bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethical reflections on how health professionals should answer the Question: What would you do if this were your family member?
Authors: Asai Atsushi , Fukuyama Miki , Ohnishi Motoki
Published: November 2022

Patient families sometimes ask health professionals, ‘What would you do if this were your family member?’ The purpose of this paper is to examine appropriate responses to this Question. Health professionals may say, ‘It all depends on the patient's wishes’, or ‘I don't know what is best, because my family is different from yours in many ways’. Some may believe that the most favourable course of action is the same regardless of who the patient is and explain this to the patient's family, while others may refuse to answer the Question saying it is personal, or argue that such a Question should neither be asked nor answered because it is unreasonable and unprofessional to do so. We believe that, in principle, health professionals should give an honest answer as to what they would do if the patient was their family member, recognising and empathising with the fact that the patient's family is in a difficult and vulnerable position, and that their circumstances forced them to ask such a Question. Moreover, personal and emotional views of health professionals regarding treatment options may help the patient's family make important decisions. An honest answer will help strengthen the trusting relationship between health professionals and the patient's family and support their decision-making.
An efficient virtual modeling regard to the axial tensile and transverse compressive behaviors of the twisted yarns
Authors: Wang Yu , Jiao Yanan , Wu Ning , Xie Junbo , Chen Li , Wang Peng
Published: November 2022

The mechanical properties of yarns have a decisive effect on the performance of fiber-reinforced composite materials. Predictive simulations of the mechanical response of yarns are, thus, necessary for damage evaluation and geometric reconstruction of textiles. This paper proposed a quasi-fiber scale virtual modeling method regard to the axial tensile and transverse compressive behaviors of the twisted yarns. A stochastic properties model of the yarn was established for characterizing the statistical distribution of tensile strength. The variation of modeling parameters, including coefficient of friction, the amounts of virtual fibers per yarn and element length, versus calculation accuracy has been determined based on axial tensile and transverse compressive behavior of quartz fibers. The relationship between modeling parameters and mechanical behavior of yarn was established within the scope of this study. Axial tensile and transverse compressive behavior of yarns with different twists were predicted. The results show that balance between the modeling precision and computational efficiency can be achieved using the parameters, the COF of 0.35, virtual fiber count of 122 and Le of 0.3. This efficient modeling method is meaningful to be developed in further virtual weaving research.
Perceived Local Population Dynamics and Immigration Policy Views
Authors: Chan Stephanie , Raychaudhuri Tanika , Valenzuela Ali A.
Published: November 2022

How do perceptions of local immigrant populations influence immigration policy views? Building on findings that Americans may not accurately perceive population dynamics, we argue that objective measures do not fully capture the effects of local context on public opinion. Our research uses novel subjective experimental reminders about current levels of and recent changes in local immigrant populations to explore how these perceptions impact immigration policy views. In a survey experiment, we asked 2,400 Americans to consider current levels of or recent changes in their local immigrant population. Asking subjects to consider current levels of local immigrant populations modestly increases support for pro-immigrant policies, with particularly strong effects among non-White and Republicans. These effects may be driven by positive perceptions of immigrants and have implications for understanding the role of local community frames in shaping public opinion about immigration, particularly for groups who do not typically support permissive immigration policies.
Cross-domain entity identity association analysis and prediction based on representation learning
Authors: Gao Mingcheng , Wang Ruiheng , Wang Lu , Xin Yang , Zhu Hongliang
Published: November 2022

Cross-domain identity association of network entities is a significant research challenge and a vital issue of practical value in relationship discovery and service recommendation between things in the Internet of things, cyberspace resources surveying mapping, threat tracking, and intelligent recommendation. This task usually adds additional difficulty to the research in practical applications due to the need to link across multiple platforms. The existing entity identity association methods in cross-domain networks mainly use the attribute information, generated content, and network structure information of network user entities but do not fully use the inherent strong positioning characteristics of active nodes in the network. In this article, we analyzed the structural characteristics of existing relational networks. We found that the hub node has the role of identity association positioning, and the importance of identity association reflected by different nodes is different. Moreover, we creatively designed a network representation learning method. We proposed a supervised learning identity association model combined with a representation learning method. Experiments on the public data set show that using the identity association method proposed in this article, the ranking accuracy of user entity association similarity is about 30% and 25% higher than the existing two typical methods.
Design, optimization and application of two-element airfoils for tactical UAV
Authors: Shunshun Wang , Zheng Guo
Published: November 2022

