Variable Rate Research Articles

The Influence of Long-term and Short-term Variables on the Oil Prices, Money Supply, Policy Rates, Output Gaps, Rupiah Exchange Rate and Gross Fixed Capital Formation on Inflation in Indonesia

This study examines the influence of long-term and short-term variables on oil prices, money supply, policy rates, gross fixed capital formation (PMTB), rupiah exchange rate against the dollar, and output gaps on inflation in Indonesia. Indonesia is one of the countries with the highest population in the world as well as one of the countries with the most significant oil wealth in the world. However, Indonesia is still classified as a developing country. One of the indicators in a country’s economy is the inflation rate. This study used secondary data from 2006:Q1-2018:Q4 with the Error Correction Model (ECM) analysis method. The result of this study is that the variable oil prices and money supply in the short and long term have a positive and significant effect on Indonesia’s inflation. In the short and long term, variable policy rates negatively and significantly impact Indonesia’s inflation. Gross fixed capital formation and the output gap in the long and short term have an insignificant positive impact on Indonesia’s inflation.

Waste Utilization in Horticulture: An Overview

Waste management in horticulture plays a pivotal role in achieving environmental sustainability and optimizing resource utilization. One of the primary methods for waste utilization is composting, which involves the decomposition of organic waste materials to produce nutrient-rich compost. Compost serves as an excellent soil amendment, enhancing soil fertility and promoting plant growth. Additionally, anaerobic digestion offers a valuable approach for converting organic waste into biogas, a renewable energy source that can be used for heating, electricity generation, and vehicle fuel. Furthermore, fermentation processes can be employed to convert fruit and vegetable waste into valuable products such as animal feed and biofuels. The by-products of fermentation, including yeast and enzymes, have applications in various industries, contributing to the circular economy model. Advancements in precision agriculture and smart waste management systems have revolutionized waste utilization in horticulture. Technologies such as GPS, GIS mapping, wireless sensor networks and big data analytics enable data-driven, decision-making and optimize resource allocation. Precision planting, targeted spraying, automated pruning/harvesting and variable rate irrigation are among the innovative practices facilitated by these technologies, leading to increased productivity and efficiency in horticultural operations. Moreover, waste utilization in horticulture contributes to mitigating environmental pollution and reducing greenhouse gas emissions. By diverting organic waste from landfills and incineration, the emission of methane, a potent greenhouse gas, is minimized. Instead, organic waste is repurposed into valuable resources, thereby closing the loop on waste streams and promoting a circular economy.

Assessment of Cardiovascular Risk Categories and Achievement of Therapeutic Targets in European Patients with Type 2 Diabetes.

Background: Individuals diagnosed with type 2 diabetes mellitus (T2DM) are more prone to experiencing severe cardiovascular (CV) events, often occurring at a younger age, due to a complex interplay of risk factors. T2DM diagnosis inherently classifies patients as belonging to a higher CV risk group. In light of the increased susceptibility to severe CV outcomes, our study aims to assess the distribution of CV risk categories and the attainment of therapeutic targets among Romanian patients diagnosed with T2DM. Methods: A cross-sectional analysis was performed, including 885 patients diagnosed with T2DM who were consecutively admitted to a secondary care hospital unit between January and July 2019. Data collection included demographics, lipid profile, glycated hemoglobin (HbA1c), blood pressure (BP), estimated glomerular filtration rate (eGFR), and medication specifics for T2DM and associated conditions. Patients were stratified into CV risk categories based on the ESC/EAS guidelines, encompassing moderate, high, and very high risk categories. The rationale for selecting these guidelines for CV risk categories was that they were current and provided best practice recommendations for T2DM patients during the cross-sectional evaluation. We assessed therapeutic target achievement rates for LDL-C, HbA1C, and BP for each CV risk category. Additionally, we examined utilization rates of statins and novel cardio- and reno-protective, non-insulin antidiabetic medications. Results: The group's average age was 62.9 ± 7.7 years and comprised 53.7% females. An average HbA1c level of 7.1 ± 1.3% was observed in the group. Within the cohort, 83% had hypertension, with a mean systolic BP of 132 ± 16.2 mm Hg and mean diastolic BP of 80 ± 9.6 mm Hg. Additionally, 64.6% of patients were obese, with a mean body mass index of 32.3 ± 5.3 kg/m2. Mean LDL-C levels varied across the different CV risk categories: 106.6 ± 35.6 mg/dL in the very high risk category, 113 ± 39.3 mg/dL in the high risk category, and 124.3 ± 38.3 mg/dL in the moderate risk category. Most treatment schemes included metformin (87.0%) and statins (67.0%), with variable use rates for other glucose-lowering and CV risk-modifying therapies. The percentage of patients using GLP-1 RAs was 8.1%, while 3.9% used SGLT2 inhibitors. Conclusions: Most Romanian patients with T2DM are at very high or high CV risk. Despite reaching glycemic control targets, most patients are not achieving the composite target, which includes, besides glycemic control, BP values and lipid profile. Many patients with T2DM are not benefiting from DM therapies with additional cardiorenal benefits or statins.

