bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence, Patterns, and Nomogram Model of Intimate Partner Violence Against Mothers During the Child-Rearing Stage: A Family System Analysis in China for Targeted Prevention Strategies
Authors: Chen Li , Pan Hong , Qian Hangfei , Chen Keke , Jian Wenqian , Wang Mengting , Zheng FeiZhong
Published: December 2024

Intimate partner violence (IPV) is a significant public health issue affecting many women worldwide. While extensive research exists on IPV during pregnancy and postpartum, there is limited information on IPV against mothers during the critical child-rearing stage, specifically the first three years following childbirth. This study examines the prevalence and patterns of IPV among mothers in China during this stage, identifying associated factors across four family subsystems: individual, husband-and-wife, mother-child, and family context, to guide the development of tailored prevention strategies. This study involved 1,099 Chinese mothers, surveyed within the first three years postpartum, through purposive sampling. The revised Conflict Tactics Scale (CTS2) was utilized to evaluate IPV, while a comprehensive questionnaire gathered data on potential risk and protective factors within the four family subsystems. Chi-square tests and lasso regression analyses were used to identify significant independent risk factors, which were used to construct nomograms of IPV among mothers during the critical child-rearing stage. The nomogram’s discrimination, calibration, clinical applicability, and generalizability were evaluated using receiver operating characteristic curves (ROC), calibration curves, decision curve analysis (DCA), and internal validation. Approximately 30% of mothers had experienced IPV within three years postpartum, with psychological violence being the most common. Three main patterns of IPV were identified, with multiple forms of violence often co-occurring. Significant risk factors for IPV included age at childbirth, attachment styles, marital issues, marital stability, feeding choices, maternal sense of parenting competence, support from friends, and family stress events. A nomogram model was developed to identify associated factors of IPV, demonstrating good performance. This model integrates factors from individual, spousal, mother-child, and family context subsystems, providing a comprehensive approach to understanding and preventing IPV during the critical child-rearing stage. The high prevalence of IPV underscores the urgent need for targeted prevention strategies to support mothers during this vulnerable period.
Where User Perceptions of Charities and Independent Nonprofit Ratings Meet: Inside the Black Box of Nonprofit Performance
Authors: LeRoux Kelly , Fayemiro Omowonuola , Entenza Jeannie , Plotner Samantha , Schlichtman Monique
Published: December 2024

Scholars have pointed to the multidimensional nature of nonprofit performance, but some contend that user perspectives are often overlooked. To the extent that users rate their experiences and interactions with nonprofits on public online platforms, such as Google, this content presents an opportunity for tapping into user perspectives of charities and considering whether these perceptions align with those of independent nonprofit rating agencies. Do online user reviews of nonprofits converge with the performance assessments of independent charity raters? We answer this question through a mixed-methods study involving a quantitative analysis of ratings data from Charity Navigator and Google user ratings for 228 nonprofits, followed by a qualitative content analysis of online reviews conducted on a subset of these cases. We find a small but positive association between user and independent ratings, although service users tend to base their ratings on different factors than ratings agencies. Our findings carry a number of important implications for those interested in nonprofit performance. For nonprofit leaders, online user ratings and reviews offer a window into the subjective impressions of service users and can serve as a complementary source of performance feedback to more traditional types of data. For funders and donors, our findings discourage exclusive reliance on independent ratings in assessing nonprofit performance and point to the need to account for user perspectives in the calculus of performance.
Reliability sensitivity analysis of automotive disc brake with multiple failure modes correlation
Authors: Yang Zhou , Li Zhi , Kou Maomao , Zhang Yimin
Published: December 2024

The failure of the automotive braking system may lead to brake failure and even severe traffic accidents. Traditional single failure mode reliability analysis can no longer meet current design requirements, while the Gumbel Copula model can measure the correlation between different failure modes and evaluate the risk of failure combinations. Therefore, the model is adopted in this paper. However, in engineering practice, the reliability prediction methods for thermal fatigue and complex modal multiple failure modes have encountered problems such as computational inefficiency and solution difficulties. To solve these problems, a new method, Multi-Failure Mode Reliability Sensitivity Analysis Method (MF-RSAM), is proposed. Based on friction vibration theory and control theory, a performance function is established with the damping ratio of the most unstable mode of the system as the response. Based on the Manson-Coffin model, a performance function is established with the maximum strain value of the brake disc surface as the response. Subsequently, the optimal Gumbel-Copula function is selected and introduced into the reliability analysis model. The Monte Carlo support vector regression method is adopted for the vibration-fatigue gradual reliability prediction of automotive braking systems under multiple failure modes. Finally, the reliability sensitivity under thermal fatigue and complex modal correlated failure modes is analysed. The results show a significant difference between the results of parametric reliability prediction considering correlated failure and single failure modes, with a maximum reduction of about 7.5% in reliability under correlated failure modes as the parameters are changed and a change in the parameter sensitivity order.
A novel herpesvirus in blue penguins putatively associated with myocardial degeneration and necrosis
Authors: Seimon Tracie A. , Nightingale Batya R. , Delaney Martha A. , Moore Robert , Alex Charles E. , Wellehan James F. X. , McAloose Denise
Published: December 2024

