bluuebunny/crossref_metadata_2025 huggingface dataset:
Burden, risk factors, and management of neutropenic fever among solid cancer patients in Ethiopia
Authors: Agegnew Wondm Samuel , Dagnew Ephrem Mebratu , Tadesse Abegaz Sumeya , Kiflu Mekdes , Kebede Bekalu
Published: May 2022

Objectives:

Although neutropenic fever is one of the most well-known oncologic emergencies and the common causes of death, a few studies have been conducted in resource-limited countries, particularly in Ethiopia. This study aimed to assess the burden, risk factors, and management of neutropenic fever among solid cancer patients in Ethiopia.

Methods:

A hospital-based retrospective follow-up study was conducted from January 2017 to February 2021. Data were collected from patient’s medical charts using a structured data abstraction format and analyzed using STATA version 14.2. Logistic regression analyses were used to identify independent predictors of neutropenic fever, and a p-value of < 0.05 was considered statistically significant.

Results:

A total of 416 patients were included, with a mean age of 51 ± 14 years. The cumulative incidence of neutropenic fever was 13%. Advanced age, low baseline white blood cell, prolonged duration of neutropenia, and presence of two or more comorbidities were factors significantly associated with neutropenic fever ( p < 0.05). Among patients who need primary prophylaxis, 68% of patients did not get appropriate primary prophylaxis, and 30%, 71%, and 93% of prescribed anti-bacterial, anti-fungal, and anti-viral agents were inappropriate according to Infectious Disease Society of America Guideline, respectively.

Conclusion:

Neutropenic fever was common among solid cancer patients and it is multifactorial. The rate of guideline adherence during prophylaxis and treatment of neutropenic fever was poor. Health care professionals should be aware of these risk factors, and greater effort is needed to reduce the risk of neutropenic fever.
Standardised nurse-led protocol of radiolucent renal and proximal ureteric stones using sodium bicarbonate oral dissolution therapy
Authors: Carey Michelle , Khalifa Ahmad O , Pinto-Lopes Rui , Datta Soumendra , Rix Gerald , Maan Zafar
Published: May 2022

Objective:

Oral dissolution therapy is a recognised treatment option for radiolucent kidney stones. A standardised nurse-led protocol was developed. Efficacy and compliance was audited and results reviewed.

Methods:

Twenty-two patients with radiolucent stones were prescribed oral sodium bicarbonate. Patients monitored their urinary pH and the Urology Nurse Practitioner checked compliance. Follow-up with non-contrast computerised tomography of the kidneys, ureters and bladder (CT KUB) was evaluated at 6 weeks.

Results:

Twenty patients with radiolucent stones completed treatment. Mean stone size was 8 mm (2–23 mm). Nine patients (45%) had complete dissolution, three (15%) had partial dissolution and eight (40%) had no visible response on follow-up CT KUB. The Hounsfield unit (HU) average was 464 (116–1285). Those patients with complete dissolution had HU of less than 605. Three patients with encrusted ureteric stents underwent complete dissolution.

Conclusions:

Utilisation of a nurse-led sodium bicarbonate dissolution therapy protocol for the treatment of radiolucent stones is effective and acceptable to patients in carefully selected cases. Orally dissolution therapy (ODT) is a suitable option in patients with multiple co-morbidities and high anaesthetic risk. In our series, ODT was also highly effective in treating radiolucent stent encrustation.
Communication of solar geoengineering science: Forms, examples, and explanation of skewing
Authors: Reynolds Jesse L
Published: May 2022

Although a judicious use of solar radiation modification (SRM, or solar geoengineering) appears able to reduce climate change, SRM would create risks of its own. How results and conclusions are conveyed is important. This article describes nine cases in which scientific articles and their official press releases communicate results inaccurately: by inappropriately comparing SRM with a reference world of non-elevated greenhouse gas concentrations; focusing on the residual climatic anomalies that SRM would not entirely eliminate; generalizing a predictably harmful assumed implementation regime to all possible SRM; or reporting conclusions that the paper does not substantiate. Notably, each of these cases unduly amplifies SRM’s apparent risks and limitations. Collectively they may skew SRM communication and cause negative impacts on scientific assessments, news reporting, and policy discussions. The article suggests explanations for why SRM scientists and their official communicators sometimes inaccurately convey their results as well as how they and others should respond.
Complement-Amplifying Conditions in Atypical Hemolytic Uremic Syndrome: A Canadian Case Series
Authors: Patriquin Christopher J. , Pavenski Katerina , Garland Jocelyn , Girard Louis-Philippe , Isenring Paul
Published: May 2022

