Probability of Occult Ankle Fracture Based on Radiograph-Measured Swelling.

INTRODUCTION: Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probability of an occult fracture using radiographic soft-tissue swelling on initial ED radiographs. METHODS: This is a retrospective study at a Level 1 pediatric trauma center from 2021 to 22. Soft-tissue swelling between the lateral malleolus and skin was measured on radiographs, and weight-bearing status was documented. Statistical analysis was conducted using Stata software. DISCUSSION: The study period involved 32 patients with an occult fracture, with 8 (25%) diagnosed with a fracture on follow-up radiographs. The probability of an occult fracture was calculated as a function of the ankle swelling in millimeters (mm) using a computer-generated predictive model. False-negative and false-positive rates were plotted as a function of the degree of ankle swelling. CONCLUSION: Magnitude of ankle soft-tissue swelling as measured on initial ED radiographs is predictive of an occult fracture. Although weight-bearing status was not a sign of occult fracture, it improves the predictive accuracy of soft-tissue swelling.

Predictors of non-offending caregiver support in cases of child sexual abuse.

BACKGROUND: In cases of child sexual abuse (CSA), a supportive non-offending caregiver (NOC) is important for the child's overall well-being and adjustment. NOC support is also predictive of CSA cases moving forward to prosecution. Limited research has studied CSA case factors in relation to NOC supportive behaviors across numerous support dimensions. OBJECTIVE: We investigated what case details predicted four different dimensions of caregiver support. PARTICIPANTS AND SETTINGS: In this secondary analysis, a sample of 500 CSA cases from four prosecutors' offices in one New England state from 2009 to 2013 were randomly selected and reviewed. METHOD: This study used regression analysis to test 13 case characteristics (e.g., disclosure of abuse, NOC's relationship to perpetrator) as predictors of NOC support dimensions: belief of victim, support of prosecution, protection of victim, and whether a child protective services neglect report was filed against the caregiver. RESULTS: When the perpetrator was their romantic partner, the NOC was less likely to protect and believe the child victim, yet more likely to support prosecution. NOCs were more likely to demonstrate belief when the child disclosed to them first. CONCLUSION: Our findings reveal the importance of the key case factors that are predictive of NOC support. This is the first study to examine these many case factors in relation to these four dimensions of support. Knowledge of these predictors can play an important role in better understanding the complexity of NOC support predictors and facilitating interventions designed to enhance such support.

Discernment of Children's True and False Memory Reports: Police Officers and Laypersons.

Adults' ability to accurately evaluate children's statements can have far-reaching consequences within the legal system. This study examined the evaluations of police officers ("experts") and laypersons ("nonexperts") when presented with videotaped interviews of children aged 3 and 5 years who provided either true or false reports or denials. Participants were drawn from several counties in the eastern United States. Children's interview statements fell within four statement types: accurate reports, false reports, accurate denials, and false denials. Both groups of participants displayed overbelief in false denials. Several control variables predicted accuracy, including children's age and children's race. A significant interaction emerged: Experts (vs. nonexperts) had greater odds of being accurate when judging false reports (vs. false denials). These findings highlight the challenges adults face when distinguishing between various types of children's statements. The results have important implications for legal contexts, emphasizing that fact finders need to be mindful of the risks associated with both overaccepting false denials and accepting false reports.

Compassion Fatigue and Family Caregivers Caring in End-Stage Heart Failure.