We identified a novel herpesvirus in 2 deceased captive blue penguins ( Eudyptula minor). Moderate-to-severe myocardiocyte atrophy and necrosis, and eosinophilic intranuclear inclusion bodies (INIBs), were seen in myocardiocytes in one bird; reticuloendothelial (RE) cell INIBs and multifocal RE cell necrosis were seen in both birds. The histologic findings were suggestive of viral infection. A herpesvirus PCR assay was positive in myocardial tissue from the bird with myocardial degeneration and in splenic tissue from both birds. Sequencing and phylogenetic analysis showed that the virus, accessioned as spheniscid alphaherpesvirus 2 (SpAHV2), groups within the Alphaherpesvirinae subfamily and forms a unique branch point in a subclade containing members of the Mardivirus, Simplexvirus, and Varicellovirus genera. Herpesvirus screening of tissues from 8 additional blue penguin postmortem examination cases (7 spleen, 1 liver) and combined conjunctival-choanal-cloacal swab samples from 13 live penguins revealed 5 additional dead and 7 live penguins that were positive for SpAHV2. The presence of SpAHV2 in healthy live animals and lack of significant herpesvirus-associated lesions as the cause of death in 6 of 7 SpAHV2-positive dead penguins suggests that this virus may be an endemic in blue penguins, and that recrudescence may cause disease and death.
Employment Outcomes for Social Security Disability Insurance Applicants Who Use Opioids
Authors: Hoffman Denise , Wu April Yanyuan , O’Leary Paul
Published: December 2024

In this article, we examine the relationship between self-reported opioid use and employment outcomes among Social Security Disability Insurance (SSDI) applicants who applied to SSDI in 2009. We use a machine learning method to identify opioids recorded in text fields on SSDI applications. Studying outcomes for 4 years after the Social Security Administration (SSA) determined the application outcome, we find a negative and statistically significant association between self-reported opioid use at application and post-determination employment-related outcomes. Notably, opioid use at the time of application was associated with a 3% point decline in the likelihood of employment in the first 4 years after determination and represents a 7.5% decline relative to the mean employment rate for the period. Results from a reduced-form model estimating the relationship between local opioid prescribing patterns and employment outcomes suggest that a 10% increase in the local opioid prescribing rate is associated with employment that is, at most, 0.3% points lower, which is similar to the documented association among the broader U.S. population. However, the potential implications for SSDI applicants are particularly notable because opioid use is about 50% higher among SSDI applicants.
Breaking the Chains: Understanding the Damaging Effects of Institutional Betrayal in Social Work
Authors: Benedict Melody , Quezada-Horne Nelia M. , Bender Destiny A. , Campbell Timothy , Larkin Heather
Published: December 2024

This pilot study explores social workers’ challenges in implementing antiracist policies within their organizations. The researchers utilized critical consciousness and institutional betrayal to delve into the complex power dynamics within social work organizations. The experiences of seven frontline social workers were explored through narrative interviews, which revealed a misalignment between social work values and organizational culture. Social workers observed racism in their organizations, inadequate organizational antiracist efforts, poor representation of diversity in leadership, poor antiracism training in social work education, and reported experiencing institutional betrayal. All were positioned in agencies that did not consistently uphold the NASW Code of Ethics. The findings suggest that social workers are experiencing institutional betrayal through domineering systems, which impedes their antiracism practices.
Probing the synergistic effect Ni and Mo contents on microstructure–toughness relationship in super-high strength steel weld metals
Authors: Wang Libo , Jiang Yishan , Wan Xiangliang , Zhong Ming , Zhu Chengyi , Li Guangqiang
Published: December 2024

This study aims to investigate the synergistic effect of Ni-Mo contents on microstructural evolution in super-high strength steel weld metals, and its following influence on toughness is also explored through crystallographic analysis. The results indicate that the microstructures of both weld metals are acicular ferrite, grain boundary ferrite, ferrite side-plate and bainitic ferrite. Compared with high-Ni–Mo weld metal, the decrease in Ni–Mo content increases the acicular ferrite fraction instead of bainitic ferrite. The crystallographic characteristics confirm that the adjacent parallel bainitic ferrite tend to be in the single Bain group in variant selection, while adjacent interlocking acicular ferrite belonged to multiple Bain groups. The multiple Bain groups contribute high-density large-angle grain boundaries, leading toughness improvement in low-Ni–Mo weld metal.
Healthcare seeking for people diagnosed with severe mental illness: Sensations, symptoms and diagnostic work
Authors: Christensen Iben Emilie , Reventlow Susanne , Grøn Lone , Risør Mette Bech
Published: December 2024

For people with mental and somatic illnesses, the interpretive process of attending to a multitude of bodily sensations and recognising them as potential symptoms represents daily and ‘chronic homework’. Based on 16 months of ethnographic fieldwork in Denmark, this study explores diagnostic work and healthcare seeking among people with severe mental and somatic illnesses. As multiple studies have shown, the transformation process for a perceived sensation to become a symptom is a socially constructed interpretative process highly dependent on social legitimisation and shaped by prior cultural knowledge. We found that people with severe mental and somatic illnesses often struggle to ‘read’ the body and its boundaries and to define and distinguish when a symptom becomes a potential sign of illness. Furthermore, they often lack opportunities for social recognition of symptoms due to the absence of social relations. Finally, lifelong experiences with the healthcare system have taught them that they must distinguish between ‘mental’ and ‘somatic’ symptoms to fit the systemic organisation of the healthcare system. This deeply rooted mind-body dualism in the organisation of healthcare services and the daily struggles of diagnostic work to comply with this organisation impacted the interlocutors’ healthcare seeking strategies. Moreover, even though they ‘make up their minds’ to seek healthcare, they risk being met with diagnostic overshadowing and reductionist clinical approaches.
Perception and analysis of dynamic stiffness of cable-stayed bridges based on wave analysis
Authors: Ji Jianyi , Huang Shiping , Huang Yonghui , Huang Kunhong , Abbasi Muhammad Asim
Published: December 2024

