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Sex and age estimation is important, particularly when information about the deceased is unavailable. There are limited radiological studies investigating side, sex and age differences in normal ankle morphometric parameters. The authors’ goal was to evaluate different ankle joint morphometric measurements and document variations among Egyptians.

A prospective study was conducted throughout 23 months on 203 (100 males and 103 females) adult Egyptians, aged between 20-69 years old, who were referred for a plain x-ray of bilateral normal ankle joints.

Ankle parameters showed no statistical difference between both sides, except for tarsal width (TaW) which was significantly higher on right than left side (26.92 ± 2.66 vs 26.18 ± 2.65 mm). Males showed significantly higher morphometric values except for anteroposterior gap (APG) and talus height (TaH) which were significantly higher in females (2.29 ± 0.80 vs 1.80 ± 0.61 mm and 13.01 ± 1.68 vs 11.87 ± 1.91 mm, respectively). There was significant increase in tibial arc length, APG, distance of level of MTiTh from anterior limit of mortise, distance of level of MTiTh from vertex of mortise, sagittal distance between tibial and talar vertices and sagittal radius of trochlea tali arc in old age group compared to young one. A significant decrease in tibial width, malleolar width, TaW and TaH was noted in old age group compared to young one.

Ankle joints of both sides are mostly symmetrical; however, there are significant differences in most morphometric values due to sex and age factors. These findings may be essential during side, sex and age determination.

The outbreak of the COVID-19 pandemic has significantly impacted healthcare systems, presenting unforeseen challenges that necessitated the implementation of change management strategies to adapt to the new contextual conditions. This study aims to analyze organizational changes within the total hip replacement (THR) surgery pathway at multiple levels, including macro, meso and micro. It employs data triangulation from various sources to gauge the complexity of the change process and comprehend how multi-level decision-making influenced an unexpected shift.

A multicentric, single in-depth case study was conducted using a mixed-methods approach. Data sources included patient-reported outcome measures specific to the THR pathway and carefully structured in-depth interviews administered to managers and clinicians in two healthcare organizations serving the same population.

Decisions made at the macro level resulted in an overall reduction in surgical activities. Organizational changes at the meso level led to a complete cessation or partial reorganization of activities. Micro-level actions for change and adaptation revealed diverse and fragmented change management strategies.

Organizations with segmented structures may require a robust and structured department for coordinating change management responses to prevent the entire system from becoming stuck in the absorptive phase of change. However, it is important to recognize that absorptive solutions can serve as a starting point for genuine innovations in change management.

The utilization of data triangulation enables the authors to visualize how specific changes implemented in response to the pandemic have influenced the observed outcomes. From a managerial perspective, it provides insights into how future innovations could be introduced.

Reality breakdowns generate reflexivity and awareness of the constructed nature of social reality. These pivotal moments can motivate institutional inhabitants to either modify their social worlds or reaffirm the status quo. Thus, reality breakdowns are the initial points at which actors can conceive of new possibilities for institutional arrangements and initiate change processes to realize them. Studying reality breakdowns enables scholars to understand not just how institutional change occurs, but also why it does or does not do so. In this paper, we investigate how institutional inhabitants responded to a reality breakdown that occurred during our ethnography of collegial governance in a large North American university that was undergoing a strategic change initiative. Our findings suggest that there is a consequential process following reality breakdowns whereby institutional inhabitants construct the severity of these events. In our context, institutional inhabitants first attempted to restore order to their social world by reaffirming the status quo; when their efforts failed, they began to formulate alternative possibilities. Simultaneously, they engaged in a distributed sensemaking process whereby they diminished and reoriented necessary changes, ultimately inhibiting the formulation of these new possibilities. Our findings confirm reality breakdowns and institutional awareness as potential drivers of institutional change and complicate our understanding of antecedent microprocesses that may forestall the initiation of change efforts.