Owning to the requirements for longer endurance, larger payloads as well as simpler mechanical structure of tactical UAV, the two-element airfoil technology is introduced. Firstly, the aerodynamic characteristics of five common low-speed airfoils are calculated and compared. The airfoil with good aerodynamic performance after segmentation is selected as initial airfoil. Then, the influence of different segmentation types on the aerodynamic characteristics of airfoils is analyzed, and the segmentation type which brings the best aerodynamic benefits is selected. The slot parameters are optimized by NSGA-II optimization algorithm under cruising, take-off, and a large angle of attack states to obtain a high-performance self-adaption tactical UAV airfoil. Finally, the new airfoil is applied to Sparrow-hawk tactical UAV, the CL1.5 /CD of acceleration state increases 15.5%, the CL of large angle of attack increases 20.4% and the CL1.5 /CD of cruising state after enlarge the aspect ratio increase12.3%.
Vertebral artery course variation leading to an insufficient proximal anchoring area for thoracic endovascular aortic repair
Authors: Yu Zuanbiao , Lyu Shuyi , Lang Dehai , Wang Di , Hu Songjie , Yin Xiaoliang , Ding Yunpeng , Xu Chunbo , Lin Chen , Hu Jiangnan
Published: November 2022

Backgrounds

We aimed to demonstrate the feasibility of thoracic endovascular aortic repair for type B aortic dissection in patients with an insufficient proximal anchoring area due to the vertebral artery originating from the aortic arch.

Methods

In this study, we report two patients with type B aortic dissection who were complicated with left vertebral artery course variation. Specifically, the left vertebral artery originated from the aortic arch. In these patients, the anchoring area (<15 mm) was not sufficient between the left vertebral artery and the ruptured aortic dissection.

Result

We reconstructed the left vertebral artery during horacic endovascular aortic repair. Both patients recovered well and were discharged without any adverse events.

Conclution

Our experience shows that horacic endovascular aortic repair is feasible in patients with type B aortic dissection who have an insufficient proximal anchoring area due to the left vertebral artery originating from the aortic arch.
Exploring sonographer emotional well-being: NHS sonographers’ experience of the restorative function of professional supervision
Authors: Carr Ryan , White Helen
Published: November 2022

Introduction:

Following recommendations of the Francis report (2013), healthcare professional groups have formalised restorative supervision within practice in order to maintain emotional well-being among staff and provide quality of care for patients. There is a scarcity of research available on how professional supervision is utilised as a restorative device within current practice for sonographers.

Methodology:

An online cross-sectional, descriptive survey was used to gain qualitative details and nominal data on sonographer experiences of professional supervision. Themes were developed through thematic analysis.

Results:

A total of 56% of participants did not identify professional supervision as part of their current practice; 50% of participants felt emotionally unsupported within their work. The majority felt ‘unsure’ of how professional supervision would affect their working day; however, they highlighted that a restorative function would be valued equally as professional development functions of practice. The barriers to professional supervision as a restorative function demonstrate that an understanding of what sonographer needs are should be considered in approaches to professional supervision.

Conclusion:

This study found that participants identify professional supervision in its formative and normative functions more commonly than its restorative functions. It also found that sonographers are found wanting of emotional support, with 50% of sonographers feeling unsupported and identifying a restorative supervision need to their working practice.

Implications for practice:

The need to establish a system that supports the emotional well-being of sonographers is highlighted. This should help with retention of sonographers in a career where burnout is evidenced.
The WEIRD Microcosm of Microaggression Research: Toward a Cultural-Psychological Approach
Authors: Bettache Karim
Published: November 2022

Microaggression research has made great strides over the past decade while steadily pushing itself into mainstream psychological science. Yet the field remains firmly situated within the Western, educated, industrialized, rich, and democratic (WEIRD) cultural context. Correspondingly, recurring criticisms against the validity of microaggressions are often rooted in individualist, decontextualized understandings of behavior, and critics’ rebuttals are often grounded in a philosophical and reflective understanding of the cultural context. In this article, I put forward that (a) the enactments and appraisals of microaggressions are the behavioral results of the cognitive salience of cultural schemas; (b) cultural schemas are informed by cultural ideologies, underlining their methodological and empirical relevance for future research; and (c) cultures are dynamic by highlighting the effects of geopolitical events on the content of cultural schemas that may moderate the perception and enactment of microaggressions. For these reasons, I argue that a cultural psychology of microaggressions may help to depathologize the individual by situating behavior in its cultural context while at the same time necessitating the inclusion of communities residing in non-WEIRD societies.
Reanimating the Master Narrative: How They Shall Not Grow Old Curates the Perception of Common Truth through CGI Animation
Authors: Woodworth-Hou Jason
Published: November 2022