The vertical dynamic stiffness of long-span cable-stayed bridges under vehicle loading is a crucial concern due to their susceptibility to sustained vibrations with notable wave effects. This study investigates the dynamics stiffness perception and enhancement mechanisms of cable-stayed bridges based on fast wave analysis method, proposing wave-associated structural concepts (WSC) for designing stiffer cable-stayed bridges under traffic loading. Initially, the wave function characterizing cable-stayed bridge vibrations is introduced into the representation of the dynamic stiffness of cables and beams, and six WSC for enhancing structural dynamic stiffness are proposed. Subsequently, the fast establishment of the core module for wave function computation is achieved through modular construction of the wave propagation matrix. By employing wave decomposition to clarify the decoupling relationships among the wave components, a distributed algorithm is applied for efficient parallel solving of the wave function. Finally, the reliability and superiority of the proposed method are validated. Using wave analysis method, the stiffness enhancement mechanisms based on WSC and the criteria for implementing WSC in cable-stayed bridges are presented. The case study indicates that the structural dynamic stiffness is related to the wave characteristics which are influenced by both excitations and structural parameters. Enabling the rapid transmission of waves to the structural foundation promote uniform energy distribution and amplitude reduction of wave, thereby enhancing the dynamic stiffness. The beam section stiffness contributes to a dual-effect stiffness enhancement in cable-stayed bridges, effectively increasing the wave velocity. An alternative definition of structural dynamic stiffness is provided based on wave propagation.
Eccentric compressive performance of circular steel slag concrete-filled steel tube stub columns
Authors: Lu Linhan , Zhang Tianhe , Ren Qingxin , Wang Qinghe
Published: December 2024

Our study investigates the feasibility of using steel slag, the by-product generated during steel production, as a sustainable material in construction. Eccentric compressive tests were carried out on five sets of 10 circular steel slag concrete-filled steel tube (SSCFST) short columns, aiming to evaluate the effectiveness of using steel slag coarse aggregate in these structures. Key parameters including failure pattern, load-displacement and load-strain curves, eccentric load capacity, ductility coefficient, lateral deflection, and cross-sectional strain distribution were measured. These metrics helped in evaluating how the replacement ratio of steel slag and eccentric distance affect columns’ eccentric mechanical properties. Additionally, a refined nonlinear analytical model for these columns was developed using ABAQUS software, with its accuracy confirmed against experimental data. The study further examined the impact of multiple factors on the columns’ eccentric compressive behavior through parametric analysis. Moreover, we assessed the precision of current design approaches for estimating the eccentric compression bearing capacity of these columns. Our findings indicate that the replacement ratio of steel slag marginally affected their eccentric compressive mechanical properties, with variations under 10%. Increasing eccentricity from 0 to 0.25 and 0.5 resulted in a decrease in eccentric bearing capacity by 20.62% and 42.05%, respectively, while the ductility coefficient increased by 23.73% and 29.95%. The confinement factor and eccentric distance emerged as crucial determinants of the eccentric compressive performance. Finally, Han’s formula was found to be effective for calculating the eccentric bearing performance of circular SSCFST stub columns.
Occupational-related risk of testing SARS-CoV-2 positive for publicly employed medical doctors in Sweden: A nationwide cohort study
Authors: Fonseca-Rodriguez Osvaldo , Tobjörk Emma , Jerndal Hanna , Eriksson Marie , Fors Connolly Anne-Marie
Published: December 2024

Aims:

Doctors have an increased risk of SARS-CoV-2 infection caused by exposure to contagious patients. We aimed to identify which clinical specialities among medical doctors had the highest occupation-related risk of testing positive for SARS-CoV-2, utilizing data for all publicly employed medical doctors in Sweden.

Methods:

Data regarding positive SARS-CoV-2 test results and employment for publicly employed doctors in Sweden were divided into three observation periods: 1) 1 February to 31 December 2020, 2) 1 January to 30 June 2021 and 3) 1 July 2021 to 31 March 2022. Individuals were stratified according to occupation clinic and compared with clinical occupations with little to no patient contact. The risk of testing positive for SARS-CoV-2 was estimated using Cox proportional hazards regression, with sex, age and vaccination status as covariates.

Results:

The study cohort included all publicly employed doctors in Sweden: 35,028 individuals. In the first period, Infectious Disease doctors had the highest incidence of SARS-CoV-2 positive tests, with an incidence of 20.2 %, compared with 8.7 % in the reference group, and an adjusted hazard ratio of 2.5 (95% confidence interval 2.02–3.04), which decreased during period 2–3. Doctors in Geriatric Medicine had an elevated risk throughout the whole study period.

