Correction of Sagittal Deformity with Bone Resection and Soft Tissue Releases.

Fixed flexion deformities (FFDs) present several unique challenges in total knee arthroplasty (TKA) and require careful consideration to achieve optimal outcomes. FFD alters normal knee biomechanics and increases energy expenditure. They may be attributed to both bony deformities and fibrosed soft tissues, which must be addressed in stepwise fashion at the time of surgery. A literature review was conducted utilizing keywords "fixed flexion deformity TKA." This review article aims to discuss the anatomy and pathology, preoperative evaluation, classification system, surgical techniques for addressing deformity, implant selection considerations, postoperative protocols, clinical outcomes, and potential complications associated with correcting FFD. By comprehensively addressing these aspects, surgeons can optimize surgical planning and improve outcomes in patients with FFD undergoing TKA.

Capturing high-resolution digital images for use in forensic document examination.

In the past, pattern disciplines within forensic science have periodically faced criticism due to their subjective and qualitative nature and the perceived absence of research evaluating and supporting the foundations of their practices. Recently, however, forensic scientists and researchers in the field of pattern evidence analysis have developed and published approaches that are more quantitative, objective, and data driven. This effort includes automation, algorithms, and measurement sciences, with the end goal of enabling conclusions to be informed by quantitative models. Before employing these tools, forensic evidence must be digitized in a way that adequately balances high-quality detail and content capture with minimal background noise imparted by the selected technique. While the current work describes the process of optimizing a method to digitize physical documentary evidence for use in semi-automated trash mark examinations, it could be applied to assist other disciplines where the digitization of physical items of evidence is prevalent. For trash mark examinations specifically, it was found that high-resolution photography provided optimal digital versions of evidentiary items when compared to high-resolution scanning.

COVID-19 and Changes in Reported Social Risk Factors at a Primary Care Practice in the South Bronx.

INTRODUCTION: Historically, Black and Hispanic patient populations in the Bronx Borough of New York City have experienced the highest rates of social risk factors, and associated poor health outcomes, in New York State. During the pandemic, Bronx communities disproportionately experienced high rates of COVID-19 illness and death. To date, little is known regarding the COVID-19 pandemic's impact on social risk factors in urban, at-risk communities. This study aimed to determine how social risk factors changed during the pandemic in a Bronx-based patient population. METHODS: Study participants were adult patients seen at a Federally Qualified Health Center in the South Bronx. Using a paired longitudinal study design, 300 participants were randomly selected for telephonic outreach during the pandemic from a sample of 865 participants who had been offered a social risk factor screener in the year prior to the pandemic. The outreach survey used included the social risk factor screener and questions regarding COVID-19 illness burden and prior engagement in social services. The McNemar test was used to analyze trends in reported social risks. RESULTS: Housing quality needs, food insecurity, and legal care needs significantly increased during the pandemic. Participants who reported COVID-19 illness burden were 1.47 times more likely to report a social risk factor (P = .02). No significant relationship was found between prior enrollment in clinic-based social services and degree of reported social risk (P = .06). CONCLUSION: Housing quality needs, food insecurity, and legal care needs increased during the COVID-19 pandemic in a predominantly Black and Hispanic identifying urban patient population. Urgently addressing this increase is imperative to achieving health equity in ongoing COVID-19 mitigation efforts.

An objective inter-comparison of trash mark constellations generated by manual and automated detection methods.

Trash marks are unintentional markings observed on printed, scanned, or photocopied documents that result from permanent defects or transient material in office machines and can be used for source attribution of questioned documents. Trash mark examinations have been in use in forensic laboratories for decades, yet the method remains relatively untested and relies on training, experience, and anecdotal information to support its validity. This study generated and harnessed objective data to empirically test one of the foundational theories for assessing the origin of photocopied documents: provided trash marks are present in sufficient quantity and/or quality, no two machines will exhibit a constellation of trash marks that is indistinguishable from another. In this project, objective trash mark location and size data was generated for 50 known photocopiers using both a traditional and a novel, automated method. Inter-machine comparisons were conducted using a novel variant of the Hausdorff distance algorithm to generate a quantitative assessment of how similar or different the 2450 pairs of trash mark constellations were from one another. This study found that each of the machines bearing one or more trash marks exhibited objective differences in their trash mark constellations, ultimately providing support for the tested hypothesis.

Correlation Between Patient-Reported "Happiness" With Knee Range of Motion and Objective Measurements in Primary Knee Arthroplasty.

