bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid Prescribing After Discharge in a Previously Mechanically Ventilated, Opioid-Naïve Cohort
Authors: Academia Emmeline C. , Gabriel Christian J. , Mueller Amanda , Schwarz Kerry A. , Bartels Karsten , Valuck Robert J. , Reynolds Paul M.
Published: April 2020

Background:

Opioids are utilized for pain management during and after mechanical ventilation in the intensive care unit (ICU).

Objective:

The purpose of this study was to determine the percentage of potentially unnecessary opioid prescriptions on discharge in previously opioid-naïve patients.

Methods:

This retrospective cohort study included mechanically ventilated, opioid-naïve ICU patients who received opioids. The primary outcome of this study was the discrepancy between the amounts of opioids prescribed at discharge versus those likely required based on actual 24-hour prehospital discharge opioid requirements.

Results:

A total of 71 patients were included. Of these, 63.3% (n = 45) of discharge prescriptions were in alignment with 24-hour predischarge requirements, and 36.7% (n = 26) of discharge prescriptions were in excess of calculated predischarge requirements. At discharge, 57.7% (n = 41) of patients received a nonopioid analgesic. Multivariable linear regression revealed that cardiothoracic ICU admission was associated with an increased risk of inappropriate discharge opioid prescribing, whereas a shorter duration of inpatient oral opioid therapy decreased risk of inappropriate discharge prescribing.

Conclusion and Relevance:

Opioid prescribing for previously mechanically ventilated patients warrants improvement as a part of the discharge planning process. Application of these data may aid in the reduction of opioid overprescribing at discharge after an ICU stay.
Overcoming Institutional and Infrastructure Weaknesses in China via Online Third-Party Marketplaces
Authors: Bei Zhiling , Gielens Katrijn
Published: April 2020

China is the world’s second largest retail market and is expected to surpass the United States in 2020. This makes China a must-win market for global and local firms. However, manufacturers often find it hard to reach Chinese consumers due to China’s institutional and infrastructure weaknesses. The advent of online third-party marketplaces provides manufacturers with a new model to tackle these challenges. The question remains, however, whether and to what extent joining online third-party marketplaces in China can generate market value. Using an event study methodology, the authors assess the net impact of online marketplace adoption in China on manufacturers’ expected profitability. Although the abnormal returns are, on average, significant and positive, stock markets recognize that not all manufacturers can reap benefits. To delve deeper into this variation, the authors relate the abnormal returns to various sources of manufacturers’ market knowledge and marketing capabilities. They find that less diversified manufacturers with marketplace experience are expected to achieve greater gains, irrespective of their origin. However, the effects of marketing strengths diverge for foreign and local firms.
Noteworthy Literature in Cardiac Anesthesia for 2019
Authors: Clendenen Nathan , Abrams Benjamin , Morabito Joseph , Grae Lyndsey , Mosca Matthew S. , Weitzel Nathaen
Published: April 2020

This article represents a selective review of literature published in 2019. Initial results from PubMed searching for a combination of terms, including cardiac anesthesiology and anesthesiology outcomes, yielded more than 1400 publications. From there, we manually screened the results and identified 5 major themes for the year of 2019, including transcatheter techniques, delirium and anesthesiology, coagulation management following cardiopulmonary bypass, perfusion management with del Nido cardioplegia, and applied clinical research. The following research accomplishments have expanded what is possible and set ambitious goals for the future.
Self-Efficacy in Researching and Obtaining Medical Cannabis by Patients With Chronic Conditions
Authors: Brady John P. , Bruce Douglas , Foster Elissa , Shattell Mona
Published: April 2020

Background. Due to the increasing availability of medical-grade cannabis for treatment of chronic conditions, we examined how prospective users navigate the process of researching, procuring, and using cannabis. Given the barriers prospective users experience, self-efficacy may be a factor for those who incorporate cannabis into treatment. Aims. The purpose of this study was to identify behaviors associated with self-efficacy in the context of researching, procuring, and using cannabis. We analyzed narratives of patients who obtained legal medical cannabis in the currently complex medical, legal, and social landscape. Method. Data were collected through 30 telephone interviews utilizing a semistructured interview protocol, which were analyzed using inductive coding. The protocol emphasized four topics: (a) symptom management/pain reduction, (b) provider communication about chronic conditions/cannabis, (c) perspectives on medicinal cannabis and stigma, and (d) views on recreational cannabis. Results. Participants demonstrated self-efficacy in three contexts: (a) self-directed experimentation with cannabis strains, dosages, and administration methods; (b) managing care by selecting and educating their providers; and (c) information-seeking and research behaviors. Discussion. High self-efficacy may be an important factor in navigating the medical cannabis process. Results suggest that providers who are not prepared to partner with patients as they seek information about medical cannabis may be replaced by dispensaries and websites with expertise in cannabis but without understanding of patients’ medical conditions and individual needs. Conclusion. Patients with higher self-efficacy may engage in various activities to investigate, procure, experiment with, and incorporate medical cannabis into their condition management outside the purview of their providers.
Human Health Risk Assessment of Trace Metals in the Commonly Consumed Fish Species in Nakuru Town, Kenya
Authors: Esilaba Felly , Moturi Wilkister Nyaora , Mokua Millicent , Mwanyika Terewe
Published: April 2020