In 2014, the British Imperial War Museum (IWM) contracted New Zealand-based filmmaker, Peter Jackson, to use their audio and video archives to create a media-based memorial to the men who served in World War 1. The documentary film, They Shall Not Grow Old ( TSNGO), released in 2018, was the product of this collaboration. Jackson took on the project to better understand his own grandfather’s experience as a soldier at the Battle of the Somme. Weta Digital Studios, founded by Jackson, converted the standard WWI newsreel footage into a product that aligned to a modern audience’s perceptual sense of truth. Weta Digital redrew and colored each frame, a process that is strikingly similar to CGI animation. Curiously, Jackson, a filmmaker whose career has hinged on his ability to collaborate with CGI animators, does not describe his new historical film treatment as animation. This article first argues that TSNGO is following in the footsteps of previous CGI animated films, in particular those that have re-edited historical footage, but more importantly asks: why would Jackson prefer to keep the word ‘animation’ out of the discussion about his new historical documentary? The answer to this question leads us to a critical discussion about how animation has become both the preserver and ‘re-imaginer’ of existing historical archives.
Safeguarding research staff “in the field”: a blind spot in ethics guidelines
Authors: Kaplan Lennart , Kuhnt Jana , Picot Laura E , Grasham Catherine Fallon
Published: November 2022

Across disciplines there is a large and increasing number of research projects that rely on data collection activities in low- and middle-income countries (LMICs). However, these are accompanied by an extensive range of ethical challenges. While the safeguarding of study participants is the primary aim of existing ethics guidelines, this paper argues that this “do no harm” principle should be extended to include research staff. This study is a comprehensive review of more than 80 existing ethics guidelines and protocols that reveals a lack of safeguarding research staff regarding the ethical challenges faced during data collection activities in LMICs. This is particularly the case when it comes to issues such as power imbalances, political risk, staff’s emotional wellbeing or dealing with feelings of guilt. Lead organizations are called upon to develop guiding principles that encompass the safeguarding of research staff, which are then to be adapted and translated into specific protocols and tools by institutions.
Exploring the perceptions and acceptability of an integrated lifestyle database for public health research and service commissioning: a qualitative study
Authors: Akanuwe JNA , Cooke S , Henderson H , Kane R
Published: November 2022

Aim:

Public health lifestyle databases at local authority level are currently poorly aligned across the UK. The integration of lifestyle databases at a regional level could provide a rich resource to support research and help inform public health leads and service commissioners in improving service delivery, facilitating decision-making and developing key public health policies. Prior to its implementation, the acceptability of an integrated lifestyle database should be explored. The aim of this study was to consult with public health stakeholders to explore the acceptability of developing and implementing a regional integrated lifestyle database across four key areas of public health: smoking cessation, diet, physical activity and alcohol consumption.

Method:

Qualitative interviews were conducted with public health stakeholders recruited from across the East Midlands region of England. All interviews were conducted using video conferencing software and recorded, transcribed, and analysed using the Framework approach. Sixteen public health stakeholders were purposively identified and invited to participate in interviews.

Results:

Stakeholders viewed the integrated database as having potential to support research, service development and commissioning decisions. Barriers such as providers’ reluctance to reveal their business strategies to rival organisations, cost of setting up and running the proposed database, complex information-sharing and governance were identified.

Conclusion:

An integrated lifestyle database has the potential to support research and service commissioning regionally. However, several barriers were identified that must be addressed prior to the development and implementation of an integrated database.
The incidence of avascular necrosis in children with cerebral palsy after hip containment surgery
Authors: Bauer Jeremy P , Sienko Susan , Roy Dennis , Nye Deric , Tarrant Seth , Price Ryan , Raney Ellen
Published: November 2022

Purpose:

To establish the rate of avascular necrosis after hip reconstruction surgery in children with cerebral palsy and to identify risk factors that influence the development of avascular necrosis in this population.

Methods:

An institutional review board–approved retrospective review was conducted on children with cerebral palsy who underwent hip containment surgery at a single institution. Radiographs were evaluated at three time points. The Reimer’s migration percentage, neck shaft angle, epiphyseal shaft angle, acetabular index, center edge angle, and acetabular angle were measured. The presence of avascular necrosis was evaluated and graded by the Bucholz/Ogden and the Kalamchi/MacEwen classification systems. Multivariate logistic regression was performed to identify risk factors associated with the development of avascular necrosis.

Results:

A total of 154 children with cerebral palsy underwent hip containment surgery on 223 hips. Twenty-nine children (18.8%) underwent both pelvic and femoral procedures; 36 children (23.4%) had only femoral procedures; 47 children (30.5%) had femoral and soft tissue; and 42 children (27.3%) had pelvic, femoral, and soft tissue procedures. Using the Bucholz and Ogden or the Kalamchi classifications, the rate of avascular necrosis was 24.7% (38/154). Of the variables evaluated, preoperative Reimers was found to be significant predictors of avascular necrosis. The rate of avascular necrosis was 26.7% for Gross Motor Functional Classification System level III, 24.1% for Gross Motor Functional Classification System level IV, and 27.3% for Gross Motor Functional Classification System level V.