Background: Compassion fatigue is a negative consequence impacting caregivers of chronic illness, such as heart failure. Reliance on family caregivers is expected to rise, placing importance on recognizing family caregiver characteristics that contribute to compassion fatigue. Purpose: This study specifically examined the associations of characteristics of family caregivers caring for end-stage heart failure, compassion satisfaction, social desirability, and the family caregiver-nursing provider relationship on compassion fatigue. Methods: An adapted interaction model of client health behavior guided this cross-sectional survey, which comprised a demographic questionnaire, the Professional Quality-of-Life Scale, the caregiver-provider relationship assessment, the Marlowe-Crowne Social Desirability Scale Short Form (Form C), and the Bakas Caregiving Outcomes Scale. Results: There were 127 family caregivers (FCGs), primarily those who have been a caregiver for longer than 1 year (78.4%), who completed the entire survey. Increased compassion satisfaction and positive caregiving effects were associated with decreased compassion fatigue (p < .001), while increased social desirability was associated with increased compassion fatigue (p < .001). A positive family caregiver-nursing provider relationship was related to decreased compassion fatigue (p < .001). More compassion fatigue was seen with lower spiritual status (p < .001). Implications: The chronic progression of heart failure presents opportunities for nursing providers to assess caregivers and offer frequent interventions. Family caregivers may not ask for help. Nursing providers must foster relationships with family caregivers to prevent negative consequences and mitigate compassion fatigue. Future research on the nursing provider relationship and FCGs is needed.

Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses.

Subjective stress severity appraisals have consistently emerged as better predictors of poor health than stressor exposure, but the reason for this is unclear. Subjective stress may better predict poor health for one of at least two reasons. First, because stressor exposure measures consider all stressors as equal, stress severity measures-which "weight" stressors by self-reported severity-might better predict poor health simply by not treating all stressors as being equally impactful. Second, subjective stress appraisals may index important individual differences in stress vulnerability. We tested these two possibilities in this preregistered, two-study manuscript. Across these two different studies, subjective stress severity was a better predictor of poor health than independently weighted stress severity or stressor exposure. These results demonstrate that, beyond weighting of stressful experiences, subjective stress severity indexes health-relevant individual differences. Moreover, the results suggest that subjective stress severity may be the preferred stress summary metric even when derived from imprecise stress assessment instruments.

Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis.

BACKGROUND: Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few have compared biomechanics in runners with TSF to controls. The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls. METHODS: Electronic databases PubMed, Web of Science, SPORTDiscus, Scopus, Cochrane, and CINAHL were searched. Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies. RESULTS: The search retrieved 359 unique records, but only the 14 that compared runners with TSF to controls were included in the review. Most studies were retrospective, 2 were prospective, and most had a small sample size (5-30 per group). Many variables were not significantly different between groups. Meta-analysis of peak impact, active, and braking ground reaction forces found no significant differences between groups. Individual studies found larger tibial peak anterior tensile stress, peak posterior compressive stress, peak axial acceleration, peak rearfoot eversion, and hip adduction in the TSF group. CONCLUSION: Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls. In individual included studies, many biomechanical variables were not statistically significantly different between groups. However, many were reported by only a single study, and sample sizes were small. We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings.

The Impact of COVID-19 on Family Caregivers of Individuals With End-Stage Heart Failure.

Before the COVID-19 pandemic, family caregivers were providing a tremendous amount of care for family members with heart failure with the prevalence of caregiver reliance in heart failure expected to increase in the United States. Social distancing and other restrictions during the COVID-19 pandemic may have added further challenges to caregiving routines. The purpose of this study was to examine the family caregiver perception of the effect of COVID-19 on caregiving routines. To determine caregiver perception of COVID-19's impact, 1 Likert question and 1 open-ended response were asked. Braun and Clark's method guided open-ended response thematic analysis. The 113 replies to the open-response question yielded themes such as social isolation, added fear, anxiety, or worry, changed appointments, wearing masks, and living status change. Social isolation (41.6%) was the most common theme; the most significant theme was living status change ( P = .003), and family caregivers reported that the pandemic affected their routines either negatively or somewhat negatively (62.1%). Family caregivers are affected during times of crisis. Research and policies that recognize the residual effects of COVID-19 on caregiving practices and support care transitions for family caregivers in the heart failure population are needed.

Identifying Obstetric Mistreatment Experiences in U.S. Birth Narratives: Application of Internationally Informed Mistreatment Typologies.