Rationale:

Thrombotic microangiopathies (TMAs) are systemic disorders that often affect the kidneys and encompass a heterogeneous group of conditions, including atypical hemolytic uremic syndrome (aHUS). The complement pathway is thought to play a crucial role in the pathogenesis of aHUS, and a favorable response can be obtained through complement C5 inhibition. There is emerging evidence to suggest that the same is also true for several other forms of TMA.

Objective:

The purpose of this series is to report cases of aHUS in which both an innate defect of the alternative complement pathway and a complement-amplifying condition were suspected.

Methods:

This case series describes 8 patients who were managed in Canadian tertiary centers for aHUS and who presented initially with complement-amplifying conditions.

Results:

In all cases, aHUS was associated with organ dysfunction and in some, with an innate defect of the alternative complement pathway. The complement-amplifying conditions identified were diverse including immune disorders, pregnancy, and a Shiga toxin infection. Patients improved rapidly when treated with eculizumab or plasma exchange.

Conclusions:

These observations illustrate the seriousness of secondary aHUS. They also add to existing lines of evidence that the complement pathway is potentially involved in this condition and that it should be considered as a therapeutic target of interest under such circumstances.
Signaling the Intent to Change Online Communities: A Case From a Reddit Gaming Community
Authors: Bergstrom Kelly , Poor Nathaniel
Published: May 2022

This study builds on existing research about churn and community movement, examining if language use on Reddit can be used to determine if people signal their intent to relocate to a new community before they actually do so. Using a computational and semantic approach, we studied the subreddits for the game series Fallout at the time Fallout 76 ( FO76) was released to see if the users of the Fallout 4 ( FO4) subreddit signaled how they would react to the new subreddit. The main difference we found was that those who stay in the FO4 subreddit or use both subreddits on average post more often and create longer posts than those who move to the FO76 subreddit or leave. This adds further evidence to support theories about community as communication, and we suggest this finding can help online community managers identify which users may be about to leave the community, aiding retention and the overall health of the community.
Aligning means and goals: Insights from professional development to promote learner-centered education in Cambodia
Authors: Eastman Dennis , Bishop Carolyn , Block Nicholas C.
Published: May 2022

As part of a multi-year project within a network of Cambodian Christian schools, researchers facilitated training with the purpose of strengthening learner-centered education. To support teachers to grow beyond previous training, leaders ensured that the structure of the training was carefully aligned with intended outcomes. Informed by questionnaires that measured teacher confidence with varied tasks, and also by teacher feedback, researchers found evidence that it was helpful that the training was delivered in a manner consistent with principles of servant leadership and that it actually modeled learner-centered education so that teachers could integrate new pedagogies into their own classroom.
Positive Parenting Program to Promote Child Development Among Children 1 to 3 Years Old: A Quasi-Experimental Research
Authors: Viet Truong Hoang , Nanthamongkolchai Sutham , Munsawaengsub Chokchai , Pitikultang Supachai
Published: May 2022

Introduction:

Child development receives lack of concern and the role of parents in promoting child development is not frequently mentioned in Vietnam. This study aimed to examine the effectiveness of Positive Parenting Program to Promote Child Development on maternal knowledge and practice and development of children aged 1 to 3 years.

Methods:

This is a quasi-experimental study conducted in Nha Trang city, Vietnam. There are a total of 60 mothers whose children were identified as suspected developmental delayed participated in the study. There were 30 mothers who attended the program as experimental group and 30 mothers who joined the study as comparison group. Ages and Stages Questionnaires, Third Edition (ASQ-3) were applied to assess the child development. Descriptive analysis and paired and independent-samples t-test were applied to examine the research objectives.