BACKGROUND: The purpose of this study was to evaluate the correlation between objective knee range of motion (ROM) and patient "happiness" with knee ROM after total knee arthroplasty. METHODS: This was a retrospective review of all primary total knee arthroplasties from June through December 2019, yielding 902 patients (1,009 knees). Records were reviewed for knee ROM preoperatively and postoperatively at 6-week follow-up as well as whether patients self-reported being "Happy with their ROM" (HWROM). Clinical records were reviewed for documents ROM as well as manipulation under anesthesia (MUA). RESULTS: The mean preoperative ROM was 110 ± 16 degrees, and 40% of patients were happy with their ROM. Postoperatively, the mean ROM was 106 ± 13 degrees (P < .001), and 76% of patients were HWROM (P < .001). The mean change in knee ROM was (-) 5 ± 17 degrees. The mean postoperative ROM and change in ROM of patients who were HWROM after surgery were 109 ± 12 degrees and (-)2 ± 16 degrees. In patients not HWROM postoperatively, the mean ROM and change in ROM were 98 ± 14 degrees and (-)12 ± 18 degrees (P < .001). Patients with a lower preoperative ROM were statistically significantly more likely to have a positive change in their HWROM (f ratio = 41, P < .001). MUAs were performed in 7.2% of knees, and 28% of patients who underwent an MUA were HWROM before MUA. CONCLUSION: Early postoperative knee ROM was correlated with patient HWROM. However, further longer term follow-up and more detailed analysis of patient happiness with ROM are needed.

Enhanced memory for context associated with corrective feedback: evidence for episodic processes in errorful learning.

Numerous studies have established that there are benefits of corrective feedback for learning, but the mechanisms of this benefit are not well understood. An important question is whether corrective feedback improves memory via episodic processes or solely via semantic mediation. If episodic processes are involved, then memory for corrective feedback should include contextual details of the feedback episode. The present study tested this hypothesis across 3 experiments (total n = 223) in which participants completed an encoding task that involved cued guessing of category exemplars. Exemplars generated by participants were equally likely to be treated as correct or incorrect, and the "correct" exemplar was presented within a feedback display after each response. Separate versions of the task manipulated font colour in either the feedback display or the initial cue/typed response display. Participants were instructed to remember either the correct exemplars or their own typed responses, and the corresponding font colours. Retrieval task (cued recall, free recall, recognition) was varied across experiments. Across all 3 experiments, a higher rate of memory accuracy was observed for context associated with corrective feedback relative to other conditions. The findings are consistent with the hypothesis that errorful learning involves episodic memory, not merely semantic mediation.

Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda.

BACKGROUND: Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. OBJECTIVE/METHODS: We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. RESULTS/CONCLUSIONS: Of 4283 people ages 30-69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.

Cortical Auditory Event-Related Potentials and Categorical Perception of Voice Onset Time in Children With an Auditory Neuropathy Spectrum Disorder.

Objective: This study evaluated cortical encoding of voice onset time (VOT) in quiet and noise, and their potential associations with the behavioral categorical perception of VOT in children with auditory neuropathy spectrum disorder (ANSD). Design: Subjects were 11 children with ANSD ranging in age between 6.4 and 16.2 years. The stimulus was an /aba/-/apa/ vowel-consonant-vowel continuum comprising eight tokens with VOTs ranging from 0 ms (voiced endpoint) to 88 ms (voiceless endpoint). For speech in noise, speech tokens were mixed with the speech-shaped noise from the Hearing In Noise Test at a signal-to-noise ratio (SNR) of +5 dB. Speech-evoked auditory event-related potentials (ERPs) and behavioral categorization perception of VOT were measured in quiet in all subjects, and at an SNR of +5 dB in seven subjects. The stimuli were presented at 35 dB SL (re: pure tone average) or 115 dB SPL if this limit was less than 35 dB SL. In addition to the onset response, the auditory change complex (ACC) elicited by VOT was recorded in eight subjects. Results: Speech evoked ERPs recorded in all subjects consisted of a vertex positive peak (i.e., P1), followed by a trough occurring approximately 100 ms later (i.e., N2). For results measured in quiet, there was no significant difference in categorical boundaries estimated using ERP measures and behavioral procedures. Categorical boundaries estimated in quiet using both ERP and behavioral measures closely correlated with the most-recently measured Phonetically Balanced Kindergarten (PBK) scores. Adding a competing background noise did not affect categorical boundaries estimated using either behavioral or ERP procedures in three subjects. For the other four subjects, categorical boundaries estimated in noise using behavioral measures were prolonged. However, adding background noise only increased categorical boundaries measured using ERPs in three out of these four subjects. Conclusions: VCV continuum can be used to evaluate behavioral identification and the neural encoding of VOT in children with ANSD. In quiet, categorical boundaries of VOT estimated using behavioral measures and ERP recordings are closely associated with speech recognition performance in children with ANSD. Underlying mechanisms for excessive speech perception deficits in noise may vary for individual patients with ANSD.