BACKGROUND: Traumatic births are those resulting in feelings of distress that persist after the birth experience. Health care providers may play a role in these experiences through various forms of mistreatment. Analyses of global birth experiences have generated several domains of mistreatment. This study applies these evidence-based domains of mistreatment as an a priori coding scheme for analysis of 96 oral narratives of U.S.-based births to describe the nature of perceived mistreatment using participants' own descriptions of experiences. METHOD: Ninety-six transcripts of oral birth stories from 61 participants were coded using the domains of mistreatment experiences described by the Bohren et al.'s (2015) systematic review of obstetric mistreatment. RESULTS: N = 131 individual experiences of perceived obstetric mistreatment were identified in 41 out of 96 narratives (42.7%). The most frequent types of experiences were Poor Rapport (90 incidences) and Failure to Meet Professional Standards of Care (29). CLINICAL IMPLICATIONS: Although most women in our study did not perceive any instances of obstetric mistreatment during their childbirth, over 40% of participants noted at least one event that fit one of the typologies we used as a framework for analysis. Visibility and review of the types of perceived mistreatment experiences that occur during birth enables health system leaders to implement prevention and accountability strategies. Most instances of perceived mistreatment during birth may be prevented through intentional implementation of individualized, respectful, supportive care during labor and birth.

Dispelling a Myth: Reevaluating the Predictive Validity of Rape Myth Acceptance for Likelihood of Engaging in Sexual Violence.

Sexual violence prevention on college campuses has received significant recent attention. A prevalent intervention paradigm has centered around re-educating young people around consent and reduce endorsement of "rape myths," based on the correlation between rape myths and sexual violence incidents. Yet many of these programs have not measurably reduced sexual assaults. We evaluated the predictive value of a rape myth measure, as compared with other predictors (criminal history, childhood victimization, aggressive tendencies, substance use, and empathy), in predicting self-reported acts of forcible and incapacitated sexual assault in college-age men (N = 304) from 45 U.S. states. Across three logistic regression model pairs, rape myths were weakly associated with violence when considered as sole predictors. However, this predictive power dissipated when other predictors were included. Comprehensive models accounted significantly better for variability in outcomes; with criminal history demonstrating consistent predictive effects. Based on these findings, we recommend further research into prevention programming based on other predictors of violence.

Avoidant authority: The effect of organizational power on decision-making in high-uncertainty situations.

Individuals in positions of power are often required to make high-stakes decisions. The approach-inhibition theory of social power holds that elevated power activates approach-related tendencies, leading to decisiveness and action orientation. However, naturalistic decision-making research has often reported that increased power often has the opposite effect and causes more avoidant decision-making. To investigate the potential activation of avoidance-related tendencies in response to elevated power, this study employed an immersive scenario-based battery of least-worst decisions (the Least-Worst Uncertain Choice Inventory for Emergency Responses; LUCIFER) with members of the United States Armed Forces. In line with previous naturalistic decision-making research on the effect of power, this research found that in conditions of higher power, individuals found decisions more difficult and were more likely to make an avoidant choice. Furthermore, this effect was more pronounced in domain-specific decisions for which the individual had experience. These findings expand our understanding of when, and in what contexts, power leads to approach vs. avoidant tendencies, as well as demonstrate the benefits of bridging methodological divides that exist between "in the lab" and "in the field" when studying high-uncertainty decision-making.

The Impact of Cast Immobilization on Return to Daycare.

