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Background: The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distribution from ligaments critical for maintaining load distribution. A serial transection of ligaments may provide insight into changes in pressure distribution under the foot to identify a potential combination of ligaments that may be involved in early deformities., Methods: Specimens were loaded using a custom designed axial and tendon loading system. Plantar pressure data for the forefoot and hindfoot were recorded before and after six sequential ligament complex transections., Findings: Sectioning the plantar fascia (first) and short/long plantar ligaments (second) failed to generate appreciable differences in load distribution. Dividing the spring ligament (third) led to changes in hindfoot load distribution with a shift towards the lateral column indicative of hindfoot valgus angulation. All subsequent conditions resulted in similar patterns in hindfoot plantar load distribution. An anterior shift in the center of pressure only occurred after transection of all six ligament complexes., Interpretation: Loss of the plantar fascia and short/long plantar ligaments are not critical in maintaining plantar load distribution or contact area. However, the additional loss of the spring ligament caused notable changes in hindfoot load distribution, indicating the combination of these three ligament complexes is particularly critical for preventing peritalar subluxation. Minimal changes in load distribution occurred when performing additional transections to reach a complete flatfoot deformity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

A large body of research has established a relation between maternal education and children's neurocognitive functions, such as executive function and language. However, most studies have focused on early childhood and relatively few studies have examined associations with changes in maternal education over time. Consequently, it remains unclear if early maternal education is longitudinally related to neurocognitive functions in children, adolescents, and young adults. In addition, the associations between changes in maternal education across development and more broadly defined neurocognitive outcomes remain relatively untested. The current study leveraged a large multicohort sample to examine the longitudinal relations between perinatal maternal education and changes in maternal education during development with children's, adolescents', and young adults' neurocognitive functions ( N = 2,688; M age = 4.26; range = 3-20 years). Moreover, we examined the differential effects of perinatal maternal education and changes in maternal education across development on executive function and language performance. Perinatal maternal education was positively associated with children's later overall neurocognitive function. This longitudinal relation was stronger for language than executive function. In addition, increases in maternal education were related to improved language performance but were not associated with executive functioning performance. Our findings support perinatal maternal education as an important predictor of neurocognitive outcomes later in development. Moreover, our results suggest that examining how maternal education changes across development can provide important insights that can help inform policies and interventions designed to foster neurocognitive development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).SD age = 4.26; range = 3-20 years). Moreover, we examined the differential effects of perinatal maternal education and changes in maternal education across development on executive function and language performance. Perinatal maternal education was positively associated with children's later overall neurocognitive function. This longitudinal relation was stronger for language than executive function. In addition, increases in maternal education were related to improved language performance but were not associated with executive functioning performance. Our findings support perinatal maternal education as an important predictor of neurocognitive outcomes later in development. Moreover, our results suggest that examining how maternal education changes across development can provide important insights that can help inform policies and interventions designed to foster neurocognitive development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: The authors examined whether ultrasound sensitivity, specificity, and accuracy in identifying intact repairs or flexor tendon gapping after zone 2 repair are affected by the number of suture strands crossing the repair or gap or imaging modality (static versus dynamic)., Methods: A total of 144 fresh-frozen cadaveric digits (thumbs excluded) were randomized to either an intact repair (0-mm gap) or simulated failed repair (4-mm gap), as well as to either a two- or eight-strand locked-cruciate repair of a zone 2 flexor digitorum profundus tendon laceration using 4-0 Fiberwire. Examinations were performed by a blinded musculoskeletal ultrasonographer in static and dynamic modes using an 18-MHz transducer. Gaps were remeasured after scanning, and the final gap width recorded. McNemar exact test was used to determine whether there were differences in sensitivity, specificity, and accuracy affected by modality (static versus dynamic), and chi-square test was used to compare sensitivity, specificity, and accuracy between number of strands (two versus eight) crossing the intact repair or repair gap (≥4 mm)., Results: Sensitivity, specificity, and accuracy improved with increased number of suture strands crossing the repair or gap (eight versus two), irrespective of modality (static versus dynamic), and dynamic compared with static scanning modes, irrespective of number of suture strands crossing the repair or gap site., Conclusions: The most sensitive and accurate means of assessing flexor tendon repair integrity and gapping were seen using the dynamic scanning mode. Increased number of suture strands did not negatively affect sensitivity, specificity, or accuracy, regardless of scanning mode (dynamic or static)., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Purpose: To determine whether a 24 MHz transducer significantly improves sensitivity, specificity and accuracy in evaluating flexor tendon repair integrity compared with an 18 MHz transducer., Methods: One hundred and twelve cadaveric digits were randomised to an intact repair or simulated 'failed' repair, and to a two- or eight-strand repair of a flexor digitorum profundus laceration. A blinded sonologist evaluated specimens in static mode using 18 and 24 MHz transducers. Gaps were remeasured after scanning, and final gap width recorded. McNemar's exact test calculated differences between sensitivity, specificity and accuracy, and chi-squared test to compare sensitivity, specificity and accuracy between number of strands (2 vs. 8) and repair gap (≥4 mm)., Results: The 24 MHz transducer had higher sensitivity (81 vs. 59%), lower specificity (67 vs. 70%) and higher overall accuracy (74 vs. 64%), than the 18 MHz transducer. The difference for sensitivity was significant (P = 0.011), but not differences for specificity and overall accuracy (P > 0.05). Pearson's correlation ( r  = 0.61) demonstrated a moderate-to-strong positive correlation between measured and true gap sizes. Increased number of suture strands (2 vs. 8) did not impair sensitivity, specificity nor accuracy., Discussion: Ultrasound may tend to overestimate gap width, and a slight risk that some intact repairs, or those with small, clinically insignificant gaps may undergo surgical exploration that may not be indicated., Conclusions: A 24 MHz transducer is a more sensitive and accurate transducer for assessing flexor tendon repair integrity and measuring small gaps., Competing Interests: None of the authors has a financial interest in any of the products, devices or drugs mentioned in this manuscript., (© 2023 Australasian Society for Ultrasound in Medicine.)

