Mechanical Support Research Articles

Abstract 4134712: Pheochromocytoma-Induced Cardiomyopathy Requiring Mechanical Support with Ejection Fracture Recovery Following Surgical Resection

Introduction: Pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla. The annual incidence is approximately 0.8 per 100,000 persons, though this is an underestimate given a high percentage diagnosed at autopsy. Classically, patients present with episodic headache, sweating, and tachycardia, however, pheochromocytomas can be associated with cardiomyopathy secondary to the catecholamine excess. We present an unusual case of pheochromocytoma-induced cardiogenic shock highlighting an excellent use of mechanical circulatory support with Impella and Extracorporeal Membrane Oxygenation (ECMO) bridging to surgical intervention resulting in left ventricular ejection fraction (LVEF) recovery. Case Description: A 49-year-old female with past medical history of asthma initially presented to an outside hospital for palpitations, chest pain, and hypertension. Transthoracic echo (TTE) showed preserved left ventricle ejection fraction (LVEF) while cardiac MRI showed a LVEF of 43% with dilated left ventricle and diffuse global hypokinesis consistent with a dilated cardiomyopathy. She underwent a coronary angiogram demonstrating nonobstructive CAD. She was then discharged with readmission a month later at our hospital for chest tightness, palpitations, vomiting, weakness, and dizziness. Repeat TTE showed a drop in LVEF to 10-15%. She progressed to cardiogenic shock requiring BiPAP and inotrope initiation, with progressive shock and hypotension ultimately requiring Impella 5.5 and venoartrial ECMO. Abdominal imaging was notable for 4.7 x 4.2 cm right adrenal nodule and further workup with serum and urine metanephrines confirmed pheochromocytoma. While supported, the patient underwent right adrenalectomy with subsequent wean of mechanical circulatory support and biventricular recovery on TTE. Discussion: Pheochromocytoma-induced heart failure is a rare but potentially life-threatening complication from excess catecholamine effects on the myocardium. Pheochromocytomas should be considered in the evaluation of idiopathic heart failure even in the absence of symptoms related to catecholamine excess. Early detection, pharmacological management, and surgical resection may prevent progression of myocardial remodeling. Mechanical circulatory support can be a valuable adjunct in managing refractory heart failure in these patients by providing temporary hemodynamic stabilization while awaiting definitive tumor resection.

Abstract 4128187: Does Health-related Quality of Life Differ by Race over time in Older Patients with Heart Failure from Before to After Heart Transplantation or Long-term Mechanical Circulatory Support?

Background: Minority patients are disproportionately affected by heart failure. Therefore, we aimed to determine the impact of race on health-related quality of life in three groups of older patients (60-80 years) with heart failure who underwent advanced surgical therapies (within race and by surgery group): (1) heart transplantation (HT, with pre-transplant mechanical circulatory support [HT MCS]), (2) HT without pre-transplant MCS (HT Non-MCS), or (3) long-term MCS, if ineligible for HT. Methods: Secondary analyses were conducted using data from the Sustaining Quality of Life of the Aged: Heart Transplant or Mechanical Support study. From 10/1/15 to 12/31/18, 396 patients with heart failure were recruited at 13 U.S. medical centers, of which 305 patients underwent HT (n=161 [68 HT MCS and 93 HT Non-MCS]) or long-term MCS (n=144) and had data through 1 year follow-up. Analysis included non-inferiority testing (Long-term MCS vs HT MCS; Long-term MCS vs HT Non-MCS). To demonstrate non-inferiority, the surgical strategies by race needed to show a difference of at least 5 percentage points, with a 95% lower confidence boundary and a two-tailed p-value<0.05 in health-related quality of life, using the Kansas City Cardiomyopathy-12 Questionnaire Overall Summary Score at baseline and 3-, 6-, and 12 months. Results: The entire cohort was on average 66.2±4.7 years, 78% male, and 84% White. All three surgical groups experienced improved health-related quality of life from before to 1 year follow-up; with the largest gain through 3-months. Using non-inferiority testing, the long-term MCS minority group did not demonstrate non-inferiority when compared to both the HT MCS minority group and HT Non-MCS minority group confidence limits above the non-inferiority margin of -5 (Figure). Also, the White long-term MCS group did not demonstrate non-inferiority when compared to the White HT MCS and White HT Non-MCS groups. Conclusion: Differences in health-related quality of life among groups based on race were not statistically significant. Per non-inferiority testing, HT is superior to long-term MCS for health-related quality of life, regardless of race.