Results:

The findings suggested that after the program implementation, the maternal knowledge of child development and child development of the experimental group were significantly higher than pre-program and the improvements of these variables were better than the comparison group ( P < .05) while the maternal practice to promote child development was significantly better only within the experimental group.

Conclusions:

The program was effective in improving several maternal outcomes and child development. The study recommends applying the Positive Parenting Program to Promote Child Development to enhance mother’s knowledge of child development and child development.
The Past, Present and Future of COVID-19 Associated Mucormycosis: A Rapid Review
Authors: Sarfraz Zouina , Sarfraz Azza , Jaiswal Vikash , Poudel Sujan , Bano Shehar , Hanif Muhammad , Singh Shrestha Prakriti , Sarfraz Muzna , Michel George , Cherrez-Ojeda Ivan
Published: May 2022

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, which is known for the multiple mutations and forms that have rapidly spread across the world. With the imminent challenges faced by low- and middle-income countries in curbing the public health fallbacks due to limited resources, mucormycosis emerged as a fungal infection associated with high mortality. In this rapid review, we explored MEDLINE, Cochrane, Web of Science, WHO Global Database, and the search engine—Google Scholar for articles listed until July 2021 and presented a narrative synthesis of findings from 39 articles. The epidemiology, causative factors, incidence parameters, pharmacological treatment, and recommendations for low- and middle-income countries are enlisted. This study concludes that a majority of the globally reported COVID-19 associated mucormycosis cases stemmed from India. Individuals receiving systemic corticosteroids or who have a history of diabetes mellitus are more prone to contracting the disease. Public health authorities in LMIC are recommended to strengthen antifungal therapies for COVID-19 associated mucormycosis and to strategize reduction in diabetes mellitus prevalence.
Valve-Sparing Aortic Root Replacement in a Patient With an FLNA Variant
Authors: Lobbestael Adam J. , Bupp Caleb P. , Haw Marcus P.
Published: May 2022

We report a case of a 38-year-old female with an FLNA variant who underwent valve-sparing aortic root replacement. FLNA encodes Filamin A, an actin-binding protein. Our patient had aortic root dilation due to this variant. Aortic root repair was conducted using the David procedure, with modifications to account for tissue fragility associated with this genetic condition. This case demonstrates the value of patient-specific genetic information for the timing of surgery and operative course planning.
Resume Research Questions Through the Seven Philosophical Foundations of Communication
Authors: Major Michael W.
Published: May 2022

While there is no lack of peer-reviewed publications that focus on resumes, there is a lack of theory-based research in the genre. Most studies on resumes report observations rather than test theories to predict screener behaviors, and recent calls to action have advocated for more theory-based resume research. This paper answers the call and offers ways in which scholars can introduce theory into the existing body of knowledge in the resume genre by exploring research questions guided by the various philosophical foundations of the communication discipline. Future resume research should reference Craig’s constitutive metamodel that offers more than 250 communication theories into seven philosophical foundations: semiotic, phenomenological, cybernetic, sociopsychological, sociocultural, critical, and rhetorical when designing studies. Exploring resume research questions based on communication theory enables scholars to use an applied research perspective across disciplinary boundaries and advance knowledge of resumes, a key component of organizational entry. This paper opens the door for scholars to contribute to this large and important question of organizational entry by outlining resume research questions that can be explored within each of the theoretical foundations of the communication discipline.
The Translation of Culture-Specific Items (CSIs) in Chinese-English Food Menu Corpus: A Study of Strategies and Factors
Authors: Amenador Kate Benedicta , Wang Zhiwei
Published: May 2022

