bluuebunny/crossref_metadata_2025 huggingface dataset:
Modeling and design optimization of shape memory alloy-enabled building skins for adaptive ventilation
Authors: Fang Yudong , Peraza Hernandez Edwin A
Published: January 2022

This paper presents a modeling and design study of shape memory alloy (SMA)-based skins that enable adaptive ventilation in buildings. The skins are formed by panels with attached SMA wires and can be periodically arranged to form a building envelope. When the environmental temperature is below the SMA austenitic transformation temperatures, the SMA wires are relaxed and the panel forms a closed surface, preventing circulation of exterior airflow into the building. When the environmental temperature exceeds such SMA transformation temperatures, the SMA wires contract and bend the panel to create an opening that enables circulation of airflow into the building. The response of the adaptive skins is evaluated through a thermomechanically coupled finite element model. The applied thermal loads are determined from published field measurements. Metallic materials and fiber-reinforced composites are explored as candidates for the panel. Genetic algorithms are employed for optimization, where the objective is that the panel exhibits a large opening when the environmental temperature exceeds a prescribed ideal temperature and stays closed otherwise. Optimization results show that two-layered composite panels with ply angles of 45°/−45° and thicknesses of 0.1/0.25 mm (layers ordered from the interior to the exterior side) display the most favorable performance.
Two Poems: “Upon Hearing Rebecca Thomas” and “Upon Viewing Kent Monkman’s Miss Chief’s Wet Dream”
Authors: Prendergast Monica
Published: January 2022

These poems were written and shared during the October 2019 International Poetic Inquiry Symposium in Halifax, Nova Scotia.
Writing as Being: On the Existential Primacy of Writing for a Deaf Scholar
Authors: Snoddon Kristin
Published: January 2022

This article employs analytic autoethnography to study online events and social media that I participated in as a deaf scholar during the COVID-19 pandemic. With reference to Derrida’s philosophy of deconstruction, this article asserts the existential primacy of writing as a critical subject of inquiry for confronting normative language ideologies about what language is and how and where language is produced, received, understood, and performed.
Comparing Public Quality Ratings for Joint Commission Accredited and Non-Joint Commission Accredited Home Health Agencies: A Replication Study
Authors: Longo Beth A. , Schmaltz Stephen P. , Williams Scott C.
Published: January 2022

This was a descriptive replication study comparing 2083 home health agencies accredited by The Joint Commission (TJC) and 8695 non-TJC-accredited home health agencies over a 3-year period using the Centers for Medicare and Medicaid Services Home Health Compare data set. Metrics included the star ratings and 17 quality measures. A longitudinal model was used to determine differences between TJC-accredited and non-TJC-accredited organizations on the quality measures. Categorical differences in star ratings were analyzed using a Cochran-Mantel-Haenszel test. TJC-accredited home health agencies had better average ratings than non-TJC-accredited home health agencies for each of the 3 years (3.4 vs 3.2, p < .001). When categories were collapsed to evaluate differences, the analysis revealed that a significantly larger proportion of TJC-accredited facilities were clustered within the higher ratings (41% for TJC-accredited vs 32% for non-TJC-accredited), and fewer TJC-accredited organizations were clustered within the lower ratings (22% for TJC-accredited vs 30% for non-TJC-accredited; p < .001). Two claims-based outcome measures (hospitalization and emergency room visits) were consistent with the original study in which TJC-accredited home health organizations had statistically significant lower rates across all 3 years studied, compared to non-TJC-accredited HHAs. This replication study validates and extends the generalizability of the findings from the original study.
Social Validity and Preliminary Outcomes of a Mentoring Intervention for Adolescents and Adults With Autism
Authors: Weiler Lindsey M. , Goerdt Annie K. , Kremer Kalli B. , Goldberg Emily , Hudock Rebekah L.
Published: January 2022

Adolescents with autism spectrum disorder (ASD) are vulnerable to declines in social connections and an increase in depression, anxiety, and other co-occurring conditions. This study introduces a novel intervention that matches adolescents and adults with ASD in one-to-one mentoring relationships in an afterschool setting and examines its social validity. In this single-group, mixed-method pilot study, participants were seven adolescent mentees (14–18 years old; 100% male), seven adult mentors (19–33 years old; 71% male), and eight parents of mentees. A combination of project-specific and standardized assessments was used to describe the participants’ perceptions of the program and to assess well-being, self-concept, and social-emotional and behavioral outcomes. Results showed high uptake, program satisfaction, positive ratings of mentoring relationship quality, and desirable pre- to post-test change on several targeted outcomes. This study provides preliminary evidence to support the applicability and utility of a mentoring program for adolescents with ASD by adults with ASD.
Autism Assessment in Low- and Middle-Income Countries: Feasibility and Usability of Western Tools
Authors: Bauer Kathleen , Morin Kristi L. , Renz Theodore E. , Zungu Sinenhlanhla
Published: January 2022