Conclusion:

The overall rate of avascular necrosis in children undergoing hip containment surgery was 26.7%. Together, age at surgery, open reduction, previous surgery, preoperative Reimers, and estimated blood loss contributed to the development of postoperative avascular necrosis; however, only preoperative Reimers significantly contributed to the development of avascular necrosis in children with cerebral palsy undergoing hip containment procedures.
Characterizing palliative care needs in people with or at risk of developing diabetic foot ulcers
Authors: Mendonça Liliane , Antunes Bárbara , Rigor Joana , Martins-Mendes Daniela , Monteiro-Soares Matilde
Published: November 2022

Aims:

Diabetic foot ulcers (DFUs) have a significant impact on a patient’s quality of life and life expectancy, with mortality rates comparable with malignant diseases. However, there is a lack of data regarding palliative care needs in this population. We aimed to characterize palliative care needs in people under diabetic foot surveillance using the Integrated Palliative care Outcome Scale (IPOS) and EuroQol-5D three-level version (EQ-5D-3L) and to assess differences between those with and without a DFU.

Methods:

We conducted a cross-sectional study with consecutive sampling inclusion of patients followed in a tertiary hospital’s Diabetic Foot Clinic between February and October 2019 with ( n = 20) and without ( n = 42) active DFU.

Results:

The most frequent symptoms encountered were pain, weakness or lack of energy, sore or dry mouth and drowsiness. Patients with an active DFU were significantly more likely to report feeling anxious or worried in comparison with those without (95% versus 55%, p = 0.002). Only 10% of the participants with an active DFU said that they were always able to share how they felt with family and friends as much as they wanted in comparison with 45% of those without ( p = 0.006).

Conclusion:

Our study identified palliative care needs in patients under diabetic foot surveillance with and without DFU, including a significant presence of physical symptoms. Patients in both groups showed signs of emotional/psychological distress, with a higher manifestation in patients with DFU. To the best of our knowledge, this is the first study addressing and characterizing palliative care needs in this population.
Evaluation of factors predicting response to abiraterone acetate in metastatic castration-resistant prostate cancer: A prospective study
Authors: Kumawat Ghanshyam , Yadav SS , Jaiswal Sanjeev , Sahu Ramdayal , Garg Anurag , Tomar Vinay
Published: November 2022

Background/Objectives:

In the current era, abiraterone acetate is mainstay of the treatment strategies of castration-resistant prostate cancer and proven to prolong overall survival. We aimed to prospectively identify factors associated with duration of response to abiraterone.

Patients and methods:

All metastatic castration-resistant prostate cancer patients eligible for abiraterone were included in the study from February 2019 till March 2020. All baseline data and potential factors associated recorded and follow-up with prostate-specific antigen (PSA), and required investigations were done at 1 month interval. Duration of PSA response was recorded, and patients were divided in five groups on the basis of duration of response. Univariate and multivariate analyses of potential factors were done, and data analysis was done with SPSS (Statistical Package for the Social Sciences) version 21.0.

Results:

In this study, after univariate analysis, seven factors were associated with longer duration of response to abiraterone. These were PSA at diagnosis (hazard ratio (HR) = −1.011 (95% confidence interval (CI) = 1.003–1.020), p-value = 0.008), PSA at start of abiraterone (HR = −1.018 (95% CI = 1.011–1.025), p-value = 0.0001), nadir PSA (HR = −1.063 (95% CI = 1.024–1.104), p-value = 0.001), prostate-specific antigen doubling (PSAD) time (HR = −0.745 (95% CI = 0.672–0.827), p-value = 0.001), raised alkaline phosphatase (ALP) (HR = −1.002 (95% CI = 1.001–1.003), p-value = 0.001), neutrophil/lymphocyte ratio (NLR) (HR = −2.16 (95% CI = 1.672–2.81), p-value = 0.001) and <5 bone metastasis (HR = −0.235 (95% CI = 0.130–0.422), p-value = 0.01). But after multivariate analysis, nadir PSA achieved, PSAD, NLR and ⩽5 bone metastasis were predictors of better response to abiraterone.

Conclusion:

This study had identified that less nadir PSA achieved, long PSAD time, low NLR and limited number of skeletal metastases were potential factors for better PSA response to abiraterone.

Level of evidence:

1
Application effect of Kolb's experiential learning theory in clinical nursing teaching of traditional Chinese medicine
Authors: Chen Lu , Jiang Wen-Juan , Zhao Ru-Ping
Published: November 2022

Objective

This study aimed to explore the practical application and effect of Kolb's experiential learning theory in the clinical nursing training of traditional Chinese medicine (TCM).

Methods

This study is a quasi-experimental study. Eighty clinical nurses from a class-III grade-A general hospital were enrolled in 2020 and 2021, respectively, as research subjects. The subjects in the control group were trained in “theory explanation, clinical practice, summary and Q&A, [and] centralized examination.” The subjects in the experimental group were first grouped according to Kolb's experiential learning style. The training followed a “problem–exploration–practice–exploration–theory–explanation–summary–centralized examination” structure based on Kolb's experiential learning cycle, the training place is Conference Room 1 of the hospital. The training time is from February to August 2020 and 2021. The application effect of the experiential learning theory was evaluated by analyzing course evaluation questionnaires and the final examination results.