The present study was conducted to determine daily intake of cadmium (Cd), copper (Cu), and lead (Pb) and to assess noncarcinogenic human health risk caused by these trace metals in the commonly consumed fish species ( Oreochromis niloticus, Rastrineobola argentea, Lates niloticus, and Protopterus aethiopicus) in Nakuru town, Kenya. Trace metal determination in the composite samples of the commonly consumed fish species was done using flame atomic absorption spectrophotometer. Cd, Cu, and Pb content in the muscle tissues of the commonly consumed fish species ranged from 0.11 ± 0.045 to 1.11 ± 0.931 mg kg−1 for Cd, 0.48 ± 0.013 to 3.00 ± 0.009 mg kg−1 for Cu, and 3.42 ± 0.045 to 12.78 ± 0.108 mg kg−1 for Pb. Cu concentrations were within Food and Agriculture Organization (FAO) recommended limits for this trace metal in fish. In contrast, Cd and Pb had values above their respective permissible limits in fish. The assessment of human exposure to trace metals indicated that exposure doses of Cd and Cu were safe for fish consumers. Conversely, target hazard quotient (THQ) values of Pb suggested possible health risks for consumers of the commonly consumed fish species in Nakuru town, Kenya.
The intellectual structure of the sharing economy
Authors: Sainaghi Ruggero , Köseoglu Mehmet Ali , Mehraliyev Fuad
Published: April 2020

This study analyzes the intellectual structure of the sharing economy (SE) in the hospitality and tourism industry, starting from a sample of 189 papers. A co-citation analysis was performed on the 99 most frequently cited studies. The analysis carried out identified five clusters. These groups include the following: (i) the constituent elements of sharing, (ii) the SE and the sharing phenomenon, (iii) noncommercial website platforms and the social impact generated by sharing firms, (iv) economic impacts, and (v) some negative impacts. Each cluster is succinctly described, presenting the main theme and some subtopics.
Why feminist technoscience and feminist phenomenology should engage with each other: on subjectification/subjectivity
Authors: Zeiler Kristin
Published: April 2020

Feminist technoscience and feminist phenomenology have seldom been brought into dialogue with each other, despite them sharing concerns with subjectivity and normativity, and despite both of them moving away from sharp subject-object distinctions. This is unfortunate. This article argues that, while differences between these strands need to be acknowledged, such differences should be put to productive use. The article discusses a case of school bullying, and suggests that bringing these analytic perspectives together enables and sharpens examinations of the role of subjectification and subject positions for subjectivity in the phenomenological sense; affectivity within material-discursive entanglements and constellations of humans and things, and as connecting the body, things and the world in specific ways; and normativity as enacted, lived and embedded in perception.
Book review: Kelly, Anthony and Westoby, Peter. 2018: Participatory Development Practice: Using Traditional and Contemporary Frameworks
Authors: Cochrane Logan
Published: April 2020

Kelly, Anthony and Westoby, Peter. 2018: Participatory Development Practice: Using Traditional and Contemporary Frameworks. London, UK: Practical Action Publishing. 234 pp. £23.70 (Paperback). ISBN: 9781853299992.
Book review: Sneyd, A. 2019: Politics Rules: Power, Globalization and Development
Authors: Sage Nick
Published: April 2020

Sneyd, A. 2019: Politics Rules: Power, Globalization and Development. Rugby, UK: Practical Action Publishing. 132 pp. £47.95 cloth, £18.95 paper. ISBN: 978-1-788530-712 (cloth), 978-1-788530-729 (paper).
Book review: Roy, Aruna. 2018: The RTI Story: Power to the People
Authors: Shyamal Manoj
Published: April 2020

Roy, Aruna. 2018: The RTI Story: Power to the People. New Delhi, India: Roli Books. 375 pp. ₹495 paperback. ISBN: 978-81-936260-4-7.
Granulox—The Use of Topical Hemoglobin to Aid Wound Healing: A Literature Review and Case Series From Singapore
Authors: Loh Clement , Tan Qian Ying , Eng Diane L. K. , Walsh Stewart R. , Chong Tze Tec , Tang Tjun Yip
Published: April 2020

Chronic wounds are an increasing burden on health care globally, and tissue hypoxia is a common issue in such wounds. Granulox (SastoMed GmbH, Georgsmarienhütte, Germany) is designed to provide wound bases with supplemental oxygen through facilitated diffusion and aid the physiological wound-healing process. It is a topical hemoglobin wound spray that is applied after wound cleaning and debridement to ensure continuous oxygen supplementation for up to 72 hours. Compared with other forms of topical oxygen therapy that require portable devices, Granulox is a spray-on application and the patient experience is similar to the use of a conventional dressing. Current clinical evidence suggests that Granulox aids with both wound healing and with symptom relief in chronic wounds, but current literature is limited by small study populations and further larger studies are required.
Minimally Invasive Mechanical Circulatory Support Through the Perioperative Pulmonary Thromboendarterectomy Period: A Case Report
Authors: Schurman Alexander M. , Cain Michael T. , Joyce David L. , Durham Lucian A. , Ishizawar David , Mohammed Asim , Joyce Lyle D.
Published: April 2020