The research on autism spectrum disorder (ASD) disproportionately originates from high-income countries, indicating a disparity of research in low- and middle-income countries (LMIC). One possible reason for this disparity is a lack of culturally appropriate screening and diagnostic tools for use in LMIC. Although a number of tools are commonly used in the United States, it is likely that using these tools in contexts in which they were not intended may be problematic. As such, this study examined factors that may inhibit the feasibility and usability of common ASD assessment tools in LMIC. Assessments were analyzed for readability, initial and continued cost, training required, restrictions on purchasing, materials required, and presence of items assessing expressive and receptive language. Results of the study indicated that the majority of validated ASD assessment tools present a multitude of barriers for use in LMIC. Implications for research and practice are discussed.
A Portrait of Peers Within Peer-Mediated Interventions: A Literature Review
Authors: Travers Hilary E. , Carter Erik W.
Published: January 2022

Although the impact of peer-mediated interventions on students with intellectual and developmental disabilities (IDD) has been studied extensively, little attention has focused on the peers without disabilities who are so central to these interventions. We reviewed 98 studies to examine the portrait of more than 3,000 peers without disabilities who have participated in peer-mediated interventions involving middle and high school students with IDD. Peer and student demographics were very diverse, as were the methods for peer recruitment and selection, the interventions they delivered, the settings in which they spent time with students with IDD, and the ways in which they were prepared for these roles. However, reporting in these areas was limited across studies. We offer recommendations for strengthening research and practice focused on the contributions of peers within these evidence-based interventions.
Performance and Integration of Smartphone Wireless ECG Monitoring into the Enterprise Electronic Health Record: First Clinical Experience
Authors: Cho Geoffrey W , Almeida Shone O , Gang Eli S , Elad Yaron , Duncan Ray , Budoff Matthew J , Karlsberg Ronald P
Published: January 2022

Introduction:

Patient initiated, remote cardiac monitoring has proved to be a significant advance in the diagnosis and management of arrhythmias. Further improvements in ease of use and access to results will further improve health outcomes and cost-effectiveness. Here we describe a proof-of-concept evaluation to assess the feasibility of successfully implementing a cloud-based management system using KardiaPro (KP) for remote electrocardiogram (ECG) monitoring to interface into EPIC, an enterprise electronic health record (EHR) system.

Methods:

The KP management system was embedded using hypertext markup language (HTML) code directly into the EHR. Encrypted credentials and patient data were bundled with an application programming interface key allowing linkage of remote monitoring from patients’ smartphones. During the time of implementation, a total of 322 patients and 32 179 ECGs were recorded.

Results:

The KP-EHR interface provided full functionality, allowing detection, interpretation and documentation of atrial fibrillation (AF), flutter events, ventricular tachycardia, and complete heart block. Our study focused on KP’s detection of AF, and 16.7% of tracings were classified as probable AF with only 2.3% of tracings not analyzed by the KP algorithm because of tracings that were too noisy or truncated. Enhanced management was facilitated with clinical information immediately accessible. Blinded physician ECG review validated the KP proprietary algorithm interpretation and ECGs.

Conclusions:

Direct integration of KP into EHR was successful and practical. It allows for historical, point of care and immediate retrieval of remote ambulatory monitoring data and documentation into the electronic health record. KP EHR integration warrants further study as it has the potential to improve cost-effectiveness and clinical diagnostic value, leading to improvements in delivery of patient care.
Barriers to early detection and management of oral cancer in the Asia Pacific region
Authors: Ng Sin Wi , Syamim Syed Mohd Sobri Sharifah Nur , Zain Rosnah binti , Kallarakkal Thomas George , Amtha Rahmi , Wiranata Wong Felix A , Rimal Jyotsna , Durward Callum , Chea Chanbora , Jayasinghe Ruwan Duminda , Vatanasapt Patravoot , Saleha binti Ibrahim Tamin Nor , Cheng Lai Choo , Mazlipah binti Ismail Siti , Tepirou Chher , Ariff bin Abdul Rahman Zainal , Rajendran Senthilmani , Kanapathy Jananezwary , Liew Chee Sun , Cheong Sok Ching
Published: January 2022

Objective

Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region.

Methods

A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey.

Results

The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested.

Conclusion

The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.
Development of a ‘real-world’ logic model through testing the feasibility of a complex healthcare intervention: the challenge of reconciling scalability and context-sensitivity
Authors: Mills Thomas , Shannon Rosie , O’Hara Jane , Lawton Rebecca , Sheard Laura
Published: January 2022

Logic models feature prominently in intervention research yet there is increasing debate about their ability to express how interventions work in the real-world. ‘Real-world’ logic models are a new proposition which express complex interventions in context. They are designed to help researchers strike a balance between context-sensitivity and scalability. This article explores the utility of real-world logic models in a trial involving a complex intervention called ‘Your Care Needs You’, designed to improve hospital-home transitions for UK older patients. The approach is found to usefully capture, refine and express important learning about intervention-implementation-context dynamics. The findings imply the need for intervention researchers to think creatively about how to implement interventions in diverse and sometimes challenging environments and to develop understanding of how complex interventions adapt on implementation to produce outcomes. The possibility of assessing the wider social and policy context within intervention research is also posed.
Health Management Occupations During COVID-19: Experiences of Older African Americans With Multimorbidity
Authors: Fritz Heather , Jones Ryan , Cutchin Malcolm P.
Published: January 2022