Results

The total score of the course evaluation questionnaire of the experimental group was 112.23  ±  5.88. The difference compared with the control group was statistically significant ( P < .01). In the experimental group, the theoretical score was 85.27  ±  3.29, and the operational score was 85.36  ±  3.01. The differences compared with the control group were statistically significant ( P < .01).

Conclusion

The application of Kolb's experiential learning theory to the training of TCM clinical nursing can make the clinical practice of TCM nursing more “scientific” and the training more effective, and it can improve the subjective initiative of students.
Issues and challenges for women in creating spaces at decision-making levels: A case study of Pakistan Muslim league-N
Authors: Gul Azeem , Kausar Syed Waqas Ali , Bi Bi Zainab
Published: November 2022

In many Western and Asian countries, women’s empowerment has increased significantly, yet women are still underrepresented in political participation and political decision-making. This study explores the political engagement of women in a society that discriminates against them on the basis of their sex, and in a political system that is heavily patriarchal. The study is aimed at exploring the issues and challenges that women confront in political participation and decision-making in the party political space. To achieve this goal, a qualitative approach has been adopted, in which data has been collected and processed in a qualitative manner. This research conducts a case study of Pakistan Muslim League (N) which served as a sample for data collection. Thematic analysis has been used to decipher the comments of important stakeholders interviewed for qualitative data, as described by Braun and Clarke. Although literature has studied the complex of multiple interlinked causes for women’s insufficient and ineffective political participation, this article presents a novel way to explore those issues and a thematic way to understand their complexity. However, the study's findings indicate that women's political engagement and decision-making are hampered for a variety of reasons. A male-dominated culture, lack of social acceptance, structural halts, gender-imbalanced political parties, societal vulnerability threats and an inability to empower women are a few of the main concerns. Numerous specific problems have been identified as well, such as the persistence of historical patterns and the opportunity gap as well as psychological satisfaction and religious excuses for the lack of political participation and the vulnerability of being scandalized, weak economic status and gender sensitivity in the workplace. In Pakistani society, these highlighted variables are so firmly ingrained in the political and social structure that they are mostly taken for granted and go unnoticed.
Identifying mental illness and monitoring mental health in probation service settings
Authors: Brooker Charlie , Sirdifield Coral , Parkhouse Thomas
Published: November 2022

There is a need to improve a) identification and monitoring of people with mental illness on probation and b) understanding of the impact of interventions on mental health outcomes for the probation population. If data were routinely collected using validated screening tools and shared between agencies, this could inform practice and commissioning decisions, and ultimately it could improve health outcomes for people under supervision. The literature was reviewed to identify brief screening tools and outcome measures that have been used in prevalence and outcome studies conducted with adults on probation in Europe. This paper shares findings from the UK-based studies in which 20 brief screening tools and measures were identified. Recommendations are made based on this literature regarding suitable tools for use in probation to routinely identify a need for contact with mental health and/or substance misuse services and to measure change in mental health outcomes.
Enhancing Social Capital: The Role of the School Counselor–Principal Alliance in School Counselor Advocacy Activities for Lesbian, Gay, Bisexual, Transgender, and Questioning or Queer Students
Authors: Wikoff Haley D. , Wood Susannah M.
Published: November 2022

This study examined how demographic variables and the school counselor–principal alliance influenced school counselors’ advocacy for LGBTQ students as measured by the Lesbian, Gay, Bisexual Active Advocacy Scale-Revised (LGBAAS-R). We surveyed 169 practicing school counselors with at least one year of experience in their current building and working with their current principal. Results indicate that the participant’s sexual orientation, engagement with professional development, presence of a Gender and Sexuality Alliance (GSA), the state in which they work, perception of a welcoming environment, years worked with the principal, and perception of a collaborative relationship with the principal were significant predictors of advocacy activity. Through advocacy, school counselors can build social capital in LGBTQ students, yet school counselors’ own identity and relationships with principals can influence their ability to engage in advocacy. Note: LGBTQ is intended to represent the diverse range of identities of gender and sexual orientation of individuals.
Social Justice, Social Capital, and Micropolitics: Improving Social Justice Through School Counselor–Principal Collaboration
Authors: Oehrtman Jeremy P. , Dollarhide Colette T.
Published: November 2022

Schools have urgent social justice needs that have become evident with the novel coronavirus (COVID-19) pandemic, discussions of racism, and increasing mental health needs of school students. School counselors can work with school principals to use the concepts of social capital and micropolitical theory to facilitate collaborative partnerships with school and district administration, community members, and families to achieve improved social justice in their schools. We present a scenario to illuminate the use of these concepts in practice.
“Dabo Wears Male Rompers”: Examining Expressions of Hegemonic Masculinity and Identity in ESPN’s College GameDay
Authors: Lever Katie
Published: November 2022