Background: Reliable methods for measuring range of motion is important for hand therapists. Currently, there is no gold standard for the measurement of thumb metacarpophalangeal joint (MCPJ) hyperextension. We hypothesised that visual and goniometric measurements of thumb MCPJ hyperextension vary greater than 10° from radiographic measurements, and between observers. Methods: Twenty-six fresh-frozen hands were measured by a senior orthopaedic resident and fellowship trained hand surgeon. Passive thumb MCPJ hyperextension was measured by visual estimation, goniometry and axis measurement on a lateral thumb radiograph. Raters were blinded to each other's and their own prior measurements. Descriptive statistics were recorded for measurement type and inter-observer agreement using a two-way intra-class correlation coefficient (ICC). Intra-observer agreement was calculated using concordance correlation coefficient (CCC). Bland-Altman plots identified trends, systemic differences or potential outliers. Results: Mean measurements for both raters were similar for visual estimation and radiographic measurements. Mean goniometric measurements were twice as high for Rater B, and closer to radiographic measurements. For both raters, mean radiographic measurements were 10° greater than the other two methods. For inter-rater agreement, measurements were within 10° most frequently with radiographic measurement, then visual estimates, and least by goniometer measurements. Rater B had better agreement comparing visual and goniometric to radiographic measurements. Conclusions: Radiographic measurement has the best inter-observer agreement and precision for evaluating passive thumb MCPJ hyperextension, especially considering adjunct corrective procedures when performing a soft-tissue basal joint arthroplasty. Rater experience improves precision, but there is still poor agreement between visual estimates and goniometer measurements compared to radiographic measurements, as the former two underestimate hyperextension by 10°. Development of a standard method of clinical measurement is needed to improve reliability.

Study Design: Retrospective review., Objectives: (1) Identify the 90-day rate of readmission following revision lumbar fusion, (2) identify independent risk factors associated with increased rates of readmission within 90 days, (3) and identify the hospital costs associated with revision lumbar fusion and subsequent readmission within 90 days., Methods: Utilizing 2014 data from the Nationwide Readmissions Database, patients undergoing elective revision lumbar fusion were identified. With this sample, multivariate logistic regression was utilized to identify independent predictors of readmission within 90 days. An analysis of total hospital costs was also conducted., Results: In 2014, an estimated 14 378 patients underwent elective revision lumbar fusion. The readmission rate at 90 days was 3.1% (n = 446). Diabetes with chronic complications was the only comorbidity found to carry significantly increased odds of readmission. Surgical complications such as deep venous thrombosis, surgical wound disruption, hematoma, and pneumonia (experienced during the index admission) were also independent predictors of readmission. Anterior approaches were associated with increased odds of readmission. The most common related diagnoses on readmission were hardware issues, postoperative infection, and disc herniation. Readmissions were associated with an average of $96 152 in increased hospital costs per patient compared with those not readmitted., Conclusion: Relevant patient comorbidities and surgical complications were associated with increased readmission within 90 days. Readmission within 90 days was associated with significant increases in hospital costs.