A 64-year-old man being evaluated for pulmonary thromboendarterectomy (PTE) preoperatively experienced pulseless electrical activity secondary to right ventricular failure while undergoing bronchoscopy. After return of spontaneous circulation, a percutaneous right ventricular assist device (RVAD) was placed through the right internal jugular vein. He continued on right ventricular support with demonstration of right ventricular recovery over the following 8 days, and subsequently underwent PTE for treatment of his primary condition. He recovered and was weaned from his RVAD support uneventfully. The need for RVAD support has traditionally been a contraindication for PTE; however, circulatory assist devices have been used as a salvage procedure for right-heart failure after PTE. This case highlights the potential for percutaneous mechanical circulatory support in treating severe perioperative right ventricular dysfunction, and to facilitate successful recovery in patients undergoing PTE.
Evaluation of Serratus Anterior Plane Block for Pain Relief in Patients Undergoing MIDCAB Surgery
Authors: Gautam Sujeet , Pande Shantanu , Agarwal Anil , Agarwal S. K. , Rastogi Amit , Shamshery Chetna , Singh Ankita
Published: April 2020

Objective

The minimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with severe chest pain in the first 2 to 3 postoperative days; this may delay the patient recovery. In this randomized controlled trial we evaluated the role of serratus anterior plane (SAP) block for postoperative pain relief in patients undergoing MIDCAB surgery.

Methods

Patients undergoing MIDCAB surgery were randomized into 2 groups of 25 each; SAP group received 20 mL of 0.2% ropivacaine with 1 μg/mL fentanyl as bolus followed by infusion at 8 mL/h; control group received saline for both bolus and infusion. Primary outcome measure was postoperative pain when supine, and during deep inspiration, coughing, and patient movement; secondary outcome measures were requirement of postoperative intravenous fentanyl and opioid-related side effects. All patients were followed at 6-hourly intervals for 48 hours in the postoperative period. Results were analyzed by the Student’s t -test, χ 2 test, Mann–Whitney U-test and Kruskall–Wallis test. A P-value <0.05 was considered significant.

Results

The 2 groups were similar with respect to patient characteristics. Static and dynamic pain visual analog scale scores were significantly reduced in the SAP group as compared to the control group at most of the time points of assessment ( P < 0.05). Patient-controlled fentanyl requirements were reduced in the SAP group as compared to control group on the second postoperative day ( P < 0.05).

Conclusions

SAP block reduced the postoperative pain scores and opioid requirements in patients undergoing MIDCAB surgery.
Galactorrhea Following Minimally Invasive Reoperative Mitral Valve Replacement: An Unexpected Complication
Authors: Hemli Jonathan M. , Uppal Simrit K. , Seetharam Karthik , Delianides Julie , Pirelli Luigi , Scheinerman S. Jacob , Patel Nirav C.
Published: April 2020

Galactorrhea, or nonpuerperal lactation, is a rare complication that can occur after trauma to the chest wall. Although galactorrhea has been reported after thoracic surgery, it has not been previously noted as a potential outcome following cardiac surgery. We present a unique case of hyperprolactinemic galactorrhea experienced by a 39-year-old nongravid female patient after having undergone reoperative mitral valve replacement via a right minithoracotomy. To the best of our knowledge, this is the first reported case of spontaneous lactation occurring after cardiac surgery.
Chemokine receptor CXCR4 activates the RhoA/ROCK2 pathway in spinal neurons that induces bone cancer pain
Authors: Xu Heng , Peng Chong , Chen Xue-Tai , Yao Ying-Ying , Chen Li-Ping , Yin Qin , Shen Wen
Published: April 2020

Background

Chemokine receptor CXCR4 has been found to be associated with spinal neuron and glial cell activation during bone cancer pain. However, the underlying mechanism remains unknown. Furthermore, the RhoA/ROCK2 pathway serves as a downstream pathway activated by CXCR4 during bone cancer pain. We first validated the increase in the expressions of CXCR4, p-RhoA, and p-ROCK2 in the spinal dorsal horn of a well-characterized tumor cell implantation-induced cancer pain rat model and how these expressions contributed to the pain behavior in tumor cell implantation rats. We hypothesized that spinal blockade of the CXCR4-RhoA/ROCK2 pathway is a potential analgesic therapy for cancer pain management.

Methods

Adult female Sprague–Dawley rats (body weight of 180–220 g) and six- to seven-week old female Sprague–Dawley rats (body weight of 80–90 g) were taken. Ascitic cancer cells were extracted from the rats (body weight of 80–90 g) with intraperitoneally implanted Walker 256 mammary gland carcinoma cells. Walker 256 rat mammary gland carcinoma cells were then injected (tumor cell implantation) into the intramedullary space of the tibia to establish a rat model of bone cancer pain.

Results

We found increased expressions of CXCR4, p-RhoA, and p-ROCK2 in the neurons in the spinal cord. p-RhoA and p-ROCK2 were co-expressed in the neurons and promoted by overexpressed CXCR4. Intrathecal delivery of CXCR4 inhibitor Plerixafor (AMD3100) or ROCK2 inhibitor Fasudil abrogated tumor cell implantation-induced pain hypersensitivity and tumor cell implantation-induced increase in p-RhoA and p-ROCK2 expressions. Intrathecal injection of stromal-derived factor-1, the principal ligand for CXCR4, accelerated p-RhoA expression in naive rats, which was prevented by postadministration of CXCR4 inhibitor Plerixafor (AMD3100) or ROCK2 inhibitor Fasudil.