BACKGROUND: Children who are prohibited from returning to daycare (RTD) after treatment with cast immobilization place an increased burden on parents and caregivers. The purpose of this study was to assess the impact of cast immobilization on RTD. Specifically, we sought to determine the prevalence of RTD after orthopaedic immobilization based on daycare facility policy. METHODS: This was a survey study of randomly selected daycare facilities servicing a total of 6662 children within 10 miles of a major metropolitan city center. The 40-question survey included information on daycare policies and experience caring for children treated with orthopaedic immobilization. The survey also included questions about daycare type, enrollment, and geographic location. Photographs of the types of immobilization were embedded in the survey to facilitate understanding. Daycare facilities were randomly selected based on a power analysis to estimate a 50% prevalence of RTD after spica casting within 10% margin of error. RESULTS: Seventy-three daycare facilities completed the survey study. The average child-staff ratio was 5:1 and most daycare facilities (78%) did not have a nurse on staff. Predetermined policies regarding RTD after injury were available at 81% of daycares. Twenty-eight (38.5%) facilities had encountered a child with a cast in the previous year. The rate of RTD for children with upper limb injuries was 90.5% compared with 79% for lower limb injuries (P=0.003). Spica casts showed the lowest RTD rate: single leg (22.5%), 1 and a half leg (18%), and 2 leg (16%) (P<0.0001). Experienced daycare facilities (>5 y) had a higher RTD rate compared with less experienced facilities (P=0.026). CONCLUSIONS: The ability to RTD is dependent on immobilization type. Children with long leg and spica casts are disproportionately restricted when compared with other cast types. At minimum, surgeons should consider the socioeconomic implications of orthopaedic immobilization. There is also a need for orthopaedic involvement in policy formation at the local level to provide standardized guidelines for re-entry into childcare facilities following orthopaedic immobilization. LEVEL OF EVIDENCE: Level IV.

Intraoperative Burden of Flexible Intramedullary Nailing and Spica Casting for Femur Fractures in Young Children.

BACKGROUND: Spica casting (Spica) remains the widely accepted treatment of closed femoral shaft fractures in young children aged 6 months to 5 years. In some centers, there has been a recent trend towards surgical fixation of these fractures with flexible intramedullary nails (FINs). Despite numerous studies evaluating both Spica and FIN treatment of femoral shaft fractures, there remains a paucity of data regarding patient burden during the intraoperative period. The purpose of this study was to compare the intraoperative burden, defined as anesthetic exposure, fluoroscopic duration, and radiation load, between Spica and FIN treatment of femoral shaft fractures in young children. METHODS: A retrospective chart review was conducted for pediatric femoral shaft fractures presenting to a tertiary pediatric referral hospital from 2012 to 2017. Comparison groups included pediatric femur fractures treated with Spica and those treated with FIN. Outcomes included anesthetic exposure, fluoroscopy duration, and radiation exposure. In addition, length of stay, clinic visits, and complications were recorded. RESULTS: Of 449 consecutive pediatric femur fractures treated at our center, 143 patients ages 2 to 6 years (mean age 3.8±1.4 y) met inclusion criteria. The Spica group contained 91 patients; FIN contained 52 patients. Mean anesthetic exposure was less for Spica compared with FIN [45.1 min, 95% confidence interval (CI): 38.0-52.3 vs. 90.7 min, 95% CI: 80.5-100.8 min; P<0.001]. On average, Spica procedures required less fluoroscopy time compared with FIN (15.4 s, 95% CI: 4.8-26.0 vs. 131.6 s, 95% CI: 117.6-145.6 s; P<0.001). Mean radiation load was less for Spica compared with FIN (1.6 mGy, 95% CI: 0.6-2.6 vs. 6.9 mGy, 95% CI: 5.7-8.1 mGy; P<0.001). There was no difference in length of hospital stay (P=0.831), follow-up visits (P=0.248), or complication rate (P=0.645) between Spica and FIN groups. The most common complication was skin irritation for Spica (18.7%) and symptomatic hardware for FIN (17.3%). CONCLUSIONS: The findings of this study suggest that pediatric patients with femoral shaft fractures experience an increased intraoperative burden when treated with FIN compared with Spica. Treatment with FIN was associated with increased exposure to anesthesia, fluoroscopic duration, and radiation load despite similar complication rates when compared with Spica. LEVEL OF EVIDENCE: Level III.

Comparison of Short-leg and Long-leg Casts for the Treatment of Distal Third Tibial Shaft Fractures in Children.