It has long been held that sport functions as a site of identity and belonging. Identity is also a key element that lays the framework for elite sport and social gathering as well as fan identification with teams and athletic figureheads (athletes and coaches) associated with their favored team. Sports fans often exercise identity in the communal bonding experiences of sport, including watching and attending games and other sports programming in groups. Outside of sporting events themselves, perhaps the most prominent sport-centric community and identity-building spectacle is ESPN's "College GameDay." First aired in 1987 as a rundown of college football scores and commentary, the popular show is now known for its in-depth analysis of high-stakes football match-ups, predictions of game outcomes, celebrity guest pickers who select the team they believe will win during the morning show, and the quirky signs made by fans who strive to be televised or featured on GameDay’s social media platforms. I argue that these popular elements of the show offer fans the opportunity to enact and express identities of hegemonic masculinity in widespread and potentially problematic ways.
Linkage of Cultural and Gender Diversity with Productivity in Chikankari Industry of Lucknow
Authors: Rinku
Published: November 2022

Cultural diversity is essential for the productivity and competitive advantage of a firm. The sociocultural diversity of workers and entrepreneurs brings innovative ideas and knowledge to increase the firm’s output, which is challenging to capture in the production function. This article highlights that the female workers use their social and cultural capital (SCC) and network as a bridge to get the work. Analysis based on OLS regression shows that labour and capital are significant for output and that gender diversity helps increase the firm productivity. However, the social structures and informal nature of the industry reduce the bargaining power of women. The interlinkage between diversity and social capital are critical factors behind the origin of the chikankari industry. It is the driving force behind the sustenance of the industry and firm productivity.
Coronal Plane Calcaneal-Talar Orientation in Varus Ankle Osteoarthritis
Authors: Kang Ho Won , Park Gil Young , Lee Dong-Oh , Ro Yoon A. , Lee Dong Yeon
Published: November 2022

Category:

Hindfoot; Ankle; Ankle Arthritis

Introduction/Purpose:

We do not yet fully understand how the subtalar joint position is related to the varus osteoarthritic ankle joint. The purposes of this study were 1) to investigate the coronal orientation of the calcaneus relative to the talus according to the ankle osteoarthritis stage, talar tilt (TT), and 2) to determine if there is a TT threshold at which apparent subtalar compensation begins to fade.

Methods:

We retrospectively reviewed 132 ankles that underwent WBCT for varus ankle osteoarthritis. The TT, subtalar inclination angle (SIA), and calcaneal inclination angle (CIA) were measured using WBCT. Ankles were divided into 5 groups according to Takakura stage and 2 groups according to the apparent compensation status of the subtalar joint and compared the index of the inclination of the subtalar joint relative to the ankle (SIA) or the index of the inclination of the calcaneus relative to the ankle (CIA). Additionally, we explored the relationship between SIA or CIA and the TT.

Results:

Apparent subtalar compensation (SIA and CIA) was significantly lower in Takakura stages 3b and 4. The SIA and CIA significantly differed according to the apparent compensation status (p<.001 and p=.030, respectively). The CIA of the noncompensated group varied widely, while the SIA was relatively constant. Furthermore, TT was greater than 9.5, which indicated a high probability of a noncompensated heel. (sensitivity, 92.6%; specificity, 89.7%).

Conclusion:

The position of the calcaneus has a appears compensatory with coronal plane orientation in varus ankle osteoarthritis when the TT is < than 9.5°.
Reconstruction of Severe Osteolytic Malleoli using Femoral Head Allograft in a Revision Total Ankle Replacement: A Case Report
Authors: Kvarda Peter , Ruiz Roxa , Hintermann Beat
Published: November 2022

Category:

Ankle Arthritis; Ankle; Hindfoot

Introduction/Purpose:

Case: A 38-year-old male patient presented with severe pain in the left ankle who underwent a total ankle replacement (TAR) and syndesmotic fusion for end-stage ankle osteoarthritis (OA) 13 years ago. Radiographic evaluation showed implant loosening and extensive osteolytic lesion of both malleoli. Revision was performed using a three-component TAR system and reconstruction of the malleoli with femoral head allograft.

Methods:

N/A

Results:

N/A

Conclusion:

Reconstruction of severe osteolytic lesions of the malleoli with femoral head allograft in the setting of revision TAR allowed to create a stable bone stock, implant anchorage, desirable stability and therefore maintaining joint function.
Short-Term Outcomes of a Two-Component Total Ankle Replacement in Revision Arthroplasty
Authors: Kvarda Peter , Toth Laszlo , Horn-Lang Tamar , Susdorf Roman , Ruiz Roxa , Hintermann Beat
Published: November 2022

Category:

Ankle Arthritis; Ankle; Hindfoot

Introduction/Purpose:

Given the growing number of primary total ankle replacements (TAR), an increase in the numbers of failed ankles and consecutive revisions might be expected. Achieving a stable and balanced ankle based on stable components while preserving the remaining bone stock as much as possible, are crucial for success in revision TAR. Most reported techniques rely on bulky implants with extended fixation features. Since 2018, we have used a novel 3-component ankle for revision surgery that is converted in situ to a fixed-bearing 2-component ankle once the components have found their position given by the individual anatomy. The purpose of this study was to determine the short-term results of this novel concept in revision TAR.