Conclusions

Collectively, the spinal RhoA/ROCK2 pathway could be a critical downstream target for CXCR4-mediated neuronal sensitization and pain hypersensitivity in bone cancer pain, and it may serve as a potent therapeutic target for pain treatment.
One-pot, catalyst-free synthesis of novel spiro[indole-3,4′-pyrano[2′,3′:4,5]pyrimido [2,1-b][1,3]benzothiazole] derivatives
Authors: Zangouei Mahdieh , Esmaeili Abbas Ali
Published: April 2020

The present report describes one-pot three-component condensation of isatins, malononitrile, and 2-hydroxy-4 H-pyrimido[2,1- b][1,3]benzothiazol-4-one in water–ethanol mixture at reflux to develop an efficient one-pot protocol for the synthesis of novel spiro[indole-3,4′-pyrano[2′,3′:4,5]pyrimido[2,1- b][1,3]benzothiazole] derivatives. The significant features of this protocol are short reaction times, avoidance of toxic catalysts, and provision of excellent yields, no column chromatographic purification, and use of ethanol-water as an environmentally benign solvent. The molecular structure of 4a has been supported by single-crystal X-ray diffraction.
Homopurine Alkaloids: A Brief Overview
Authors: Daley Sharna-kay , Cordell Geoffrey A.
Published: April 2020

The isolation, structure elucidation, synthesis, biological properties, and biosynthesis of the homopurine alkaloids are reviewed, with an emphasis on the “victim-guardian” relationships between co-occurring alkaloids.
Politicians in Newspaper News: Who Attracts Coverage in Kenyan Politics
Authors: Ireri Kioko , Ochieng Jimmy
Published: April 2020

The present research examines the coverage of 349 Kenyan politicians in four English national newspapers between 2013 and 2017. Within the contexts of media coverage based on news values, and reporting as a mirror of political reality, the study investigates whether gender, tribe, party size, seniority, committee or party leadership, commenting on corruption and devolution, and criticizing the government predicted the visibility of members of parliament (MPs) in newspaper news. Findings show that seniority, committee or party leadership, commenting on devolution and corruption, and criticizing government emerged as the main predictors of the parliamentarians’ coverage in news media. Overall, committee or party leadership, commenting on corruption, and criticizing the government were the strongest determinants of the MPs coverage.
Expectations of artificial intelligence and the performativity of ethics: Implications for communication governance
Authors: Kerr Aphra , Barry Marguerite , Kelleher John D
Published: April 2020

This article draws on the sociology of expectations to examine the construction of expectations of ‘ethical AI’ and considers the implications of these expectations for communication governance. We first analyse a range of public documents to identify the key actors, mechanisms and issues which structure societal expectations around artificial intelligence (AI) and an emerging discourse on ethics. We then explore expectations of AI and ethics through a survey of members of the public. Finally, we discuss the implications of our findings for the role of AI in communication governance. We find that, despite societal expectations that we can design ethical AI, and public expectations that developers and governments should share responsibility for the outcomes of AI use, there is a significant divergence between these expectations and the ways in which AI technologies are currently used and governed in large scale communication systems. We conclude that discourses of ‘ethical AI’ are generically performative, but to become more effective we need to acknowledge the limitations of contemporary AI and the requirement for extensive human labour to meet the challenges of communication governance. An effective ethics of AI requires domain appropriate AI tools, updated professional practices, dignified places of work and robust regulatory and accountability frameworks.
Folk theories of algorithmic recommendations on Spotify: Enacting data assemblages in the global South
Authors: Siles Ignacio , Segura-Castillo Andrés , Solís Ricardo , Sancho Mónica
Published: April 2020

This paper examines folk theories of algorithmic recommendations on Spotify in order to make visible the cultural specificities of data assemblages in the global South. The study was conducted in Costa Rica and draws on triangulated data from 30 interviews, 4 focus groups with 22 users, and the study of “rich pictures” made by individuals to graphically represent their understanding of algorithmic recommendations. We found two main folk theories: one that personifies Spotify (and conceives of it as a social being that provides recommendations thanks to surveillance) and another one that envisions it as a system full of resources (and a computational machine that offers an individualized musical experience through the appropriate kind of “training”). Whereas the first theory emphasizes local conceptions of social relations to make sense of algorithms, the second one stresses the role of algorithms in providing a global experience of music and technology. We analyze why people espouse either one of these theories (or both) and how these theories provide users with resources to enact different modalities of power and resistance in relation to recommendation algorithms. We argue that folk theories thus offer a productive way to broaden understanding of what agency means in relation to algorithms.
Factors associated with health-related quality of life in Japanese patients with hip osteoarthritis: A cross-sectional study
Authors: Tanaka Shigeharu , Robbins Shawn M , Inoue Yu , Tanaka Ryo
Published: April 2020

Background/Purpose:

Chronic symptoms related with hip osteoarthritis (OA) can negatively affect health-related quality of life (HRQoL). The purpose of this study was to examine factors related to a HRQoL measure that considers an Asian lifestyle in Japanese patients with hip OA.

Methods:

Forty-seven female subjects participated. The dependent variable was the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), which assessed HRQoL. Potential factors were measured as independent variables. After screening, potential variables were entered into a multiple regression analysis to determine which variables were related to HRQoL.

Results:

In the regression model, knee extension muscle strength on the unaffected side and hip flexion range of motion (ROM) on the affected side were associated with HRQoL. Higher strength and higher ROM were related to greater HRQoL.