BACKGROUND: Long-leg casts (LLCs) are an established treatment for pediatric tibial shaft fractures including fractures involving the distal third. There is a paucity of literature assessing the use of short-leg cast (SLC) for tibial shaft fractures. The purpose of this study was to determine if SLC were as effective as LLC for the treatment of pediatric distal third tibial shaft fractures. METHODS: A retrospective review was conducted on consecutive distal third tibial shaft fractures treated at a tertiary pediatric hospital from 2013 to 2018. Exclusion criteria included midshaft and proximal fractures of the tibia, distal fractures that violated the tibial physis or plafond, and pathologic fractures. We compared primary outcomes of time to weight-bearing, time to union, and final angulation between LLC and SLC groups. RESULTS: Eighty-five patients aged 5 to 17 years (mean age: 9.2±3.2 y) met inclusion criteria, including 50 LLC and 35 SLC patients. Time to weight-bearing for SLC (3.3±0.6 wk) was shorter compared with LLC (6.4±0.7 wk, P<0.0001). Overall, fractures treated with SLC had a shorter time to the union (7.4±0.9 wk) compared with LLC (9.0±0.9 wk, P=0.026) without statistical differences in final angulation at the time of union. There was a higher percentage of cast complications in the LLC treatment group (12%) compared with SLC (6%). CONCLUSIONS: SLC demonstrated earlier time to weight-bearing and shorter time to fracture union when compared with LLC. Surgeons should consider SLC and early weight-bearing for the treatment of distal third tibial shaft fractures in children. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

Novel Superhydrophobic Surface with Solar-Absorptive Material for Improved De-Icing Performance.

Ice accretion is detrimental to numerous industries, including infrastructure, power generation, and aviation applications. Currently, some of the leading de-icing technologies utilize a heating source coupled with a superhydrophobic surface. This superhydrophobic surface reduces the power consumption by the heating element. Further power consumption reduction in these systems can be achieved through an increase in passive heat generation through absorption of solar radiation. In this work, a superhydrophobic surface with increased solar radiation absorption is proposed and characterized. An existing icephobic surface based on a polytetrafluoroethylene (PTFE) microstructure was modified through the addition of graphite microparticles. The proposed surface maintains hydrophobic performance nearly identical to the original superhydrophobic coating as demonstrated by contact and roll-off angles within 2.5% of the original. The proposed graphite coating also has an absorptivity coefficient under exposure to solar radiation 35% greater than typical PTFE-based coatings. The proposed coating was subsequently tested in an icing wind tunnel, and showed an 8.5% and 50% decrease in melting time for rime and glaze ice conditions, respectively.

Infantile Tumoral Calcinosis of the Cervical Spine: A Case Report.

Tumoral calcinosis (TC) is an exceedingly rare disease, significantly so when located in the spine. Here, we present a 4-month-old patient with decreased head control and range of motion of the neck for several weeks. CT and MRI demonstrated a calcified mass in the retropharyngeal area and surrounding C1/C2, and TC was suspected. The patient underwent surgical biopsy and aspiration, which confirmed TC. The purpose of this case report is to document a rare disease, significantly so when taking into account both the location of the lesion and the patient's age, and to detail the treatment and response.

Comparison of lower limb muscle architecture and geometry in distance runners with rearfoot and forefoot strike pattern.

