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A perceived ‘lack of time’ is consistently the most commonly reported barrier to exercise. However, the term fails to capture the multifaceted nature of time-related factors. Recognising the need for a more comprehensive analysis of ‘lack of time’ as a barrier to exercise, the aim of this study was to develop the exercise participation explained in relation to time (EXPERT) model. The model was developed through a sequential process including (1) an umbrella literature review of time as a barrier, determinant, and correlate of physical activity; (2) a targeted review of existing temporal models; (3) drafting the model and refining it via discussions between eight authors; (4) a three-round Delphi process with eight panel members; and (5) consultations with seven experts and potential end-users. The final EXPERT model includes 31 factors within four categories: (1) temporal needs and preferences for exercise (ie, when and how long does an individual need/want to exercise), (2) temporal autonomy for exercise (ie, autonomy in scheduling free time for exercise), (3) temporal conditions for exercise (ie, available time for exercise) and (4) temporal dimensions of exercise (ie, use of time for exercise). Definitions, examples and possible survey questions are presented for each factor. The EXPERT model provides a comprehensive framework for understanding the multi-dimensional nature of ‘time’ as it relates to exercise participation. It moves beyond the simplistic notion of 'lack of time' and delves into the complexity of time allocation in the context of exercise. Empirical and cross-cultural validations of the model are warranted.

ObjectiveTo explore whether physical activity is inversely associated with the onset of depression, we quantified the cumulative association of customary physical activity with incident depression and with an increase in subclinical depressive symptoms over time as reported from prospective observational studies.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, PsycINFO, PsycARTICLES and CINAHL Complete databases, supplemented by Google Scholar.Eligibility criteriaProspective cohort studies in adults, published prior to January 2020, reporting associations between physical activity and depression.Study appraisal and synthesisMultilevel random-effects meta-analysis was performed adjusting for study and cohort or region. Mixed-model meta-regression of putative modifiers.ResultsSearches yielded 111 reports including over 3 million adults sampled from 11 nations in five continents. Odds of incident cases of depression or an increase in subclinical depressive symptoms were reduced after exposure to physical activity (OR, 95% CI) in crude (0.69, 0.63 to 0.75; I2=93.7) and adjusted (0.79, 0.75 to 0.82; I2=87.6) analyses. Results were materially the same for incident depression and subclinical symptoms. Odds were lower after moderate or vigorous physical activity that met public health guidelines than after light physical activity. These odds were also lower when exposure to physical activity increased over time during a study period compared with the odds when physical activity was captured as a single baseline measure of exposure.ConclusionCustomary and increasing levels of moderate-to-vigorous physical activity in observational studies are inversely associated with incident depression and the onset of subclinical depressive symptoms among adults regardless of global region, gender, age or follow-up period.

Supplemental Digital Content is available in the text.Posterior malleolar fractures (PMFs) have been demonstrated to result in poorer outcomes than other types of ankle fractures with a higher incidence of posttraumatic arthritis. Accordingly, there has been a recent surge in interest in reduction and fixation of PMFs. Operative criteria for PMFs have been based on size, step-off, ankle joint instability, and syndesmotic injury, though universally accepted criteria have yet to be defined. Anatomically, the posterior malleolus is important as an insertion point of the posterior inferior tibiofibular ligament and thereby may play a role in syndesmotic stability. However, the important lateral ankle ligament complex is also important in governing stability of the talus within the ankle mortise. PMFs have been classified by the Haraguchi system based on morphology and extent. Radiographs, although always appropriate to perform as the initial diagnostic imaging study, are likely insufficient to evaluate the size and displacement; computed tomography scan is recommended for optimal evaluation for preoperative planning. When treating the posterior malleolus by a posterolateral approach, prone and lateral positioning of the patient facilitates exposure, although it can also be performed in the supine position with a large bump and with a leg that can be safely passively internally rotated sufficiently, or externally rotated if a posteromedial approach is used. Fixation can be performed with lag screw fixation alone versus buttress or standard plating techniques. Wound complications and posttraumatic arthritis are relatively common complications encountered in the treatment of PMFs.Level of Evidence:Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Complications after total ankle arthroplasty can be difficult to treat with limited viable options. Often, companies have described product revision techniques using larger components and tibial intramedullary stems to increase contact surface area while increasing stability. Revision techniques for tibial stemmed components normally call for retrograde reaming via access into the intramedullary canal of the tibia through both the talus and the calcaneus. However, this creates a challenge for the foot and ankle surgeon when the talar component is stable and does not require revision. In this study, we present a novel technique using antegrade reaming for revising a failed tibial component to a stemmed implant while maintaining the original, stable talar component. We also highlight our case study in a patient who has had this technique performed.

IMPORTANCE Creative arts therapies (CATs) can reduce anxiety, depression, pain, and fatigue and increase quality of life (QOL) in patients with cancer. However, no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients has been conducted. OBJECTIVES To estimate the effect of CAT on psychological symptoms and QOL in cancer patients during treatment and follow-up and to determine whether the effect varied according to patient, intervention, and design characteristics. EVIDENCE REVIEW We searched ERIC, Google Scholar, MEDLINE, PsycInfo, PubMed, and Web of Science from database inception to January 2012. Studies included RCTs in which cancer patients were randomized to a CAT or control condition and anxiety, depression, pain, fatigue and/or QOL were measured pre- and post-intervention. Twenty-seven studies involving 1576 patients were included. We extracted data on effect sizes, moderators, and study quality. Hedges d effect sizes were computed, and random-effects models were used to estimate sampling error and population variance. FINDINGS During treatment, CAT significantly reduced anxiety (Δ = 0.28 [95% CI, 0.11-0.44]), depression (Δ = 0.23 [0.05-0.40]), and pain (Δ = 0.54 [0.33-0.75]) and increased QOL (Δ = 0.50 [0.25-0.74]). Pain was significantly reduced during follow-up (Δ = 0.59 [95% CI, 0.42-0.77]). Anxiety reductions were strongest for studies in which (1) a non-CAT therapist administered the intervention compared with studies that used a creative arts therapist and (2) a waiting-list or usual-care comparison was used. Pain reductions were largest during inpatient treatment and for homogeneous cancer groups in outpatient settings; significantly smaller reductions occurred in heterogeneous groups in outpatient settings. CONCLUSIONS AND RELEVANCE Exposure to CAT can improve anxiety, depression, and pain symptoms and QOL among cancer patients, but this effect is reduced during follow-up.

The authors conducted a study to compare the effectiveness of two dry-field isolation techniques with that of a control technique (no isolation) in reducing spatter from a dental operative site.