Older African Americans with multimorbidity are at an especially high risk of adverse outcomes due to synergistic risks conferred by age, chronic disease burden and social determinants of health. Chronic condition self-management is one way older African Americans can use health management occupations and exercise agency to reduce their risk of becoming severely ill, and during the ongoing pandemic, of COVID-19 infection. The objective of this study was to understand how the COVID-19 pandemic shaped health management occupations of older African Americans. In-depth qualitative interviews were conducted with 30 African Americans aged 65 and older who reported having two or more chronic conditions. Data were analyzed using thematic analysis. Data suggest how key health management occupations (accessing care; managing medications, nutrition, and physical activity; and social and emotional health promotion and maintenance) were utilized and also shaped by the pandemic. Another key finding was perceived benefits of the pandemic on health and well-being.
Cost-effectiveness of enfortumab vedotin in previously treated advanced urothelial carcinoma
Authors: Wu Qiuji , Qin Yi , Liao Weiting , Zhang Mengxi , Yang Yang , Zhang Pengfei , Li Qiu
Published: January 2022

Background:

Antibody-drug conjugates have recently been introduced as a treatment for advanced urothelial carcinoma. The EV-301 study demonstrated that enfortumab vedotin (EV) improved overall survival compared with conventional chemotherapy. To assess the cost-effectiveness of EV for the treatment of advanced urothelial carcinoma (UC) from a payer perspective in middle- and high-income countries.

Methods:

A decision analysis model was developed to assess the efficacy and economic viability of EV as a subsequent-line treatment following disease progression in patients with advanced urothelial carcinoma already treated with PD-1 or PD-L1 inhibitors. Clinical and utility values were obtained from the published literature and available databases. Cost data were obtained from payer perspectives in the United States, United Kingdom, and China. Quality-adjusted life-years (QALYs) were used to measure health outcomes, and incremental cost-effectiveness ratios (ICERs) used to evaluate cost-effectiveness in comparison to willingness-to-pay in the United States, United Kingdom, and China. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model.

Results:

Compared with chemotherapy, EV increased the benefit by 0.16-0.17 QALYs, resulting in ICERs of $2,168,746.71, $2,164,494.38, and $1,775,576.56 per QALY in the United States, United Kingdom, and China, respectively. One-way sensitivity analysis indicated that the largest effect on outcome was the utility value for progression-free survival. Probabilistic sensitivity analysis demonstrated that the probability of EV being cost-effective was 0%.

Conclusions:

EV provides an additional health benefit over chemotherapy for patients with advanced urothelial carcinoma but is not cost-effective from a payer perspective in the United States, United Kingdom, or China.
Predictive Risk Models to Identify Patients at High-Risk for Severe Clinical Outcomes With Chronic Kidney Disease and Type 2 Diabetes
Authors: Sheer Richard , Nair Radhika , Pasquale Margaret K. , Evers Thomas , Cockrell Meghan , Gay Alain , Singh Rakesh , Schmedt Niklas
Published: January 2022

Introduction/Objective:

Predictive risk models identifying patients at high risk for specific outcomes may provide valuable insights to providers and payers regarding points of intervention and modifiable factors. The goal of our study was to build predictive risk models to identify patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) at high risk for progression to end stage kidney disease (ESKD), mortality, and hospitalization for cardiovascular disease (CVD), cerebrovascular disease (CeVD), and heart failure (HF).

Methods:

This was a retrospective observational cohort study utilizing administrative claims data in patients with CKD (stage 3-4) and T2D aged 65 to 89 years enrolled in a Medicare Advantage Drug Prescription plan offered by Humana Inc. between 1/1/2012 and 12/31/2017. Patients were enrolled ≥1 year pre-index and followed for outcomes, including hospitalization for CVD, CeVD and HF, ESKD, and mortality, 2 years post-index. Pre-index characteristics comprising demographic, comorbidities, laboratory values, and treatment (T2D and cardiovascular) were evaluated and included in the models. LASSO technique was used to identify predictors to be retained in the final models followed by logistic regression to generate parameter estimates and model performance statistics. Inverse probability censoring weighting was used to account for varying follow-up time.

Results:

We identified 169 876 patients for inclusion. Declining estimated glomerular filtration rate (eGFR) increased the risk of hospitalization for CVD (38.6%-61.8%) and HF (2-3 times) for patients with eGFR 15 to 29 mL/min/1.73 m2 compared to patients with eGFR 50 to 59 mL/min/1.73 m2. Patients with urine albumin-to-creatinine ratio (UACR) ≥300 mg/g had greater chance for hospitalization for CVD (2.0 times) and HF (4.9 times), progression to ESKD (2.9 times) and all-cause mortality (2.4 times) than patients with UACR <30 mg/g. Elevated hemoglobin A1c (≥8%) increased the chances for hospitalization for CVD (21.3%), CeVD (45.4%), and death (20.6%). Among comorbidities, history of HF increased the risk for ESKD, mortality, and hospitalization for CVD, CeVD, and HF.