Methods:

This single-center retrospective cohort study included 57 patients (57 ankles, mean age 63+-13 years) treated for failed TAR with the semi-constrained HINTERMANN Series H2© (H2) implant between February 2018 and February 2020. Survival analysis was performed and potential risk factors using Cox regression, were assessed. Clinical and radiological outcomes were assessed preoperatively and at the last follow-up. Clinical outcomes included pain on a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot score and patient satisfaction. Radiological outcomes were tibial articular surface angle (TAS), tibiotalar surface angle (TTS), talar tilt angle (TT) in the coronal plane and anteroposterior offset (AP-Offset) ratio in the sagittal plane, as well as signs of radiolucency and/or loosening on plane weightbearing radiographs.

Results:

The median follow-up was 2 (2.0 to 4.0) years. The cumulative incidence for secondary revision after 1 and 2 years was 5.1% (95%CI 0-11) and 7.4% (0-14) respectively. Four patients needed a secondary revision (three for pain/arthrofibrosis and one for aseptic loosening). While the AOFAS hindfoot score increased from median 54 (range 9-94) to 75 (19-98) (p=0.00001), satisfaction increased from moderate to good (p=0.0017). Radiographically, all components were stable without signs of increased shear-forces in terms of loosening or radiolucency.

Conclusion:

Obtained results with the novel customized semi-constrained total ankle implant design at short-term are encouraging, with a satisfactory survival rate and acceptable revision rate. The fixation concept without extended fixation features was shown to last against increased shear forces.
Comparison of Outcomes Between Knotless Anchor Repair and Knot Anchor Repair for All- Arthroscopic Anterior Talofibular Ligament Repair in Chronic Ankle Instability
Authors: Lee Sung Hyun , Yoo Byung min
Published: November 2022

Category:

Arthroscopy; Ankle; Sports

Introduction/Purpose:

Arthroscopic anterior talofibular ligament (ATFL) repair using a suture anchor is effective and has excellent short- to mid-term patient outcomes reported in previous studies. Recent study suggested that knotless suture anchor had advantage compare to knot suture anchor. The aim of this study is to compare clinical outcomes after knot anchor versus knotless anchor repair for all-arthroscopic ATFL repair in patients with chronic lateral ankle instability.

Methods:

Between 2017 and 2018, patients who underwent arthroscopic ATFL repair using knot or knotless suture anchors and were available at least 2 years follow up were included in this study. Total, 68 patients were included, and sorted to 2 groups according to characteristics of anchor. (KL group (n=42): knotless anchor, K group (n=26): knot anchor). Clinical outcomes were compared using a visual analog scale (VAS), Foot and Ankle Outcome Score (FAOS), and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view MRI.

Results:

There were no significant differences between 2 groups in clinical scores and radiologic findings. There were 3 knot irritation (11.5%) and 1 SPN neuropathy (3.8%) in K group, but there were no statistical differences.

Conclusion:

Arthroscopic ATFL repair using knotless suture anchor showed comparable outcomes to knot anchor, without complication due to knot.
Ballistic Injuries to the Foot and Ankle: Antibiotic Administration and Infection Rate
Authors: Luginbuhl Joshua C. , Rallis Gavin , Gokcen Eric C.
Published: November 2022

Category:

Trauma; Ankle; Hindfoot; Midfoot/Forefoot; Other

Introduction/Purpose:

Although frequently non-fatal, ballistic injuries to the foot and ankle can lead to significant morbidity and functional impairment. General management principles are often employed, however there is a paucity of data related outcomes following ballistic injury to the foot and ankle.

Methods:

A retrospective chart review of inpatients who sustained a ballistic injury to the foot and ankle was performed at a single level one trauma institution from 2014 to 2019. A total of 64 patients were identified. Each chart was reviewed for demographics, foot and ankle injury sustained, associated non-orthopaedic injuries, antibiotics received, procedures undergone, and complications documented.

Results:

The patients were more frequently male (M:F, 11.8:1) with a mean age of 31.2 years (18-75). Fifty-two (81.3%) patients received antibiotics, all of which covered for gram positive organisms. Twelve of these patients also received coverage for gram- negative organisms. Two (3.1%) patients developed a documented infection. One patient who received gram positive antibiotic coverage sustained 1 fracture, underwent bedside bullet removal, and developed a cellulitis that responded to oral antibiotics. The other patient received both gram positive and gram negative coverage, sustained 6 fractures in the foot with extensive soft tissue injury, underwent operative debridement, and ultimately required transmetatarsal amputation due to infection/osteomyelitis.