Abstract 4129440: Ventricular Stunning Following Direct Current Cardioversion: A Case Report

Background: Ventricular stunning refers to a transient mechanical dysfunction of the myocardium, typically manifesting in response to ischemic insults, reperfusion injury, inflammatory states, or neurohormonal overload. Here, we present an unusual case of ventricular stunning precipitated by direct current electrical cardioversion (DEC). Case Report: A 73-year-old man with a history of heart failure with reduced ejection fraction, paroxysmal atrial fibrillation (AF), coronary artery disease, and chronic kidney disease was admitted to a Veterans Affairs hospital for heart failure exacerbation. His hospitalization was complicated by recurrent episodes of symptomatic AF with ventricular rates in the 120-150’s. This was initially managed with intravenous amiodarone and eventually DEC. He continued to experience symptomatic episodes of AF. Later in the hospitalization a repeat DEC with a single 200 joule shock was performed with restoration of sinus rhythm. Several hours afterwards he was found to be unresponsive and hypotensive. Cool extremities and rising serum lactate raised suspicion for cardiogenic shock resulting in transfer to the intensive care unit where vasopressor and inotropic support were initiated. Echocardiogram revealed a precipitous decrease in left ventricular ejection fraction from 25% to 5%. Serum troponin concentrations were unchanged from prior and ECGs demonstrated rate-controlled AF. Clinical Decision Making: This case highlights an episode of unexpected decrease in cardiac output following an otherwise routine repeat DEC for recurrent AF requiring escalation to mechanical circulatory support. His decompensation worsened, necessitating transfer to the local university center for placement of catheter-based miniaturized ventricular assist device (Impella 5’5). Over the subsequent days, with supportive care, his left ventricular ejection fraction recovered to baseline, and mechanical and inotropic support were withdrawn. Conclusion: Ventricular stunning, leading to cardiogenic shock, is a rare and incompletely understood complication of DEC. It warrants consideration when monitoring patients after cardioversion. Implementing vigilant observation protocols post-DEC to detect ventricular stunning and predisposing risk factors could significantly enhance clinical management strategies.

Abstract 4134778: Myocardial Recovery and Survival after Weaning of Left Ventricular Assist Device Therapy in Patients with Toxic and non-Toxic Cardiomyopathy, A Canadian Experience

Left ventricular assist devices (LVAD) are increasingly used in refractory heart failure, mainly as a bridge to transplant or as destination therapy. LVAD unloading of the left ventricle (LV) can also promote myocardial recovery leading to improvement of the LV systolic function, allowing LVAD explantation. However, parameters associated with LVAD weaning and long-term outcomes are not well documented. The aim of this study was to assess the clinical and echocardiographic characteristics of weaned patients and to evaluate their event-free survival post-explantation. We conducted a single-center retrospective study recruiting patients who underwent a second or third generation LVAD implantation at a Canadian cardiology center between November 2009 and October 2021. A total of 98 patients underwent LVAD implantation during this period. All patients were on guideline-directed medical therapy (GDMT). Fourteen patients (14%) had significant LV recovery and were explanted/decommissioned after a median support time of 309 days (range 55-595 days). Toxic cardiomyopathy, defined as abuse of amphetamines (n=2), energy drinks (n=2) or multiple substances (n=6), was the most likely diagnosis in 10 of the weaned patients (71%). The LVEF was significantly higher and the left ventricular end-diastolic diameter (LVEDD) was significantly lower in weaned patients compared to unweaned patients after 3 months of support. Myocardial recovery manifested as pump thrombosis in 4 of the weaned patients (29%). Prior to explantation, 12 patients had a decrease in GDMT doses to minimize post explantation vasoplegia. After explantation, median follow-up time was 40 months (range 8-109 months) and the majority of patients were anticoagulated for 3 months. At last follow up, the LVEF was 44±6% and no patient had a LVEF below 35%. All patients were NYHA I or II and no death, heart transplant, or mechanical support initiation occurred. LVAD therapy can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially young patients with toxic and non-ischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months following implantation is associated with successful weaning. Pump thrombosis seems to be associated with LV reverse remodeling and weaning of mechanical support in certain patients. Weaned patients maintain satisfactory LVEF recovery after explantation and have good long-term event-free survival.