Conclusions:

The predictive models developed in this study could potentially be used as decision support tools for physicians and payers, and the risk scores from these models can be applied to future outcomes studies focused on patients with T2D and CKD.
Risk for Subsequent SARS-CoV-2 Infection and Severe COVID-19 Among Community-Dwellers With Pre-Existing Cervicocephalic Atherosclerosis: A Population-Based Study
Authors: Del Brutto Oscar H. , Mera Robertino M. , Del Brutto Victor J. , Recalde Bettsy Y. , Rumbea Denisse A. , Costa Aldo F. , Sedler Mark J.
Published: January 2022

Background:

COVID-19 patients may develop atherosclerosis-related complications. Whether a proportion of these patients already had asymptomatic cervicocephalic atherosclerosis before SARS-CoV-2 infection is not known. This study assessed whether pre-existing cervicocephalic atherosclerosis increased the susceptibility to SARS-CoV-2 infection or resulted in more severe or fatal COVID-19.

Methods:

Individuals enrolled in the Atahualpa Project cohort who received head CT (for assessing carotid siphon calcifications) and B-mode ultrasounds (for measurement of the carotid intima-media thickness) prior to the pandemic were eligible for this study. Among this cohort, those who also received serological tests for detection of SARS-CoV-2 antibodies and clinical evaluations for assessment of COVID-19 severity were enrolled. Multivariate logistic regression and exposure-effect models were fitted to assess the association between pre-existing atherosclerosis biomarkers, and SARS-CoV-2 seropositivity and COVID-19 severity.

Results:

Overall, 154 of 519 study participants (30%) had evidence of cervicocephalic atherosclerosis. A total of 325 (63%) individuals became SARS-CoV-2 positive, and 65 (23.5%) of seropositive individuals had severe or fatal COVID-19. The risk of SARS-CoV-2 seropositive status did not differ across individuals with and without atherosclerosis biomarkers ( P = .360). Likewise, seropositive individuals with pre-existing atherosclerosis were not more prone to develop severe or fatal COVID-19 than those without evidence of atherosclerosis ( P = .274). Average estimated exposure effects of pre-existing cervicocephalic atherosclerosis versus no atherosclerosis over SARS-CoV-2 seropositivity and COVID-19 severity were not significant.

Conclusions:

Pre-existing cervicocephalic atherosclerosis does not increase the risk of acquiring SARS-CoV-2 infection nor the severity of COVID-19 among seropositive individuals.
Barriers to Access for Cervical and Breast Cancer Screenings Among Female Latinx Migrant Farmworkers in the US: A Scoping Literature Review
Authors: Pariser Ada , Hirko Kelly A. , Muñoz Gladys M. , Pico-Gleason Gladys , Robinson Chelsea , Kerver Jean M.
Published: January 2022

Identification of barriers to cancer screening among female migrant farmworkers is needed to inform intervention development and healthcare policy. Thus, our purpose was to systematically review and summarize findings from prior studies of barriers faced by Latinx migrant farmworkers in accessing cervical and breast cancer screenings in the US. Medline and Embase were used to identify literature through October 2021 using the search terms “migrant farmworkers AND. . .cancer; healthcare access; breast; cervical; federally qualified health centers,” and “migrant cancer screening” and “migrant farmworker cancer screening.” Snowball sampling by reviewing citations in each selected article was also used. Exclusion criteria included those articles that focused on specific types of cancer other than breast or cervical, those not within the US, not referencing Latinx migrants, not referencing cancer screening, or those focused on pediatric populations. Data was synthesized by 3 authors and selected articles were assessed for common themes. Nineteen articles met inclusion criteria. Common themes about barriers to cancer screening included: lack of cancer knowledge, cost/inability to pay, lack of health insurance coverage, cultural perceptions, fear, language difficulties, and transportation and time constraints. Findings suggest that barriers to cancer screening among migrant farmworkers may be addressed by providing education about cancer screening and treatment, addressing fear, language, and cultural barriers, and providing transportation and health insurance coverage. Consideration of these barriers is necessary to effectively address cancer disparities in this vulnerable population of female farmworkers.
Finding Silver Linings: A Mixed Methods Analysis of COVID-19’s Challenges and Opportunities for College Students’ Functioning and Outlook
Authors: Broner Sarah E. , Hareli Maya , Gonzales Carol H. , Conley Colleen S. , Ruggieri Amanda L.
Published: January 2022

This study examines the impact of the COVID-19 pandemic on college students’ lives. A mixed methods approach, analyzing open- and closed-ended questions about challenges and opportunities, reveals numerous ways in which the pandemic has impacted students in general and differentially by gender, sexual orientation, race/ethnicity, and family income. Cisgender male and heterosexual students generally reported less of a mental health impact from the pandemic. Gender and sexual minorities, and low- to middle-income students, also noted some effects of the pandemic more often than their peers. Finally, thematic analysis revealed that where students found challenges, they also found opportunities within the broad categories of Lifestyle and Routines, Academic/Professional, Health, Interpersonal, and Societal impacts, evidencing heterogeneity and resilience in finding silver linings despite the challenging pandemic. This research has implications for equitably deploying and tailoring university and mental health resources both during and beyond the pandemic to improve student well-being and success.
Acrylonitrile induction of rodent neoplasia: Potential mechanism of action and relevance to humans
Authors: Kobets Tetyana , Iatropoulos Michael J , Williams Gary M
Published: January 2022