Uterine tone influences fertility of Merino ewes following laparoscopic artificial insemination

Artificial insemination (AI) plays a critical role in facilitating rapid genetic and production gains within the sheep industry. However, variable rates of AI success remain a concern for the industry and a barrier to adoption. Furthermore, the degree to which female factors influence the success of intrauterine laparoscopic AI rather than natural mating remains unknown. As such, this study investigates the effect of several factors collected during the time of AI, on the success of intrauterine laparoscopic AI. Data was generously donated by artificial breeding companies and stud breeders during routine commercial AI operations. AI data was collected over 3 breeding seasons during commercial AI programs (N = 24 programs) using Merino ewes (N = 24,700). Sire ID (N = 253), time of AI following progesterone removal (approx. 43–59 h post removal), uterine tone and intra-abdominal fat (both scored 1–5) as well as age of the ewe were all recorded at the time of AI. Transcutaneous ultrasound subsequently determined pregnancy rate approximately 55 days post-AI. A multivariate regression analysis was performed and revealed pregnancy success to increase when semen was inseminated into a ewe with a uterine tone score of 4 or 5 (P < 0.001). The remaining factors fell short of significance within the multivariate model. An interclass coefficient variation matrix was also used to determine the proportion of variation contributed to AI success by random factors allocated in the model; site, sire, AI date and breeding season (45.99 %, 29.94 %, 15.15 % and 8.92 %, respectively). These results highlight the influence of uterine tone on ewe fertility following laparoscopic AI, but also that program location and the sire used can further modify this influence on pregnancy rate. These factors must now be considered in combination with semen factors per individual sire used during AI to ascertain the contribution of several factors to the success of laparoscopic AI in Australia.

Mechanical and microstructural responses in molybdenum-rhenium alloys under hot compressions

To study temperature and rate-dependent behaviors of molybdenum-rhenium (Mo–Re) alloys, compressive tests at variable temperatures and strain rates were conducted. After the same machining and thermal annealing processes, fully recrystallization happens in Mo and Mo–Re alloys with low Re content (5 wt %), while recovery occurs in Mo–Re alloys with high Re content (14 wt% and 42 wt %). The strength increases as Re content rises at all temperatures (300 °C, 600 °C and 1200 °C), meaning sufficient strengthening effect of Re. The rate-dependent behaviors, however, show different trends between Mo and Mo–Re alloys. Positive strain rate sensitivity is detected in Mo and low Re Mo–Re alloys in all temperatures, which is consistent to other research. While, near zero strain rate sensitivity is found in high Re Mo–Re alloys at 600 °C. Such an unusual phenomenon may be contributed to high stored dislocation density during mechanical processes. The stored dislocations are activated at a proper temperature to accommodate plastic flow, which weakens the influence of strain rate on strength.