This study investigated how culture-specific items (CSIs) are translated in the Chinese-English food menu corpus. This overarching aim was divided into two specific objectives: identifying which procedures prevail in translating cultural items and determining what factors impinge on the selection of specific procedures. The analysis of the corpus was done descriptively and by utilizing “Sketch Engine.” The theoretical issues addressed in the study included the scope and definition of CSI, the categorization of procedures presented in the data for CSI translation, and the place of food items within the category of CSI. Results of the study indicated that neutralizing strategy is employed more than foreignizing and domesticating strategies, with the latter being last in descending order. The major factors identified were metonymical/metaphorical use of the CSI, brand, polysemous nature of source CSI, degree of cultural markedness, and false relationship of the ST item with the TT item. Correlations between some factors and procedures were moderately strong as their values were above 50 out of the ideal value (100). However, other correlations were weak and therefore requires further investigation.
CSR and CEO’s Moral Reasoning in the Automotive Industry in the Era of COVID-19
Authors: Garcia-Ortega Beatriz , Galan-Cubillo Javier , de-Miguel-Molina Blanca
Published: May 2022

This paper assesses whether and to which extent the COVID-19 pandemic, which represents a scenario of high moral intensity, is influencing the moral reasoning of top CEOs (chief executive officers) in the paradigmatic case of the automotive industry and how this moral reasoning relates to their CSR response to the crisis and their CSR plans in the long run. To this end, we took the CEO letters before and after the pandemic outbreak of the top 15 automotive companies, and applied Weber’s method to conduct a moral reasoning categorization, along with an examination of their CSR approach and initiatives. The results show a predominant moral paralysis among these CEOs, where positive reactions addressed are philanthropic in nature and more likely to be a transient response to the crisis, rather than a sustained long-term improvement of their CSR rooted in a significant moral approach enhancement. Furthermore, CEOs at the lowest stages of moral reasoning, primarily focused on their own business and immediate stakeholders, are less likely to highlight these philanthropic initiatives. The outcome evidences the convenience of addressing CSR from the lens of moral reasoning, and it further draws the attention of the scientific community, companies and their top management, stakeholders, and society to the relevance of investigating and considering the moral reasoning of top management in large corporations and its implications.
The Impact of Internet Use on Community Participation of Older Adults: Evidence From China
Authors: Xiaobing Huang , Meng Chen
Published: May 2022

This article explores the association between Internet use and community participation of older adults using data from the China Longitudinal Aging Social Survey (CLASS) in 2016. The empirical results indicate that there is a significant positive association between Internet use and the intention of community participation of older adults. Moreover, mediating effect investigation shows that Internet use promotes the intention of community engagement of the older adults by improving subjective health. The benchmark results are still consistent after addressing the potential endogeneity by employing propensity score matching method. Finally, subsample analysis suggests no significant difference in this positive effect between urban and rural older adults.
Revisiting Hukou Transfer Intentions Among Floating Population in Chinese Cities: Spatial Differences and Multi-Level Determinants
Authors: Lao Xin , Zhao Zhihao , Gu Hengyu
Published: May 2022

The hukou transfer intentions (HTI), as an essential indicator of migration behaviors, is of great significance to the urbanization development and the citizenization process of China’s floating migrants. Although extant studies have devoted extensively to the influence factors of HTI, their spatial differences and multi-level determinants are comparatively under-researched. Based on the China Migrants Dynamic Survey (CMDS) data in 2016, we employed the spatial analysis method to discover a remarkable spatial disparity of HTI among cities of different sizes and found that HTI is affected by individual-level and city-level factors using a multilevel model. Besides city sizes and economic development levels, city amenity factors and housing prices also positively impact HTI. The cross-level interactions also indicate the greater preference of older, higher-educated, and wealthier floating migrants for larger cities than their counterparts, and the greater preference of older, higher-educated, and longer-term floating migrants for cities with higher housing prices than their counterparts, implying an accelerated agglomeration of talent with more social capital in leading cities. Several policy implications can be drawn from the discoveries of this study.
Understanding Who Uses Whole Health Services: A Program Evaluation
Authors: Mitzel Luke D. , Possemato Kyle , Smith Allyson R. , Seifert Cheryl A. , Ramon Abigail E. , Grewal Harminder
Published: May 2022

Background

The Veterans Health Administration is rolling out a Whole Health system of care as part of an enhanced focus on proactive, person-centered healthcare.

Objective

Our program evaluation seeks to characterize what Veterans use Whole Health services, for what diagnoses they are seeking Whole Health services, and to examine “high utilizers” of Whole Health services.

