients with a wide spectrum of foot and ankle conditions. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure.

Methods:

A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment at a busy tertiary referral orthopaedic practice over a 3-year period (2017-2019). A total of 15,902 responses for the Activities of Daily Living (ADL) subscale and a total of 14,344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed using the mean and standard deviation of scores for both groups (FAAM versus CAT), frequency distributions of the scores and score differences for both groups, Pearson and intraclass correlation coefficients, and Bland-Altman assessments of patterns in score differences.

Results:

The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (compared to 22 questions for the FAAM) and 12 in 14.9% of cases. The number of questions answered on the Sports subscale was 6 in 66.4% of cases (compared to 10 for the FAAM) and 5 in 33.6% of cases. The mean difference between the full FAAM ADL subscale (out of 100 points) and CAT was 0.6266 of a point and scores were within 7.5 points in greater than 95% of cases. The mean difference between the FAAM Sports subscale (out of 100 points) and CAT was 0.5967 of a point and scores were within the minimal clinically important difference of 9 in greater than 95% of cases.

Conclusion:

The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do.
Metatarsal Pronation: Does It Matter?
Authors: Chambers Monique C. , Birhiray Dion , Botros Mina A. , Granberry William M.
Published: March 2021

Category:

Bunion

Introduction/Purpose:

Hallux Valgus is a complex deformity with several attendant components that are present to varying degrees in each patient. Historically primary attention has been paid to correction of the coronal plane deformity, but recent investigations suggest a substantial contribution to the deformity from the axial rotational abnormality of the metatarsal. While the effect of this metatarsal pronation has been demonstrated, the relative contribution of this parameter compared to other components has not been considered. This study aims to investigate the rotational aspect of the deformity and its contribution to successful radiographic correction of the deformity.

Methods:

A retrospective review of 100 consecutive Lapidus bunionectomy procedures was performed. There were 80 of patients and 89 feet. patients <18yrs, revision surgery and combined surgery, other than forefoot procedures were excluded. There were 79 (88%) females and 10 (12) males. The mean age was55. All feet were followed till radiographic healing was complete. Each foot was examined radiographically and pre and post-operative findings were compared. Along with the typical measurements of Hallux valgus parameters in the coronal plane, an additional measurement was included to estimate metatarsal head pronation (MT head shape and sesamoid position). The radiographic outcomes were then compared to determine the independent effect of metartarsal rotation on outcomes (recurrence, time to fusion). Pearson correlation was utilized to determine significant associations with the outcome parameters for recurrence, time to fusion, and failure to correct the hallux valgus angle (HVA).

Results:

The average HVA correction was 20.08 degrees and 6.86 degrees for IMA. A total of 68 feet had a positive preop round head sign and correction to a normal MT head shape was observed in 47 feet. A significant increase in recurrence was associated with patients that had persistent MT round sign following correction (p=0.001) and in patients with a higher sesamoid position in the preop period p<0.001). The average time to fusion was 9.56 with 47 (52%) feet were healed at 6 weeks postop. A higher (more lateral) sesamoid position and a higher postop HVA were also associated with longer time to fusion or delayed union.

Conclusion:

Adequate preoperative radiographic assessment is of the utmost importance to assess the various forces that can contribute to hallux valgus deformity. Newer techniques address coronal and sagittal plane deformity. Failure to correct MT head pronation may lead to increased hallux valgus recurrence, despite sagittal correction measured by improvement of the HVA and IMA angles. Factors that impact time to fusion are also associated with a higher risk of HV recurrence. Sesamoid position and metatarsal head pronation should be considered, and correction of these parameters may be necessary to avoid delayed healing and persistent or recurrent HV.
Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study
Authors: Crocker Caitlin Curtis , Abyar Eildar , Young Sean , Razaghi Fatemah , McGwin Gerald , Johnson Michael D.
Published: March 2021

Category:

Ankle; Hindfoot

Introduction/Purpose:

Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers.

Methods:

Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test.

Results:

Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision.

Conclusion:

The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.
Radiographic and Clinical Analysis of the INBONE II Total Ankle Arthroplasty
Authors: Day Jonathan , Kim Jaeyoung , Ellis Scott J. , Deland Jonathan T. , O’Malley Martin J. , Cody Elizabeth , Demetracopoulos Constantine A.
Published: March 2021

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The use of total ankle arthroplasty (TAA) in the treatment of ankle arthritis has grown substantially as advancements are made in design and surgical technique. Among the criteria guiding the choice between arthroplasty versus arthrodesis, the long-term survival and postoperative outcomes are of crucial importance. First FDA approved in 2005, the INBONE I prosthesis was subsequently replaced by the INBONE II in 2010. While outcomes of the INBONE I have been published, there is limited long-term survivorship data for the INBONE II. The purpose of this study is to determine the minimum 5-year survivorship of the INBONE II prosthesis and causes of failure. In addition, we evaluate long-term radiographic and patient- reported outcomes.

Methods:

We retrospectively identified 46 prospectively followed patients from 2010 to 2015 who underwent TAA with the INBONE II prosthesis at our institution. Of these, 44 cases (41 patients) had minimum follow-up of 5 years (mean, 6; range, 5 to 9). Mean age was 65.6 years (range, 42 to 81) and mean BMI was 27.6 (range 20.1 to 33). Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Chart review was performed to record incidences of revision and reoperation. Preoperative, immediate and minimum 5-year x-rays were reviewed; coronal tibiotalar alignment (TTA) was measured on standing AP radiographs to assess alignment of the prosthesis. A TTA of +-5° from 90° indicated neutral alignment, while <85° and >95° was considered varus and valgus alignment, respectively. Radiographic subsidence as well as presence and location of periprosthetic cysts were documented. Pre- and minimum 5-year FAOS domains were compared.

Results:

Survivorship was 97.7% with one revision of the talar component due to aseptic loosening and subsidence. The rate of other reoperations was 4.5% (2); one patient underwent medializing calcaneal osteotomy for valgus heel alignment, another patient underwent ostectomy and debridement for ankle impingement. Average preoperative TTA was 88.5 degrees with 15 neutral (average TTA of 89.7°), 14 varus (74°) and 12 valgus (104°) ankles. Average postoperative TTA was 88.6° with 35 neutral (89.3°), 6 varus (84.7°), and no valgus ankles. Radiographic subsidence was observed in one patient who underwent revision, and periprosthetic cysts were observed in 7 patients. There was significant improvement in all FAOS domains at final follow-up.

Conclusion:

This is the largest study to date dedicated to evaluating survivorship of the INBONE II prosthesis. Our data suggests a high survival rate and low reoperation rate with long-term follow-up of the INBONE II implant. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at minimum 5-year follow-up.