Medium spatiotemporal characteristics based global optimization method for energy efficiency trade-off issue in variable flow rate HVAC system

During the optimization and control processes of variable flow rate heating, ventilation, and air conditioning (HVAC) systems, the medium temporal and spatial characteristics often significantly influence the control effectiveness and energy efficiency of the overall system. Unfortunately, much of the existing research predominantly concentrates on enhancing the performance of specific individual components, neglecting the impact of medium temporal and spatial characteristics on the overall HVAC system performance. Consequently, issues such as energy efficiency trade-offs in practical systems remain inadequately addressed. In this paper, the medium spatiotemporal characteristics of HVAC systems are systematically illustrated and modeled. A novel optimization method based on these characteristics is proposed to improve the overall performance of the HVAC system. This method adopts an event-driven optimization strategy to determine the optimal timing with consideration of temporal characteristics, and an adaptive hybrid algorithm is proposed to determine the optimal setpoints with consideration of spatial characteristics. By comparing to conventional methods with constant setpoints, genetic algorithm (GA) based setpoints, and differential evolution (DE) based setpoints in both simulation test and experiment, the proposed method demonstrates the ability to reduce electricity consumption by 21.2%, 13.1%, and 10.0%, respectively. The methodology in this research provides significant guidance for engineers to promote the decoupling control and overall optimization of HVAC systems. Additionally, the results have referable values for implementing the most appropriate algorithm in practice.

Multi-objective optimization of production system with staggered production

In the manufacturing industry, timely order fulfilment from diverse customers is important for operational profitability, given the constraints of limited production capacity. This paper proposes a novel queueing system for a production system, in which order processing times are categorised as regular or rush based on customer preference. The proposed queueing system employs variable service rates and service strategies in conjunction with staggered production to deal with heterogeneous arrivals. We compute the steady-state probability distribution and develop system performance indicators. The lower and upper bounds of the expected sojourn time for rush and regular orders are derived. Numerical results show that an appropriate switching policy can reduce rush orders by approximately 35% while regular orders increase by less than 10%, demonstrating significant improvement in order fulfilment management. We formulate a multi-objective optimisation problem and implement the NSGA-II algorithm to obtain Pareto optimal solutions. Finally, three regression models are proposed to determine the minimum cost and the associated optimal service rates, given the maximum acceptable value of the expected number of rush orders. The established models can explain at least 80% of the dataset of the optimal solutions and thus our numerical findings provide useful guidance for decision-makers and production managers.

Global latitudinal gradients and the evolution of body size in dinosaurs and mammals

Global climate patterns fundamentally shape the distribution of species and ecosystems. For example, Bergmann’s rule predicts that homeothermic animals, including birds and mammals, inhabiting cooler climates are generally larger than close relatives from warmer climates. The modern world, however, lacks the comparative data needed to evaluate such macroecological rules rigorously. Here, we test for Bergmann’s rule in Mesozoic dinosaurs and mammaliaforms that radiated within relatively temperate global climate regimes. We develop a phylogenetic model that accounts for biases in the fossil record and allows for variable evolutionary dispersal rates. Our analysis also includes new fossil data from the extreme high-latitude Late Cretaceous Arctic Prince Creek Formation. We find no evidence for Bergmann’s rule in Mesozoic dinosaurs or mammaliaforms, the ancestors of extant homeothermic birds and mammals. When our model is applied to thousands of extant dinosaur (bird) and mammal species, we find that body size evolution remains independent of latitude. A modest temperature effect is found in extant, but not in Mesozoic, birds, suggesting that body size evolution in modern birds was influenced by Bergmann’s rule during Cenozoic climatic change. Our study provides a general approach for studying macroecological rules, highlighting the fossil record’s power to address longstanding ecological principles.

Redesign and Performance Test of Liquid Fertilizer Based on Variable Rate Application on Chili Cultivation

