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Many studies have begun investigating possible transportation landscapes in the autonomous vehicle (AV) era, but empirical results on longer-term decisions are limited. We address this gap using data collected from a survey designed and implemented for Georgia residents in 2017–2018. Focusing on a hypothetical all-AV future, this section of the survey included questions regarding advantages/disadvantages of AVs, short-term mode choice impacts, medium-term impacts on activity patterns, and long-term behavioral changes – specifically, whether/how AVs will influence individuals to change residential location and the number of cars in the household. We hypothesize that AVs could act in concert with attitudinal preferences to stimulate changes in these long-term decisions, and that some medium-term activity changes triggered by AVs could motivate people to relocate their residence or shed household vehicles. We applied exploratory factor analysis to measure the perceived likelihood that AVs would prompt various medium-term changes. We then included some of those measures, among other variables, in a cross-nested logit (CNL) model of the choice of the residential location/vehicle ownership bundle. Although more than half of respondents expected “no change” in their bundle, we found that younger, lower income, pro-suburban, and pro-non-car-mode individuals were more likely to anticipate changing their selections. In addition, some expected medium-term impacts of AVs influenced changes in these longer-term choices. We further applied the CNL model to two population segments (Atlanta and non-Atlanta-region residents). We found notable improvement in goodness of fit and different effects of factors across segments, signifying the existence of geography-related taste heterogeneity.

Many studies have explored travelers’ perceptions of self-driving cars (or autonomous vehicles, AVs) and their potential impacts. However, medium-term modifications in activity patterns (such as increasing trip frequencies and changing destinations) have been less explored. Using 2017–2018 survey data collected in the US state of Georgia, this paper (1) measures (at a general level) how people expect their activity patterns to change in a hypothetical all-AV era; (2) identifies population segments having similar profiles of expected changes; and (3) further profiles each segment on the basis of attitudinal, sociodemographic, and geographic characteristics. In the survey, respondents were asked to express their expectations regarding 16 potential activity modifications induced by AVs. We first conducted an exploratory factor analysis (EFA) to reduce the dimensionality of the activity-change vector characterizing each individual, and estimated non-mean-centered (NMC) factor scores (which have been rarely used in applied psychology). The EFA solution identified four dimensions of activity change: distance, time flexibility, frequency, and long distance/leisure. Next, we clustered Georgians with respect to these four-dimensional expectation vectors. The cluster solution uncovered six segments: no change, change unlikely, more leisure/long distance, longer trips, more travel, and time flexibility & more leisure/long distance. Using NMC factor scores identified considerably more inertia with respect to expectations for change than would have been apparent from the usual mean-centered scores. Finally, the various segments exhibit distinctive demographics and general attitudes. For example, those in the more leisure/long distance cluster tend to be higher income and are more likely to be Atlanta-region residents compared to other clusters, while those in the no change and change unlikely clusters tend to be older and are more likely to be rural residents.

This study offers an early glimpse of how individuals perceive the advantages/disadvantages of AVs, their mode-use intentions, and potential market segments with respect to mode use, should AVs eventually become the only way to travel by car. To do so, we implemented a statewide survey of Georgia residents (N = 2890) and using that data, we applied factor analyses to two blocks of AV-related statements. The first block measured 12 perceptions of AVs, and yielded two psychological constructs: AV pros (advantages/ benefits) and AV overuse cons (negative outcomes specifically associated with the excessive use of AVs). The second block of statements measured respondents’ inclinations between AV and non-AV options for 12 hypothetical transportation “needs”, and factor analysis identified four mode-use propensity constructs: AV(-inclined) over walk/bike, AV over flight, zero-occupant AV over occupied AV, and AV over transit. The main goal of the paper was to segment the sample on the basis of these four mode-use propensities, to identify clusters with similar propensity profiles or response vectors. We applied latent class cluster analysis to do so, and identified seven potential market segments: some preferring AV options in general, others preferring non-AV options or having unique propensity patterns based on certain contexts (e.g. long distance travel and vehicle occupancy). In the model, socio-demographics, geography, attitudes, and perceptions of AVs help characterize those market segments, and this provides a basis for deeper interpretation and consideration of policy implications.

