The Clinical Emergency Data Registry: Structure, Use, and Limitations for Research.

The Clinical Emergency Data Registry (CEDR) is a qualified clinical data registry that collects data from participating emergency departments (EDs) in the United States for quality measurement, improvement, and reporting purposes. This article aims to provide an overview of the data collection and validation process, describe the existing data structure and elements, and explain the potential opportunities and limitations for ongoing and future research use. CEDR data are primarily collected for quality reporting purposes and are obtained from diverse sources, including electronic health records and billing data that are de-identified and stored in a secure, centralized database. The CEDR data structure is organized around clinical episodes, which contain multiple data elements that are standardized using common data elements and are mapped to established terminologies to enable interoperability and data sharing. The data elements include patient demographics, clinical characteristics, diagnostic and treatment procedures, and outcomes. Key limitations include the limited generalizability due to the selective nature of participating EDs and the limited validation and completeness of data elements not currently used for quality reporting purposes, including demographic data. Nonetheless, CEDR holds great potential for ongoing and future research in emergency medicine due to its large-volume, longitudinal, near real-time, clinical data. In 2021, the American College of Emergency Physicians authorized the transition from CEDR to the Emergency Medicine Data Institute, which will catalyze investments in improved data quality and completeness for research to advance emergency care.

Leveraging a Learning Collaborative Model to Develop and Pilot Quality Measures to Improve Opioid Prescribing in the Emergency Department.

The American College of Emergency Physicians (ACEP) Emergency Medicine Quality Network (E-QUAL) Opioid Initiative was launched in 2018 to advance the dissemination of evidence-based resources to promote the care of emergency department (ED) patients with opioid use disorder. This virtual platform-based national learning collaborative includes a low-burden, structured quality improvement project, data benchmarking, tailored educational content, and resources designed to support a nationwide network of EDs with limited administrative and research infrastructure. As a part of this collaboration, we convened a group of experts to identify and design a set of measures to improve opioid prescribing practices to provide safe analgesia while reducing opioid-related harms. We present those measures here, alongside initial performance data on those measures from a sample of 370 nationwide community EDs participating in the 2019 E-QUAL collaborative. Measures include proportion of opioid administration in the ED, proportion of alternatives to opioids as first-line treatment, proportion of opioid prescription, opioid pill count per prescription, and patient medication safety education among ED visits for atraumatic back pain, dental pain, or headache. The proportion of benzodiazepine and opioid coprescribing for ED visits for atraumatic back pain was also evaluated. This project developed and effectively implemented a collection of 6 potential measures to evaluate opioid analgesic prescribing across a national sample of community EDs, representing the first feasibility assessment of opioid prescribing-related measures from rural and community EDs.

Pre-implantation mouse embryo movement under hormonally altered conditions.

Pre-implantation embryo movement is crucial to pregnancy success, but the role of ovarian hormones in modulating embryo movement is not understood. We ascertain the effects of altered hormonal environment on embryo location using two delayed implantation mouse models: natural lactational diapause (ND); and artificially induced diapause (AD), a laboratory version of ND generated by ovary removal and provision of supplemental progesterone (P4). Previously, we showed that embryos in a natural pregnancy (NP) first display unidirectional clustered movement, followed by bidirectional scattering and spacing movement. In the ND model, we discovered that embryos are present as clusters near the oviductal-uterine junction for ∼24 h longer than NP, followed by locations consistent with a unidirectional scattering and spacing movement. Intriguingly, the AD model resembles embryo location in NP and not ND. When measuring serum hormone levels, unlike the popular paradigm of reduced estrogen (E2) levels in diapause, we observed that E2 levels are comparable across NP, ND and AD. P4 levels are reduced in ND and highly increased in AD when compared to NP. Further, exogenous administration of E2 or P4 modifies embryo location during the unidirectional phase, while E2 treatment also affects embryo location in the bidirectional phase. Taken together, our data suggest that embryo movement can be modulated by both P4 and E2. Understanding natural hormonal adaptation in diapause provides an opportunity to determine key players that regulate embryo location, thus impacting implantation success. This knowledge can be leveraged to understand pregnancy survival and implantation success in hormonally altered conditions in the clinic.

Design, Synthesis and Aromaticity of an Alternating Cyclo[4]Thiophene[4]Furan.