Liquid fertilizer applicator based on Variable Rate Application (VRA) is a technology that is used to fertilize in a controlled and precise manner. This study aims to improve the effectiveness and efficiency of the fertilization process of chili plants. The development carried out is esp32 cam which serves to detect chili plants that lack elements. The method used is input of the nutritional needs of chili plants, spray doses of each plant, and a microcontroller to control applicator components such as sprayer pumps, selenoid valve, and esp32 cam. In this liquid fertilizer applicator there are 2 pipes, each pipe has 4 nozzles. The results of laboratory tests show that the discharge of liquid fertilizer sprayed follows the input results of the nutritional needs of chili plants. The discharge released on the PWM sprayer motor varies from 40 to 100% resulting in very different discharge variations in each PWM spray. The efficiency of this VRA-based liquid fertilizer applicator reaches 87% or an increase of about 14.7% from the applicator before development. Regression analysis of dimmer level to spraying discharge showed a function y = 6.3016x + 18.937 with an R 2 of 0.9921. While the regression analysis of the dimmer level of the applicator speed obtained the function y = 94.075x + 20.203 with an R2 of 0.9936. Keywords: Chili plants, Liquid, Fertilizer, Applicator, VRA.

Optimising Precision Agriculture Choices for Arable Farmers in Germany and the UK: the LINKDAPA Approach

SummaryFarmer adoption of so‐called Precision Agriculture (PA) or ‘smart’ technologies in the arable sector has grown in the last few decades with a focus on Global Navigation Satellite Systems (GNSS) and variable rate technologies (VRT). This has led to increased generation of large volumes of data about fields and their crop yields which could be used to increase the environmental and financial performance for farmers. However, survey results show that cost and adaptability have been issues for many farmers in the UK and Germany that have held back such adoption. The LINKDAPA (LINKing multi‐source Data for Adoption of Precision Agriculture) project's approach sought to minimise both concerns by creating a customisable web platform that incorporates both GNSS and VRT into one, easy to use, affordable option for farmers. The project developed an online cloud‐based decision support tool which takes into account different fertiliser strategies based on novel algorithms using soil, historic yield and satellite data. Co‐created by researchers, farmers and agricultural technology firms, the LINKDAPA approach offers both economical and easy to implement solutions for farm management to mitigate resource loss‐ratios such as in fertiliser use, provide financial performance analyses, and multi‐year graphical imagery for soil mapping.

Retention rates and reasons for non-retention in exercise oncology trials in the post-treatment phase-a systematic review.

Retention is a key marker of trial success. Poor retention can induce bias, reduce statistical power and minimise the validity of trials. This review examined retention rates in exercise trials in cancer survivors, reasons for non-retention and retention strategies utilised. A systematic review was conducted using a predefined search strategy in EMBASE RCTs, MEDLINE OVID, CINAHL, Web of Science-Core Collection and Cochrane Central Register of Controlled Trials (CENTRAL). The search was conducted on 27/03/2023. Title and abstract screening, full text review and data extraction were completed in duplicate. Of 17,524 studies identified, 67 trials involving 6093 participants were included. The median overall retention rate immediately post-intervention was 89.85%, range (52.94-100%) and mean 87.36% (standard deviation 9.89%). Trials involving colorectal cancer survivors only had the highest median retention rate (94.61%), followed by breast (92.74%), prostate (86.00%) and haematological cancers (85.49%). Studies involving mixed cancer cohorts had the lowest retention rate (80.18%). The most common retention strategies were wait-list control groups, regular check-ins/reminders and free exercise equipment. Common reasons for non-retention were lost to follow-up, health problems, personal reasons including family/work commitments and travel burden, and disease progression. Retention rates in exercise oncology trials are approximately 90% immediately post-interventions. Our previous work highlighted variable suboptimal recruitment rates of median 38% (range 0.52-100%). Recruitment rather than retention should be prioritised for methodology research in exercise oncology. Optimising the quality of exercise oncology trials is critical to informing high quality survivorship care. PROSPERO registration number: CRD42023421359.

Methodological considerations for behavioral studies relying on response time outcomes through online crowdsourcing platforms

This perspective paper explores challenges associated with online crowdsourced data collection, particularly focusing on longitudinal tasks with time-sensitive outcomes like response latencies. Based on our research, we identify two significant sources of bias: technical shortcomings such as low, variable frame rates, and human factors, contributing to high attrition rates. We explored potential solutions to these problems, such as enforcing hardware acceleration and defining study-specific frame rate thresholds, as well as pre-screening participants and monitoring hardware performance and task engagement over each experimental session. With this discussion, we intend to provide recommendations on how to improve the quality and reliability of data collected via online crowdsourced platforms and emphasize the need for researchers to be cognizant of potential pitfalls in online research.