Background: During the modified Broström procedure for chronic ankle instability, surgeons often experience cases with insufficiently restored mechanical stability even after anatomical ligament repair. In these cases, longer postoperative immobilization and delayed rehabilitation can be required, and a risk for recurrence of instability may persist. This study aimed to evaluate the clinical usefulness of suture-tape augmentation based on intraoperative stress radiographs during anatomical ligament repair for chronic ankle instability. Methods: Twenty-four patients who underwent additional suture-tape reinforcement because of residual mechanical instability on intraoperative stress radiographs were followed up ≥3 years. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Changes in mechanical stability were analyzed through periodic stress radiographs, and postural control ability was evaluated with the modified Romberg test. Results: FAOS and FAAM scores improved significantly from preoperative mean 55.1 and 52.4 points to 92.3 and 90.2 points at final follow-up, respectively (P <.001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean 15.8 degrees and 13.6 mm to 2.9 degrees and 4.2 mm, respectively (P <.001). Balance retention time improved significantly from preoperative mean 3.6 to 6.4 seconds (P <.001). Although 9 patients experienced sprain injury after surgery, no patient showed recurrence of mechanical and subjective instability, and 21 patients (87.5%) were able to return to preinjury level of sports activity. Conclusion: Evaluation of residual mechanical instability through intraoperative stress view and additional suture-tape augmentation showed satisfactory clinical outcomes at midterm follow-up. Suture-tape augmentation based on intraoperative stress radiographs seems to be a useful surgical option for patients with insufficiently restored mechanical stability even after anatomical ligament repair. This combined procedure can provide a reliable mechanical stability that can be performed after recognition of residual instability during the index surgery. [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection is an effective procedure for treating non‐invasive colorectal tumors. However, in cases of severe fibrosis, endoscopic submucosal dissection may be technically difficult, leading to incomplete resection. Here, we describe the case of a 74‐year‐old man who had early rectal cancer along with severe submucosal fibrosis caused by prior local excision. Combination treatment with endoscopic submucosal dissection and transanal minimally invasive surgery successfully enabled complete resection. [ABSTRACT FROM AUTHOR]

Background: Autologous osteochondral transplantation (AOT) is an option to treat large osteochondral lesions of the talus (OLTs), accompanying subchondral cyst, and previous unsuccessful bone marrow stimulation (BMS) procedures. Although there is extensive literature on the outcomes of surgical interventions for medial osteochondral lesions, research focusing on lateral lesions remains limited. This article presents the intermediate-term clinical and radiologic outcomes following AOT for lateral OLTs., Methods: Twenty-eight patients with lateral OLTs were followed up for a minimum of 3 years after AOT. Clinical evaluations included the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessments evaluated articular surface (subchondral plate) irregularity, progression of degenerative arthritis, and changes in talar tilt and anterior talar translation. The quality of osteochondral graft was evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score., Results: The average FAOS and FAAM scores significantly increased from 39.6 to 91.2 and from 37.8 to 89.8 points, respectively, at the final follow-up ( P  < .001). Radiologic assessments revealed 2 patients (7.1%) with articular step-off ≥2 mm and 1 patient (3.6%) with progressive arthritis. The average MOCART score reached 92.8 points. Postoperative complications included 2 patients with wound problems, 1 with a superficial peroneal nerve injury, and 1 with donor site morbidity. The rate of return to preinjury level of sports activity was 82.1%. At a mean follow-up of 68.5 months, no patient required reoperation for OLT or recurrent ankle instability., Conclusion: AOT for lateral OLTs demonstrated favorable intermediate-term clinical and radiologic outcomes. Most lateral OLTs were accessible via lateral ankle ligament division and capsulotomy, with minimal occurrence of iatrogenic complications such as recurrent ankle instability. AOT appears to be an effective surgical option for patients with large lateral osteochondral lesions unresponsive to conservative treatment, large subchondral cysts, and prior unsuccessful BMS procedures., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Disclosure forms for all authors are available online.

Objectives: The study aimed to evaluate the efficacy of a continuous closed irrigation system (CCIS) after open debridement for patients with intractable septic ankle arthritis., Patients and Methods: The retrospective study analyzed the intractable septic arthritis of 12 (6 males, 6 females; mean age: 64.1±14.7 years; range, 33 to 80 years) patients managed by CCIS between July 2015 and July 2020. All patients had previously undergone operations to treat septic ankle arthritis without resolution of the infection. After open debridement, the CCIS was usually equipped with two outflow tubes and one inflow tube. Saline inflow was about 1 L per day., Results: The mean follow-up period was 30.8±14.9 (range, 15 to 70) months. The CCIS was maintained for a mean of 5.1±2.1 (range, 3 to 7) days. The mean number of operations the patients had previously undergone was 2.83±1.5 (range, 1 to 6). For 11 (91.6%) out of 12 patients, infection did not recur after one-time CCIS, and laboratory test results remained normal. Six patients had previously undergone total ankle replacement arthroplasty. These patients underwent antibiotics-mixed cement arthroplasty after CCIS. For five of six with infected total ankle replacement arthroplasty, infection did not recur after CCIS. However, one patient without the removal of both implants experienced recurrence at the same site after four postoperative months. In the reoperation, after the removal of both implants and the application of antibiotics-mixed cement arthroplasty, the infection was cleared., Conclusion: Use of CCIS after open debridement for intractable septic ankle arthritis is a good treatment option since it is relatively simple and safe, with good results.