Gluing osteochondral fragments: development of a novel strategy for dual adhesive application in a preclinical model

This study proposes a novel dual adhesive approach for fixing osteochondral fractures, aiming to address the limitations of current fixation methods by incorporating both a bone adhesive (phosphoserine modified calcium phosphate cement PM-CPC) and a cartilage adhesive (methacrylated phosphoserine-containing gelatin MePGa hydrogel). The feasibility and efficacy of this approach were investigated using an ex vivo bovine knee model. Results indicate successful gluing of osteochondral cylinders with both adhesives, with no significant difference in adhesion strength between the groups (adhesion strength mean of 1211.6 kPa, SD 602.4 kPa, and mean of 1299.6 kPa, SD 850.9 kPa for groups 1 and 2 respectively). Importantly, the inclusion of the hydrogel component in the dual adhesive system aims to enhance cartilage repair potential, complementing the mechanical support provided by the bone adhesive. Each adhesive offers distinctive benefits: PM-CPC for mechanical support and bone repair, and MePGa hydrogel for cartilage repair. The study demonstrates the potential of the dual adhesive strategy for osteochondral repair, though further refinement and in vivo validation are needed.

Building A Research Culture: Interventions And Innovations

This study explored the promotion of research-based strategies and practices in Philippine public schools. The Department of Education supported this initiative by encouraging teachers and school leaders to engage in research to develop evidence-based solutions. Using a phenomenological approach and action research design, the researchers examined the concepts of ”building” and ”research culture.” The research culture emerged as a way of life and part of the teacher’s identity, involving five key actions: becoming, experiencing, feeling, sustaining, and developing. These actions encompassed the elements of forming a teacher-researcher identity, navigating challenging and positive experiences, investing emotions in research, and maintaining the culture through various support mechanisms. The ’developing’ action highlighted the dynamic nature of research culture and continuous learning. The study introduced the MOVERS (Moving Research through Blended Learning Space) intervention in different schools, providing coaching and mentoring to teachers’ as they craft their concept paper presentations. This programme also addressed the challenges of conducting research during the new normal. Future research should consider measuring MOVERS’ impact after multiple iterations.

Potential of an Attractive High-Rate Navel Orangeworm (Lepidoptera: Pyralidae) Pheromone Dispenser for Mating Disruption or for Monitoring

Mating disruption is used to manage Amyelois transitella (Walker) (Lepidoptera: Pyralidae). Current mating disruption uses a single compound, but at least one other is necessary for source contact in laboratory assays and efficient capture in traps in the field. We conducted experiments to examine disruption of sexual communication and attraction of males to these high-rate dispensers with either one or both compounds. Trap suppression experiments compared males captured in pheromone traps in orchard blocks treated at a low, medium, or high number of dispensers per ha, and a trapping study used the dispensers as attractants in sticky traps to compare their relative attractiveness. The 2-compound dispensers suppressed male capture in pheromone traps more effectively than the 1-compound dispensers at the intermediate density. The trapping study found that both dispensers captured fewer males than a monitoring lure in the absence of mating disruption but more males in the presence of mating disruption. These data provide additional support for a hybrid mechanism of mating disruption for this species and indicate that the use of the more attractive 2-compound dispensers could make mating disruption more effective at the lowest dispenser density currently used. Alternatively, a lure base on the 2-compound dispenser could provide equally effective monitoring in the presence of mating disruption.