Acrylonitrile, an industrial chemical, is a multisite carcinogen in rats and mice, producing tumors in four tissues with barrier function, that is, brain, forestomach, Zymbal’s gland, and Harderian gland. To assess mechanism(s) of action (MoA) for induction of neoplasia and to evaluate whether the findings in rodents are indicative of human hazard, data on the potential key effects produced by acrylonitrile in the four rodent target tissues of carcinogenicity were evaluated. A notable finding was depletion of glutathione in various organs, including two target tissues, the brain, and forestomach, suggesting that this effect could be a critical initiating event. An additional combination of oxidative DNA damage and cytotoxic effects of acrylonitrile and its metabolites, cyanide, and 2-cyanoethylene oxide, could initiate pro-inflammatory signaling and sustained cell and tissue injury, leading to compensatory cell proliferation and neoplastic development. The in vivo DNA-binding and genotoxicity of acrylonitrile has been studied in several target tissues with no compelling positive results. Thus, while some mutagenic effects were reported in acrylonitrile-exposed rodents, data to determine whether this mutagenicity stems from direct DNA reactivity of acrylonitrile are insufficient. Accordingly, the induction of tumors in rodents is consistent primarily with a non-genotoxic MoA, although a contribution from weak mutagenicity cannot be ruled out. Mechanistic data to support conclusions regarding human hazard from acrylonitrile exposure is weak. Comparison of metabolism of acrylonitrile between rodents and humans provide little support for human hazard. Three of the tissues affected in bioassays (forestomach, Zymbal’s gland, and Harderian gland) are present only in rodents, while the brain is anatomically different between rodents and humans, diminishing relevance of tumor induction in these tissues to human hazard. Extensive epidemiological data has not revealed causation of human cancer by acrylonitrile.
Reconstructive Surgical Management of Charcot Neuropathy of the Foot and Ankle: A Retrospective Study
Authors: Pattisapu Naveen , Bettin Clayton C. , Yeoh Jane C. , Sarfani Shumaila
Published: January 2022

Category:

Diabetes

Introduction/Purpose:

Treatment of Charcot neuropathy (CN) of the foot and ankle remains a challenge for both patient and surgeon. Non-operative treatment with immobilization in a cast/orthosis has long been the mainstay of treatment, but more recently surgical intervention-with attention to internal fixation-has gained interest because of the poor long-term outcomes with non-operative care.

Methods:

To assess long-term outcomes between CN patients managed with reconstructive surgeries at a tertiary referral center; a retrospective chart review analyzed comorbidities, demographics, and complications (ulceration, infection, and below the knee amputation).

Results:

Over the last 16 years, 31 patients with CN were treated with internal fixation (midfoot fusion, open reduction, or hindfoot fusion nail). Average BMI was 33.5, average number of comorbidities was 2.93, and the percentage of patients with a vascular deficit was 19.3%. The rate of infection and ulceration prior to surgery was 19.4% (6/31 patients) and 45.2% (14/31 patients) respectively. After surgery, the rate of new infections was 38.7% (12/31 patients). The rate of new ulcerations was 41.9% (13/31 patients). The rates of below the knee amputation was 19.4% (6/31 patients).

Conclusion:

A 16-year retrospective review of operative management of Charcot neuropathy in 31 patients at a tertiary referral center found high rates of ulceration, infection, and amputation in patients treated with internal fixation. This study could prove valuable in counseling CN patients regarding reconstructive surgery.
Association of Length of Stay and COVID-19 in Rotational Ankle Fracture Surgery in the National COVID Cohort Collaborative (N3C)
Authors: Pitts Charles C. , Levitt Eli , Patch David A. , Terrero Alfredo , Butler Reed , Ponce Brent A. , Theiss Steven M. , Spitler Clay A. , Johnson Michael D.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Coronavirus (COVID-19) is an emerging, rapidly evolving situation. The National COVID Cohort Collaborative (N3C) is an innovative approach to integrate real-world clinical observations into a harmonized database. To investigate the outcomes of adults with ankle fracture surgery during the (COVID-19) pandemic, we had the following research question: What are the outcomes of ankle fracture patients with COVID-19 (invasive ventilation, length of stay, death)? The purpose of this abstract is to introduce the largest cohort of ankle fracture patients to date with a comparison between lab- confirmed COVID-19-positive and COVID-19-negative.

Methods:

A retrospective cohort of adults with ankle fracture surgery in the N3C Data Enclave. The N3C Data Enclave is an NIH-funded, secure platform through which the harmonized clinical data from electronic health records is stored ( https://covid.cd2h.org/ ). COVID-19 status was determined using a set of 55 SARS-CoV-2 polymerase chain reaction and antigen lab tests. Ankle fracture surgery was defined using SNOMED codes for 'fracture of bone' and one of the following CPT codes '27766, 27769, 27792, 27814, 27822, 27823, 27829' for 'ankle fracture surgery.'

