Radiodensity Analysis of Lateral Column Superconstruct Fixation Sites in Midfoot Charcot Neuroarthropathy.

Lateral column deterioration and subsequent loss of function poses a challenge for limb preservation in patients with Charcot neuroarthropathy (CN). Application of "superconstructs" provides stability and clinical improvement to an often-ulcerated lateral foot. This study examines radiodensity in Hounsfield units (HU) to compare bone quality of lateral column fixation targets using computed tomography (CT) scans between patients with and without midfoot CN. A retrospective chart review identified control (nondiabetic, non-CN; n = 29) and midfoot CN (n = 21) groups. Patient demographics and medical history were collected. Two reviewers measured the mean HU of circular regions of interest centered on the fourth and fifth metatarsal heads as well as the anterior, middle, and posterior thirds of the calcaneus. Radiodensity was compared between groups, among calcaneal locations, Eichenholtz stages and Brodsky types. A p value ≤.05 was considered statistically significant. Age and body mass index were not significantly different between groups. The CN group exhibited greater HU than the control group at the metatarsal head and calcaneus (p < .001). The anterior calcaneus exhibited greater HU than the posterior calcaneus in the CN group (p = .02). The difference in HU was not statistically significant between Stages 0-1 and Stages 2-3 or midfoot Brodsky Types. Indirect bone density analysis revealed an increased density in CN compared to control patients with no significant difference between midfoot CN stages or types. The anterior calcaneus was the densest rearfoot bone among the CN patients, a result that may have implications in surgical fixation.

Ritual Abuse Survivors' Perspectives on Research Participation: An Exploratory Mixed Methods Online Study.

This exploratory study sought a deeper understanding of the perspectives of self-defined ritual abuse (RA) survivors, who had experienced sexual victimization, on participation in research. A mixed-methods qualitative design involving online survey and follow-up virtual interviews included 68 adults across eight countries. Content and thematic analysis of responses indicated that RA survivors were keen to be involved in a range of research activities to share their experience, knowledge, and support for other survivors. Having a voice, gaining knowledge, and feeling empowered were reported as advantages of participation, while concerns included exploitation, researcher ignorance, and emotional dysregulation caused by content discussed. To enable their engagement in the future research, RA survivors identified participative research designs, anonymity, and increased opportunities for inclusion in decision-making.

Radiodensity Analysis of Medial Column Superconstruct Fixation Sites in Midfoot Charcot Neuroarthropathy.

Charcot neuroarthropathy (CN) is a highly destructive, pathologic process with devastating consequences to foot structure and viability. The use of intramedullary fixation "superconstructs" allows for "re-bar" support of compromised bone and allows for some dynamic fixation. This study examines radiodensity in Hounsfield units (HU) to compare bone quality of medial column fixation targets using computed tomography scans between patients with and without midfoot CN. A retrospective chart review identified control (nondiabetic, non-CN; n = 29) and midfoot CN (n = 21) groups. Patient demographics and medical history were collected. Two reviewers measured the mean HU of a circular region of interest centered on the first metatarsal head and the anterior, middle, and posterior thirds of the talar body. Radiodensity was compared between groups, and among talar locations, Eichenholtz stages and Brodsky types, with statistical significance set at p ≤ .05. Age and body mass index were not significantly different between groups. The CN group maintained greater mean HU than the control group at the metatarsal head (p < .001), and talar body locations (p < .019). The difference in mean HU of these bones was not statistically significant between Stages 0 to 1 and Stages 2 to 3 or Brodsky Types 1 and 2. Mean HU differences among talus positions were not statistically significant. Indirect bone density analysis using HU showed an increased density in CN patients with no significant difference among talar body locations or midfoot Charcot stages and types. These results may assist in optimizing fixation length. Future studies may examine these densities in ankle CN.

Scholarly Productivity Among Academic Foot and Ankle Surgeons Affiliated With US Podiatric Medicine and Surgery Residency and Fellowship Training Programs.

Foot and ankle surgeons practicing within academic medicine balance clinical or surgical training, course instruction, administrative duties, and research. Along with clinical skills and patient volume, promotion within academia often relies on scholarly productivity. Previous research across specialties described this productivity using variables including publications, citations, and the h-index, a scale that quantifies the productivity and citation impact of published works, among academic ranks. As no studies examine the scholarly impact of foot and ankle surgeons with academic appointments, this study aimed to analyze the productivity and gender differences present in this specialty. A systematic review of academic-affiliated foot and ankle surgery residencies and fellowships was performed; and faculty members were screened for sex, academic rank, publication history, citations, h-index, and years in practice. Among 234 programs reviewed, 44 programs allowed for the analysis of 106 practitioners with an academic rank eligible for analysis. Overall, 78.3% of practitioners were male with the most common rank being assistant professor. Men published more documents and maintained higher citations as well as longer years in practice, and this was significant (p < .05). A significant difference was exhibited among all academic ranks (p ≤ .001). Multivariate regression revealed the publication history and years in practice are strongly correlated with the h-index of providers (p ≤ .001). Foot and ankle surgeons practicing in an academic setting may use the results of this study to gauge their productivity and identify benchmarks that similar providers have met at varying academic ranks.