Topology Optimization of the Bracket Structure in the Acquisition, Pointing, and Tracking System Considering Displacement and Key Point Stress Constraints

The lightweight and displacement-stable design of the mechanical support structure within the APTS (Acquisition, Pointing, and Tracking System) is crucial for enhancing the payload capacity of remote sensing, satellite communication, and laser systems, while still meeting specified functional requirements. This paper adopts the Solid Isotropic Material with Penalization (SIMP) method to investigate the structural topology optimization of the L-shaped bracket in the APTS, aiming to minimize structural compliance while using volume, key point displacement, and maximum stress as constraints. In the optimization model, differences in the topology of the L-shaped bracket structure are explored to minimize structural compliance, which was performed under volume, key point displacement, and stress constraints, and the results are compared with the initial reinforced structure. The innovative L-shaped bracket structure obtained through topology optimization uses significantly less material than the initial reinforced design, while still meeting the displacement and stress constraints. After smoothing, rounding, and finite element analysis, the displacement and stress performance of the optimized L-shaped bracket structure satisfies the set constraints. The method proposed in this paper offers an innovative solution for the lightweight design of mechanical support structures in APTS, with significant engineering application potential.

School Innovation Culture as Predictor of Teachers’ Research Competence

The study assessed the school innovation culture and teachers' research competence in selected higher education institutions in Hunan, China. It assessed the culture of school innovation using the sub-variables strategy, support mechanism, structure, and creative behavior. To assess research competence, the study used the sub-variables research methodology, ethics, and utilization of research. The study also determined the predictive role of innovation culture on teachers' research competence. The study involved 305 teacher respondents selected randomly from a total population of 1460 teachers. The researcher developed the instrument used for data gathering. It was validated, pilot tested, and showed acceptable reliability results. The findings revealed a weak innovation culture in the schools investigated. The respondents assessed innovation culture as weak in all its sub-variables. It implies a lack of organized effort to foster an innovation culture in the investigated schools. The findings also showed poor research competence among the respondents. They have poor competence in research methodology, ethics, and utilization. Based on the results of the multiple linear regression analysis, the study concluded that school innovation culture has a predictive influence on teachers' research competence. This implies that a weak school innovation culture has a negative impact on the research competence of teachers. The study highlights the need to strengthen innovation culture to increase school research productivity.

