Scarf osteotomy for hallux valgus surgery: determining indications for an additional Akin osteotomy.

INTRODUCTION: There is a lack of clear indications to carrying out an Akin osteotomy in addition to scarf osteotomy. Recent studies have shown that a proximal distal phalangeal articular angle (PDPAA) of > 8° as an indication to carrying out additional Akin osteotomy correlates with better radiological outcomes with lesser risk of recurrence. Our study aimed to validate carrying out the additional Akin osteotomy at a PDPAA > 8° while looking into functional outcomes which have not been studied. METHODS: Patients who underwent scarf and combined scarf and Akin osteotomy in our institutional registry was identified. Patient reported outcome measures were compared between patients who underwent scarf and combined scarf and Akin osteotomy. The Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Score (AOFAS), Short Form-36 Physical Component Score (PCS) and Mental Component Score (MCS) were measured pre-operatively and across a follow up period of 2 years. RESULTS: A total of 212 cases were identified. At a PDPAA > 8, there was no difference in VAS, AOFAS, PCS and MCS between patients that had isolated scarf osteotomy and those that received combined scarf and Akin osteotomy pre-operatively, and at 6 months. However, at 2 years post-operatively, patients that received scarf and Akin osteotomy had a significantly better AOFAS score as compared to patients with isolated scarf osteotomy (82.3 ± 15.3 vs 88.4 ± 13.0, p = 0.0224). On the contrary, at a PDPAA < 8, patients who underwent combined scarf and Akin osteotomy had a significantly lower VAS score at 6 months (1.16 ± 2.16 vs 0.321 ± 1.09, p = 0.00633) and 2 years (0.698 ± 1.73 vs 0.333 ± 1.46, p = 0.0466). They also had a higher AOFAS score at 6 months (80.7 ± 14.3 vs 85.4 ± 12.5, p = 0.0123) and 2 years (83.0 ± 14.0 vs 90.7 ± 9.9, p < 0.0001). CONCLUSION: PDPAA > 8° can serve as a valid indication to carrying out additional Akin on top of scarf osteotomy based on functional outcomes. However, further studies should investigate a PDPAA threshold that is lower than 8°, which can potentially allow more patients to receive the additional Akin osteotomy that can bring better functional outcomes.

Workplace and lifestyle heterogeneity in subjective wellbeing: Latent Class Analysis of UK Time Use Survey before and during COVID-19

BackgroundMental health in the UK had deteriorated compared with pre-pandemic trends. The impact of COVID-19 on the subjective wellbeing of working populations with distinct lifestyles is not yet studied. MethodsCombining time use surveys collected pre- and during COVID-19, latent class analysis was used to identify distinct lifestyles based on aggregated daily activity patterns and reported working modes. We provide qualitative pen portraits alongside pre-versus-during pandemic comparisons of intraday time use and wellbeing patterns. Lifestyle heterogeneity in wellbeing was quantified in relation to aggregated activity types. ResultsCOVID-19 impact on wellbeing varied significantly between usual working hours (6am-6pm) and rest of the day. The decline in wellbeing outside of usual working hours was significant and consistent across lifestyles. During usual working hours, the direction of impact varied in line with working modes: wellbeing of homeworkers decreased, remained relatively stable for commuters, and increased for certain hybrid workers. Magnitude of impact correlates strongly with lifestyle: those working long and dispersed hours are more sensitive, whereas non-work dominated lifestyles are more resilient. ConclusionThe direction and magnitude of impact from COVID-19 were not uniformly manifested across activity types, time of day, and latent lifestyles. Blurring work-life boundaries and general anxiety about the pandemic may be key determinants of the decline outside of usual working hours. During usual working hours, strong yet complex correlations between wellbeing and time-use changes suggested that policies aiming to enhance wellbeing of workers need to consider not only spatial flexibility but also provide wider support for temporal flexibility. What is already knownIn the UK, mental health deteriorated compared with pre-pandemic trends. It is presumed that not everyone was affected equally, but there has been little evidence distinguishing population groups with distinct working modes and lifestyles. What are the new findingsDirection of COVID-19 impact strongly correlates with working mode and extent of spatial flexibility: wellbeing decreased for homeworkers, but increased for some hybrid workers. Magnitude of COVID-19 impact strongly correlates with lifestyle and extent of temporal flexibility: those working long and dispersed hours more were sensitive, whereas non-work dominated lifestyles were more resilient. How might this impact policyPolicymakers and employers need to consider the important function workplace has on mental health. As homeworking arrangements become permanent, the psychosocial function of traditional workplaces will become more pertinent. Flexibility around the established work-time regime will also benefit workers mental health, and give them greater control to choose and transition between lifestyles.

De novo design of ACE2 protein decoys to neutralize SARS-CoV-2

There is an urgent need for the ability to rapidly develop effective countermeasures for emerging biological threats, such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes the ongoing coronavirus disease 2019 (COVID-19) pandemic. We have developed a generalized computational design strategy to rapidly engineer de novo proteins that precisely recapitulate the protein surface targeted by biological agents, like viruses, to gain entry into cells. The designed proteins act as decoys that block cellular entry and aim to be resilient to viral mutational escape. Using our novel platform, in less than ten weeks, we engineered, validated, and optimized de novo protein decoys of human angiotensin-converting enzyme 2 (hACE2), the membrane-associated protein that SARS-CoV-2 exploits to infect cells. Our optimized designs are hyperstable de novo proteins ([~]18-37 kDa), have high affinity for the SARS-CoV-2 receptor binding domain (RBD) and can potently inhibit the virus infection and replication in vitro. Future refinements to our strategy can enable the rapid development of other therapeutic de novo protein decoys, not limited to neutralizing viruses, but to combat any agent that explicitly interacts with cell surface proteins to cause disease.