Complexity of avian evolution revealed by family-level genomes

Despite tremendous efforts in the past decades, relationships among main avian lineages remain heavily debated without a clear resolution. Discrepancies have been attributed to diversity of species sampled, phylogenetic method and the choice of genomic regions1–3. Here we address these issues by analysing the genomes of 363 bird species4 (218 taxonomic families, 92% of total). Using intergenic regions and coalescent methods, we present a well-supported tree but also a marked degree of discordance. The tree confirms that Neoaves experienced rapid radiation at or near the Cretaceous–Palaeogene boundary. Sufficient loci rather than extensive taxon sampling were more effective in resolving difficult nodes. Remaining recalcitrant nodes involve species that are a challenge to model due to either extreme DNA composition, variable substitution rates, incomplete lineage sorting or complex evolutionary events such as ancient hybridization. Assessment of the effects of different genomic partitions showed high heterogeneity across the genome. We discovered sharp increases in effective population size, substitution rates and relative brain size following the Cretaceous–Palaeogene extinction event, supporting the hypothesis that emerging ecological opportunities catalysed the diversification of modern birds. The resulting phylogenetic estimate offers fresh insights into the rapid radiation of modern birds and provides a taxon-rich backbone tree for future comparative studies.

Placebo Effects Are Small on Average in the 7.5% CO2 Inhalational Model of Generalized Anxiety.

Anxiety disorders are highly prevalent and socio-economically costly. Novel pharmacological treatments for these disorders are needed because many patients do not respond to current agents or experience unwanted side effects. However, a barrier to treatment development is the variable and large placebo response rate seen in trials of novel anxiolytics. Despite this, the mechanisms that drive placebo responses in anxiety disorders have been little investigated, possibly due to low availability of convenient experimental paradigms. We aimed to develop and test a novel protocol for inducing placebo anxiolysis in the 7.5% CO2 inhalational model of generalized anxiety in healthy volunteers. Following a baseline 20-minute CO2 challenge, 32 healthy volunteers were administered a placebo intranasal spray labelled as either the anxiolytic "lorazepam" or "saline." Following this, participants surreptitiously underwent a 20-minute inhalation of normal air. Post-conditioning, a second dose of the placebo was administered, after which participants completed another CO2 challenge. Participants administered sham "lorazepam" reported significant positive expectations of reduced anxiety (P = .001), but there was no group-level placebo effect on anxiety following CO2 challenge post-conditioning (Ps > .350). Surprisingly, we found many participants exhibited unexpected worsening of anxiety, despite positive expectations. Contrary to our hypothesis, our novel paradigm did not induce a placebo response, on average. It is possible that effects of 7.5% CO2 inhalation on prefrontal cortex function or behavior in line with a Bayesian predictive coding framework attenuated the effect of expectations on subsequent placebo response. Future studies are needed to explore these possibilities.

Resilience of sustainability for a smart production system to produce biodiesel from waste animal fat

The smart production system is implemented for more effective labor, less waste, and a reduction of energy consumption. Biofuels are significant substitutes for conventional fuels and decreases air pollution and carbon monoxide, can be made through a smart production system with automated machines. Biodiesel can be produced using an assortment of sources that can be both edible and inedible, but animal fat is a sensible alternative among inedible sources because of its affordable price and ease of availability. The model studies the smart biodiesel production system with energy utilization and less carbon emissions to produce pure biodiesel. The multi-objective mathematical model minimizes the total biodiesel supply chain cost followed by minimizing the total biodiesel supply chain environmental impact and enhancing its social impact. The smart production system with a variable production rate produces the biodiesel with less impurities, but still impurities in the biodiesel, that can be detected by a two-stage autonomated inspection system. The impure biodiesel is remanufactured in the biorefineries at the end of every natural production cycle. For the best utilization of energy, various energy costs, such as lighting and air handling costs are calculated. The improved augmented ϵ-constraint approach with lexicographic optimization is utilized to solve the model. The four mathematical examples are studied, and the repercussions of mathematical experiments reveal that the animal fat purchasing cost is 44.32% of the total cost, and the percentage of impurities in biodiesel can be decreased through minimum energy consumption. The managerial insights of the model, graphical representation, and sensitivity analysis of key parameters are provided in this research. The conclusions can be useful to investors in a sustainable smart production system and biofuel policymakers.