Managing hypertension in rural Uganda: Realities and strategies 10 years of experience at a district hospital chronic disease clinic.

The literature on the global burden of noncommunicable diseases (NCDs) contrasts a spiraling epidemic centered in low-income countries with low levels of awareness, risk factor control, infrastructure, personnel and funding. There are few data-based reports of broad and interconnected strategies to address these challenges where they hit hardest. Kisoro district in Southwest Uganda is rural, remote, over-populated and poor, the majority of its population working as subsistence farmers. This paper describes the 10-year experience of a tri-partite collaboration between Kisoro District Hospital, a New York teaching hospital, and a US-based NGO delivering hypertension services to the district. Using data from patient and pharmacy registers and a random sample of charts reviewed manually, we describe both common and often-overlooked barriers to quality care (clinic overcrowding, drug stockouts, provider shortages, visit non-adherence, and uninformative medical records) and strategies adopted to address these barriers (locally-adapted treatment guidelines, patient-clinic-pharmacy cost sharing, appointment systems, workforce development, patient-provider continuity initiatives, and ongoing data monitoring). We find that: 1) although following CVD risk-based treatment guidelines could safely allocate scarce medications to the highest-risk patients first, national guidelines emphasizing treatment at blood pressures over 140/90 mmHg ignore the reality of "stockouts" and conflict with this goal; 2) often-overlooked barriers to quality care such as poor quality medical records, clinic disorganization and local employment practices are surmountable; 3) cost-sharing initiatives partially fill the gap during stockouts of government supplied medications, but still may be insufficient for the poorest patients; 4) frequent prolonged lapses in care may be the norm for most known hypertensives in rural SSA, and 5) ongoing data monitoring can identify local barriers to quality care and provide the impetus to ameliorate them. We anticipate that our 10-year experience adapting to the complex challenges of hypertension management and a granular description of the solutions we devised will be of benefit to others managing chronic disease in similar rural African communities.

Identifying and Reengaging Patients Lost to Follow-Up in Rural Africa: The "Horizontal" Hospital-Based Approach in Uganda.

Among the many challenges facing health systems grappling with the explosive growth of chronic disease in Africa are continuity of care, particularly in poor, rural areas. We report the strategy, field experience, and results of an ongoing 6-year follow-up program operating in a rural district hospital in Kisoro, Uganda, that attempts to locate and reengage patients lost to follow-up (LTFU) from communities that are largely without phones, addresses, or paved roads. The program works with diverse hospital clinics, including chronic diseases, HIV, tuberculosis (TB), nutrition, and women's health, to identify patients who have not returned to care, employing a modest staff who spend about 20 days monthly making outreach visits by motorcycle in search of approximately 130 patients. We describe the organization of this unique "horizontal" program and report on follow-up outcomes between November 2015 to October 2016. Between 30% and 60% of patients were found to have lapses in care. The follow-up program was able to locate 64% of patients, with a reengagement rate of 54% to 92% (average, 69%) depending on the clinic. The program costs approximately US$5 per patient LTFU but about US$40 per patient maintained in care. The hospital-based follow-up program that cuts across diverse clinics and wards was novel and feasible in this rural sub-Saharan African setting.

Modeling age differences in effects of pair repetition and proactive interference using a single parameter.

In this article, we apply the REM model (Shiffrin & Steyvers, 1997) to age differences in associative memory. Using Criss and Shiffrin's (2005) associative version of REM, we show that in a task with pairs repeated across 2 study lists, older adults' reduced benefit of pair repetition can be produced by a general reduction in the diagnosticity of information stored in memory. This reduction can be modeled similarly well by reducing the overall distinctiveness of memory features, or by reducing the accuracy of memory encoding. We report a new experiment in which pairs are repeated across 3 study lists and extend the model accordingly. Finally, we extend the model to previously reported data using the same task paradigm, in which the use of a high-association strategy introduced proactive interference effects in young adults but not older adults. Reducing the diagnosticity of information in memory also reduces the proactive interference effect. Taken together, the modeling and empirical results reported here are consistent with the claim that some age differences that appear to be specific to associative information can be produced via general degradation of information stored in memory. The REM model provides a useful framework for examining age differences in memory as well as harmonizing seemingly conflicting prior modeling approaches for the associative deficit. (PsycINFO Database Record

A Positive Generation Effect on Memory for Auditory Context.