Conclusions:

Our study shows an association between working in a speciality that involves caring for contagious COVID-19 patients, which raises concerns about infection control measures and routines being insufficient to prevent occupational infection in future pandemics.
Diagnostic Performance of the Maximal Systolic Acceleration for Detecting a Significant Stenosis in the Aortoiliac and Popliteal Pathway: A Retrospective Cohort Study
Authors: Willems Siem A. , Dolfing Saskia G. , van Wissen Rob C. , van der Meer Rutger W. , van Schaik Jan , van der Vorst Joost R. , Schepers Abbey , Hamming Jaap F. , Brouwers Jeroen J. W. M.
Published: December 2024

Introduction:

Identifying peripheral arterial disease (PAD) remains challenging with currently used bedside tests. The maximal systolic acceleration (ACCmax) is a promising noninvasive parameter measured by duplex ultrasonography and reflects the arterial perfusion proximal to its measurement point. The principal aim of this study was to analyze the diagnostic accuracy of the ACCmax for detecting significant stenosis in different arterial segments, which could be useful in clinical decision-making.

Materials and Methods:

A retrospective cohort study was conducted in a tertiary referral hospital. Patients aged 18 years and older who underwent ACCmax measurement(s) alongside computed tomography angiography (CTA) of the abdominal aorta and lower extremities were qualified for inclusion. A significant stenosis was defined as a lumen reduction of more than 50% on CTA. Diagnostic accuracy of the ACCmax was investigated for the aortoiliac and popliteal arterial pathways.

Results:

A total of 196 patients (373 limbs) were included in the study. Diagnostic performance of the ACCmax (cut-off value of 7.70 m/s2) to detect a significant stenosis in the aortoiliac pathway showed a sensitivity of 89%, specificity of 97%, positive likelihood ratio of 29.23 and negative likelihood ratio of 0.12 (area under the curve [AUC] 0.941). For the popliteal pathway (cut-off value of 6.30 m/s2), these results were 90%, 95%, 17.14 and 0.12, respectively, with an AUC of 0.958.

Conclusion:

The ACCmax showed a promising diagnostic accuracy for detecting a significant stenosis in the aortoiliac and popliteal pathway.

Clinical Impact

The maximal systolic acceleration (ACCmax) is a promising non-invasive parameter measured by duplex ultrasonography to diagnose peripheral arterial disease (PAD) and reflects the arterial perfusion proximal to its measurement point. This study focused on its diagnostic accuracy to detect a significant stenosis in the aortoiliac and popliteal pathway, which revealed to be promising with excellent sensitivity and specificity. These findings suggest that ACCmax measurements could play a key role in developing a new diagnostic approach for PAD.
Perinatal Hypoxic-hypoglycemic Injury and Epilepsy: A Comprehensive Analysis of Clinical and Laboratory Data in Adults
Authors: Gultekin Zaim Ozge Berna , Gocmen Rahsan , Dericioglu Nese
Published: December 2024

Objective. Perinatal hypoxia and/or hypoglycemia (PHH) is a serious condition leading to many neonatal deaths worldwide. It causes motor and cognitive deficits, visual disturbances, and seizures in survivors. There is limited information on the clinical course of seizures, EEG and MRI findings in adults. Methods. Adult patients with epilepsy due to PHH were included. Data on patients’ demographic and clinical features, age at seizure onset, type and frequency of seizures, antiseizure medications and EEG features were extracted from electronic health records. Seizure outcome was classified as “seizure-free for at least one year at last follow up” versus “continuing seizures”. Clinical and laboratory variables that could be associated with seizure outcome were investigated statistically in a subset of patients. Results. Forty-one patients (median age: 32 years) were included. Bilateral cerebral lesions, predominantly affecting the posterior regions, were present in 88% of the cases. Almost 80% experienced focal to bilateral tonic-clonic seizures. Approximately 60% of patients were on polytherapy. Half of the patients were seizure free at last follow-up. Seizure frequency decreased over time in 75% of the cohort. EEG demonstrated background slowing in 44% of patients, with epileptic discharges detected in 27%. The only variable correlated with seizure freedom was older age at seizure onset ( P = .034). Conclusion. Almost half of the patients may reach seizure freedom. Seizure frequency decreases in 75% over time. Cranial MRI or EEG findings are not correlated with seizure outcomes. The only variable associated with seizure freedom at last follow up is older age at seizure onset.
Comparison and Validation of Methods for Restoring Neck Length in Hip Arthroplasty That Can Be Applied for Femoral Neck Fracture
Authors: Anatone Alex J. , Rahman Rafa , Uppstrom Tyler J. , Blevins Jason L. , Sculco Peter K. , Ricci William M.
Published: December 2024