We examined the association between footfall pattern and characteristics of lower limb muscle function and compared lower limb muscle function between forefoot and rearfoot runners. Fifteen rearfoot and 16 forefoot runners were evaluated using ultrasonography of the gastrocnemii and tibialis anterior while strike index and heel strike angle quantified footfall pattern. Higher strike index was associated with lower medial gastrocnemius echo intensity (p = 0.05), lower lateral gastrocnemius echo intensity (p = 0.04), smaller tibialis anterior pennation angle (p = 0.05), and longer lateral gastrocnemius fascicle length (p = 0.04). Larger heel strike angle was associated with smaller medial gastrocnemius cross-sectional area (p = 0.04), shorter lateral gastrocnemius fascicle length (p < 0.01), and lower plantar flexion moment (p < 0.01). Larger plantar flexion moment was associated with lesser medial gastrocnemius echo intensity (p = 0.04), lesser lateral gastrocnemius echo intensity (p = 0.03), and greater lateral gastrocnemius fascicle length (p = 0.02). A smaller plantar flexion moment, larger heel strike angle, lower tibialis anterior echo intensity, larger tibialis anterior pennation angle, and smaller lateral gastrocnemius pennation angle were observed in rearfoot compared to forefoot runners (p < 0.05). Lower limb muscle architecture is associated with footfall pattern and ankle mechanics during running. Abbreviation: EMG: electromyographic; MG: medial gastrocnemius; LG: lateral gastrocnemius; TA: tibialis anterior; EI: echo intensity; CSA: cross-sectional area; PA: pennation angle; FL: fascicle length; FT: fat thickness.

Born this way? A review of neurobiological and environmental evidence for the etiology of psychopathy.

Across a significant body of research, psychopathy has often been conceptualized as a biologically based malady. In this research, genetic and neurobiological differences have been conceptualized to underlie psychopathy, while affected individuals' life experiences only influence expressed psychopathic features and their severity. Psychopathy research has largely ignored developmental evidence demonstrating significant influences of environment on both biological and behavioral processes, resulting in several prominent criticisms (Edens & Vincent, 2008; Loeber, Byrd, & Farrington, 2015). The current review was conducted with two main aims: (a) to collect and consider etiological evidence from the extant body of research on genetic and neurobiological factors in psychopathy; and (b) to evaluate findings from genetic, neurotransmitter, brain structure, and brain function studies in the context of relevant evidence from developmental research. Examples from research on adversity and traumatic stress, a common correlate of psychopathy, were used to highlight current research gaps and future directions to aid in the integration of developmental and neurobiological research agendas. While some promising evidence exists regarding possible underlying neurobiological processes of psychopathic traits, this evidence is insufficient to suggest a largely biological etiology for the disorder. Further, information from developmental and epigenetic research may suggest complex, multidimensional trajectories for individuals experiencing psychopathy. Based on these observations, the authors make several recommendations for future research, as well as for current clinical application and practice.

The Scope and Nature of Reading Comprehension Impairments in School-Aged Children with Higher-Functioning Autism Spectrum Disorder.

This study of 8-16-year-olds was designed to test the hypothesis that reading comprehension impairments are part of the social communication phenotype for many higher-functioning students with autism spectrum disorder (HFASD). Students with HFASD (n = 81) were compared to those with high attention-deficit/hyperactivity disorder symptomatology (ADHD; n = 39), or typical development (TD; n = 44), on a comprehensive battery of oral language, word recognition, and reading comprehension measures. Results indicated that students with HFASD performed significantly lower on the majority of the reading and language tasks as compared to TD and ADHD groups. Structural equation models suggested that greater ASD symptomatology was related to poorer reading comprehension outcomes; further analyses suggested that this relation was mediated by oral language skills.

A Comprehensive Examination of Reading Heterogeneity in Students with High Functioning Autism: Distinct Reading Profiles and Their Relation to Autism Symptom Severity.

The goal of this study was to identify unique profiles of readers in a sample of 8-16 year olds with higher functioning autism spectrum disorders (HFASD) and examine the profiles in relation to ASD symptom severity. Eighty-one students were assessed utilizing a comprehensive reading battery that included basic word reading, language, and comprehension. Using Latent Profile Analysis, four empirically distinct profiles of readers emerged. Next, using the Autism Diagnostic Observation Schedule, Second Edition (Lord et al., Autism diagnostic observation schedule, 2nd edn, Western Psychological Services, Torrance, CA, 2012), analyses were conducted to determine if significant differences existed between profiles as a result of ASD symptomatology. Findings demonstrate the heterogeneous nature of reading profiles in students with HFASD and significant differences between the reading profiles and ASD symptom severity.