Study Design: Retrospective cohort study., Objective: Evaluate the trends in management and inpatient outcomes in patients with syndromic scoliosis undergoing spinal deformity correction., Summary of Background Data: Syndromic scoliosis (SS) refers to scoliosis that is most commonly associated with systemic disease including Ehler Danhlos syndrome (EDS), Marfan syndrome (MF), Down syndrome (DS), Achondroplasia (AP), and Prader-Willi syndrome (PWS). Limited data exist evaluating hospital outcomes in patients with SS undergoing spinal deformity correction., Methods: The Kids' Inpatient Database (KIDS) was queried from 2001 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. These patients were then sub-divided into two cohorts: (1) patients with idiopathic scoliosis (IS) and (2) patients with syndromic scoliosis. Trends in surgical management, and postoperative morbidity and mortality were assessed. Length of stay and total hospital charges were additionally analyzed. A sub-analysis to characterize outcomes in each syndrome was also performed., Results: An estimated 1071 patients with SS were identified and compared with 24,989 pediatric patients with IS. MF (36.8%), Down syndrome (16.0%), and PWS (14.9%) were the most common diagnoses among patients with SS. Between 2001 and 2012, there was a significant decline in the number of anterior procedures performed in both cohorts. Conversely, the number of posterior based procedures increased. SS was associated with increased major complications (2.7% compared with 1.0% in IS; P < 0.001) and minor complication rates (41.0% compared with 28.5% in IS; P < 0.001). Patients with AP incurred the highest rate of major complications (10.7%), minor complications (60.8%), and intraoperative durotomies (6.1%). Total hospital charges increased significantly over the 12-year span., Conclusion: Trends in management of syndromic scoliosis have paralleled that of idiopathic scoliosis. Syndromic scoliosis is associated with increased risks with surgical deformity correction. Further prospective studies are warranted to evaluate the reasons for these differences., Level of Evidence: 3.

The adverse effects of institutionalized care and psychosocial deprivation have been documented for more than 100 years. Children who have been raised in institutions are at heightened risk of developing internalizing and externalizing disorders. Given the profound biological and psychological effects of institutional rearing, identifying neural and cognitive factors that influence the emergence of psychopathology in institutionalized children is of great interest. Using data from the Bucharest Early Intervention Project, a randomized control study on the effects of institutional care and a foster care intervention, this article examines two factors that appear to influence the emergence of psychopathology in children who have been institutionalized-neural indices of cognitive control and visual attention biases.

Children raised in institutions experience psychosocial deprivation that has detrimental influences on attention and mental health. The current study examined patterns of attention biases in children from institutions who were randomized at approximately 21.6 months to receive either a high-quality foster care intervention or care-as-usual. At age 12, children performed a dot-probe task and indices of attention bias were calculated. Additionally, children completed a social stress paradigm and cortisol reactivity was computed. Children randomized into foster care (N=40) exhibited an attention bias toward positive stimuli but not threat, whereas children who received care-as-usual (N=40) and a never-institutionalized comparison group (N=47) showed no bias. Stability of foster care placement was related to positive bias, while instability of foster care placement was related to threat bias. The magnitude of the positive bias was associated with fewer internalizing problems and better coping mechanisms. Within the foster care group, positive attention bias was related to less blunted cortisol reactivity., (Copyright © 2016 Elsevier B.V. All rights reserved.)