Background: Restoring leg length during total hip arthroplasty (THA) for femoral neck fracture is challenging due to the lack of an intact femoral neck on the fractured side. Thus, templating methods typically use size of the intact contralateral hip to estimate length. Common reference points include the distance from the lesser trochanter to the center of the femoral head (LTC) and femoral head diameter (FHD). Objectives: We sought to (1) investigate the LTC:FHD ratio as a preoperative templating method and (2) compare this method with calibrated LTC measurements. Methods: We performed a retrospective review of patients undergoing primary THA between 2021 and 2022 with recorded intraoperative measurements of LTC and FHD at a single academic orthopedic specialty hospital. Preoperative hip X-rays were used to determine the “predicted LTC length” with 2 separate methods: the LTC:FHD ratio yielding the “Ratio Predicted LTC” and the calibrated measurements method yielding the “Calibrated Predicted LTC.” These measurements were compared with intraoperative measurements of the LTC length to determine accuracy. Results: Sixty-two hips in 59 patients were studied. The ratio predicted LTC and contralateral ratio predicted LTC length showed no significant difference from the intraoperative LTC length with a strong correlation between the 2 measurements (correlation coefficient = 0.77 and 0.80). The calibrated predicted LTC lengths were significantly different from the intraoperative LTC lengths (mean difference, 3.0 mm; 95% confidence interval [CI] = [2.2, 3.8]). Conclusions: This retrospective review suggests the LTC:FHD ratio multiplied by intraoperative FHD may be an accurate method for restoring anatomic femoral head height in THA (LTCa = [LTCr/FHDr] × FHDa). This method may be useful in hip fracture populations with distorted proximal femoral anatomy.
Parent-assisted Friendship Intervention for Improving Play and Social Skills in Pakistani School Children with Autism: A Randomized Controlled Pilot Study
Authors: Tara Urooj , Rauf Nelofar , Arshad Ali
Published: December 2024

Children with autism spectrum disorder (ASD) are mostly excluded from mainstream classrooms in Pakistan due to difficulties in their social skills to keep up with the class. The purpose of the current pilot study was to test run the Children’s Friendship Training program for children with ASD. The sample consisted of the parents and their children with ASD, ages ranging from 7 to 12 years, studying in inclusive schools in Pakistan. The training program focused on teaching social skills to children with ASD through parent assistance. Participants were assigned to treatment or control groups through randomization process. A pre–post testing was done with a treatment group ( n = 6) and a control group ( n = 4). Data were collected on the Social Skills Improvement System and Quality of Play Questionnaire. The results of this pilot study suggest that the intervention can be successfully implemented on a small scale. The next step would be to expand the intervention to a larger population and evaluate its effectiveness in the broader context.
Beauty is context-dependent: Naturalness, familiarity, and semantic meaning influence the appreciation of geometric shapes
Authors: Juravle Georgiana , Spence Charles
Published: December 2024

Rounded shapes are associated with softness and warmth, whereas Platonic solids are associated with hardness and coldness. We investigated the temperature-shape association through sensorial/conceptual qualities of geometric ice-like textured shapes. In Experiment 1, participants viewed symmetrical rotating 3D shapes (five Platonic solids—cube, tetrahedron, octahedron, icosahedron, dodecahedron; a star polyhedron and a sphere) and control shapes (naturalistic and angular), rating them in terms of liking, hardness, temperature, wetness, and texture. In Experiment 2, participants visualized ice, and selected/rated, from 22 adjectives, those corresponding to the concept of ice. In Experiment 3, for each of the shapes from Experiment 1, participants chose the most appropriate conceptual attribute from among the six attributes most frequently reported in Experiment 2. All shapes looked cold. Liking and hardness ratings were similar for the ice-sphere and the Platonic solids, with an enhanced liking and the attribution of the “beautiful” concept for starlike ice shapes. The cube was appreciated as solid and the Platonic solids as strong and bright. Self-reported introversion, extroversion, and fitness level were significantly related to the appreciation of geometric ice structures. These findings are discussed in relation to crossmodal correspondences and the role of individual differences.
Persistent numbness of the lower lip and chin due to inferior alveolar nerve injury after implant placement: A clinical report
Authors: Turkyilmaz Ilser
Published: December 2024

The number of dental implants placed and restored every year is increasing across the world. However, there has been an increase in the number of reports with implant-related surgical complications in which the inferior alveolar nerve injury is the most serious one. This surgical problem can be avoided by using cone beam computed tomography (CBCT), three-dimensional (3D) implant planning software, and computer-aided design and computer-aided manufacturing (CAD-CAM) technology such as stereolithographic surgical guides. The objective of this report is to present the clinical and radiologic findings of a female patient with the injury of inferior alveolar nerve after implant insertion where CBCT has not been used prior to implant placement.
Exploring factors affecting patient satisfaction in online healthcare: A machine learning approach grounded in empathy theory
Authors: Chen Junbai , Wu Guoping , Zhang Tong , Zhao Butian , Wang Ruojia , Zhai Xing , Guo Fengying
Published: December 2024

Objective

Empathy between doctors and patients is crucial in enhancing patient satisfaction with medical consultations. This study, grounded in empathy theory, employs natural language processing and machine learning algorithms to explore the factors influencing patient satisfaction in online healthcare services, particularly the impact of doctor–patient empathy.

Methods

Utilizing the three dimensions of the Jefferson Scale of Physician Empathy, seven variables were extracted from patient–doctor dialogs as independent variables, with patient satisfaction as the dependent variable. Employing machine learning algorithms, a classification model was constructed to identify the best-fitting model for exploring the pivotal factors influencing patient satisfaction in online medical services. The optimal model was then chosen to investigate the essential factors impacting patients’ satisfaction with online healthcare.