Conclusion:

Ballistic injuries to the foot and ankle are common injuries encountered by orthopaedists in an urban setting. The infection rate (3.1%) in our series is low and comparable to infection rates seen after ballistic injury to the hand. Negative outcomes after ballistic injury are associated with multiple fractures and soft tissue compromise. We advocate for early antibiotic administration and a high index of suspicion for infection in these cases.
Charcot Neuroarthropathy is Associated with Higher Rates of Phantom Limb after Major Amputation
Authors: Martinazzi Brandon J. , Nam Hannah , Lorenz F. Jeffrey , Mansfield Kirsten N. , Dopke Kelly , Ptasinski Anna , Kirchner Gregory , Aynardi Michael C.
Published: November 2022

Category:

Diabetes; Trauma

Introduction/Purpose:

Phantom limb is a complication associated with lower extremity amputation. However, its rate in patients with Charcot Neuroarthropathy that undergo major amputation is not well-described. Moreover, there is limited research exploring outcomes of patients with Charcot Neuroarthropathy that require amputation. Therefore, the purpose of this cohort study was to determine if patients with Charcot Neuroarthropathy that undergo major amputation had an increased rate of phantom limb compared to patients that underwent amputation without a coexisting diagnosis of Charcot.

Methods:

Using ICD and CPT codes, an online research database was used to identify patients that underwent a major lower extremity amputation. For the purposes of our study, we defined a major amputation as a below-knee amputation (BKA). Patients were then separated into two groups. Group A consisted of patients that underwent BKA and also had a coded diagnosis of Charcot Neuroarthropathy. Group B consisted of patients that underwent BKA and lacked a diagnosis of Charcot. Statistical analysis was then run to determine the relative risk of developing phantom limb in patients that underwent BKA with a diagnosis of Charcot Neuroarthropathy compared to those without the diagnosis. Demographic data of the cohort was also collected.

Results:

From 2012-2022, a total of 11,374 patients underwent a BKA. Of these patients, 804 also had a diagnosis of Charcot Neuroarthropathy (Group A) and 10,570 did not (Group B). The rate of phantom limb in Charcot patients was 23.1% (186/804). The rate of phantom limb in patients without Charcot Foot was 19.5% (2063/10570). Patients with Charcot Neuroarthropathy that underwent a BKA had an increased risk of developing phantom limb compared to patients that underwent a BKA without Charcot (RR: 1.2, 95% CI: 1.039-1.352).

Conclusion:

Phantom limb is a serious complication following major amputation. Our results indicate that patients with a coexisting diagnosis of Charcot Neuroarthropathy that go on to require BKA may have an increased risk of developing phantom limb. Furthermore, our study adds to the limited research on outcomes of patients with Charcot Neuroarthropathy.
5-Year Follow-Up of Neuropathic Minimally Invasive Surgery for the Management of Diabetic Forefoot Ulcers
Authors: Miller Roslyn
Published: November 2022

Category:

Diabetes; Bunion; Lesser Toes

Introduction/Purpose:

Diabetic forefoot ulcers are associated with a high risk of recurrence, subsequent infection and amputation. Patients who have an amputation for diabetic foot disease have a significantly increased 5-year morbidity and mortality. Minimally invasive surgery to redistribute forces includes any combination of percutaneous Achilles/extensor tendon lengthening, osteotomy/excision of the metatarsal head or sesamoids, and phalangeal osteotomy. The purpose of this case- controlled cohort study is to determine if there is any significant reduction in re-ulceration and amputations rates in patients treated with Neuropathic Minimally Invasive Surgeries, versus conservative management with wound debridement, antibiotics and total contact casting.

Methods:

Patients who had presented to the diabetic foot clinics that subsequently underwent Neuropathic Minimally Invasive Surgery over a 5-year period were matched with a similar group of patients (age, sex, neuropathy, peripheral vascular disease) who were managed conservatively. The conservative group of patients were identified from the Scottish SCI-Diabetes database. Outcomes of recurrent ulceration and amputation, time to heal and number of clinic visit were all compared.

Results:

Patients who underwent minimally invasive surgery had predictable healing of their ulcers in 6 weeks. Very few represented a recurrent ulcer, though some did develop an ulcer at a different site. Subsequent amputation rates were lower in the surgical group versus the non-surgical group. The number of clinic visits significantly reduced in the operated group, versus the conservatively treated group.

Conclusion:

Patients with recurrent diabetic foot ulcers benefit from early assessment to determine if they would be a good surgical candidate for Neuropathic Minimally Invasive Surgery. Many diabetic patients have an alteration in their foot biomechanics, whether soft tissue, osseous or both. Minimally invasive surgeries provide relatively predictive times to ulcer healing. Re-ulceration at the same time is reduced. This has a significant impact on the patients' quality of life. There is also a major benefit to healthcare systems where there is a significant burden of the health care budget being allocated for regular dressings and wound reviews.