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Background: Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiologic outcomes. It remains unknown whether these clinical and radiologic outcomes are maintained in the medium to long term. The aim of this study was to investigate the minimum 5-year clinical and radiologic outcomes following third-generation MIS hallux valgus surgery in the hands of a high-volume MIS surgeon. Methods: A retrospective observational single highly experienced MIS surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60-month clinical and radiographic follow-up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) preoperatively, 6 months, and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, EuroQol-5D visual analog scale and the visual analog scale for pain. Results: Between 2012 and 2014, 126 consecutive feet underwent isolated third-generation PECA, with complete data available for 78 (61.9%) feet. The median follow-up was 65.0 (IQR 64-69; range 60-88) months. There was a significant improvement in radiographic deformity correction; the median IMA improved from 12.0 degrees (interquartile range [IQR]: 10.8-14.2) to 6.0 degrees (IQR: 4.2-7.3) ( P < .001), and the median HVA improved from 27.2 degrees (IQR: 20.6-34.4) to 7.2 degrees (IQR: 3.4-11.6). Median MOXFQ Index score at ≥60-month follow-up was 2.3 (IQR: 0.0-7.8). The radiographic recurrence rate (defined as HVA >15 degrees) was 7.7% at final follow-up. The complication rate was 4.8%. Conclusion: Radiologic deformity correction for the 78 feet we were able to follow that had third-generation PECA performed by a single highly experienced MIS surgeon was found to be maintained at a mean follow-up of average 66.8 months, with a radiographic recurrence rate of 7.7%. Clinical PROMs and patient satisfaction levels were high and comparable to other third-generation studies with shorter duration of follow-up. Level of Evidence: Level IV, retrospective cohort study.

Objectives: The incidence of type 2 diabetes in UK Black African and Caribbean communities is up to three times higher than in the general population, and engagement with self-management advice is poorer. This study explores the perspective of those living with diabetes to understand how the cultural salience of advice could be improved. Design: Participants were recruited via community venues, faith institutions and primary care. Eight focus groups were conducted with 41 individuals (Black African n = 23, Black Caribbean n = 18). Grounded theory methods were used for analysis. Results: Although motivated to manage the condition, individuals experienced a misalignment between elements of the care provision and cultural norms. Explanatory models of diabetes differed from the biomedical model reducing trust in treatment protocols. A lack of cultural salience reduced the accessibility of advice. Furthermore, elements of self-management advice were seen to conflict directly with some cultural traditions and practices. Individuals had to reconcile the two perspectives in order to proceed with self-management, often prioritising cultural norms and advice from informal sources over healthcare advice. Building personal relationships with the healthcare team improved trust and engagement. Conclusion: Findings suggest the needs in these communities were not being fully met. The healthcare interaction was pivotal in improving trust and engagement and reducing misinformation. However, appropriately informed community support also offers the potential to mitigate misalignment and to improve equity of access.

Background: Coronal and sagittal plane deformities of the lesser toes are common yet challenging to treat. Traditional open releases and translational Weil osteotomies can be unpredictable and lead to postoperative stiffness. We present the results of a percutaneous closing wedge extracapsular osteotomy of the proximal phalanx to treat valgus deformity of the second toe. Methods: Thirty-one patients underwent 40 percutaneous osteotomies at a median age of 58.6±9.4 years. Using a small dorsomedial incision, a percutaneous proximal metaphyseal medial closing-wedge extracapsular osteotomy of the second toe is performed, leaving the dorsolateral cortex intact. An irrigated low-speed, high-torque 2- × 8-mm burr is used under image guidance. The osteotomy is then closed to correct deformity and taped for 2 weeks. Patient-reported outcomes and weightbearing radiographs were obtained. Results: Questionnaire data was available for 89.7% (n=35) of cases. Most cases (91.4%) were either satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies, with a median length from surgery to radiographic follow-up of 1.6 years (range 0.5-6.3; SD ±1.5). Median second-toe valgus angle (STVA) decreased from 16.2±10.7 degrees to 5.0±7.0 degrees ( P < .001) at final follow-up. All osteotomies united with no delayed union. There were no wound complications or infections. We found 2 cases of radiographic recurrence. Conclusion: Percutaneous proximal phalanx base metaphyseal closing wedge extracapsular osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first-ray corrective surgery and is associated with high levels of patient satisfaction. Level of Evidence: Level IV, retrospective case series

Objectives Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners. Methods Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients’ perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings. Results The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners required effective categorization of health care patients’ reported problem(s) and an understanding of practitioners’ capabilities. We identified individual and organizational responses that could minimize the impact on patients, practitioners and practices of imperfections in the matching process. Conclusions The processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. As practitioner employment under the Primary Care Network contracts continues to increase, it is not clear how the necessarily fine-grained adjustments will be made for practitioners working across multiple practices.