Results

A total of 7586 data points were collected, with 5447 consultation dialogs (71.8%) receiving a satisfactory rating from patients. LightGBM emerged as the best-performing model, achieving an F1 score of 0.78 and an area under the curve value of 0.81. Factors within the Standing in Patient's Shoes and Perspective Taking dimensions were identified as key determinants of patient satisfaction in online healthcare services.

Conclusion

This study broadens the conventional scope of applying empathy theory, signifying its crucial role in cultivating doctor–patient empathy within the realm of online healthcare and elevating the overall quality of medical services. The findings indicate that two pivotal factors influencing patients’ satisfaction with online healthcare are doctors’ perceived competence and ability to empathize, understanding patients’ perspectives, and offering assistance.
Serum neurofilament light chain levels in patients with small-fiber neuropathy
Authors: Zohar Daniela Noa , Keren Daria , Qassim Lamis , Eltity Mailam , Shavit-Stein Efrat , Chapman Joab , Dori Amir
Published: December 2024

Background

Serum neurofilament light chain (sNfL) levels are an increasingly employed tool for the assessment of active axonal injury in a variety of neurological disorders including polyneuropathy. Injury to the small nerve fibers can lead to small fiber neuropathy (SFN), a neurological condition which is clinically manifested by combination of burning pain, various sensory disturbances and symptoms of autonomic dysfunction. SFN is evident by identifying reduced epidermal nerve fiber density (ENFD) in skin biopsy.

Objective

To assess the utility of sNfL measurement as a marker for active axonal injury in a population of patients who were referred for skin biopsy as part of the evaluation of chronic sensory symptoms.

Methods

sNfL levels were measured in 94 patients at the time of skin biopsy. Clinical, electrodiagnostic, and imaging data were collected and neurological comorbidities including central nervous system disorders, large-fiber polyneuropathy, and radiculopathy which may increase sNfL levels were reviewed.

Results

Eighty-six patients had pathological skin biopsy result supporting the diagnosis of SFN. sNfL was increased in 9 (10%) SFN patients. Seven of them had neurological comorbidities which may explain the elevated sNfL. The other two patients had history of hypothyroidism and endometriosis.

Conclusions

sNfL levels are typically normal in patients with SFN. Furthermore, when sNfL are elevated, evaluation for another neurological disorder should be considered.
Platelet-Derived Growth Factor has Context-Dependent Effects on Osteogenesis in Bone Marrow-Derived Cells
Authors: Huffman Nicholas , Gillis Julianne , Magesh Amogh , Sangadala Sreedhara , Patel Jay M. , Bariteau Jason T.
Published: December 2024

Category:

Basic Sciences/Biologics; Ankle Arthritis

Introduction/Purpose:

Arthrodesis stands as the primary method for treating advanced osteoarthritis in the foot and ankle [1]. However, a significant hurdle in this procedure is non-union occurrence, emphasizing the need for adjuncts to enhance osteogenesis and ensure successful fusion. Platelet-Derived Growth Factor (PDGF) emerges as the only clinically approved bone graft substitute for ankle and hindfoot fusion. Bone marrow stimulation, crucial for recruiting cells to aid healing in arthrodesis, is a standard step in all fusions. While preclinical studies on PDGF have mainly focused on human cell lines, the in vitro impact of PDGF on marrow-derived cells, crucial for arthrodesis sites, remains unexplored. This study aims to assess the osteogenic potential of PDGF on heterogeneous marrow-derived cells in both 2D and 3D environments.

Methods:

Marrow-derived cells (MDCs) from young bovine femoral condyle were utilized without sorting or filtering, to maintain heterogeneity. For 2D assays, MDCs were plated at 10,000 cells per well and cultured in osteogenic media. Both alizarin staining and alkaline phosphatase activity were assessed at 14 days. For 3D assays, we cultured MDCs in fibrin gels at 2M/mL. in osteogenic media for 28 days. For 3D analysis, micro CT and alizarin red staining were performed on fibrin gels.

Results:

In 2D in vitro analysis, PDGF demonstrated significant increase in alizarin red staining and ALP activity [Figure 1A, 1B]. In 3D analysis, PDGF showed no significant increase in and has trended toward a decrease in alizarin red staining and in micro CT [Figure 1C, 1D].

Conclusion:

While many studies have examined the impact of PDGF on human cell lines, this is the first work to analyze the effects of PDGF in a representative distal extremity fusion environment. In our current study, in 2D PDGF demonstrates significant osteoinducton, while in 3D, no increase is seen and a trend towards decreased osteogenic function was observed. Our findings reveal that the differential effects of PDGF in 2D and 3D which may vary depending on the surrounding environment. This work highlights the need for further studies to fully grasp how PDGF functions in an arthrodesis.
Preoperative Opioid Dependence Associated with Increased Costs and Wound Dehiscence Following Total Ankle Arthroplasty
Authors: McDonald Weston E. , Guareshi Alexander S. , Morningstar Joshua L. , Friedman Richard J. , Gross Christopher E. , Scott Daniel J.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

The overuse of opioid medications in patients undergoing orthopaedic surgery has become widely labeled as a national epidemic. Recent literature, particularly in the fields of orthopaedic spine surgery and joint arthroplasty, has illustrated an association between chronic opioid use and increased costs and postoperative complications. The purpose of this study is to evaluate the influence of chronic opioid dependence on postoperative outcomes following total ankle arthroplasty (TAA). We hypothesized that preoperative opioid dependence would be associated with higher rates of complications, revisions, readmissions, and mortality following TAA, as well as increased cost and longer hospital stays.