Results:

A total population of 3.4 million patient records was queried in the National COVID Cohort, identifying 2,032 participants with ankle fracture surgery. The age range of the overall group was 18-98 years. Comparing COVID-19-positive to COVID-19-negative, the age (48.9 years vs 47.7 years) and gender (66.7% female vs 55.1% female) distribution of each group were comparable (both p>0.05). COVID-19-positive comprised 2.4% of the group (n=48). The length of stay was 4.7 days longer in the COVID-19-positive group (8.7 days vs 4.0 days, p<0.001). Higher proportions of COVID-19-positive patients who required invasive ventilation (12.5% vs 3.2%, p<0.002). The number of outcomes for mortality was too few to report.

Conclusion:

Based on the initial results, rotational ankle fractures requiring surgery necessitated longer hospitalizations in COVID-19-positive patients during the COVID-19 pandemic than in patients without the virus. The average increased length in hospitalization was, on average, about 6 days. When treated in isolation, ankle fractures can often be treated on an outpatient basis, and a multiple-day increase in average hospital stay is substantial. Though the overall complication profiles (with the exception of pulmonary disease) were similar, lengthy hospital stays could lead to delays in the recovery and rehabilitative process, and functional outcomes could not be determined in our study.
Revision First Metatarsophalangeal Joint Fusion for Non-Union, Implant Failures, and Failed Hallux Valgus Correction: Does the Indication Matter?
Authors: Prat Dan , Haghverdian Brandon A. , Pridgen Eric , Lee Wonyong , Wapner Keith L. , Chao Wen , Farber Daniel C.
Published: January 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

The most common indications for revision of 1st Metatarsophalangeal (MTP) joint surgery are symptomatic failures of prior fusion, failed hallux valgus correction, and failed MTP arthroplasty implants. The outcome of revision 1st MTP fusion has rarely been studied. The purpose of this study was to compare the clinical, radiographic, and patient-reported outcomes of revision MTP fusion for different indications.

Methods:

A retrospective chart review was performed for patients who underwent revision 1st MTP fusion between January 2015 and December 2019 in a single-center, by 4 fellowship-trained foot and ankle surgeons. The complication, revision, and non- union rates as well as VAS and PROMIS scores and pre-operative and post-operative radiographs were analyzed and compared between the different indication groups. Univariate and multivariate analysis and logistic regression models were used to obtain odds ratio of the explanatory variables for outcome measures.

Results:

A total of 79 cases of revision MTP fusion were included. Thirty-eight cases of hallux valgus corrections salvage, 22 failed MTP arthroplasty implants, 6 failed polyvinyl alcohol hydrogel implants, 13 prior MTP fusion non-unions. The mean follow-up time was 350 days (Median 226, SD 306). Seven cases (8.9%) required structural iliac-crest bone graft during the revision. Seven cases (8.9%) required allograft augmentation. The overall complication rate was 40.7%. Fifteen patients (18.5%) were classified as Clavien-Dindo grade 3, which represents a complication that may require a revision surgery (i.e. non-union, deep infection, loss of correction). Eventually, 7 cases (8.9%) underwent further revision surgery. The logistic regression model demonstrated that indication for revision was not significantly related to union rate (p=0.280). Visual-Analogue-Scale significantly improved at 6 weeks, 3 months, and at last follow-up in all indications for revision (p=0.001). PROMIS-10 Physical and PROMIS-10 Mental did not change significantly during follow-up (p=0.860, p=0.589).

Conclusion:

Treatment of 1st MTP joint surgery failures is a clinical challenge in orthopaedic surgery. In our study, revision of 1st MTP joint surgery with MTP fusion had higher non-union rates and higher overall complication rates compared to primary 1st MTP fusion. Nevertheless, revision rates remained comparable to primary 1st MTP fusion. Complication rates and patient- reported outcomes were similar between the different indications for revision groups. Visual-analogue-scale improved significantly during follow-up in all groups. Diabetes mellitus had a significant impact on non-union rates and overall complication rates.
Differences in the 30 Days vs One-Year Complications and Reoperations after Total Ankle Replacement and Ankle Arthrodesis: A Large Database Study
Authors: Riepen Dietrich , Sambandam Senthil , Mounasamy Varatharaj , Wukich Dane K.
Published: January 2022

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Total ankle replacement (TAR) and Ankle arthrodesis (AA) are two commonly performed procedures for end stage arthritis of ankle joint. Aim of this study was to analyze the characteristics of the complications and reoperations at 30 days and 1 year in a matched sample of TAR and AA in a large database population

Methods:

Commercially available patient database record (PearlDiver) was used for this study. Patient undergoing TAR and AA were identified using CPT code. After matching two groups for diabetes, smoking, obesity and comorbidities scores, the differences in the risk of complications at 30 days and 1 year and the risk of reoperation at 1 year were noted in both groups.

Results:

There were 1287 patients in each matched group. Four hundred and thirty patients were diabetic, 102 patients were smokers and 543 patients were obese. The risk of surgical site infection and wound dehiscence were higher at 30 days in the AA group. Vast majority of observed complications (More than 50% of complications) happened after 30 days. AA group showed higher risk of SSI, wound dehiscence, mechanical complications and pneumonia at 1 year. The risk of reoperation was also higher in the AA group at 1 year.