In vitro Culture and Multilocus Genotyping of Giardia duodenalis Trophozoites Obtained from Human Fecal Samples in Southwest Iran.

The enteric protozoa, Giardia duodenalis (G. duodenalis), consists of eight distinct assemblages (A-H) with identical morphological characteristics and a direct life cycle. Successful axenic cultivation of this parasite is an important preliminary step for biological, drug resistance and phylogenetic studies. Moreover, G. duodenalis exhibits great genetic and biotypic diversity. The current study aimed to evaluate In vitro culture and multilocus genotyping of G. duodenalis trophozoites obtained from human fecal samples in southwest Iran. Thirty human fecal specimens containing G. duodenalis cysts were collected from Ahvaz city (southwest of Iran). The purification of cysts was carried out by the sucrose flotation technique. The cysts were inoculated in a modified TYI-S-33 medium and was daily monitored for the development and viability of trophozoites. After extracting DNA, gdh, bg and tpi genes were evaluated using molecular techniques (the semi-nested PCR for gdh gene and the nested PCR for tpi and bg genes). Eventually, the amplified fragments were sequenced and then, the phylogenetic tree was drawn. Of 30, the trophozoites were encysted from five samples. All three genes were detected in two cases of five samples using molecular techniques. The multilocus phylogenetic analysis demonstrated that all the two samples belonged to assemblage A and sub-assemblage AІІ. Our findings indicated the presence of different numbers of trophozoites with variable development and survival rates in modified TYI-S-33 medium. Furthermore, the multilocus genotyping showed that these trophozoites belonged to assemblage A and sub-assemblage AІІ.

Nutritional parameters and productive performance of grazing sheep using castor bean cake as supplement or fertilizer.

The objective was to evaluate the effect of detoxified castor bean replacing soybean meal in the concentrate diet or as nitrogen organic fertilizer replacing urea on intake and nutrient digestibility, blood parameters and productive performance of sheep finished on irrigated Tamani grass pasture under continuous stocking and variable stocking rate. The treatments were two concentrate diets: standard (ground corn and soybean meal) and alternative diet (ground corn and detoxified castor bean cake), and two nitrogen fertilizers: chemical (urea) and organic (fresh castor bean cake). The randomized complete block design was used in a 2 × 2 factorial arrangement with four replications (500m² paddocks). Four sheep (2 castrated males and 2 females) were distributed in each experimental unit, totaling 64 animals with an average initial weight of 19.42 ± 3.6kg. No effects (P > 0.05) were observed on the variables inherent to the evaluation of the pasture. The average stocking rate (SR) among treatments was 85.50 sheep/ha, equivalent to 9.87 Animal Units (AU)/ha. The alternative diet presented lower dry matter digestibility (62.71%), with no negative effects on nutrient intake and kidney parameters. Animals fed the standard and alternative diet showed average daily gain of 103.75 and 86.76g/day, respectively. A finishing period of up to 100 days is recommended for sheep selected for production systems in semi-arid regions managed intensively on pasture. Detoxified castor bean cake did not alter nutrient intake, liver and kidney parameters of the sheep and can be used in pasture-based sheep farming.