The current study aimed to extend the results of White et al. (2015) by examining the moderating role of attention biases at age 5 on the relations between Behavioral Inhibition (BI) during toddlerhood and anxiety symptoms at age 10. Children's BI at 2 and 3 years of age was measured using laboratory assessments, and attention bias towards threat was assessed using a dot-probe task at age 5. Latent Class Analysis (LCA) was used to identify the probability for children's membership in an anxiety class, which reflected primary anxiety at age 10 that was not comorbid with symptoms of inattention. Maternal and self-report measures of children's mental health, collected via questionnaires and semi-structured diagnostic interviews, were used as indicators for the LCA. The results revealed that threat-related attention biases moderated the relation between BI and anxiety, such that BI positively predicted the probability of being in the anxiety class only when children had an attention bias towards threat. BI was unrelated to anxiety when children had no attention bias or an attention bias away from threat. These results indicated that attention biases during preschool may differentiate between inhibited children who are at heightened risk for anxiety later in childhood from those who are not. The results are discussed in a framework detailing the role of attention biases in increasing the sensitivity for anxiety-related problems in children who display high levels of BI during early childhood.

Background: Children raised in institutions are at increased risk of developing internalizing and externalizing problems. However, not all children raised in institutions develop psychopathology. Deficits in error monitoring may be one risk pathway for children with a history of institutionalization given that these skills are related to both internalizing and externalizing psychiatric disorders. Error monitoring and the neural circuitry that supports it have a protracted developmental time course and are highly susceptible to the effects of adversity. As such, they may play an important moderating role between a history of institutional rearing and subsequent psychopathology., Methods: We investigated the impact of psychosocial deprivation on behavioral and neural responses (event-related potentials: ERPs) to a Flanker task assessing error monitoring and the relations between these measures and psychopathology for 12-year-old children in the Bucharest Early Intervention Project (BEIP). The BEIP involves two groups of institutionalized children randomly assigned in infancy to receive either a foster care intervention (FCG) or care as usual (CAUG)., Results: Children who experienced institutional care, particularly those in the CAUG, showed perturbed behavioral performance and ERPs on the Flanker task. Additionally, an ERP measure of error monitoring [error-related negativity (ERN)] moderated the relations between time spent in institutions and externalizing and ADHD behaviors. When the amplitude of the ERN was smaller, time spent in institutional care was positively related to ADHD and externalizing behaviors, whereas time spent in institutions was unrelated to externalizing problems when children evidenced a larger ERN. Neural correlates of error monitoring did not moderate the relations between time spent in institutionalized care and internalizing behaviors., Conclusions: Exposure to institutional care early in life may affect brain circuitry associated with error monitoring. Perturbations in this neural circuitry in combination with psychosocial deprivation are possibly a risk pathway associated with the development of externalizing and ADHD problems., Competing Interests: No conflicts declared., (© 2016 Association for Child and Adolescent Mental Health.)

Objective: Behavioral inhibition (BI) during early childhood predicts risk for anxiety disorders and altered cognitive control in adolescence. Although BI has been linked to variation in brain function through adulthood, few studies have examined relations between early childhood BI and adult brain structure., Method: The relation between early childhood BI and cortical thickness in adulthood was examined in a cohort of individuals followed since early childhood (N = 53, mean age 20.5 years). Analyses tested whether anxiety and/or cognitive control during adolescence moderated relations between BI and cortical thickness. Cognitive control was measured with the Eriksen Flanker Task. Initial analyses examined cortical thickness in regions of interest previously implicated in BI, anxiety disorders, and cognitive control: dorsal anterior cingulate (dACC), anterior insula (aI), and subgenual anterior cingulate (sgACC); and volumes of the amygdala and hippocampus. Exploratory analyses examined relations across the prefrontal cortex., Results: BI during early childhood related to thinner dACC in adulthood. Neither anxiety nor cognitive control moderated this relation. A stronger congruency effect on the Eriksen Flanker Task during adolescence independently related to thinner dACC in adulthood. Higher anxiety during adolescence related to thicker cortex in the right ventrolateral prefrontal cortex (VLPFC) in adulthood among those with low BI as children., Conclusion: Temperament in early childhood and the interaction between temperament and later anxiety relate to adult brain structure. These results are consistent with prior work associating BI and anxiety with functional brain variability in the dACC and VLPFC., (Published by Elsevier Inc.)

The error-related negativity (ERN) is an event-related potential that occurs approximately 50 ms after an erroneous response. The magnitude of the ERN is influenced by contextual factors, such as when errors are made during social evaluation. The ERN is also influenced by individual differences in anxiety, and it is elevated among anxious individuals. However, little research has examined how individual differences in anxiety interact with contextual factors to impact the ERN. Social anxiety involves fear and apprehension of social evaluation. In the present study, we explored how individual differences in social anxiety interact with social contexts to modulate the ERN. The ERN was measured in 43 young adults characterized as being either high or low in social anxiety, while they completed a flanker task in two contexts: alone and during social evaluation. The results revealed a significant interaction between social anxiety and context, such that the ERN was enhanced in a social relative to a nonsocial context only among highly socially anxious individuals. Furthermore, the degree of such enhancement significantly correlated with individual differences in social anxiety. These findings demonstrate that social anxiety is characterized by enhanced neural activity to errors in social-evaluative contexts.

