BACKGROUND: More personalized alignment techniques in total knee arthroplasty (TKA) have recently been described particularly for the young and active patients. Performing the ideal tibial cut might be challenging with a conventional ancillary. Therefore the aims of this study were: (1) to describe specific tibial landmarks to optimize the tibial cut in TKA; (2) to compare the accuracy of the tibial cut with these landmarks compared to a conventional technique.
METHODS: This retrospective case-control study compared primary TKAs performed using a conventional technique with extramedullary guide associated with specific tibial landmarks. For each case, one control patient was matched based on body mass index (BMI), age, preoperative Hip Knee Ankle (HKA) angle, and Medial Proximal Tibial Angle (MPTA). All control patients were operated by the same surgeon and similar conventional technique but without landmarks. The MPTA target was to reproduce preoperative deformity with a 3° of varus limit. 34 TKA were included in each group. There was no preoperative difference between both groups. Mean age was 63 years old ± 8. Mean BMI was 32 kg/m2 ± 5. Mean HKA was 170.6° ± 2.5. Mean MPTA was 85.1° ± 2.3. The radiographic assessment was performed preoperatively and at 2 months: HKA, mechanical Medial Distal Femoral Angle (mMDFA), MPTA, tibial slope, restoration of the joint line-height.
RESULTS: The tibial landmarks corresponded to the line of insertion of the deep medial collateral ligament fibers extended to the capsular insertion above the Gerdy tubercle. The postoperative MPTA was significantly more varus (87.2° ± 1.6 in landmark group versus 88.3° ± 2.2; p = 0.027) and closer to preoperative bone deformity in landmark group (p = 0.002) with significantly less outliers than in the conventional group. There was no significant difference between both groups postoperatively for HKA (175.4° ± 2.3 versus 175.9° ± 2.5; p = 0.42); mMDFA (88.9° ± 2.3 versus 88.2° ± 2.1; p = 0.18); tibial slope (82.6° ± 1.9 versus 82.4° ± 2.6; p = 0.67), the restoration of the joint line-height (1.5 mm ± 2 versus 1.8 mm ± 2; p = 0.56).
CONCLUSIONS: Specific tibial landmarks during TKA can be used to increase the accuracy of the tibial cut when using personalized alignment techniques in TKA.
METHODS: IV.

OBJECTIVE: Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus.
METHODS: Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed.
RESULTS: It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05).
CONCLUSIONS: The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.

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UNASSIGNED: Although studies have demonstrated that implementation leadership and climate are important constructs in predicting evidence-based practice (EBP) implementation, concrete descriptions of how they operate during organizational implementation efforts are lacking. This case study fills that gap through an in-depth description of an organization with effective implementation leadership that successfully built a strong implementation climate. This case study provides an illustration of implementation leadership and climate in tangible, replicable terms to assist managers, practitioners, and researchers in addressing the organizational context in their own implementation projects.
UNASSIGNED: A single organization, intrinsic case study was employed to paint a multifaceted picture of how one organization leveraged implementation leadership to strengthen a climate for the successful implementation of digital measurement-based care. The case was drawn from a cluster-randomized trial designed to test the effects of a leadership-focused implementation strategy on youth-level fidelity and clinical outcomes of digital measurement-based care. Following the completion of the trial, case study activities commenced. Descriptive summaries of multiple data sources (including quantitative data on implementation leadership and climate, coaching call and organizational alignment meeting recordings and notes, and development plans) were produced and revised iteratively until consensus was reached. Leadership actions were analyzed for corresponding dimensions of implementation leadership and climate.
UNASSIGNED: Specific actions organizational leaders took, as well as the timing specific strategies were enacted, to create a climate for implementation are presented, along with lessons learned from this experience.
UNASSIGNED: This case study offers concrete steps organizational leaders took to create a consistent and aligned message that the implementation of a specific EBP was a top priority in the agency. The general approach taken to create an implementation climate provides several lessons for leaders, especially for EBPs that have broad implications across an organization.
Using treatments with known positive impact in community-based mental health programs is challenging. Many studies suggest leaders of these programs can help. Similarly, certain features of community-based programs can also be helpful. This case study of an outpatient mental health clinic provides rich descriptions of actions leaders took that shaped the environment in their program and helped improve the use of a treatment with known positive impact. This case study can serve as a practical guide for leaders to reference when aiming to improve the use of treatments with known impact in their own programs.

Although impaction of the maxillary permanent central incisor is uncommon in dentistry due to its significance to facial aesthetics which are challenging to treat. To abstain from the consequences related to aesthetic and functional occlusion, early detection of an impacted central incisor is imperative. This case report describes a male patient, aged 22 years, who had an impacted central incisor tooth in the maxillary anterior region. A surgery was performed to remove the impacted supernumerary tooth that was preventing the eruption of the central incisor. Using a combination of surgical exposure and orthodontic force, the impacted right maxillary central incisor was relocated to its proper occlusion in the dental arch.