Glucose Lability and Complications in Diabetic Ankle Fractures

Introduction/Purpose: Rotational ankle fractures in diabetics have long posed difficult clinical challenges, with several observational studies noting increased risk of complications and amputation following treatment of unstable ankle fractures in diabetics. Several treatment options exist, including non-operative management, external fixation, open reduction internal fixation, staged fixation, and fusion. Hemoglobin A1C produces a mean blood glucose level over a three-month period. There is mounting evidence that glucose variability may be an alternative predictor of complication profile in non-orthopedic procedures, as well as in the total joint arthroplasty literature. The purpose of this investigation is to retrospectively analyze complication rates for diabetics with rotational ankle fractures at a single institution and assess their association with both the hemoglobin A1C and glucose variability. Methods: After obtaining Institutional Review Board approval, all patients from 2015-2022 with a diagnosis of diabetes and ankle fracture were retrospectively identified based on ICD-9/ICD-10 codes. These charts were manually reviewed to determine fracture classification and treatment. For operatively and non-operatively managed ankle fractures, the patient’s hemoglobin A1C was recorded when available within 3 months of the date of injury. Glucose variability was calculated using a coefficient of variation. Results: Two-hundred patients were included for analysis, of which 29% (n=58) were treated non-operatively. The majority of surgically treated patients underwent acute ORIF (58%, n=116). 8.5% were treated with staged fixation, 3.5% with acute hindfoot fusion, and 1% with external fixation alone. The overall complication rate was 27.5% (n=55). There were no statistically significant differences in both A1C (7.81 +/- 1.89 vs 7.73 +/- 1.96) and glucose variability, as measured by the covariance of variation (0.23 +/- 0.15 vs 0.20 +/- 0.13) in patients who did and did not experience postoperative complications. Higher glucose variability did trend towards predicting complications, though not in a statistically significant fashion (OR=1.57, p=0.35). Conclusion: Ankle fractures in patients with diabetes pose a challenge for orthopedic surgeons, as evidenced by the high medical and surgical complication rate observed in this study and others. No statistical significance was found between higher A1C and complication rate or between glucose variability and complication rate. Further investigation on the impact of glucose variability on complication rates in a larger cohort of this patient population is warranted. Univariable logistic Regression Results for the association of the odds of post-operative complication with patient characteristics.

Polyvinyl Alcohol Hydrogel Hemiarthroplasty of First Metatarsophalangeal Joint Hallux Rigidus.

Background Hallux rigidus (HR) is the most common arthritic condition of the foot. Although first metatarsophalangeal joint (MTPJ) arthrodesis has been the historical gold-standard treatment, polyvinyl alcohol (PVA) hydrogel implants have gained popularity as a joint-sparing technique. However, recent studies have shown variable failure rates of PVA hydrogel implants. The purpose of this study was to report the five-year experience with PVA hydrogel implants performed by a single surgeon. Methodology Health records were queried from August 2016 to 2021 for patients who underwent primary PVA hydrogel implant hemiarthroplasty for symptomatic late-stage HR. Patient demographics and postoperative outcomes variables were evaluated. Kaplan-Meier analysis was used to evaluate implant survival. A total of 146 PVA hydrogel implant procedures were performed with a minimum six-month follow-up. Results The majority of patients were female (n = 103, 70.5%), with a mean age of 58.1 (±10.1) years, body mass index of 27.3 (±5.2) kg/m2, and American Society of Anesthesiologists score <3 (n = 131, 89.7%).The majority had stage II or III disease (n = 115, 78.8%). Patients experienced significant improvement in visual analog scale score (p < 0.0001) and hallux dorsiflexion (p = 0.0005). There were 22 (15.1%) complications, including implant subsidence (n = 15, 10.3%), deep infection (n = 6, 4.1%), and hypertrophic ossification (n = 1, 0.7%). Revision surgeries were required in 12.3% (n = 18) of patients at an average of 9.4 (±9.2) months postoperatively. This included nine (6.2%) revision PVA hydrogel implant procedures and nine (6.2%) first MTJP arthrodesis. The one- and two-year survival rates for MTPJ arthrodesis (n = 9) were 95.9% and 86.3%, respectively. Conclusions In the largest single-surgeon series reported, first MTPJ hemiarthroplasty with a PVA hydrogel implant significantly improved pain and hallux dorsiflexion at an average of 14.5 months postoperatively. There was a high two-year survivorship of 86.3% until failure which required first MTPJ arthrodesis. Future studies should be performed to refine the indications for PVA hydrogel implants and identify risk factors.

Psychological safety and perceived organizational support in emergency medicine residencies.

The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE. Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments. A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE. PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.