The response to the COVID-19 pandemic has amplified stress and social isolation for many children, but those children living with a diagnosis of autism spectrum disorder (ASD) have been disproportionately affected. Prior to the pandemic, children with ASD often faced social isolation due to struggles with their social communication and social development. Planning for children with ASD to return to community experiences, including school, appointments, and even recreational activities, will require an understanding of the impact of COVID-19 on the child and their family. As the child and family are working to adjust to changes like new routines, sleep patterns, and sensory issues as a result of the pandemic, the pediatric nursing community should be knowledgeable and prepared to develop creative opportunities to meet the needs of this vulnerable population.

The goal of the current case study was to illustrate evidence-based cognitive-behavioral treatment (CBT) for an adolescent female with comorbid major depressive disorder, generalized anxiety disorder, attention deficit hyperactivity disorder, suicidal ideations, and a history of multiple involuntary hospitalizations. Multimodal assessment of the child’s symptoms was conducted, including parent, teacher, and child self-report, academic data, and hospital records to inform case conceptualization. Treatment included a combination of psychoeducation, cognitive restructuring, positive self-talk, relaxation skills, and the support of a school-based personal aide. Significant improvements with inattentive, anxiety, and depressive symptoms were reported, with gains being maintained at 1 year follow-up. In addition to a reduction of reported psychosocial problems, treatment benefits also included a decrease in classroom disruptions, improvement in academic performance, and withdrawal of paraprofessional support at school. This study illustrates the use of school-based CBT strategies coupled with additional focused Tier 4 behavior supports as an efficacious treatment for youth with significant comorbidity.

Researchers have studied academic orientation—students’ valuing of and commitment to education—as in part a function of a cultural fit between students’ cultural capital, competencies, identity, and the institutional culture of the education system. Recent research on students’ aspirations and commitment highlights the moral undertones of such cultural fit. Scholars have identified the perceived moral connotations of becoming “an educated person” and illustrated how students’ academic orientation may be intertwined with the unique moral culture of the education system. Neoinstitutional scholars have examined modern education systems’ emphasis on an individualizing type of moral culture, that is, an institutional moral culture emphasizing individual autonomy, rights, and achievement over traditional mores, knowledge, and social hierarchies. Scholars have yet to bridge these streams of research by examining the link between students’ personal moral culture and the institutional moral culture of education systems. In this study, we consider whether students whose moral orientation matches the individualizing moral culture of education systems are more academically oriented. We conceptualize this link as moral fit, and we use moral foundations theory to identify students’ personal moral culture. Analysis of a unique sample of students drawn from all secondary schools in Iceland (N = 10,525) shows (1) individualizing moral intuitions (those that emphasize the individual as the basic moral unit) are associated with a greater academic orientation, net of parental involvement, cultural capital, and other important controls, and (2) this association is only lightly moderated by differences in the school structure.

Much of the research on parents of children with intellectual and developmental disabilities (IDD) has focused on the negative effects on the couple relationship. The current study contributes to the understanding of parental relationship satisfaction in a sample of parents of children with Down syndrome (DS), through a mixed methods study that included data from a large national sample. Parents of children with DS were divided into two groups based on high and low relationship satisfaction scores, with quantitative and qualitative data analyses comparing these two groups. Results indicated differences between high relationship satisfaction and low relationship satisfaction groups on measures of hope, life satisfaction, and coping scores. Qualitative results also indicated group differences. Future research and implications for professionals working with parents of children with DS and other IDD diagnoses should include understanding the unique factors that affect interpersonal functioning.