Self-generation of information during memory encoding has large positive effects on subsequent memory for items, but mixed effects on memory for contextual information associated with items. A processing account of generation effects on context memory (Mulligan in Journal of Experimental Psychology: Learning, Memory, and Cognition, 30(4), 838-855, 2004; Mulligan, Lozito, & Rosner in Journal of Experimental Psychology: Learning, Memory, and Cognition, 32(4), 836-846, 2006) proposes that these effects depend on whether the generation task causes any shift in processing of the type of context features for which memory is being tested. Mulligan and colleagues have used this account to predict various negative effects of generation on context memory, but the account also predicts positive generation effects under certain circumstances. The present experiment provided a critical test of the processing account by examining how generation affected memory for auditory rather than visual context. Based on the processing account, we predicted that generation of rhyme words should enhance processing of auditory information associated with the words (i.e., voice gender), whereas generation of antonym words should have no effect. These predictions were confirmed, providing support to the processing account.

Compensation for visually specified coarticulation in liquid-stop contexts.

The question of whether speech perceivers use visual coarticulatory information in speech perception remains unanswered, despite numerous past studies. Across different coarticulatory contexts, studies have both detected (e.g., Mitterer in Perception & Psychophysics, 68, 1227-1240, 2006) and failed to detect (e.g., Vroomen & de Gelder in Language and Cognitive Processes, 16, 661-672. doi: 10.1080/01690960143000092 , 2001) visual effects. In this study, we focused on a liquid-stop coarticulatory context and attempted to resolve the contradictory findings of Fowler, Brown, and Mann (Journal of Experimental Psychology: Human Perception and Performance, 26, 877-888. doi: 10.1037/0096-1523.26.3.877 , 2000) and Holt, Stephens, and Lotto (Perception & Psychophysics, 67, 1102-1112. doi: 10.3758/BF03193635 , 2005). We used the original stimuli of Fowler et al. with modifications to the experimental paradigm to examine whether visual compensation can occur when acoustic coarticulatory information is absent (rather than merely ambiguous). We found that perceivers' categorizations of the target changed when coarticulatory information was presented visually using a silent precursor, suggesting that visually presented coarticulatory information can induce compensation. However, we failed to detect this effect when the same visual information was accompanied by an ambiguous auditory precursor, suggesting that these effects are weaker and less robust than auditory compensation. We discussed why this might be the case and examined implications for accounts of coarticulatory compensation.

Closing the empathy gap in college students' judgments of end-of-life tradeoffs.

When considering hypothetical end-of-life (EOL) scenarios involving 80-year-old intensive-care unit patients, young adults are more likely than older adults to judge that shorter lifespan would be a fair trade in exchange for a more pleasant death. This result has been interpreted in terms of an empathy gap, in which individuals fail to relate to the affective states of others. If so, the effect should be reduced when young adults consider scenarios involving patients similar to themselves. The present study examined college students' willingness to trade healthy lifespan for better death in EOL scenarios involving 80-year-old and 22-year-old cancer victims. Results indicated students under 30 were less likely to trade lifespan in the 22-year-old scenarios, and were less likely to trade lifespan in either set of scenarios when the 22-year-old scenarios were presented first. The findings are consistent with an empathy gap account of judgments concerning EOL care.

The classification of inkjet inks using AccuTOF™ DART™ (Direct Analysis in Real Time) mass spectrometry--a preliminary study.

A novel approach for the analysis of inkjet inks is being reported. A time-of-flight mass spectrometer, coupled with a Direct Analysis in Real Time (DART™) ion source (AccuTOF™ DART™), was used to determine if inkjet inks from various manufacturers and models of printers could be reliably differentiated, characterized, and identified. A total of 217 ink standards were analyzed. As inkjet printing often involves the use of multiple colors (e.g., cyan, magenta, yellow, and black) to form an image or text, two different approaches to creating a library of standards and sampling methods were evaluated for implementation in a standard operating procedure. This research will show that a microscopic examination of the region of interest is requisite to identify what colors were utilized during the printing process, prior to comparing with known standards. Finally, blind testing was administered with 10 unknown samples to assess the validity and accuracy of the methodology.

Synergistic effects of encoding strategy and context salience on associative memory in older adults.

Older adults' deficits in memory for context and memory for inter-item associations are often assumed to be related, yet typically are examined in separate experiments. The present study combined associative recognition and list discrimination into a single task with conditions that varied in terms of item, pair, and context information, and independently manipulated context salience and encoding strategy between subjects in order to examine their effects on memory for associative information in young and older adults. Older adults' memory for pairs was found to be less affected than that of young adults by manipulations of context and associative information, but the age difference in context effects on pair memory was influenced by an interaction of encoding strategy and context salience. The results provide novel evidence that older adults' deficits in associative memory involve interactions between context and inter-item associations.