Anatomic Description of the Fourth and Fifth Tarsometatarsal Articulation: A Cadaveric Study.

The fourth and fifth tarsometatarsal joint, consisting of the fourth and fifth metatarsal and the cuboid, imparts a significant amount of motion to the foot during ambulation. Injury to this joint complex, through chronic deformation or acute trauma, often necessitates arthroplasty, arthrodesis, or fusion. Currently, there exists no studies that investigate the anatomy of this articulation. The purpose of this study is to describe the medial and lateral anterior cuboid articulations which allows for surgical planning and the advancement of hardware design. Twenty fresh-frozen below-the-knee cadaver legs were thawed and the cuboids were excised. The width and height of the entire joint complex were measured as the longest span across the total articular surface of the anterior cuboid. The width and height of each articular facet were recorded as the span across the geometric bisection of each individual surface. The mean anterior cuboid articulation width and height was 25.62 mm and 16.74 mm, respectively. The mean medial cuboid articulation width and height was 11.7mm and 13.65 mm, respectively. The mean lateral cuboid width and height was 16.74 mm and 12.78 mm, respectively. The medial articulation maintained a larger mean height and narrower mean width than the lateral facet (p < .05). The unique anatomy of the lateral tarsometatarsal joint complex plays an important functional role and requires attention when deciding between arthrodesis or arthroplasty. Increasing the understanding of the clinical anatomy of this joint will better prepare surgeons and product designers to anticipate hardware needs.

The July Effect in Podiatric Medicine and Surgery Residency.

The period when medical students begin residency in teaching hospitals throughout the United States heralds a period known in the medical community as the "July Effect." Though several sentinel studies associated this timeframe with an increase in medical errors, residencies since demystified this phenomenon within their respective specialty. This study aims to evaluate the presence of the July Effect in a podiatric medicine and surgery residency program. A retrospective chart review was conducted, comparing patient demographics and surgical outcomes including length of stay, operative time and readmission rate between the first (July, August, September) and fourth (April, May June) quarters of the academic year from 2014-2019. A total of 206 patients met the inclusion criteria, where 99 received care in the first, resident-naïve, quarter and 107 received care in the fourth, resident-experienced, quarter. No difference in patient demographics including sex, body mass index, or comorbidity index was appreciated between both quarters (p<0.05). Those patients who underwent soft tissue and bone debridements, digital, forefoot, midfoot and rearfoot amputations experienced no statistically significant difference in length of stay, operative time, or readmission rate between both quarters (p<0.05). The results of this study did not support the presence of the July Effect in our foot and ankle surgery residency. Future studies can further explore this phenomenon by examining patients admitted following traumatic injury or elective procedures. Moreover, this study shows the curriculum employed at our program provides sufficient support, guidance, and resources to limit errors attributed to the July Effect.

Child Sexual Abuse in Pakistan Schools: A Non-Systematic Narrative Literature Review.

The current non-systematic narrative review of literature sought to explore the need for research into child sexual abuse (CSA) in Pakistan's schools. The limited literature that exists suggests that CSA is a pervasive problem in Pakistan as it is in neighboring India, and indeed, throughout the world. Government agencies and schools in Pakistan appear to be in their infancy in terms of recognizing and responding to CSA. High-profile media cases, however, have led to some promising child safety changes. The current narrative review identified the need for studies with methodological rigor to identify the nature and extent of children who have experienced CSA in Pakistan. Future studies also need to explore how best to conceptualize school-based abuse prevention in Pakistan. Recommendations are made for practice and research.

Safeguarding Culture in the Catholic Church of England and Wales in the Twenty-First Century: An Examination of Progress.