Conclusion:

Ankle arthrodesis is associated with higher risk of local and systemic complications at 30 days and 1 years and higher reoperation rate at 1 year. Most complications happened after 30 days which highlights the fact that studies reporting 30 days complications after AA and TAR may underestimate the complications.
Incidence of (Osteo)Chondral Lesions Concomitant to Chronic Lateral Ankle Instability: Systematic Review and Meta-Analysis
Authors: Rikken Quinten , Wijnhoud Emma , Dahmen Jari , Sierevelt Inger , Stufkens Sjoerd A. , Kerkhoffs Gino
Published: January 2022

Category:

Ankle

Introduction/Purpose:

To determine the incidence of (osteo)chondral lesions ((O)CLs) in patients with chronic lateral ankle instability (CLAI).

Methods:

A literature search was conducted in PubMed (MEDLINE), EMBASE (Ovid), and the Cochrane Library databases for articles published from January 2000 until December 2020. Two authors independently screened the search results and conducted the quality assessment using the MINORS criteria. Clinical studies that reported findings on (O)CLs of the ankle as per preoperative or intraoperative diagnostic measures in patients with CLAI (> 6 months of symptoms) were included. Chondral and osteochondral lesions were analyzed altogether for the primary outcome, namely, the incidence of (O)CLs in ankles with CLAI. Additionally, a subgroup analysis for the incidence of (O)CLs located on the talus. Secondary outcomes included the study-, patient, and lesion characteristics. Lesions characteristics included lesion localization and chondral- or osteochondral involvement. A random-effects model with 95% confidence intervals (95% CI) was used to analyze the primary outcome and subgroup analysis. Secondary outcomes were pooled using a simplified pooling method.

Results:

12 studies with a total of 2145 patients with 2170 ankles with CLAI were included. The overall pooled incidence of (O)CLs in ankles with CLAI was 32.2% (95% CI 22.7 - 41.7). The pooled incidence of talar (O)CLs was 26.5% (95% CI 19.0 - 34.0). Overall the most common location of OCLs in patients with CLAI is the talus with 85%, of which 68% of (O)CLs are located on the medial talus and 32% are located laterally. 43% of lesions were chondral lesions and 57% of lesions were osteochondral in nature.

Conclusion:

(O)CLs were found in up to 32% of ankles with CLAI. Furthermore, most lesions are located on the medial talar dome. These findings will aid physicians in the early recognition and treatment of ankle (O)CLs in the context of CLAI.
The INBONE-2 Total Ankle Prosthesis: Outcomes At 5 to 9 Years Follow-Up
Authors: Rushing Calvin J. , Malloy McCoy Antonio M. , Berlet Gregory C. , Hyer Christopher F.
Published: January 2022

Category:

Ankle; Hindfoot; Other

Introduction/Purpose:

Short and medium term outcomes of the INBONE I and INBONE II tibial stems have been favorable. The INBONE-2 talus has been shown to have lower reoperation and failure rates compared to its predecessor, INBONE-1 at short term follow-up. The purpose of the present study was to assess mid-term outcomes for the INBONE-2 prosthesis at 5 to 9 years follow-up considering both the tibial and talar components.

Methods:

All patients who underwent primary total ankle arthroplasty (TAA) with INBONE-2 between July 2010 and July 2014 at a single institution and who were at least 5 years postoperative were included. A total of 15 ankles with a mean follow up 85 (range, 61-113) months met the criteria. Radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperative, and at the most recent follow-up. Medical records were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook at el., respectively.

Results:

Survivorship for the INBONE-2 at a mean of 85 months was 93.7%. Coronal and sagittal tibiotalar alignment improved after surgery (p=0.081, p=0.15), and was maintained at the most recent follow-up (p=0.684, p=0.837). One ankle (6.7%) required early component revision; while 4 (26.7%) required a non-implant related revision. Six complications (2 high grade, 1 intermediate, and 3 low) in 5 ankles (33.3%) were recorded according to the Glazebrook classification system.

Conclusion:

The present study is the first to report midterm follow-up after TAA with the INBONE-2. High survivorship, maintenance of correction, and a low incidence of major complications was observed. The most common complication overall was lateral gutter impingement, which accounted for the majority of the non-revisional reoperations.
Surgical Intervention for 5th Metatarsal Fracture in the Athlete: A Systematic Review
Authors: Samsonov Alan , Diamond Julia L. , Randall Grace , Mercer Nathaniel P. , Ubillus Hugo , Hurley Eoghan T. , Kennedy John G.
Published: January 2022

Category:

Midfoot/Forefoot; Sports

Introduction/Purpose:

To provide an overview and evaluation of the available evidence on surgical intervention for 5th metatarsal fractures in the athletic population.

Methods:

PubMed, Cochrane, and Embase databases were systematically reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The level and quality of evidence (LOE and QoE) were recorded and assessed. Return to sport/play (RTS/RTP), radiographic outcomes, complications, reoperations, and revisions were also evaluated.