Methods:

The Nationwide Readmissions Database (NRD) was queried from 2015-2020 to identify 29,751 patients undergoing primary elective TAA. Patients were divided into two cohorts based on the presence of preoperative opioid dependence, with 861 (2.9%) being chronic opioid users or having opioid use disorders. Preoperative demographics, comorbidities, postoperative outcomes, cost of admission, and total length of stay (LOS) were analyzed between cohorts. Multivariate regression analyses were conducted to identify independent predictors of postoperative outcomes other than preoperative opioid dependence.

Results:

The overall cohort was majority male (54.2%) with mean age of 64.15 (range 17-90) years, and Charlson-Deyo Comorbidity Index (CCI) score of 0.65 (range 0-12). When stratifying by preoperative opioid dependence, it was found that opioid dependent patients were statistically significantly older (Opioid=62.74 years; Nonopioid=65.21 years; p<.001), from lower income quartile (p=.042), more likely to have Medicaid insurance (p<.001), and had a higher CCI score (Opioid=0.97; Nonopioid=0.64; p<.001). Multivariate regression analysis of 180-day postoperative outcomes found that preoperative opioid dependence was significantly predictive of increased risk of wound dehiscence (p<.001), adverse discharge (p<.001), and extended stay greater than 4 days (p<.001). Further, preoperative opioid dependence is predictive of more than a $1,000 increase in total cost of procedure (β= 1,052.27; 95% CI= 117.62-1,986.91; p=.027). (Table1)

Conclusion:

Chronic preoperative opioid use was significantly predictive of higher rates of postoperative complications, LOS, and a substantially higher cost of procedure following TAA. Physicians should consider this modifiable risk factor when identifying patients and tailoring medication regimens for patients receiving ankle arthroplasty.
Progressive Collapsing Foot Deformity Classes Correction after Isolated Arthroscopic Anterolateral Subtalar Arthrodesis
Authors: Bernasconi Alessio , Lalevée Matthieu , Fernando Céline , Izzo Antonio , Cesar Netto Cesar de , Lintz François
Published: December 2024

Category:

Hindfoot; Midfoot/Forefoot

Introduction/ Purpose:

Subtalar osteoarthritis in the context of flatfoot recently renamed Progressive Collapsing Foot Deformity (PCFD) may be treated through subtalar joint (SJ) arthrodesis with anticipated consequences on three-dimensional bony configuration. This study investigates the correction of PCFD-related deformities achieved after Anterolateral Arthroscopic Subtalar Arthrodesis (ALAPSTA).

Methods:

In this retrospective study, we evaluated pre- and post-operative (at 6 months) weight bearing computed tomography (WBCT) images of patients diagnosed with PCFD with a degenerated SJ (2A according to PCFD classification) and/or peritalar subluxation (2D) with or without associated flexible midfoot and/or forefoot deformities (1B, 1C and 1E) which underwent ALAPSTA as a standalone procedure between 2017 and 2020. Multiple measurements were used to assess and compare pre and post-operative PCFD classes.

Results:

Thirtythree PCFD (33 patients, median age 62) were included. Preoperative medial facet subluxation was 28.3%. Overall PCFD 3D deformity improved with a reduction of the foot and ankle offeset from 9.3 points to 4 (p< 0.001). Class A (hindfoot valgus, measured through the tibiocalcaneal angle, the calcaneal moment arm, the calcaneal offset and the hindfoot angle), class B (midfoot abduction, measured using the talonavicular coverage angle and the axial talo-first metatarsal angle) and class C (forefoot varus, measured through the sagittal talo-first metatarsal angle and the forefoot arch angle) significantly improved after surgery (p< 0.001 for all measurements). No patient had a valgus deformity at the ankle pre-operatively (therefore no patient presented with class E), and no significant change of the talar tilt was observed (p=0.12).

Conclusion:

In this series, ALAPSTA performed as a standalone procedure to treat patients diagnosed with PCFD with a degenerated subtalar joint and/or peritalar subluxation was effective not only at correcting hindfoot alignment but also flexible midfoot abduction and flexible forefoot varus.
Quality of Initial Reduction of Tibial Plafond Fractures as Predictors of Trauma Injury Outcome
Authors: Wilson Jennie-Ann L.
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

High energy trauma to the ankle joint can cause soft tissue damage and bone disruption of the tibial plafond. Currently, the most widely accepted treatment options are the External Fixation and the Open Reduction and Internal Fixation (ORIF) surgical procedures. The goal of this study was to determine if the quality of these procedures in patients with a Type-C Tibial Plafond Fracture has a relationship with a patient’s chances of developing a post-surgical complication.