Children raised in institutions experience psychosocial deprivation that can negatively impact attention skills and emotion regulation, which subsequently may influence behavioral regulation and social relationships. The current study examined visual attention biases in 8-year-old children who were part of the Bucharest Early Intervention Project (BEIP). Relations among attention biases and concurrent social outcomes were also investigated. In early childhood, 136 children abandoned at birth or shortly thereafter into institutional care were randomized to receive a high-quality foster care intervention or care-as-usual within the context of the Bucharest Early Intervention Project (BEIP). At 8 years of age, 50 care-as-usual, 55 foster care, and 52 community controls performed a behavioral dot-probe task, and indices of attention biases to threat and positive stimuli were calculated. Concurrent data on social behavior were collected. Children placed into the foster care intervention had a significant attention bias toward positive stimuli, while children who received care-as-usual had a significant bias toward threat. Children in the foster care intervention had a significantly larger positive bias when compared to the care-as-usual group. A positive bias was related to more social engagement, more prosocial behavior, less externalizing disorders, and less emotionally withdrawn behavior. The magnitude of positive bias was predicted by age of placement into foster care among children with a history of institutionalization. An attention bias towards positive stimuli was associated with reduced risk for behavioral problems amongst children who experienced early psychosocial deprivation. Research assessing attention biases in children experiencing early environmental stress may refine our understanding of the mechanisms underlying risk for later psychiatric and social disorders and inform prevention efforts., (© 2014 John Wiley & Sons Ltd.)

The goal of the present study was to investigate infants' processing of female and male faces. We used an event-related potential (ERP) priming task, as well as a visual-paired comparison (VPC) eye tracking task to explore how 7-month-old "female expert" infants differed in their responses to faces of different genders. Female faces elicited larger N290 amplitudes than male faces. Furthermore, infants showed a priming effect for female faces only, whereby the N290 was significantly more negative for novel females compared to primed female faces. The VPC experiment was designed to test whether infants could reliably discriminate between two female and two male faces. Analyses showed that infants were able to differentiate faces of both genders. The results of the present study suggest that 7-month olds with a large amount of female face experience show a processing advantage for forming a neural representation of female faces, compared to male faces. However, the enhanced neural sensitivity to the repetition of female faces is not due to the infants' inability to discriminate male faces. Instead, the combination of results from the two tasks suggests that the differential processing for female faces may be a signature of expert-level processing., (Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Early psychosocial deprivation can negatively impact the development of executive functions (EFs). Here we explore the impact of early psychosocial deprivation on behavioral and physiological measures (i.e., event-related potentials; ERPs) of two facets of EF, inhibitory control and response monitoring, and their associations with internalizing and externalizing outcomes in the Bucharest Early Intervention Project (BEIP; Zeanah et al., 2003). This project focuses on two groups of children placed in institutions shortly after birth and then randomly assigned in infancy to either a foster care intervention or to remain in their current institutional setting. A group of community controls was recruited for comparison. The current study assesses these children at 8-years of age examining the effects of early adversity, the potential effects of the intervention on EF and the role of EF skills in socio-emotional outcomes. Results reveal exposure to early psychosocial deprivation was associated with impaired inhibitory control on a flanker task. Children in the foster care intervention exhibited better response monitoring compared to children who remained in the institution on the error-related positivity (Pe). Moreover, among children in the foster care intervention those who exhibited larger error-related negativity (ERN) responses had lower levels of socio-emotional behavior problems. Overall, these data identify specific aspects of EF that contribute to adaptive and maladaptive socio-emotional outcomes among children experiencing early psychosocial deprivation.

This article is based on a presentation given at Congress 2001 in Harrogate. It focuses on the risks to perioperative team members arising from the production of smoke during electrosurgical and laser procedures. It identifies the sources and nature of the risks, the failure of masks to provide adequate protection and suggests the standards that need to be set to reduce the risks.