Policy-makers and hospital boards throughout the world have implemented different measures to create and sustain effective hospital-physician relationships. The \'integrated funding\' policy reform in the Netherlands was aimed at increasing hospital-physician alignment and led to the unforeseen formation of medical specialist enterprises (MSEs): a fiscal entity representing all self-employed physicians in a hospital. It is unknown how hospitals and MSEs perceive their alignment and how they govern the relationship. This study explores the hospital-MSE relationship, and how governance styles influence perceived alignment in this relationship.
A multiple case study of five non-academic hospitals in the Netherlands was performed. Data was derived from two sources: (1) analysis of hospital-MSE contracts and (2) semi-structured interviews with hospital and MSE board members. Contracts were analysed using a predefined contract analysis template. Interview recordings were transcribed and subsequently coded using the sensitizing concepts approach.
Contracts, relational characteristics, governance styles and perceived alignment differed substantially between cases. Two out of five contracts were prevention contracts, one was a mixed type, and two were promotion contracts. However, in all cases the contract played no role in the relationship. The use of incentives varied widely between the hospitals; most incentives were financial penalties. The governance style varied between contractual for two hospitals, mixed for one hospital and predominantly relational for two hospitals. Development of a shared business strategy was identified as an important driver of relational governance, which was perceived to boost alignment.
Large variation was observed regarding relational characteristics, governance and perceived alignment. MSE formation was perceived to have contributed to hospital-physician alignment by uniting physicians, boosting physicians\' managerial responsibilities, increasing financial alignment and developing shared business strategies. Relational governance was found to promote intensive collaboration between hospital and MSE, and thus may improve alignment in the hospital-physician relationship.

Innovations in material properties of goaltender skates have improved the protective characteristics of the boot, leading to redesign of the blade holder to resemble players\' holders. The redesigned blade holder introduces the ability to customize blade alignment, which may grant a performance advantage. We investigated the effect of blade alignment on kinematics and plantar pressure during the execution of two different goaltender-specific movement patterns: (1) the butterfly drop to recovery and (2) the lateral butterfly slide to recovery. The main objective of this study was to investigate the effect of three blade alignment conditions. The secondary objective was to compare two neutral alignment conditions, which was facilitated by studying the effects of two different holders on kinematics and plantar pressure during two goaltender-specific techniques. A male goaltender with professional experience completed an A-B-A design, executing five trials of A, B, and A for both movements with each blade alignment condition (n = 30 per collection, n = 90 overall) on synthetic ice in a controlled lab environment. Blade alignment conditions were defined by the alignment of the blade holder on the boot and the type of blade holder. Kinematic and plantar pressure data were collected simultaneously using 3D motion capture and in-skate pressure insoles, respectively. Increased butterfly drop velocity (2.07 ± 0.09 m/s) and peak plantar pressure (77.19 ± 2.67 psi) were revealed when executing the butterfly drop with medial alignment. This work suggests medial blade alignment may enable the goaltender to drop into the butterfly position faster, potentially increasing the likelihood of making a save.

BACKGROUND: In a super-aging society, medical-dental collaboration is increasingly vital for comprehensive patient care. Particularly in dysphagia rehabilitation and perioperative oral functional management, dental hygienists\' active involvement is pivotal to interprofessional collaborative practice. Despite this societal expectation, dental hygienists\' experiences and perceptions of interprofessional collaboration have not been explored. This study aims to investigate dental hygienists\' interprofessional identity formation and perceptions of interprofessional collaboration. Specifically, it was explored from the perspectives of dental hygiene students and hospital dental hygienists.
METHODS: This study is underpinned by Wenger\'s social theory of learning, which focuses on identity as a component in the process of learning in communities. Semi-structured interviews were conducted with 11 dental hygiene students in their final year at a technical college and five dental hygienists engaging in interprofessional care at a university hospital in Japan. The narrative data were analysed using an inductive approach to thematic analysis to extract themes regarding the identification of self in interprofessional teams.
RESULTS: Dental hygiene students found several barriers to the collaboration, including power relation and conceptual hierarchy, limited understanding of other professional roles, and differences in language and jargon. They viewed themselves as inferior in the interprofessional team. This resulted from their limited knowledge about general health and less responsibility for problems directly related to patient life and death. However, they could ultimately perceive the negative experiences positively as challenges for the future through reflection on learning in clinical placements. Contrarily, dental hygienists did not have such negative perceptions as the students did. Rather, they focused on fulfilling their roles as dental professionals in the interprofessional team. Their identities were formed through actively involving, coordinating their activity, and creating new images of the world and self in inter-professional communities of practice.
CONCLUSIONS: Interprofessional identity is relational as well as experiential, which is developed in complex and socially dynamic processes across intra- and inter-professional communities of practice. Engagement, imagination, and alignment are essential aspects of their interprofessional identities, which inform conceptual foundations of interprofessional education and collaborative practice in health care.

One of the most frequent verbal expressions that people use when interacting with each other in French is tu vois \'you see\' (Cappeau, 2004). Drawing on interactional linguistics and multimodal analysis, we examine the interactional functioning of this verbal expression when occurring in turn-final position. Previous studies on tu vois \'you see\' in this position document only its use for marking the end of an utterance or for turn-yielding. The following aspects have thus far remained unexplored: The interactional environment in which the construction occurs, how it is connected to the speaker\'s embodied conduct, the way in which it contributes to mobilizing a response from the recipient, as well as the nature of this response. Our paper addresses these issues and shows that turn-final tu vois \'you see\' is systematically produced with a final rising intonation and coupled with the speaker\'s gaze directed to the recipient. This multimodal practice is recurrently deployed in turns conveying the speaker\'s emotional stance, in turns performing a dispreferred action, like disagreeing, and in turns claiming insufficient knowledge. The response that is invited using this multimodal practice is distinctly tailored to each of these actions: an affiliative response, an aligning response, and a response addressing the prior speaker\'s claim of insufficient knowledge from the recipient\'s own point of view. By presenting an in-depth study of the action sequences in which tu vois \'you see\' is employed, as well as of its multimodal packaging, this contribution highlights the prospective, i.e., response-mobilizing potential of this interactional resource and shows that its use entails sequential implications even when it accompanies actions that project only weakly a response from the recipient.

Dysphagia is a less reported but serious adverse outcome post occipitocervical fusion. Any patient suffering from dysphagia and or nasal regurgitation post fusion in flexion should be offered early revision. The right position for occipitocervical fusion is neutral alignment.