A new class of conjugated macrocycle, the cyclo[4]thiophene[4]furan hexyl ester (C4TE4FE), is reported. This cycle consists of alternating α-linked thiophene-3-ester and furan-3-ester repeat units, and was prepared in a single step using Suzuki-Miyaura cross-coupling of a 2-(thiophen-2-yl)furan monomer. The ester side groups help promote a syn conformation of the heterocycles, which enables formation of the macrocycle. Cyclic voltammetry studies revealed that C4TE4FE could undergo multiple oxidations, so treatment with SbCl5 resulted in formation of the [C4TE4FE]2+ dication. Computational work, paired with 1 H NMR spectroscopy of the dication, revealed that the cycle becomes globally aromatic upon 2e- oxidation, as the annulene pathway along the outer ring becomes Hückel aromatic. The change in ring current for the cycle upon oxidation was clear from 1 H NMR spectroscopy, as the protons of the thiophene and furan rings shifted downfield by nearly 6 ppm. This work highlights the potential of sequence control in furan-based macrocycles to tune electronic properties.

Evaluating Diversity and Inclusion Content on Graduate Medical Education Websites.

Websites are important tools for programs to provide future residency applicants with freely accessible information regarding their program, including diversity, equity, and inclusion (DEI) initiatives. OBJECTIVE: To describe the variability of DEI content in residency programs and compare DEI website content by specialty. METHODS: Using the 2021 Accreditation Council for Graduate Medical Education (ACGME) list of residency programs, residency training websites were identified and evaluated. Information was extracted from program websites as indicators of DEI content. Chi-square analysis and one-way ANOVA were chosen to assess for statistical differences. RESULTS: In total, 4644 program websites representing 26 specialties were assessed. Among all the programs, the average DEI completeness of a program website was 6.1±14.6% (range 0-100%). While 6.2% of all programs had a diversity webpage, only 13.3% included a commitment to DEI, and few programs (2.7%) provided information about underrepresented in medicine (URiM) faculty. CONCLUSIONS: Graduate medical education programs can enhance information for current and prospective applicants about DEI initiatives on their websites. Including DEI initiatives on residency websites may improve diversity recruitment efforts.

How well do urology residency program webpages recruit underrepresented minorities?

INTRODUCTION: Historically, the field of medicine has suffered from a lack of diversity. This project examines if urology residency program websites were actively attempting to recruit underrepresented minority applicants with the hypothesis that while some programs would attempt to attract such applicants on their website, the majority would not. MATERIALS AND METHODS: A cross-sectional analysis of program webpages for information regarding underrepresented minorities was performed. Electronic Residency Application Service residency database was used to identify 130 urology residency programs. Three were no longer accepting residents and were not included. The publicly available webpages of 137 urology residency training programs identified were reviewed. RESULTS: Only 26.3% (36) of programs included any information regarding diversity or inclusion on their webpage. The most common references to diversity were a link to a Department of Diversity and Inclusion (28, 20.4%) and information regarding a "commitment to diversity" (28, 20.4%). Only two programs included all seven categories searched for. CONCLUSIONS: Residency program websites may be an important tool to recruit underrepresented minorities and currently there is significant room for improvement. Given that urology is already behind other fields in terms of representation, it is especially important to make an active, visible attempt to recruit underrepresented minorities.

The TFAP2A-IRF6-GRHL3 genetic pathway is conserved in neurulation.

Mutations in IRF6, TFAP2A and GRHL3 cause orofacial clefting syndromes in humans. However, Tfap2a and Grhl3 are also required for neurulation in mice. Here, we found that homeostasis of Irf6 is also required for development of the neural tube and associated structures. Over-expression of Irf6 caused exencephaly, a rostral neural tube defect, through suppression of Tfap2a and Grhl3 expression. Conversely, loss of Irf6 function caused a curly tail and coincided with a reduction of Tfap2a and Grhl3 expression in tail tissues. To test whether Irf6 function in neurulation was conserved, we sequenced samples obtained from human cases of spina bifida and anencephaly. We found two likely disease-causing variants in two samples from patients with spina bifida. Overall, these data suggest that the Tfap2a-Irf6-Grhl3 genetic pathway is shared by two embryologically distinct morphogenetic events that previously were considered independent during mammalian development. In addition, these data suggest new candidates to delineate the genetic architecture of neural tube defects and new therapeutic targets to prevent this common birth defect.

Choosing wisely in emergency medicine: Early results and insights from the ACEP emergency quality network (E-QUAL).