This paper develops the argument that post-COVID-19 recovery strategies need to focus on building back fairer cities and communities, and that this requires a strong embedding of ‘ age-friendly’ principles to support marginalised groups of older people, especially those living in deprived urban neighbourhoods, trapped in poor quality housing. It shows that older people living in such areas are likely to experience a ‘double lockdown’ as a result of restrictions imposed by social distancing combined with the intensification of social and spatial inequalities. This argument is presented as follows: first, the paper examines the disproportionate impact of COVID-19 on older people, highlighting how the pandemic is both creating new and reinforcing existing inequalities in ageing along the lines of gender, class, ethnicity, race, ability and sexuality. Second, the paper explores the role of spatial inequalities in the context of COVID-19, highlighting how the pandemic is having a disproportionate impact on deprived urban areas already affected by cuts to public services, the loss of social infrastructure and pressures on the voluntary sector. Finally, the paper examines how interrelated social inequalities at both the individual and spatial level are affecting the lives of older people living in deprived urban neighbourhoods during the pandemic. The paper concludes by developing six principles for ‘age-friendly’ community recovery planning aimed at maintaining and improving the quality of life and wellbeing of older residents in the post-pandemic city.

Purpose: This study compared the impact, challenges, and benefits of the Circle of Security-Parenting (COS-P) intervention across two delivery modes: group center-based (GCCOS-P) and individual home-based (IHCOS-P). Methods: This mixed-methods study compared the impact of the COS-P on parental reflective functioning and parental stress across two delivery modes: GCCOS-P ( n = 7) and IHCOS-P ( n = 7). It compared the challenges and benefits of each, from the qualitative perspectives of participants ( n = 2 IHCOS-P; n = 3 GCCOS-P) and facilitators ( n = 4). Results: Quantitative statistical analysis comparing pre- and postintervention measures suggest that each delivery mode was equally effective in reducing parental stress and generally noneffective with respect to parental reflective functioning. Challenges and benefits of each mode, inherent in the peer/shared learning environment of the GCOS-P and the individualized, flexible delivery of the IHCOS-P, were identified. Discussion: This study adds to knowledge about the widely utilized COS-P, highlighting challenges and benefits of two modes of delivery.

Background: There are many options for incision closure in forefoot surgery. The aim of this study was to compare topical skin adhesive (2-octyl-cyanoacrylate) to simple interrupted nylon sutures. Methods: A prospective randomized controlled trial comparing topical skin adhesive (TSA) and nylon sutures (NSs) for elective open forefoot surgery. Primary outcome was Hollander Wound Evaluation Scale (HWES) assessed 2 weeks following surgery. Secondary objectives included time taken for wound closure, wound assessment, patient satisfaction with wound cosmesis, incision pain, and infection rate. Results: Between January and December 2018, 84 feet (70 patients) underwent hallux valgus scarf/Akin osteotomy or first metatarsophalangeal arthrodesis and were randomized to receive either intervention (topical skin adhesive) or control (3/0 nylon sutures). We found worse HWES scores when using TSA compared to NSs (1.07 vs 0.60). Incision closure time was slower for TSA (mean, 272 vs 229 seconds). At 2 weeks postoperatively, wound care was faster for TSA (mean 71 secs) vs NSs (mean 120), and patient-reported pain was less with TSA (visual analog scale: TSA 1.2 vs NSs 2.1). A high degree of overall patient satisfaction was reported in both groups, without significant difference. Conclusion: Closure of elective forefoot surgery incisions with topical skin adhesive or interrupted nylon sutures offers high satisfaction rates, low pain scores, and low complications. However, topical skin adhesive was associated with more inflammation and areas of wound separation compared to nylon sutures. We recommend the use of sutures for wound closure in forefoot surgery. Level of Evidence: Level I, randomized controlled trial.

Previous research has noted the transformation of the American parties since the 1970s, as exhibited in their increased ideological polarization and transformation on social issues like civil rights, abortion, and the environment. We contribute to the literature on party change by theoretically stressing the decentralized and individualistic nature of American parties, while using a measure of party change that is based on legislative behavior beyond roll call voting. Our paper uses social network analysis to analyze the parties from the 93rd to 110th Congresses, utilizing bill cosponsorship to define connections between members. Our analysis illustrates how the core of the party, that is, who are most central in the cosponsorship network, has changed over time. We find evidence that party centrality influenced retirement decisions, thereby reinforcing and contributing to party change.