Conclusion:

Results can help health-care providers develop appropriate rehabilitation programs for improving HRQoL in patients with hip OA.
Estimating the First 90 of the UNAIDS 90-90-90 Goal: A Review
Authors: Sohail Maira , Levitan Emily Bess , Rana Aadia Iftikhar , Heath Sonya Lynn , Rastegar Jeremiah , Kempf Mirjam-Colette , Long Dustin Marsh
Published: April 2020

Estimating the population with undiagnosed HIV (PUHIV) is the most methodologically challenging aspect of evaluating 90-90-90 goals. The objective of this review is to discuss assumptions, strengths, and shortcomings of currently available methods of this estimation. Articles from 2000 to 2018 on methods to estimate PUHIV were reviewed. Back-calculation methods including CD4 depletion and test–retest use diagnosis CD4 count, or previous testing history to determine likely infection time thus, providing an estimate of PUHIV for previous years. Biomarker methods use immunoassays to differentiate recent from older infections. Statistical techniques treat HIV status as missing data and impute data for models of infection. Lastly, population surveys using HIV rapid testing most accurately calculates the current HIV prevalence. Although multiple methods exist to estimate the number of PUHIV, the appropriate method for future applications depends on multiple factors, namely data availability and population of interest.
EFFECTS OF A SIMULATED GAME ON PITCHING KINEMATICS IN YOUTH FEMALE SOFTBALL PITCHERS
Authors: Oliver Gretchen D. , Downs Jessica L. , Friesen Kenzie B. , Anz Adam W. , Dugas Jeff R. , Andrews James R.
Published: April 2020

Background:

Despite evidence that overuse is the most common mechanism of injury, softball pitchers currently have no pitch count regulations. Pain has been associated with certain pitching pathomechanics, and some reports indicate increased pain following a single pitching bout.

Hypothesis/Purpose:

The purpose of this study was to analyze kinematic variables such as center of mass (COM), trunk, and stride length during the first and last inning of a simulated game in youth softball pitchers. We hypothesized COM to be shifted back toward the drive leg, stride length would be increased, and trunk kinematics would be altered during the last inning of a simulated game as compared to the first inning.

Methods:

Participants included thirty-two softball pitchers (12.4±1.6yrs., 159.4±8.9cm, 62.0±13.6kg). Participants were deemed injury and surgery free for the past six months and were currently active as a pitcher on their teams’ roster. Kinematic data were collected at 100Hz using an electromagnetic system. After warm-up, participants were instructed to throw random game situations, provided by the investigator, with the catcher located at regulation distance (43ft). Participants were required to produce three outs an inning as per a regulation softball game. Three fastballs from the first and last inning were recorded and used for analysis. Kinematics were analyzed at five different pitch events including: start of pitch, top of pitch, foot contact, ball release, and follow through.

Results:

A paired samples t-test revealed a statistically significant difference in trunk rotation during the first three pitching events from the first and last inning. Specifically, pitchers exhibited less trunk rotation towards the pitching arm side. A bivariate Pearson’s correlation showed volume of pitches was correlated with stride length (r=.367, p=.039) and COM (r=.364, p=.041) at the start of the pitch, and trunk flexion at top of pitch (r=-.392, p=.026), foot contact (r=-.413, p=.019), and follow-through (r=-.436, p=.013).

Conclusion/Significance:

Trunk kinematics, stride length, and COM were altered as pitch volume increased. These results provide clinical importance as the trunk pathomechanics seen may be indicative of poor trunk control and fatigue. Although it is out of the realm of this study to state whether the kinematic changes seen are associated with injury, we do know that deficits in the kinetic chain are associated with injury and that trunk pathomechanics are associated with pain in collegiate softball pitchers. Research should continue to investigate the effects of pitch count, pitch mechanics, and injury in youth softball pitchers.
Characterizing the Prevalence of Cam-Type Hip Impingement in Professional Women’s Ice Hockey Players
Authors: Carter Cordelia W. , Whitney Darryl , Campbell Abigail , Feder Oren , Kingery Matthew , Baron Samuel , Lomas Guillem
Published: April 2020

Background

Recent studies have demonstrated a high prevalence of femoroacetabular impingement (FAI) in elite men’s ice hockey players, yet little is known about the hips of elite women’s ice hockey players.

Purpose

The primary purpose of this study was to determine the prevalence of radiographic cam-type FAI in professional women’s ice hockey players in the National Women’s Hockey League (NWHL). The secondary purpose was to analyze the relationship between the presence of cam deformity and both hip range-of-motion (ROM) and age of menarche.

Methods

Clinical, radiographic and demographic data were collected during player pre-participation physicals. ROM measurements were performed with a goniometer. Alpha angles were measured on 45° Dunn radiographs, with alpha angles >55° defined as cam-positive ( Figure 1). Measurements were performed 3 separate times by 4 investigators. One-way ANOVA, independent means t-test and Pearson correlation coefficients were calculated, with statistical significance set at p<0.05.

Results

Twenty-six female athletes were included. Average menarchal age was 13.8 ±1.5 years. 24 (92%) had alpha angles >55°; 20 (77%) had bilateral cam deformity. Inter-rater reliability was excellent at 0.86. Intra-rater reliability was also excellent, with mean ICC=0.87 (range= 0.82-0.90 for each rater). There was a significant positive association between age of menarche and alpha angle (p<0.02, Figure 2). There was no association between alpha angle and hip ROM.