Spaces, Pedagogies and Technologies

23 Things International (23T) is a 14-week, online, self-directed course for doctoral researchers, supervisors and early career researchers. It provides the basis of engagement with 23T to promote building academic and research networks, increase familiarity with resources underpinning research, and establish professional profiles. The programme, first launched in 2020 as a collaboration between UK and NZ universities, initially attracted 250 participants. In 2021 the collaboration grew, and it attracted 400. The following years, 2022 and 2023, the number of collaborating institutions grew again, reaching about 550 participants. This year there were more than 1000 participants. Adopting a socio-technical framework (Bostrom & Heinen, 1977), this paper draws on end-of-programme evaluation data from participants in 23T, delving into perspectives on whether and how they connected with peers during this course. Within a broadly interpretive approach (Erickson, 2012), the analysis involved the refinement of major and common ideas (Mayring, 2000) held by participants. Two themes emerged from the 2020 to 2023 end-of-programme evaluation: opportunities to network with the diversity of peers need to be better engineered in; and explicit pedagogical guidance is required to develop deeper partnerships among participants. Apart from grouping participants into pods based on research interests, the course includes mechanisms of support, including an engagement mentor and live networking events. However, the networking and partnership opportunities were still viewed as insufficient by participants, and the number of participants attending live events was low (average of 5 per session). One of the participants commented, “Given the lack of engagement I found within my pod, I would have preferred a much bigger facilitated session for discussions and sharing of ideas”. While it is argued that intentionally designed spaces, pedagogies and technologies can lead to enhanced learning and teaching experiences (Dron, 2023), many 23T participants did not agree. Not only was engagement in the created spaces lower than hoped, it seemed that the digital learning and teaching pedagogies (e.g., the creation of communities of practice via pods) were not as effective as intended either. The design of the spaces has been revised over the last 4 years, yet outcomes appear to be similar. The adoption of ‘proven’ pedagogies found in the literature was also in vain. The integration of digital technologies into networking and partnership opportunities seems limited. Given that the participants of 23T are in their highest qualification status, we face a conundrum about why the spaces, pedagogies and technologies within the programme appear to be not interconnected when it comes to networking and partnership opportunities as we enter the so-called “post digital learning spaces of higher education” (Lamb, et. al., 2022). We now think that building digital literacy prior to the commencement of the programme and providing explicit digital literacy support during the programme might be a key to addressing this conundrum. It is hoped that this development will increase future participants’ understanding of the networking opportunities built into the course and stimulate them to engage actively and with purpose.

Exploring Sex-Based Neuropsychological Outcomes in Pediatric Brain Cancer Survivors: A Pilot Study

Background: The increasing survival rates among pediatric cancer patients underscore the critical need to understand the long-term psychosocial impacts of cancer treatments, such as cisplatin and carboplatin. While these treatments are lifesaving, they may pose risks to neurodevelopmental processes. Despite the substantial body of research highlighting cognitive impairments associated with cancer treatments, there remains a gap in understanding how these effects differ by sex. As sex differences could inform tailored interventions and support mechanisms for affected individuals, this pilot study aimed to examine the sex differences in neuropsychological outcomes in patients treated for brain cancer with cisplatin and/or carboplatin. Methods: Our study employed rigorous/structured neuropsychological assessments to evaluate executive functions in pediatric cancer survivors treated with cisplatin and/or carboplatin. We utilized the BRIEF and TOL tests to assess the key domains of executive function, including inhibitory control, cognitive flexibility, and problem-solving abilities. Additionally, psychosocial factors were evaluated using the Resiliency Scale to measure resilience and the PAT test to assess family psychosocial risk. Results: In our cohort of 17 patients, significant sex differences emerged, where males outperformed females in areas such as inhibitory control, impulse regulation, and strategic planning. Conclusions: These findings highlight the complexity of cognitive outcomes in pediatric cancer survivors. Understanding sex-specific differences is essential for developing tailored interventions that optimize cognitive and psychosocial outcomes. Future research should focus on larger cohorts and longitudinal studies to validate these findings and guide targeted interventions to improve survivorship outcomes.

Designing Dialogic Peer Feedback in Collaborative Learning: The Role of Thinq Tank

As technology continues to reshape education, the integration of peer feedback (PF) is increasingly recognized as a key element in promoting student collaboration and learning. This design study tracks the development and implementation of the Thinq Tank tool, which is aimed at facilitating dialogic PF within computer-supported collaborative-inquiry learning (CSCiL) environments. The research was conducted through three design iterations, comparing two key experimental conditions: one contrasting non-dialogic PF with dialogic PF, and another comparing dialogic PF with scripted dialogic PF featuring dynamic sentence-starters and defined roles. Utilizing a quasi-experimental design, we assessed the overall impact on scientific (collaborative) learning outcomes, students’ perceptions of PF, and the composition and elements of PF dialogues. The findings suggest that the integration of dialogic PF within a CSCiL lesson series helps to boost scientific collaborative learning outcomes and increases student receptivity to PF. The study demonstrates that integrating structured support mechanisms within PF tools promotes PF dialogues in which students critically evaluate each other’s work and collaboratively think about ways to improve quality. These insights illustrate that structured, technology-supported PF can significantly advance inquiry outcomes and foster deeper collaborative learning in secondary STEM education.