PURPOSE: To characterize performance among ED sites participating in the Emergency Quality Network (E-QUAL) Avoidable Imaging Initiative for clinical targets on the American College of Emergency Physicians Choosing Wisely list. METHODS: This was an observational study of quality improvement (QI) data collected from hospital-based ED sites in 2017-2018. Participating EDs reported imaging utilization rates (UR) and common QI practices for three Choosing Wisely targets: Atraumatic Low Back Pain, Syncope, or Minor Head Injury. RESULTS: 305 ED sites participated in the initiative. Among all ED sites, the mean imaging UR for Atraumatic Low Back Pain was 34.7% (IQR 26.3%-42.6%) for XR, 19.1% (IQR 11.4%-24.9%) for CT, and 0.09% (IQR 0%-0.9%) for MRI. The mean CT UR for Syncope was 50.0% (IQR 38.0%-61.4%). The mean CT UR for Minor Head Injury was 72.6% (IQR 65.6%-81.7%). ED sites with sustained participation showed significant decreases in CT UR in 2017 compared to 2018 for Syncope (56.4% vs 48.0%; 95% CI: -12.7%, -4.1%) and Minor Head Injury (76.3% vs 72.1%; 95% CI: -7.3%, -1.1%). There was no significant change in imaging UR for Atraumatic Back Pain for XR (36.0% vs 33.3%; 95% CI: -5.9%, -0;5%), CT (20.1% vs 17.7%; 95% CI: -5.1%, -0.4%) or MRI (0.8% vs 0.7%, 95% CI: -0.4%, -0.3%). CONCLUSIONS: Early data from the E-QUAL Avoidable Imaging Initiative suggests QI interventions could potentially improve imaging stewardship and reduce low-value care. Further efforts to translate the Choosing Wisely recommendations into practice should promote data-driven benchmarking and learning collaboratives to achieve sustained practice improvement.

Aerosol and droplet generation from orbital repair: Surgical risk in the pandemic era.

INTRODUCTION: The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device. MATERIAL AND METHODS: The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300-10.000 µm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control. RESULTS: No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling. DISCUSSION AND CONCLUSIONS: Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling.

Aerosol and droplet generation from mandible and midface fixation: Surgical risk in the pandemic era.

PURPOSE: The COVID-19 pandemic has led to concerns over transmission risk from healthcare procedures, especially when operating in the head and neck such as during surgical repair of facial fractures. This study aims to quantify aerosol and droplet generation from mandibular and midface open fixation and measure mitigation of airborne particles by a smoke evacuating electrocautery hand piece. MATERIALS AND METHODS: The soft tissue of the bilateral mandible and midface of two fresh frozen cadaveric specimens was infiltrated using a 0.1% fluorescein solution. Surgical fixation via oral vestibular approach was performed on each of these sites. Droplet splatter on the surgeon's chest, facemask, and up to 198.12 cm (6.5 ft) away from each surgical site was measured against a blue background under ultraviolet-A (UV-A) light. Aerosol generation was measured using an optical particle sizer. RESULTS: No visible droplet contamination was observed for any trials of mandible or midface fixation. Total aerosolized particle counts from 0.300-10.000 µm were increased compared to baseline following each use of standard electrocautery (n = 4, p < 0.001) but not with use of a suction evacuating electrocautery hand piece (n = 4, p = 0.103). Total particle counts were also increased during use of the powered drill (n = 8, p < 0.001). CONCLUSIONS: Risk from visible droplets during mandible and midface fixation is low. However, significant increases in aerosolized particles were measured after electrocautery use and during powered drilling. Aerosol dispersion is significantly decreased with the use of a smoke evacuating electrocautery hand piece.

Changing the Criminal Justice System Response to Sexual Assault: An Empirical Study of a Participatory Action Research Project.

In jurisdictions throughout the United States, thousands of sexual assault kits (SAKs; also known as a "rape kits") have not been submitted by the police for forensic DNA testing. DNA evidence may be helpful to sexual assault investigations and prosecutions by identifying perpetrators, revealing serial offenders through DNA matches across cases, and exonerating those who have been wrongly accused. This paper describes a longitudinal action research project conducted in Detroit, Michigan after that city discovered approximately 11,000 untested sexual assault kits in a police department storage facility. We conducted a root cause analysis to examine individual, organizational, community, and societal factors that contributed to the development of the rape kit backlog in Detroit. Based on those findings, we implemented and evaluated structural changes to increase staffing, promote kit testing, and retrain police and prosecutors so that cases could be reopened for investigation and prosecution. As we conducted this work, we also studied how this action research project impacted the Detroit criminal justice system. Participating in this project changed stakeholders' attitudes about the utility of research to address community problems, the usefulness of DNA evidence in sexual assault cases, and the impact of trauma on survivors. The results led to new protocols for SAK testing and police investigations, and new state legislation mandating SAK forensic DNA testing.