Methods:

This retrospective study included a population of 131 patients with a Type-C Tibial Plafond Fracture who were operated on at Grady Memorial Hospital from 2012 to 2023. No exclusions based on past medical history were applied. Grady Sectra Fluoroscopy videos as well as AP and Lateral x-rays were evaluated and the AP translation, Lateral Translation, Anatomic Lateral Distal Tibia Angle (aLDTA), and Anterior Distal Tibia Angle (ADTA) measurements of the tibial plafond fracture post External Fixation and ORIF procedures were recorded, and any differences were assessed. Binary Logistic Regression was used to determine if there was a significant difference in any of the External Fixation measurements and post-operative complications. Pearson Correlation was used to determine if the alignment in the External Fixation was a predictor of the alignment after ORIF.

Results:

The initial population sample of 131 patients was reduced to 99 patients due to patients being excluded from the study because their imaging files were incomplete. The data showed that neither the translational nor angular alignments post External Fixation nor ORIF had any statistically significant correlation to a patient’s chances of developing a post-surgical complication. Using the Pearson Efficient, the External Fixation AP and Lateral translation measurements were 0.16 (p-value 0.12) and 0.171 (p-value 0.095) respectively, so there was no significant correlation to the final AP and Lateral measurements of the ORIF procedure. The External Fixation aLDTA and ADTA values of 0.289 (p-value 0.004) and 0.336 (p-value < 0.001) respectively, were significantly related to the final aLDTA and ADTA angles of the ORIF procedure.

Conclusion:

The results from this study will have a positive implication on clinical practice as it encourages trauma orthopedic surgeons to achieve tibial plafond alignment angles during the External Fixation procedure that are as anatomically correct as possible in order to improve the efficacy and accuracy of the ORIF procedure.
Randomised Prospective Trial Comparing the Salto Talaris Fixed-Bearing and Salto Mobile-Bearing Total Ankle Replacement
Authors: Sevic Aleksandar , Patel Chetan , Tomlinson Matthew P.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Comparative studies examining Fixed-Bearing (FB) and Mobile-Bearing (MB) Total Ankle Replacement (TAR) designs have demonstrated similar results and successful long-term outcomes for both. To date there has been no study directly comparing FB and MB designs of the same prosthesis. We present the first randomised prospective trial comparing patient satisfaction, functional outcomes and radiographic results of the Salto Talaris Fixed-Bearing and the Salto Mobile-Bearing Total Ankle Replacement in the treatment of end-stage ankle arthritis.

Methods:

A total of 106 adult patients with end-stage ankle arthritis were enrolled in the study between November 2014 and October 2021 with similar demographic comparison. Prospective patient-reported outcomes and standardised weightbearing ankle radiographs were performed preoperatively, at 6 weeks, 6 months and 12 months post-operatively, followed by yearly intervals. Foot Function Index, Revised Foot Function Index, 12-Item Short Form Survey and Total Ankle Joint Replacement Questionnaire were used for patient reported scoring. All surgeries were performed by a single non-design orthopaedic foot and ankle specialist with experience in over 200 Salto and Salto Talaris TAR prior to the study. Radiographs were examined independently by two clinicians. Complete patient data and radiographs were available for 101 patients with an average follow up of 3 years.

Results:

Both groups demonstrated statistically significant improvement from preoperative evaluation to most recent follow up with no statistically significant difference between the two groups in all outcome measures. Radiographic incidence of subchondral cyst formation was 17.4% and 49.1% for FB and MB, respectively. Talar subsidence occurred in 8.7% and 18.2% of FB and MB, respectively. Implant subluxation was observed in 1.8% of MB TAR. Two patients required revision, one from each cohort reflecting a revision rate of 2.2% for FB and 1.8% for MB TAR.

Conclusion:

Our study demonstrates a higher than previously reported rate of subchondral cyst formation in the MB TAR and comparatively higher talar subsidence in the MB TAR vs FB however this did not correlate with clinical outcome measures which were favourable for both groups.
Return to Work after Total Ankle Arthroplasty
Authors: Sakkab Ramez , Jain Vikram , McAlister Jeffrey
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

End-stage ankle arthritis has demonstrated as detrimental an impact on work status and quality of life as that of the knee or hip. Inability to return to work, whether sedentary or physical, can incur significant economical burden. Total ankle arthroplasty has emerged as an increasingly common surgical treatment for end-stage ankle arthritis but its ability to enable patients’ return to work has not been elucidated.

Methods:

Patients from January 1st, 2020 to January 1st, 2024 were included in a multicenter prospective database for end-stage ankle arthritis treated with a total ankle replacement. Inclusion criteria included patients younger than 65 years, actively employed at the time of surgery, and two years of follow up. This cohort had 57 patients with an average age of 50.6 ± 12.6 years and was balanced in terms of sex (49% female). Foot function index (FFI), ankle osteoarthritis (AOS), and SF-36 scores were obtained pre and post-operatively.

Results:

All patient outcome scores significantly improved after arthroplasty (p < 0.01). The employment rate prior to surgery was 86% (49), which decreased to 78.9% (45) at the 2-year postoperative mark and was significant (p=0.024). Patients returned to sedentary and manual labor work at an average 2.8 and 13.3 weeks after surgery, respectively.

Conclusion:

After total ankle arthroplasty, patients younger than 55 returned to sedentary work at a mean 2.8 weeks post-operatively. And 13.3 weeks when returning to weight bearing labor. At 2-year follow-up, significantly more were unemployed (86% to 78.9%, p=0.024). This small cohort provides a launch point for patient discussion regarding their timeline to return to manual labor after total ankle arthroplasty.