Digital Competency Development Among merchant Vocational Education Lecturers: An Analysis of Personal and Institutional Factors Influencing Teaching Effectiveness in Indonesian Higher Education

This study examines digital competencies among lecturers in Indonesian Maritime Vocational Colleges, aiming to analyze the relationship between lecturer profiles, institutional factors, and digital competency development. The research objectives focus on understanding how personal characteristics and institutional support mechanisms influence digital teaching capabilities while identifying effective strategies for enhancing digital competencies in maritime vocational education. Through a quantitative approach utilizing a comprehensive survey of lecturers across maritime institutions, the study employs DigCompEdu-based measurement tools to assess ten crucial dimensions of digital competency. The methodology combines questionnaires and structured interviews, analyzing data through confirmatory factor analysis and linear regression. Results reveal that while overall digital competency scores are above average on a Likert scale, significant variations exist across different competency domains. Digital tool usage demonstrates the strongest positive correlation with competency development, followed by attitudes toward technology. The study identifies age as negatively correlated with digital competency, while workload shows an unexpected positive relationship. Institutional factors, including curriculum support and professional development opportunities, significantly influence digital competency development. These findings contribute to understanding digital competency development in vocational education settings and provide practical insights for enhancing digital integration in maritime education institutions.

The impact of practicum job demands and resources on pre-service teachers’ occupational commitment and job intent

Around the world, there is a need to understand how to support pre-service teachers through their initial teacher education (ITE). The current study applied the Job Demands-Resources Theory to examine the associations among Australian pre-service teachers’ job demands and resources. The structural equation modelling found that perceived autonomy support, and relatedness with colleagues and students, were positively related to work outcomes of occupational commitment and job intent. Conversely, factors like disruptive student behaviour and time pressure were negatively associated with these outcomes. These findings suggest the relevance of providing support mechanisms for pre-service teachers to enhance their important ITE phase.

DIREITOS HUMANOS E O AMPARO AS FAMÍLIAS VÍTIMAS DE CRIMES CONTRA A VIDA

The scope of this study is to address human rights – a central aspect of any legal reflection, after all, all rights have an anthropocentric nature – in line with the social and legal support of families whose lives were cut short by violence. In particular, the families of victims of crimes against life. In the wake of this process, the research problem consists of asking how to strengthen means of social and legal protection for “those who remain”, that is, the relatives of victims of completed homicides. The general objective is to reflect on crimes against life from a different perspective of criminal protection: one that focuses not on the life that was cut short, but on the life that, with difficulty, must continue. Hence the importance of a fair investigation, trial, instruction and judgment to ensure that the truth is reconstructed and clarified for the relatives. The methodology used consists of a bibliographic review, carried out in a critical, systemic and integrative manner of the relevant literature, based on an inductive method, explanatory research and a qualitative approach. First, the article discusses the dignity of the human person as a legal- philosophical value. Second, it recognizes the protection of the legal asset “life” as played by criminal law. Third, it analyzes ways to socially and legally protect families of homicide victims. As a result, it is established that the social and legal protection of families of homicide victims requires an integrated and multifaceted approach. First, the dignity of the human person, as a fundamental value, must be central to policies and practices aimed at these families, ensuring that their integrity and rights are preserved and respected throughout the entire judicial process. Second, it is imperative that criminal law, when protecting the legal asset “life”, is not limited to punishing the perpetrator, but also considers the lasting impact on survivors and seeks to offer ongoing support. In addition, the research showed that, in order to strengthen social and legal protection, it is necessary to implement effective mechanisms of psychological, social and legal support, which go beyond palliative measures.