Intervention Effects of "Girls on the Move" on Increasing Physical Activity: A Group Randomized Trial.

BACKGROUND: Limited intervention success in increasing and sustaining girls' moderate-to-vigorous physical activity (MVPA) underscores a need for continued research. PURPOSE: The aim of this study was to evaluate the effect of a 17-week Girls on the Move (GOTM) intervention on increasing MVPA among fifth- to eighth-grade girls. METHODS: This study is a group (cluster) randomized trial, including 24 schools, pair matched and assigned to intervention (n = 12) or control (n = 12) conditions. Participants included 1,519 girls in racially diverse public schools in urban, underserved areas of the Midwestern USA. The intervention included three components: (i) 90-min after-school physical activity (PA) club offered 3 days/week; (ii) two motivational, individually tailored counseling sessions; and (iii) an interactive Internet-based session at the midpoint of the intervention. Main outcome measures were weighted mean minutes of MVPA per week post-intervention and at 9-month follow-up measured via accelerometer. RESULTS: No between-group differences occurred for weighted mean minutes of MVPA per week at post-intervention (B = -0.08, p = .207) or 9-month follow-up (B = -0.09, p = .118) while controlling for baseline MVPA. CONCLUSIONS: Research is needed to identify interventions that assist girls in attaining and maintaining adequate PA. CLINICALTRIALS.GOV IDENTIFIER: NCT01503333.

Improving Timely Linkage to Care among Newly Diagnosed HIV-Infected Youth: Results of SMILE.

Delayed linkage to care deprives youth living with HIV of the benefits of HIV treatment and risks increased HIV transmission. Developing and testing linkage-to-care models that are capable of simultaneously addressing structural and individual obstacles are necessary to attain national goals for timely linkage of newly diagnosed youth to care. We assessed an integrated, multi-pronged strategy for improving youth's timely linkage to care carried out in eight adolescent medicine clinical trials units (AMTUs) in the USA. In phase I, the intervention strategy paired intensive medical case management with formalized relationships to local health departments, including granting of public health authority (PHA) to four of the AMTUs. In phase II, local coalitions run by the AMTUs to address structural changes to meet youth's HIV prevention and HIV testing needs began to advocate for local structural changes to improve timely access to care. Results of an ARIMA model demonstrated sustained decline in the average number of days to link to care over a 6-year period (ARIMA (1,2,1) AIC = 245.74, BIC = 248.70, p < .01)). By the end of the study, approximately 90% of youth linked to care had an initial medical visit in 42 or fewer days post-diagnosis. PHA improved the timeliness of linkage to care (b = - 69.56, p < .05). A piecewise regression suggested the addition of structural change initiatives during phase II made a statistically significant contribution to reducing time to linkage over and above achievements attained via case management alone (F (3,19) = 5.48, p < .01; Adj. R2 = .3794). Multi-level linkage-to-care interventions show promise for improving youth's timely access to HIV medical care.

A retrospective study of fecal output and postprocedure colic in 246 horses undergoing standing sedation with detomidine, or general anesthesia with or without detomidine.

OBJECTIVE: To determine time to first passage of feces, total fecal piles and incidence of colic in the first 24 hours postprocedure in horses undergoing standing sedation with detomidine, or general anesthesia with or without detomidine. STUDY DESIGN: Retrospective cohort study. ANIMALS: A total of 246 horses. METHODS: Records of all horses that underwent standing sedation or general anesthesia between December 2012 and March 2016 were reviewed. Horses aged <6 months, admitted for colic or cesarean section, with inadequate data, and those not administered xylazine and/or detomidine were excluded. Records included patient signalment, fasting duration, procedure performed, drugs administered, time to first feces, number of fecal piles during 24 hours postprocedure and mention of colic. Chi-square, Fisher's exact and Tukey's post hoc comparison tests were used. Parametric data were reported as mean ± standard deviation with significance defined as p <0.05. RESULTS: In total, 116 and 57 horses underwent general anesthesia without detomidine (group GA) and with detomidine (group GA-D), respectively, and remaining 73 horses underwent standing sedation with detomidine (group S-D). Detomidine dose was significantly higher in group S-D than in group GA-D. Time to first feces was longer (7.1 ± 4.2 hours), and group S-D horses passed one fewer fecal pile (6.3 ± 2.4) than group GA horses. There was no interaction between detomidine treatment and preprocedure food withholding and the time to first feces or the number of fecal piles in the first 24 hours postprocedure. Overall, seven horses (2.8%) showed signs of colic (five, one and one in GA, GA-D and S-D, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: Detomidine administration, as part of an anesthetic protocol or for standing sedation procedures, should not be expected to contribute to postprocedural colic.