Using measurement-based and feedback-informed approaches is key to providing effective family-centered clinical care; a strength-based approach is shown to improve treatment outcomes and satisfaction. Yet, there are few brief, psychometrically sound assessment tools for preschool-age and elementary school–age children. In response, we developed a nine-item, two-scale measure, the Weekly Assessment of Child Behavior–Positive (WACB-P), suitable for children ages 2 to 12 years. We examined the psychometric properties of the WACB-P based on two low-income clinical samples differing in intervention modality and location (Sample 1: N = 285; Sample 2: N = 137). WACB-P demonstrated high internal validity and test–retest reliability. The item response theory (IRT) paradigm applied to the Intensity Scale revealed that the items showed moderate discrimination and adequate precision, particularly effectively capturing behavioral challenges. Repeated-measures analysis of covariance (RM-ANCOVA) showed significant linear effects from session to session, suggesting sensitivity to change during treatment. WACB-P demonstrated strong convergent validity with established measures of child behavior problems. These favorable results position the WACB-P as a suitable choice for agencies providing measurement-based behavioral health care for young children and their families.

Long-term individual recovery from a catastrophic event involves the restoration of critical lifelines such as housing and employment as well as social and emotional well-being, particularly for displaced and highly traumatized populations. One strategy for measuring recovery over time involves a longitudinal observational cohort. This analysis examines the cost and effort involved in developing and maintaining a longitudinal cohort. The Gulf Coast Child and Family Health Study recruited 1,079 randomly sampled individuals in Louisiana and Mississippi within months after Hurricane Katrina and followed them for 13 years. Participants in the study were interviewed in person five times over the study period. Despite the challenges involved in maintaining a transient and economically vulnerable study cohort, 80.4 percent of all eligible participants were surveyed at the fifth time point, over a decade after the event. At each round of data collection, the refusal rate ranged from less than 1 percent to 3.3 percent. Reasons for non-participation included institutional inaccessibility for those who were incarcerated, in treatment programs, or in nursing homes. Physical and mental health issues which precluded participation included cognitive decline and significant loss of function. Other participants were lost to follow-up or death. At the final round of face-to-face interviewing in 2018, the average field cost per survey was $353.27, not including a respondent incentive of $50, and required an average of 15.74 hours per case to complete. This report describes the strategies employed to maintain such a long-term disaster cohort.

Care coordination is central to health care delivery system reform efforts to control costs, improve quality, and enhance patient outcomes, especially for individuals with complex medical and social needs. The potential impact of addressing health-related social needs further illustrates the importance of coordinating health care services with community-based organizations that provide social services and support. This study offers early findings from a unique approach to care coordination delivered by 17 Medicaid Accountable Care Organizations and 27 partnering community-based organizations for individuals with behavioral health conditions and/or those needing long-term services and supports. Interview data from 54 key informants were qualitatively analyzed to understand factors affecting cross-sector integrated care. Key themes emerged, essential to implementing the new model statewide: clarifying roles and responsibilities; promoting communication; facilitating information exchange; developing workforce capacity; building essential relationships; and responsive, supportive program management through real-time feedback, financial incentives, technical assistance, and flexibility from the state Medicaid program.

We evaluated glycaemic status in 948 Black adults with HIV and report a high prevalence of dysglycaemia (37.2%). HbA1c testing identified 38 (4.0%) individuals not previously known to have diabetes mellitus (DM) and showed suboptimal or poor glycaemic control in more than half of those with a prior DM diagnosis despite high levels of HIV control.

Recent research in the United States has argued that the threat of confirming the “racist cop” stereotype may paradoxically increase the propensity for coercive policing by depressing officers’ self-legitimacy. The current study aimed to assess the influence of the threat of the “racist cop” stereotype on officers’ self-legitimacy and their attitudes toward force in an Australian policing jurisdiction. An online survey was completed by 306 frontline officers in Queensland, Australia. Structural equation modeling was used to assess the influence of stereotype threat on officers’ attitudes toward force, and the extent to which this is mediated by perceptions of self-legitimacy. The findings confirmed previous findings, with increased officer perceptions of stereotype threat associated with increased support for coercive policing, mediated by reduced self-legitimacy. The findings are discussed with reference to how the validity and salience of the “racist cop” stereotype can be diminished.