Methods

Data were collected on 174 Veterans using Whole Health services from December 2018 through March 2020 and consisted of chart review and self-report data.

Results

Women were more likely than men Veterans to use individual only Whole Health services. High utilizers (the top 30% of the sample in Whole Health services used) were more likely to attend groups than the remainder of the sample.

Conclusion

Future work should examine the community-building aspects of Whole Health and ways to create group programming tailored to women Veterans.
Knee osteoarthrosis with extra-articular femoral deformity treated with total knee arthroplasty: A case series
Authors: Tsoi Calvin , Wong Yiu Chung
Published: May 2022

A successful Total knee arthroplasty (TKA) procedure requires restoration of mechanical axis and soft tissue balancing. Deformity of tibia and femur occurs with history of trauma or osteotomy, infection, metabolic bone disease and excessive bowing. Tackling pre-existing extra-articular deformity of lower limbs during total knee arthroplasty can be challenging due to difficulty in restoring alignment axis and soft tissue balancing. We have recorded 6 patients underwent total knee arthroplasty with preexisting extra-articular femoral deformity by intra-articular correction from 1995 to 2017. All patients had extra-articular deformity of the femur due to fracture malunion which were treated either conservatively, plating or intra-medullary nail. Coronal deformity is corrected from an average of 15.5 degrees to 4.6 degrees from neutral axis. Sagittal deformity is corrected from average of 6.8 degrees to 3.6 degrees. One patient developed progressive genu recurvatum at 7 years follow-up with range of motion at 25 degrees extension and 110 degrees flexion. The average pre-operative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 68.5 (range 51−87) decreased to 50.7 (range 21–71) at 12 months post-operative and Knee score averaged 53.3 (range 51–55) increased to an average of 88.5 (range 82–94). There was only one revision for aseptic loosening 16 years after total knee replacement (TKR) and no other cases of radiological sign of aseptic loosening. In conclusion, Intra-articular correction of an extra articular femoral deformity for TKR is an attractive approach in mild to moderate deformity further from the knee joint.
Biomechanical study of embracing and non-embracing rib plates
Authors: Huang Gang , Li Pu , Li Gaoyang , Yang Jinliang
Published: May 2022

The study was carried out to explore the biomechanical properties of embracing and non-embracing rib plates. Forty-eight adult cadaver rib specimens were divided randomly into six groups: three fixation model groups were made using embracing plates (two pairs of equals on both sides of the broken end), and the other three groups were fixed with a pre-shaped anatomical plate (three locking screws on each side of the end were equally spaced). The biomechanical properties of these models were analyzed using non-destructive three-point bending tests, non-destructive torsion experiments, and destructive axial compression tests. In this study, the gap of fracture ends was widened in embracing plate group in the non-destructive three-point bending experiment. No change in the fracture ends was detected in the pre-shaped anatomical plate group. The bending stress of the pre-shaped anatomical plate group was significantly enhanced at the 2–12 mm displacement points (p < 0.05). Moreover, there was no significant difference in torque noticed between the two groups in the torsion experiment (p = 0.082). In the destructive axial compression experiment, the load index of the two groups were higher than the normal physiological load, suggesting that both materials could provide sufficient strength for rib fractures. The pre-shaped anatomical plate displayed more reliable attachment in terms of stability, bending, and load. Our results indicated that the embracing plate has the advantage of fretting at the fracture end.
The Conundrum of Anticoagulation and Antiplatelet Therapy in Spontaneous Coronary Artery Dissection
Authors: Cordova Sanchez Andres , Mogadam Emad , Aiello Dana
Published: May 2022

Spontaneous coronary artery dissection (SCAD) is a relatively rare and frequently misdiagnosed disease. The current knowledge of its pathophysiology and management is limited and based mostly on hypotheses. We present a patient with recurrent SCAD whose condition worsened soon after discontinuation of anticoagulation, prompting us to question the current management and review the evidence about pathophysiology, anticoagulation, and antiplatelet therapy.
Psychological Readiness to Return to Sport at 6 Months is Higher After Bridge-Enhanced ACL Repair than Autograft ACL Reconstruction
Authors: Sanborn Ryan M. , Badger Gary J. ,   *The BEAR Trial Team, Yen Yi-Meng , Murray Martha M. , Christino Melissa A. ,   *The BEAR Trial Team: Benedikt Proffen, Sant Nicholas , Barnett Samuel , Fleming Braden C. , Kramer Dennis E. , Micheli Lyle J.
Published: May 2022

Background:

Prior clinical studies have shown that psychological factors have a significant effect on an athlete’s readiness to return to sport following ACL reconstruction (ACLR).