Age differences and schema effects in memory for crime information.

UNLABELLED: BACKGROUND/STUDY CONTEXT: This study investigated age-related differences in memory for crime information. Older adults have been found to rely more than young adults on schema- and stereotype-based processing in memory, and such age differences may have implications in the criminal justice system. Some prior research has examined schema-based processing among older adults in legal settings, but no studies have tested for schema effects on older adults' memory for specific details of a crime. METHODS: Older adults (N = 56, ages 65-93) and young adults (N = 52, ages 18-22) read a passage about a criminal suspect's "bad" or "good" childhood, and then read a crime report containing incriminating, exonerating, and neutral details with regard to the suspect. Participants were subsequently tested on recognition of accurate versus altered details from the crime report. Participants also rated the suspect"s guilt, and completed a battery of neuropsychological tests. Correct and false recognition rates were analyzed with ANOVA to compare means across age group, evidence type, and background type, and guilt ratings were analyzed with linear regression using neuropsychological scores as predictors. RESULTS: Among older adults, an interaction was found between evidence type (incriminating/exonerating) and suspect's background (good/bad childhood) in false recognition of altered details from the crime report, supporting the hypothesis that schema-based processing influenced older adult memory from crime information. Additionally, although guilt ratings were not related to the suspect's background for either age group, they were predicted by older adults' short-delay recall (ß = -.37), suggesting that cognitive decline may play a role in older adults' interpretations of evidence. CONCLUSION: The findings suggest reduced cognitive capacity in older adults increases schema-based processing in memory for crime information, and are consistent with research in other domains that has demonstrated greater schema effects in memory with aging. The results may have implications for criminal justice, and open up possibilities for further research on how young and older adults may differ in memory for specific types of crime information.

How does context play a part in splitting words apart? Production and perception of word boundaries in casual speech.

Four experiments examined listeners' segmentation of ambiguous schwa-initial sequences (e.g., a long vs. along) in casual speech, where acoustic cues can be unclear, possibly increasing reliance on contextual information to resolve the ambiguity. In Experiment 1, acoustic analyses of talkers' productions showed that the one-word and two-word versions were produced almost identically, regardless of the preceding sentential context (biased or neutral). These tokens were then used in three listening experiments, whose results confirmed the lack of local acoustic cues for disambiguating the interpretation, and the dominance of sentential context in parsing. Findings speak to the H&H theory of speech production (Lindblom, 1990), demonstrate that context alone guides parsing when acoustic cues to word boundaries are absent, and demonstrate how knowledge of how talkers speak can contribute to an understanding of how words are segmented.

A standard set of American-English voiced stop-consonant stimuli from morphed natural speech.

Linear predictive coding (LPC) analysis was used to create morphed natural tokens of English voiced stop consonants ranging from /b/ to /d/ and /d/ to /g/ in four vowel contexts (/i/, /æ/, /a/, /u/). Both vowel-consonant-vowel (VCV) and consonant-vowel (CV) stimuli were created. A total of 320 natural-sounding acoustic speech stimuli were created, comprising 16 stimulus series. A behavioral experiment demonstrated that the stimuli varied perceptually from /b/ to /d/ to /g/, and provided useful reference data for the ambiguity of each token. Acoustic analyses indicated that the stimuli compared favorably to standard characteristics of naturally-produced consonants, and that the LPC morphing procedure successfully modulated multiple acoustic parameters associated with place of articulation. The entire set of stimuli is freely available on the Internet (http://www.psy.cmu.edu/~lholt/php/StephensHoltStimuli.php) for use in research applications.

The use of filtered light for the evaluation of writing inks analyzed using thin layer chromatography.

Thin layer chromatography (TLC) is a scientific methodology that can be used to compare and characterize ink formulations. Occasionally, when evaluating chromatographic profiles on a TLC plate with ambient light, different ink formulations, or the same inks from different batches, may appear indistinguishable. The use of filtered light can be very effective to illuminate characteristics that are not readily apparent with ambient light. There are a diverse number of components commonly found in writing inks, and it may be that some of them respond to particular wavelengths of energy that are not visible to the unaided eye (i.e., colorless). There has been very little information published that addresses the use of filtered light for evaluating TLC plates. Twenty-nine ballpoint writing ink samples were selected for TLC analysis. Further evaluation using an alternate light source, coupled with the appropriate filter, proved to be an effective means for definitive discrimination in some cases.