Students placed in special education programs for emotional and behavioral disorders with emotional disturbance (ED) identification have academic outcomes that lag both students in regular and special education. This issue is especially important for youth attending urban schools. Although prior research has examined students identified as ED, little research has examined how students who experience de-identification fare with regard to academic or behavioral outcomes. To our knowledge, this is the first study to examine the relationship between ED de-identification and student outcomes in the United States. The study uses longitudinal, administrative data to estimate the relationship between special education de-identification from ED and both academic and school discipline outcomes. Results of regression models with a variety of fixed effects, including student fixed effects, suggest that students who are de-identified have higher academic achievement after de-identification and a lower probability of experiencing an in-school suspension (ISS). Results for out-of-school suspension (OSS) are mixed. The results suggest that appropriately timed exit from special education services for students with ED who have been determined by individualized education program (IEP) teams to be suitable for de-identification is unlikely to harm students academically but that extra attention to OSS may be needed. The results point to the need for more attention to de-identification.

Burnout syndrome results from unmanaged chronic workplace stress. It is characterized by emotional exhaustion, lack of a sense of personal accomplishment, and depersonalization. Burnout is associated with the development of poor work-related outcomes, mental health disorders, substance abuse, and cardiovascular disease. Burnout in physicians and other health care providers can negatively affect patient care. The prevalence of burnout in anesthesiology is among the highest of all medical specialties, with rates approaching 40%. Unique risk factors for the development of burnout in anesthesiologists may include environmental social isolation, long work hours, lack of control over one’s career, and the presence of certain personality traits that select for a career in anesthesia. System-based interventions targeting workplace contributions to burnout and individual resilience and mindfulness training can be helpful in reducing burnout symptoms. Future research efforts examining both the health care environmental structure and the specific burnout risk factors for anesthesiologists will help produce targeted treatment strategies for members of the anesthesiology community.

Despite an increase in research relating to racial disparities in policing—particularly in the area of deadly force—there have been comparatively few attempts to theorize which factors predict disparate policing. We fill this gap by combining routine activity theory from criminology with situationist approaches to discrimination from social psychology. We propose that disparate policing is most likely to occur when officers who are vulnerable to situational risk factors for bias encounter citizens who are members of vulnerable out-groups. We argue that situational risk factors for bias and aggression among police provoke feelings of threat and motivate self-protection and/or feelings of disgust and out-group derogation. We present social psychological laboratory research and, where available, field research specific to policing as a way of exploring and bolstering the proposed framework. This work supports an agenda for future scientific research that may assist practitioners in identifying likely opportunities for reform even as we await further field research that tests these hypothesized parameters.

Controversy exists over the use of electrocardiograms (ECGs) in sports pre-participation screening. We performed a meta-analysis comparing the effectiveness of history and physical examination (H&P) with ECG at detecting both cardiac disease and sudden cardiac death–associated conditions (SCD-AC). Pre-participation studies published from 2015 to 2020 with athletes 10 to 35 years old were included. This yielded 28 011 athletes screened and 124 cardiac diagnoses, 103 of which were SCD-AC. A meta-analysis of log odds ratios (ORs) was conducted using a random-effects model. The ORs for the association between H&P and detecting both cardiac disease and SCD-AC were not statistically significant (OR = 3.4, P = .076; OR = 2.9, P = .078). The ORs for the association between ECG and detecting both cardiac disease and SCD-AC were statistically significant (60, P < .001; 148, P < .0001). In conclusion, the odds of detecting both cardiac disease and conditions related to SCD with ECG are greater than with H&P during sports pre-participation screening.

Kaposi sarcoma is a malignant neoplasm arising from the endothelial cell lining of blood and lymphatic vessels. Herein, we discuss etiopathogenesis, clinical presentation, diagnostic criteria, updated guideline-based approach to its management and newer experimental approaches. Given its efficacy and side effect profile, pegylated doxorubicin is the currently preferred first-line therapy in advanced disease. Paclitaxel remains an alternative first-line option. At the time of relapse, patients can be retreated with the same agents as they often maintain their clinical efficacy. New therapeutic options are on the rise, with pomalidomide being approved in 2020 as a second-line therapy. Optimal control of retroviral infection in human immunodeficiency virus (HIV) positive is instrumental in preventing disease occurrence in most patients. Suppressing human herpes virus type 8 (HHV-8) infection might also play a role in controlling Kaposi sarcoma growth, yet clinical trials are lacking. Unraveling the molecular and genetic intricacies of Kaposi sarcoma's pathogenesis might allow for the emergence of novel and effective therapeutic strategies. Clinical trials are currently underway to establish potential roles for various targeted agents, immune checkpoint inhibitors (ICIs) and experimental agents in the treatment of advanced Kaposi sarcoma.