Conclusion

Elite female ice hockey players have a higher prevalence of cam morphology than the general population. The positive association between alpha angle and age of menarche supports the etiological hypothesis of the cam lesion resulting from activity-related stress at the proximal femoral physis during a period of physiologic vulnerability. Professional women’s ice hockey players have a high risk of developing cam morphology of the proximal femur, although each player’s age of menarche may mediate her individual risk for cam lesion development.

[Figure: see text][Figure: see text]
THE UTILITY AND VALIDATION OF THE FREQUENCY OF CONCUSSION SYMPTOMS (FOCS) QUESTIONNAIRE
Authors: Burkhart SO , Ellis CS , Jones CA , Smurawa TM , Polousky JD
Published: April 2020

Background:

Individuals with concussion show elevated scores on symptom checklists as long as the impairment is detectable (Peterson et al., 2003). The research question was to examine whether a questionnaire based on concussion symptom frequency (FOCS) would demonstrate sensitivity and specificity in differentiating concussion from non-concussion and provide beneficial clinical data when added to symptom severity measures such as the PCSS.

Purpose:

The purpose of this study was to determine the clinical utility of concussion symptom frequency using the Frequency of Concussion Symptoms (FOCS) Questionnaire in a sample of pediatric patients.

Methods:

Pediatric patients ages 13-18 diagnosed with a concussion (n=250) and orthopedic controls (n=250) presenting to an outpatient orthopedic clinic were administered the FOCS and PCSS at the time of initial clinical evaluation. All patients were administered the FOCS and PCSS by certified athletic trainers who were educated and trained on administration. The Frequency of Concussion Symptoms (FOCS) Questionnaire is a self-report measure consisting of 28 items, rated on a 5-point scale from 4 ( constantly) to 0 ( never). The PCSS is a self-report measure consisting of 22 items rated on a 7-point scale from 0 ( none) to 6 ( severe). Demographic data were summarized using descriptive statistics. Point estimates and 95% confidence intervals were calculated for all end points. Pearson correlations were calculated based on numerical values from the FOCS and PCSS data to establish validity. A regression analysis was performed to examine the coefficient of determination for FOCS and PCSS scores.

Results:

The total concussion sample consisted of 103 females and 147 males (mean age=15.03, SD=1.38), the orthopedic control sample consisted of 92 females and 158 males (mean age=15.46, SD=1.12). There was a positive correlation between the FOCS and PCSS in concussion patients (r=0.73, p=0.002) and in orthopedic controls (r=0.68, p=<0.001). Concussion and orthopedic control samples were not correlated on the FOCS (r=0.09, p<0.001) and PCSS (r=0.21, P=0.02). Multiple regression analysis was used to measure FOCS and PCSS scores in concussion patients (R2=0.78, p=<0.001).

Conclusions:

This is the first study of its kind examining concussion symptom frequency and severity to improve clinical symptom reporting. Adding frequency to symptom severity accounted for 78% of the variance. This may be the result of less subjectivity in frequency versus severity. This study was limited by sample size, further research is warranted to explore the relationship between symptom frequency and severity.
TRENDS IN US HIGH SCHOOL AND CLUB CHEER PRACTICE CONCUSSION REPORTING FROM 2012-2017
Authors: Burkhart Scott O.
Published: April 2020

Background:

Sport-related concussion (SRC) is one of the leading injuries among the 3.24 to 4.03 million athletes participating in cheerleading from 2012-2017. The purpose of this study was to provide a descriptive epidemiology of SRC in the school and club cheerleading practice setting from the 2012 to 2017 calendar years.

Methods:

Female cheerleading athletes, ages 12 to 18 participating in school or club cheer from 2012 to 2017 were included in the current study. Injury and exposure data from school and club cheerleading practices from the Rank One Health Injury Surveillance Database (ROH ISD) were analyzed. SRC counts, percentages, rates per 10,000 athletic exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Any RR or IPR with a 95% CI not containing 1.0 were considered statistically significant.

Results:

From 2012-2017, 951 SRCs were recorded from a sample of 51,812 females participating in school cheerleading and 12,643 females participating in club cheerleading. Cheerleading SRCs accounted for 0.40% of all injuries in sports from 2012-2017. The total SRC rate in school cheerleading was 6.02/10,000 AEs (95% CI = 5.87, 6.17). The total SRC rate in club cheerleading was 11.98/10,000 AEs (95% CI = 11.74, 12.22). The SRC rate was higher in club practices than in school practices (RR = 1.99; 95% CI = 1.89, 2.09). More SRCs occurred at school cheerleading practices (65.62%) than club practices (34.48%). The proportion of SRCs from falls onto hardwood surfaces was higher in club cheerleading practices than school cheerleading practices (IPR = 1.69; 95% CI = 1.61, 1.77) while the proportion of falls onto padded surfaces was higher in school cheerleading practices than club cheerleading practices (IPR = 2.26; 95% CI = 2.18, 2.34).

Conclusions:

The findings from this study provide the largest SRC incidence rates for school and club cheerleading practices to date and reveal evidence of differences in the club and school practice settings. Club cheerleading practice SRCs occurred at a higher rate than school cheerleading practice SRCs and appear to be significantly reduced by practicing on padded surfaces. These findings should be considered when educating cheerleading coaches, parents, and athletes regrading concussion injury risks as well as identifying potential areas of injury prevention. Further research is warranted to identify potential causes for injury trends observed in the current study.
MOVEMENT VARIABILITY IN PRE-TEEN AND TEENAGE ATHLETES DURING SPORTS RELATED TASKS
Authors: Edison Bianca , O’Callahan Bridget , Mueske Nicole M. , Conrad-Forrest Adriana , Katzel Mia J. , Zaslow Tracy , Wren Tishya A. L.
Published: April 2020

Background:

Movement variability may affect injury assessment and may change as athletes mature.