How to Right a Wrong: Empirically Evaluating Whether Victim, Offender, and Assault Characteristics can Inform Rape Kit Testing Policies.

Hundreds of thousands of previously untested sexual assault kits (SAKs) have been uncovered in police property storage facilities across the United States, representing a national failure in institutional response to sexual assault. Faced with this discovery, jurisdictions must now decide if and how they should test these kits. Some stakeholders have suggested prioritizing kits for testing by victim, offender, or assault characteristics, based on the belief that these characteristics can predict the likely utility of DNA testing. However, little research has examined the empirical merits of such prioritization. To address this gap in the literature and inform SAK testing policies, we randomly sampled 900 previously untested SAKs from Detroit, MI. The sampled SAKs were submitted for DNA testing, and eligible DNA profiles were entered into Combined DNA Index System (CODIS), the federal DNA database. Police records associated with each SAK were coded for victim, offender, and assault characteristics, and logistic regression analyses were conducted to test whether these characteristics predict which SAKs yield DNA profiles that match ("hit") to other criminal offenses in CODIS. Testing this sample of previously-untested SAKs produced a substantial number of CODIS hits, but few of the tested variables were significant predictors of CODIS hit rate. These findings suggest that testing all previously-unsubmitted kits may generate information that is useful to the criminal justice system, while also potentially addressing the institutional betrayal victims experienced when their kits were ignored.

Rapid prototyping technology for cranioplasty: A case series.

Cranial vault defects may be acquired or congenital in origin. Rehabilitation of these patients often poses challenge to the operating team and prosthodontist. Polymethylmethacrylate is a commonly used alloplastic graft material which is used for the fabrication of cranial prosthesis. Nowadays, with the advancement in the bioengineering, custom-made template and cranial prosthesis can be made by rapid prototyping technology (RPT) by patient three-dimensional (3D) computed tomography (CT) scan images. This series of two cases explained two different techniques for the rehabilitation of the patient with frontotemporoparietal cranial defect. Case 1 had a history of cerebrovascular accident, followed by decompression craniotomy which led to frontotemporoparietal defect of the left side. This defect area was associated with the cerebrospinal fluid accumulation which made delineation of underlying bony margins difficult and interfered with conventional impression procedures. Case 2 had a road traffic accident which led to intracerebral hemorrhage followed by decompression craniotomy which resulted in frontotemporoparietal defect of the right side. The patient had a poor neuromuscular control which impedes with the upright posture of the head during impression making of the defect area. Therefore, these cases were planned to rehabilitate by RPT. In these techniques, the prosthesis was made using custom-made skull template produced by RPT, using the data of 3D-CT scan images. This technique resulted in the prosthesis with good esthetics and better fit of the prosthesis. The contours of the prosthesis were replicated in the same manner as compared to the contralateral side. RPT is an additive manufacturing technology which is now used in the field of dentistry too. This technique is easy to use; fabricate prosthesis with high precision is less time-consuming and has fewer chances of error.

Sources and Types of Social Support for Physical Activity Perceived by Fifth to Eighth Grade Girls.