Hypothesis/Purpose:

We hypothesized that patients who underwent Bridge-Enhanced ACL Repair (BEAR) would have higher levels of psychological readiness for return to sport compared to ACLR, and baseline characteristics and 6-month outcomes would predict psychological readiness at 6 months following an ACL surgical procedure.

Methods:

100 patients (median age 17 years; median pre-operative Marx Activity Score 16) with complete mid-substance ACL injuries were randomized to either the BEAR procedure (n=65) or autograft ACLR (n=35) and underwent surgery within 45 days of injury. Objective, functional, and patient-reported outcomes, including the ACL-Return to Sport after Injury (ACL-RSI) scale, were assessed at 6 months, 12 months, and 24 months.

Results:

Patients who underwent the BEAR procedure had significantly higher ACL-RSI scores at 6 months compared to those that underwent an ACLR (71.1 vs 58.2, p=.008), and scores were similar at 12 months and 24 months. Baseline factors independently predictive of higher ACL-RSI scores at 6 months were having a BEAR procedure and participating in Level 1 sports prior to injury, which explained 15% of the variability in ACL-RSI scores. Regression analysis of baseline and 6-month outcomes as predictors indicated that the IKDC score at 6 months explained 45% of the 6-month ACL-RSI variance. Subsequent analysis, with IKDC excluded from the model, indicated that decreased pain, increased hamstring and quadriceps strength in the surgical limb, and decreased side-to-side difference in AP knee laxity were significant predictors of a higher ACL-RSI score at 6 months, explaining 34% of the variability in ACL-RSI scores. Higher ACL-RSI scores at 6 months were associated with earlier clearance to return to sports.

Conclusion:

Patients who underwent the BEAR procedure had higher ACL-RSI scores at 6 months after surgery. Better ACL-RSI scores at 6 months were related most strongly to higher IKDC scores at 6 months. Lower pain levels, better muscle recovery, and less knee laxity at 6-months post-surgery were also associated with improved ACL-RSI scores at that time point.
Biomarkers of Knee Joint Healing in Adolescents Following Anterior Cruciate Ligament Reconstruction: A Systematic Review
Authors: Ek Orloff Lisa E. , Del Bel Michael J. , Romanchuk Nicholas J. , Carsen Sasha , Imbeault Pascal , Benoit Daniel L.
Published: May 2022

Background:

Anterior cruciate ligament (ACL) injuries are increasing in prevalence by 2.3% annually in adolescents and have been linked to an increased risk for early-onset knee osteoarthritis (OA). Current ACL rehabilitation guidelines do not directly account for the physiological healing process of the knee joint. Instead, the sole focus is on a patients’ perceived function and their ability to meet functional benchmarks in the lower extremities. The physiological healing process could provide prognostic insight for clinicians and physiotherapists when rehabilitating ACL-injured patients.

Hypotheses/Purpose:

The purpose of this systematic review was to identify existing literature to determine i) the most prevalent biomarkers for reflecting knee joint healing in patients after ACL reconstruction (ACLR), and ii) the quantity of these studies which include adolescents. Methods: Following PRISMA guidelines, Medline, Embase, SCOPUS and Web of Science databases were searched up until September 2020. Studies were included if they (1) included participants who had sustained a primary ACL injury and undergone a subsequent ACLR, and (2) measured at least one biomarker of knee joint healing at more than one time point. An NIH quality assessment tool was used to assess study quality. The following data were extracted: participant age; biological sample(s); biomarker(s) analyzed.