Hypothesis/Purpose:

We hypothesized that pre-teen athletes would exhibit greater variability than teenage athletes when performing drop jump, heel touch, and single leg hop motions.

Methods:

55 uninjured pediatric athletes were divided into pre-teen (age 7-12 years; n=29; 11 female) and teenage (age 13-15 years; n=26; 13 female) groups of similar size. All participants performed 2-3 repetitions per side of three sports related tasks: drop jump (41 cm), heel touch (single-leg squat from 15 cm or 23 cm step, depending on whether subject height <155 cm), and single leg hop for distance. 3D kinematics were recorded using motion capture during the loading phase of each task. To assess intra-individual variability, we examined the standard deviation (SD) and range (maximum-minimum) of key metrics among the multiple repetitions of each task performed by each participant. Variability was compared between age groups using 2-sided t-tests.

Results:

In the drop jump and heel touch, the younger group was more variable than the older group (Figure 1.1 left). The median within-subject SD of repeat measurements varied from 1-6° in the sagittal plane, 1-3° in the frontal plane, and 1-4° in the transverse plane over both groups (Table 1.2), while the within-subject range of measurements varied from 2-11° in the sagittal, 2-5° in the frontal, and 2-7° in the transverse planes (Table 1.3). Representing a worst-case scenario, the 95th percentile for range of measurements was >15° for many sagittal plane variables and >10° for many frontal and transverse plane variables in the younger group. In the singl- leg hop, the older group was much more variable than the younger group in the sagittal plane, particularly at the trunk, pelvis, and ankle (Figure 1.1 right). The younger group was still more variable than the older group at the trunk and pelvis in the transverse plane. Median within-subject variability ranged from 2-9° for SD and 3-17° for range of repeat measurements.

Conclusion:

There was substantial within-subject variability in performing sports related tasks for pediatric athletes of all ages. Variability was generally lower for older athletes, but was particularly high in the older group for sagittal plane trunk and pelvis motion during single-leg hop landing, which may reflect the need to adjust for less constrained positioning of a larger proximal mass. The high variability in performing sports tasks suggests that multiple trials should be analyzed for a more complete and representative evaluation.

[Figure: see text][Table: see text][Table: see text]
DUAL-TASK BALANCE CONTROL IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION
Authors: Zaslow Tracy , Burton Camille , Mueske Nicole M. , Conrad-Forrest Adriana , Edison Bianca , Wren Tishya A. L.
Published: April 2020

Background:

Previous research has identified deficient dual-task balance control at the time of return to play (RTP) and possible worsening after RTP in older adolescents/young adults with concussion. These findings have not been investigated in younger patients with concussion.

Hypothesis/Purpose:

We hypothesized that concussed adolescents would have slower walking speed and increased medial-lateral (ML) center of mass (COM) movement, which would normalize by the time of RTP but worsen after resuming activity.

Methods:

13 adolescent concussion patients (7 male; age 10-17 years) were prospectively evaluated at their initial visit (IV) (mean 18, range 4-43 days post-concussion), at RTP clearance (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days post-RTP) along with 11 controls (3 male) seen for similarly timed visits. Standing balance was assessed using range and root mean squared (RMS) COM motion in the anterior-posterior (AP) and ML directions during standing on both legs with eyes open while performing quiet standing, dual-task audio Stroop, side-to-side head turns, and side-to-side thumb tracking tasks. Dynamic balance was assessed using walking speed and COM ML range and velocity during walking alone and with side-to-side head turns and verbal fluency (reciting words starting with “F”) dual tasks. Patients were compared against controls using t-tests, and changes over time were evaluated using linear mixed-effects regression.

Results:

During standing, patients had higher COM ML RMS than controls at IV during head turns and higher COM AP range during thumb tracking. COM ML motion decreased from IV to RTP (head turns range -6.5mm, p=0.058; head turns RMS -16.8mm, p=0.002; thumb range 9.2mm, p=0.012) and increased from RTP to 1 month follow-up (head turns RMS +10.0mm, p=0.040; Stroop RMS +8.4mm, p=0.086). Patients walked slower than controls at IV during all tasks, and COM ML range was higher in patients vs. controls during verbal fluency at IV and RTP. Walking speed increased from IV to RTP during verbal fluency (+7.8cm/s, p=0.044), from RTP to post-RTP in single task walking (+6.1cm/s, p=0.041), and at each successive visit during head turns (+6.0cm/s and +6.5cm/s, p<0.07). COM ML range also decreased in patients from IV to RTP with verbal fluency (-14.7mm, p=0.011) and from RTP to post-RTP in single task walking ( 4.0mm, p=0.061).