In the wake of reported scandals of child sexual abuse by Roman catholic priests in mainstream media in the 1980s/1990s and conviction of Catholic priests on similar charges in England and Wales, Lord Nolan was invited by the Archbishop of Westminster in 2000 to undertake a review of child safeguarding policies of the Catholic Church of England and Wales since 1994, known as the Nolan Report. The Nolan Report led to the establishment of the first Catholic Office for protection of children (COPCA) which remained operative from 2001-2007 before being later modified in light of the Cumberlege Review (2007) as the National Child Safeguarding Commission (NCSC) and the Catholic Safeguarding Advisory service (CSAS) since 2008 which continue to operate till today. This article conducts a hermeneutical analysis of the Nolan Report, the Cumberlege Report, the annual reports of COPCA and the National Catholic Safeguarding Commission from 2007 till 2017. Wider academic literature on the subject is included in order to critically examine the performance of these child safeguarding structures developed to prevent and control clerical sexual abuse and to evaluate the utility of the child protection measures in place within the Catholic Church of England and Wales, since 2001.

Why the Focus of Clerical Child Sexual Abuse has Largely Remained on the Catholic Church amongst Other Non-Catholic Christian Denominations and Religions.

The current study considers reasons for the consistent focus of academic research and mainstream media on clerical child sexual abuse (cCSA) largely within the Roman Catholic Church, seeming to ignore cCSA in other Christian denominations and religions. This study includes an analysis of traditional mainstream media and case reports on cCSA in non-Catholic churches and other religious faiths. The authors highlight the inadequacy of research and identify a wide range of gaps in this so far neglected area. Commonalities of cCSA and institutional responses are identified across denominations and religions, and reasons for the apparent over focus on the Catholic Church are discussed. The mains potential reasons identified were: (a) the centralized nature of the Church's universal organizational stature and management structure; (b) the anti-Catholic political and media bias in Protestant-dominated developed countries; (c) secular legal systems with access to powerful lawyers and insurance companies to locate responsibility at organizational level in order to seek compensation and finally; (d) the organized institutional power exercisable by respective bishops to silence victims. Future research needs to move beyond analysis of existing academic literature, press, and case review reports to comparative empirical studies across denominations and religions.

Perspectives of Young Child Abuse Survivors on Confidentiality: An Exploratory Literature Review.

The current systematic narrative literature review sought to discover the views of young child sexual abuse (CSA) survivors, unknown to child protection services, on confidentiality. Due to the paucity of research on young CSA survivors, the review was widened to include users of sexual health services. Seventeen databases were searched, and results were refined by reading titles and abstracts, followed by full text. Analysis involved an exploratory interpretist approach to identify conceptual themes and research methodologies. Fifteen published papers were identified. Research methods were narrow and included surveys, interviews, and focus groups, with limited youth participation. In addition to the theme of confidentiality essential to this study, themes identified included - needing accurate information about services, the importance of someone non-judgemental to talk to, control over decisions affecting their lives, and better access to services. Studies indicated young people were fearful of child protection involvement. In conclusion, studies suggest young survivors unknown to child protection services need a higher level of confidential services and more control of their information. Further research involving young survivors in participatory methods is needed to explore issues of confidentiality, survivor participation, and fear of child protection agencies.

Exploration of the Relationship between Severe and Complex Disabilities and Child Sexual Abuse: A Call for Relevant Research.

Despite the awareness that children with severe and complex difficulties experience child sexual abuse (CSA), the development of research in this area is still in its infancy. This call for relevant research seeks to identify the main gaps in knowledge in order to inform future debate, potential research questions, and raise issues for practice. Themes are identified relevant to researchers and practitioners globally. These include the complexity and duality of definition: recognition of CSA; barriers to communication with children and between services; diversity of segregated and inclusive settings; interaction of age and gender; adult and peer abuse in institutions; sexuality and disability; and intrusive care and medical practices. Recommendations for future research and practice in creating safe environments are provided.

The Roman Catholic Church: A Centuries Old History of Awareness of Clerical Child Sexual Abuse (from the First to the 19th Century).

Debates in international forums and in mainstream media on the role, responsibility, liability, and response of ecclesiastical authorities of the Roman Catholic Church (RCC) toward clerical child sexual abuse (cCSA) fail to take into account the historical roots and awareness of the problem. Reports also fail to mention the historic organizational laws RCC developed over centuries. In contrast, RCC documents evidence that the Catholic Church not only carried century's old history of cCSA, but also repeatedly condemned cCSA by successive papal authorities, organizational laws, and institutional management mechanisms. During the first millennium, however, church laws remained confined to the bookshelves and were not converted into appropriate management policies and infrastructural models. This was largely due to the absence of a central administrative organizational structure, which developed later in the 12th century, following the Second Council of Lateran (1139) when the Papacy asserted its authority to establish administrative control over the organizational church. It was only then that management policies started to be framed and institutional structures enacted to deal more appropriately with cCSA from the 14th to 20th centuries. Despite this, RCC developed a culture of secrecy using clandestine organizational management models and institutional laws prescribed in 1568, 1622, 1741, 1866, 1922, and 1962 which aimed to manage cCSA. The current study traces reported cCSA as far back as the first century and critically examines the organizational laws, and institutional policies developed by RCC to address clerical sexual misconduct up to the end of the 19th century.