Results:

Twenty-eight studies were included in this review spanning a total of 761 patients and 765 fractures. The weighted mean age of the study population was 24 years, and the mean follow-up was 33.8 months. Surgical techniques and fracture types varied across the studies, but the majority (18) used internal fixation. Nonunion occurred in 5.8% (11/190) of patients who received a surgical treatment other than internal fixation, but only in 2.3% (11/480) of patients who received surgical treatment with internal fixation. Patients presenting with acute 5th MTP fractures returned to play significantly faster than those with delayed union 5th MTP fractures (7.6 weeks vs. 11.2 weeks) (p<.001). However, reoperation/revision rates were highest in patients who received surgery for acute 5th MTP fracture, of which 8.3% (16/192) of patients with acute fracture underwent reoperation or revision after surgical management.

Conclusion:

The current systematic review showed favorable outcomes for the surgical treatment of 5th MTP fractures in the athletic population. Athletes who underwent surgical treatment for an acute 5th MTP fracture returned to play at a faster rate compared to other fracture types but were associated with a high complication rate and a higher reoperation and revision rate.
The Incidence of Deltoid Ligament Interposition in Bimalleolar Equivalent Ankle Fractures
Authors: Schiff Adam P. , Kumar Jayanth , Burnham Robert R. , Hamid Kamran S. , Pinzur Michael S.
Published: January 2022

Category:

Ankle

Introduction/Purpose:

When performing surgical fixation of bimalleolar equivalent ankle fractures, there has been considerable debate regarding fixation of the deltoid ligament. Many surgeons would agree that deltoid ligament repair should be undertaken if there is radiographic evidence of medial interposition of the deep deltoid. The incidence of deltoid ligament interposition has not been addressed in current literature. This study aims to assess the incidence of deltoid interposition in bimalleolar equivalent ankle fractures to provide further guidance on the importance of acute deltoid ligament repair.

Methods:

Over a five year time frame, 49 bimalleolar equivalent ankle fractures were repaired in 30 males and 19 females with a mean age, 37 (15-73) years. There was no exclusion criteria and patients were consecutively enrolled if they sustained a bimalleolar equivalent ankle fracture.

Results:

During this time frame, 49 patients who sustained a bimalleolar equivalent ankle fracture underwent surgical fixation with routine repair of the deltoid ligament. 18 patients (36.73%) had deltoid interposed within the medial gutter. 13 patients (26.53%) had an osteochondral defect.

Conclusion:

The incidence of deltoid interposition seen with medial exploration within this cohort was 37%. While the benefits of deltoid ligament repair are still controversial, persistent medial gutter soft tissue interposition could lead to symptoms of impingement or even result in persistent medial widening. This study supports increased scrutiny to the relationship of the medial gutter and deltoid ligament in acute bimalleolar equivalent ankle fractures.
Accessory Cuboid Facet Associated with Calcaneonavicular Coalitions
Authors: Scott Daniel J. , Riccio Anthony , Kanaan Yassine , Zide Jacob R.
Published: January 2022

Category:

Hindfoot; Other

Introduction/Purpose:

Though resection and soft tissue interposition is the mainstay of surgical treatment for symptomatic calcaneonavicular coalitions (CNCs) that fail conservative treatment, some consternation exists as to balancing adequacy of resection with violation of adjacent talonavicular and calcaneocuboid (CC) articulations. As better understanding of nearby articular anatomy might be helpful in determining extent of resection, this study aims to identify differences in the anatomy of the CC articulation between feet with and without CNCs.

Methods:

A retrospective radiographic analysis of patients with symptomatic CNCs presenting to a single tertiary care pediatric hospital from 2010-2019 was performed. Patients without computed tomographic (CT) or magnetic resonance imaging (MRI) were excluded. Using either CT or MRI and standardized anatomic landmarks, the length and morphology of the calcaneal and cuboid articular surfaces were documented at the CC joint. When bilateral imaging was available in patients with a unilateral coalition, measurements were also made on the uninvolved side to provide a cohort of normal controls for comparison.

Results:

81 CNCs in 55 patients were identified along with18 normal feet. Mean age was 11.7 years at the time of advanced imaging. In the coalition group, an accessory cuboid facet was identified articulating with the calcaneal portion of the coalition in 61/81 (75.3%) feet. The mean total length of the cuboid articular surface measured 28.6 mm (range, 22.4-34.9 mm). The average length of the accessory facet was 10.6 mm (range, 6.0-15.5 mm) while the length of the primary cuboid articulation with the calcaneus was 15.9 mm (range, 6.4-23.2 mm). Thus, the accessory facet comprised 37.2% of the cuboid articular surface in these patients. Patients without CNCs had a significantly larger primary cuboid articulation with the calcaneus of 21.6 mm (p<0.0001). An accessory cuboid facet was identified in only a single foot in the normal cohort.

Conclusion:

An accessory cuboid facet is present in over 75% of patients with CNCs and comprised nearly 40% of the proximal cuboid articular length. Moreover, significant differences in the shape of the cuboid portion of the CC joint were present in feet with and without CNCs. This information may be useful when planning the extent of CNC surgical resection as including the coalition side of the accessory articulation may have value in restoring hindfoot motion.