BACKGROUND: Information is lacking on forms and sources of social support for physical activity (PA) received by adolescent girls during various pubertal stages. Two study purposes were to (a) identify the sources and forms of social support for PA perceived by adolescent girls, and (b) examine associations of pubertal stage and social support with PA. METHODS: A secondary analysis of data from a randomized trial was conducted. Fifth through eighth grade girls (N = 1,519) completed surveys on social support for PA and pubertal stage and wore an accelerometer. RESULTS: Girls in early-middle and late-post puberty most frequently received social support from their mothers. A higher proportion of girls in late-post puberty, compared to early-middle puberty, received social support from nonfamily adults (4.2% vs. 3.0%, p = .019). Girls identifying three sources participated in more moderate-to-vigorous PA than those having fewer sources (t1,512 = -3.57, p < .001). Various forms of social support, except for encouragement, were positively related to moderate-to-vigorous PA. Girls in early-middle puberty reported greater social support than those in late-post puberty (t1,512 = 3.99, p < .001). Social support was positively associated with moderate-to-vigorous PA, while girls in late-post puberty had lower moderate-to-vigorous PA than those in early-middle puberty. CONCLUSIONS: Mothers are important sources of social support for PA. Having more than two sources may result in greater PA. Encouraging girls to increase their PA may not be sufficient. CLINICAL RELEVANCE: Efforts are needed from health professionals to prevent any decline in social support for PA as girls advance across adolescence.

Physical Activity Among Female Adolescents in Jeddah, Saudi Arabia: A Health Promotion Model-Based Path Analysis.

BACKGROUND: In Saudi Arabia, about 14.8% of female children and adolescents of less than 20 years old are obese, compared with only 9.4% of male children and adolescents. One major factor linked to the high prevalence of obesity and related chronic illnesses involves inadequate physical activity (PA). Only 25% of female adolescents in Saudi Arabia meet the recommendation calling for 60 minutes of moderate to vigorous PA per day. OBJECTIVE: The aim of this research was to examine relationships among self-reported PA and cognitive and affective variables, including perceived barriers to PA, PA self-efficacy, enjoyment of PA, social support for PA, and commitment to PA. METHODS: Female Saudi adolescents 13-18 years of age were recruited from 10 public intermediate and high schools in Jeddah, Saudi Arabia. Female adolescents who met the inclusion criteria completed surveys and participated in height and weight measurements at schools. A structural equation model based on the health promotion model was estimated, with commitment to PA hypothesized to mediate relationships between health promotion model (HPM) predictors and self-reported PA. RESULTS: A total of 405 female adolescents with a mean age of 15.4 years took part in the study, of whom 25.3% were overweight or obese. Mean PA level measured via the Physical Activity Questionnaire for Adolescents was 2.1 (SD = 0.66), which is low. Commitment to PA partially mediated the relationships of PA self-efficacy, enjoyment of PA, and social support for PA; 25.4% of the variance in PA was explained. The model did not support the indirect relationship of perceived barriers through commitment or the direct relationship between enjoyment and PA. DISCUSSION: This study indicates that Saudi female adolescents are in need of interventions to increase their PA. The findings suggest that addressing perceived barriers to PA and targeting PA self-efficacy, enjoyment of PA, and social support for PA to enhance commitment to PA may be a fruitful approach in nursing interventions to increase PA among Saudi female adolescents.

Corrective Efficacy of Calcaneal Lengthening Osteotomy for Planovalgus Deformity in Cerebral Palsy Patients.

Introduction Planovalgus deformity is common in children with spastic cerebral palsy (CP), particularly spastic diplegia and spastic quadriplegia. It results from muscle imbalance over the immature foot skeleton, leading to hindfoot valgus, forefoot abduction, and joint subluxation. Surgical interventions, like calcaneal lengthening osteotomy (CLO), are frequently employed to correct this deformity, but objective guidelines for its use in CP patients are lacking. Material and methods This retrospective cohort study examined the efficacy of CLO in correcting plano valgus deformity in pediatric CP patients at the Pediatric Orthopedic Unit of Christian Medical College (CMC) in Vellore, India. Data from patient records and radiographs were collected, including demographics, pre- and postoperative angles, and surgical details. Statistical analysis was performed to assess changes in angles and associations with various factors. Results After the surgery, there was a notable enhancement in the calcaneal pitch, lateral talo-first metatarsal angle, and naviculocuboid overlap, as shown by the CLO results. However, tibiocalcaneal angles did not show significant changes. Associations were observed between age, Gross Motor Function Classification System (GMFCS) level, additional surgeries, and postoperative angle corrections. Conclusion CLO shows promise in correcting plano valgus deformity, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up is crucial to monitor correction durability. Specific radiographic angles provide insights into CLO's biomechanical effects, but study limitations warrant caution in interpretation. CLO effectively corrects plano valgus deformity in pediatric CP patients, with age, GMFCS level, and comorbidities influencing outcomes. Long-term follow-up and further research are needed to optimize management strategies and enhance understanding of surgical outcomes.