Critique of the Vatican's Role in Recent Child Protection Practice: A Brief Report.

The current report aims to clarify the practices and implicit intentions of the Holy See in addressing child sexual abuse (CSA) by clerics in the twenty-first century. Church investigation reports, United Nations reports, press coverage, and academic literature were explored to understand the relationship between Church intention and practice. Various types of literature highlight the Roman Catholic Church (RCC) as an organization that is self-referential and self-defensive, with the implicit aim of protecting the reputation of RCC at the expense of children. Organizational responses are seen as promoting the protection of perpetrating clerics, resulting in the spread of CSA by clergy nationally and globally. Recommendations are made for the introduction of modern-day management practices in RCC, filtered through a faithful understanding of gospel principles. The authors suggest that the United Nations may be an important vehicle for fostering leverage for change in RCC child protection practice.

Participatory Action Research on Help-Seeking Behaviors of Self-Defined Ritual Abuse Survivors: A Brief Report.

The existence of ritual abuse is the subject of much debate. Ritual abuse survivor perceptions of seeking help have not been explored, and studies have yet to utilize self-defined survivors as collaborative researchers. This study addresses both issues. Participatory action research was utilized to design a survey and semistructured interview to investigate ritual abuse survivor experience of seeking help. Sixty-eight participants completed the survey, and 22 were interviewed. A group approach to thematic analysis aided validity and reliability. Participants reported experiencing disbelief and a lack of ritual abuse awareness and help from support services. In contrast, participatory action research was reported by participants as educative and emancipatory. Future research should explore the benefits of participatory action research for survivors of different forms of oppression.

School-based child sexual abuse prevention programs: moving toward resiliency-informed evaluation.

Although recent years have seen an increase in the range of child sexual abuse prevention programs delivered in schools, there have been relatively few efficacy studies. Those conducted have focused primarily on intrinsic child factors and have often lacked an explicit theoretical framework. We offer resiliency theory as a useful and apposite theoretical framework for program evaluation. Resiliency theory suggests that a wider range of factors should be considered, including intrinsic (personal characteristics) and extrinsic (environmental) factors. Such factors may increase risk or, alternatively, protect children from the negative effects of adversity. We argue that a resiliency perspective to efficacy studies should recognize a long-term view on children's capacity to cope and can employ both standardized and contextual resiliency-informed measures.

Exploratory evaluation of a school-based child sexual abuse prevention program.

Internationally, efficacy studies of school-based child sexual abuse prevention programs display a series of methodological shortcomings. Few studies include adolescent participants, recording of disclosures has been inconsistent, and no studies to date have assessed presenter adherence to program protocols or summated the costs of program implementation. A pretest-posttest waitlist control design was used to evaluate the Tweenees program delivered to grade 6 (n = 88) and grade 7/8 students (n = 117) compared to a control (n = 185). Outcome measures included a knowledge/skills questionnaire, systematic coding of disclosures, and video interaction analysis of lessons. Costs were calculated per student, class, and school. Adolescents made small knowledge and skills gains indicating a program ceiling effect. Implementation analysis suggests low levels of adult control facilitated disclosures. Program costs were relatively inexpensive. Recommendations are made for future research.

Diabetes-Related Major and Minor Amputation Risk Increased During the COVID-19 Pandemic.

BACKGROUND: Along with significant case transmission, hospitalizations, and mortality experienced during the global severe acute respiratory syndrome coronavirus 2 pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a Level I trauma center in central Ohio. METHODS: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and were divided into prepandemic (n = 120) and pandemic groups (n = 150). Data regarding demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed. RESULTS: The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased, with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for undergoing a major amputation was 3.1 times higher than before the pandemic. In addition, the severity of infections increased during the pandemic, and a larger proportion of the cases were classified as emergent in the pandemic group compared to the prepandemic group. CONCLUSIONS: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes mellitus (DM)-related foot problems, resulting in more severe infections and more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood that it was a major amputation also increased.

Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury-An RCT study.

Objective: Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol-GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery. Methods: The study's design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre-treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences - International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study. Results: Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study's findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic. Conclusion: The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.

A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Videoconference Psychotherapy During COVID-19 With Frontline Mental Health Workers: A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol.

Objective: The COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency. Methods: A total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a "Blind 2 Therapist" EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants' experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood. Results: Regarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood. Conclusion: The research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial. Clinical Trial Registration: Clinical Trial Registration: https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.