Conclusion:

Adolescent concussion patients had deficits in static and dynamic balance control at initial presentation. This tended to improve by RTP and only worsened post-RTP for dual-task ML control during standing, suggesting that current conservative treatment protocols are appropriate.
HEALTH DISPARITIES IN ADHERENCE WITH PRESCRIBED REHABILITATION FOLLOWING SURGICAL TREATMENT OF KNEE INJURIES IN PEDIATRIC PATIENTS
Authors: Metz Allan K. , Hart-Johnson Tami , Blackwood R. Alexander , Crawford Eileen A.
Published: April 2020

Background:

Rehabilitation is paramount to recovery following surgery for ligamentous and meniscal knee injuries, but there exists little research regarding adherence with rehabilitation in pediatric populations, especially how this relates to health disparities in this population.

Hypothesis/Purpose:

Our study aimed to evaluate the effect of patient socioeconomic/demographic factors on adherence with physical therapy appointments following surgical repair or reconstruction of knee injuries. This information would be used to raise awareness of health disparities and potentially develop a set of predictors for a higher risk of non-adherence with prescribed rehabilitation.

Methods:

This study was a retrospective chart review of patients under the age of 18 who underwent physical therapy at the authors’ institution following initial surgical repair or reconstruction of a knee injury (ACL, MCL, LCL, PCL, meniscus, patellar tendon, and tibial eminence injuries included). Surgeries from 1 January 2015 to 31 December 2016 were considered, with physical therapy being considered for dates extending to 1 January 2018. Rate of adherence with physical therapy, reasons for lack of attendance, and socioeconomic/demographic variables were gathered. Data was evaluated utilizing bivariate and separate hierarchical linear regression analyses.

Results:

Our study population was comprised of 108 individuals with a mean age of 15.15 ± 2.04 years and a mean compliance rate with physical therapy of 80.2 ± 11.8%. Bivariate analysis revealed Hispanic/Latino patients were more likely to cancel/no show (18 ± 22.82) than non-Hispanic/Latino patients (7.55 ± 6.88, p = 0.010). Logistic regression revealed patients were significantly less likely to attend 85% of rehabilitation visits if in single-parent households ( p = 0.024). The interaction of insurance type and residence stability (maintaining a single residence during treatment) found patients with public insurance and stable housing were less likely to reach the 85% compliance threshold (Table 1). At trend level, linear regression revealed an inverse relationship with distance and physical therapy attendance ( p = 0.082), in addition to linear regression showing unstable residence ( p = 0.052) and public insurance ( p = 0.067) as significant at trend level of patients not reaching 85% compliance.

Conclusion:

Our study revealed single-parent households and Hispanic/Latino patients were significantly correlated with lower rehabilitation adherence, in addition to trends showing distance to physical therapy, unstable housing, and public insurance correlated with lower compliance. Our work highlights potential predictors of rehabilitation noncompliance and allows for targeted efforts to increase adherence in patients with these factors.

[Table: see text]
TROCHLEAR MORPHOLOGY DEVELOPMENT: STUDY OF NORMAL PEDIATRIC KNEE MRIS
Authors: Trivellas Myra , Kelley Ben , West Nicole , Jackson Nicholas , Beck Jennifer
Published: April 2020

Introduction:

Trochlear dysplasia is a known risk factor for patellar dislocations yet normal trochlea development is not well described. This study will define the articular cartilage and subchondral trochlear morphology development in pediatric patients using MRI evaluation.

Methods:

Retrospective knee MRI review including patients aged 3-16 years with non-patellofemoral related diagnoses. ICD-9/ICD-10 codes identified eligible study patients. Measurements of the trochlea were made based on previously established methods using the axial MRI image just distal to the physis at the deepest portion of the trochlear groove. Three linear (Lateral Trochlear Height (LTH), Medial Trochlear Height (MTH), Central Trochlear Height (CTH)) and three angular (Sulcus Angle (SA), Lateral Trochlear Slope (LTS), Medial Trochlear Slope (MTS)) were made at the Articular Cartilage (AC) and Subchondral Bone (SCB) (Figure 1). Twelve measurements were made independently by two study authors. Interrater reliability was assessed. Trochlea measurements were summarized across age quartiles: 1st (age 5.1 - 8.3y), 2nd (8.3 - 11.5y), 3rd (11.5 - 14.3y), 4th (14.3 - 16.9y). Associations between age and trochlea measures were assessed using linear regression with Huber-White adjusted standard errors.

Results:

246 knee MRIs from 230 patients were included in this study. 113 patients (51%) were female while 117 (49%) were male. 116 MRIs (47%) were of the Left knee and 130 (53%) were Right knee. Average patient age was 11.4±3.4 years. Interrater agreement was high (ICC values >0.7). Mean values for measurements are presented by age quartiles (Table 1). LTH, MTH, and CTH showed linear increase with age (range 2 to 2.6 mm per year, p<0.001). SA, LTS, MTS measured at the AC showed no change with age (p>0.05) however LTS and MTS measured at SCB showed significant increases with age (0.6 and 0.9 degrees per year, p<0.001) while SA showed a decrease with age (-1.4 degrees per year, p<0.001). There were no significant differences found in the age associations by laterality, left vs right. There were no gender differences in the age associations for SA, LTS, MTS (p>0.05) however for MTH, LTH, and CTH, males were found to have a significantly greater growth rate (p<0.001).

Conclusions:

This study found an increase in articular cartilage and subchondral bone MTH, LTH, and CTH over time as well as an increase in subchondral bone LTS, MTS, and SA. However, no significant change in articular cartilage LTS, MTS, or SA was found. This normative data indicates that articular cartilage angles determine final trochlear morphology.

[Table: see text][Figure: see text]