Examining the Support of Students in e-Learning Context: e-Tutors’ Perspectives

Student support received some attention from e-learning institutions but with some caution in the extent of empirical studies where -tutors’ perceptions were explored. The premise of this research paper is to contribute to an understanding of how support is understood from the e-tutors’ perspectives. It also aims to suggest new and alternative support mechanisms for the e-tutors. Six e-tutors were participants in the Design Thinking and Technology course modules for honours students at a distance learning institution. A quantitative approach and web questionnaires were used to collect the data and were analyzed and visualized through pie charts to represent the data. The findings reveal a significant gap in the e-tutors' ability to effectively support students based on the constructs that were developed. This highlights a critical area for improvement in the training and resources provided to e-tutors to enhance the efficacy of online education.

A Cross-Sectional Study Investigating the Role of Meaning and Purpose in Life Among Older Individuals (≥50-Years Old) in Recovery from Alcohol Use Disorder/Problem Drinking

ABSTRACT Meaning and purpose in life (MPL) is an important domain of the recovery capital model. Yet, this important recovery support mechanism has received scant attention, particularly in relation to older individuals recovering from alcohol use disorder (AUD)/problem drinking. Framed within Viktor Frankl’s theory of meaning, the study used two measures, the Purpose in Life Test and the Meaning in Life Questionnaire, to collect the data of 381 older individuals (≥50-years old) in recovery. The data was analyzed against four independent variables: onset age of problem drinking (early- and late-onset), gender, continuous years in recovery and recovery pathways. The study found a significant relationship between MPL and continuous years in recovery, suggesting that as the length of time in recovery increases, so too, do levels of MPL.

Digital Innovation Practices and Supporting Mechanisms in Schools

Digital Innovation Practices and Supporting Mechanisms in Schools

Advancing Adult-Acquired Flatfoot Deformity Treatment: Enhanced Biomechanical Support Through Graphene Oxide-Integrated Bioengineered Grafts Tested In Silico

Adult-Acquired Flatfoot Deformity (AAFD) is a progressive orthopedic condition causing the collapse of the foot’s medial longitudinal arch, often linked with injuries to the plantar arch’s passive stabilizers, such as the spring ligament (SL) and plantar fascia. Conventional treatment typically involves replacing the SL with synthetic material grafts, which, while providing mechanical support, lack the biological compatibility of native ligaments. In response to this shortcoming, our study developed an electrospun, twisted polymeric graft made of polycaprolactone (PCL) and type B gelatin (GT), enhanced with graphene oxide (GO), a two-dimensional nanomaterial, to bolster biomechanical attributes. The addition of GO aimed to match the native ligamentous tissue’s mechanical strength, with the PCL-GT-GO 2.0% blend demonstrating an optimal Young’s modulus of 240.75 MPa. Furthermore, the graft showcased excellent biocompatibility, evidenced by non-hemolytic reactions, suitable wettability and favorable platelet aggregation—essential features for promoting cell adhesion and proliferation. An MTT assay revealed cell viability exceeding 80% after 48 h of exposure, highlighting the potential of the graft as a regenerative scaffold for affected ligaments. Computational modeling of the human foot across various AAFD stages assessed the graft’s in situ performance, with the PCL-GT-OG 2.0% graft efficiently preventing plantar arch collapse and offering hindfoot pronator support. Our study, based on in silico simulations, suggests that this bioengineered graft holds significant promise as an alternative treatment in AAFD surgery, marking a leap forward in the integration of advanced materials science for enhanced patient care.

Challenges and Support Frameworks for Producing High Quality Business Research: A Case Study of Lebanese Scholars

AbstractThis paper aims at exploring the contexts of academic research outputs faced by Lebanese researchers at four major Lebanese business schools. It analyzes both challenges and support mechanisms at these institutions to suggest improvements to the existing framework considering the researchers’ perspectives and opinions. A multiple case study was carried out at four major Lebanese business schools in which 14 individuals involved in research were interviewed. Thematic analysis was carried out to explore the host of challenges faced in the sphere of research output. This study may provide other institutions and researchers in the region and the developing world with a greater insight into necessary alterations to their own research challenges and approaches.