Results:

Seven studies met inclusion criteria for this systematic review (Table 1). Interleukin-6 (IL-6) and C-terminal crosslinking telopeptide of type II collagen (CTX-II) were the most prevalent biomarkers used in the literature (3/7 studies). These biomarkers reflected knee joint healing through consistent elevation and/or gradual decrease following ACLR. Six studies evaluated adult populations (age range; Table 1). One study (average age 19.6±4.5) evaluated the effect of age on biomarker levels of knee joint healing and showed a negative correlation between age and CTX-II concentrations (r=-.769, p < 0.001). Conclusions: This systematic review identified (i) seven studies which evaluated healing using biomarkers following ACLR, (ii) IL-6 and CTX-II were most commonly used, and (iii) there is little research evaluating the physiological healing of the knee joint in any cohorts, in particular adolescent patients following ACLR. Adolescents are unique from adults due to growth and sex hormone variation. Therefore, what little biomarker research completed in adults cannot simply be extrapolated to adolescents. In addition to existing biomechanical rehabilitation tasks, we propose that rehabilitation and return to activity assessment following ACLR in adolescents could be informed by the healing status of the knee, improving outcomes and reducing their risk of early-onset knee OA. [Table: see text]
Relationship Between Ankle Dorsiflexion Mobility and Functional Return to Sport Test Performance in Athletes Who Have Undergone ACL Reconstruction
Authors: Dabis Jessica B. , Ulman Sophia , Cooper Savannah , Kemper W. Craig , Zimmerhanzel David , Wilson Philip L. , Ellis Henry B.
Published: May 2022

Background:

Limited ankle dorsiflexion (DF) range has been associated with knee injuries and altered biomechanics during functional squatting and landing tasks. Prior studies correlating weight-bearing DF with altered landing mechanics have primarily used advanced motion capture technology, with limited research using clinically validated scoring tools.

Hypothesis/Purpose:

To assess the relationship between decreased DF and functional testing performance in youth athletes who have undergone anterior cruciate ligament reconstruction (ACLR).

Methods:

A retrospective review of standardized data was conducted on patients who had undergone ACLR at a pediatric sports medicine practice that had completed functional testing between December 2017 and November 2020. Patients with testing completed at a minimum of five months post-operatively, and who planned to return-to-sport (RTS) were included. Functional testing included validated protocols for the Y-Balance Test (YBT) and the Landing Error Scoring System (LESS), as well as a modified Single-Leg Squat Endurance Test (SLSET) utilizing the VAIL sports test scoring criteria. DF was measured in a weight-bearing lunge position off the front foot. Subjects were categorized into a pass or fail group based on their YBT and LESS scores (YBT≥94%, LESS≤4), and t-tests were performed to identify significant differences in DF between groups ( α=0.05). Lastly, Pearson correlations were performed to identify potential relationships between DF and SLSET total score as well as normalized anterior reach collected as a component of the YBT ( α=0.05).

Results:

303 patients (148 (48.8%) males, 15.94±2.15 years, 7.46±2.11 months post-operative) were included for analysis. Significant correlations were identified between DF and YBT composite score ( p <0.001) and LESS total score ( p <0.001; Table 1). Additionally, positive relationships were found between DF and both SLSET total score ( p <0.001, r = 0.296) and anterior reach ( p <0.001; r =0.400). Average values for DF, YBT, and LESS can be found in Table 2.

Conclusion:

In this pediatric ACLR population, decreased ankle dorsiflexion is associated with high risk movement patterns during functional testing. This study adds to the literature by identifying clinically applicable DF thresholds associated with passing scores on the YBT and LESS functional tests. Clinical interventions aimed at improving ankle dorsiflexion to >36° may be an important component of ACL rehabilitation. [Table: see text][Table: see text]
Monitoring Recovery After Pediatric ACL Reconstruction Utilizing Promis
Authors: Block Andrew M. , Ganapathy Aravinda , Nepple Jeffrey J.
Published: May 2022

Introduction:

Anterior Cruciate Ligament Reconstruction (ACL-R) is increasingly common procedure performed in pediatric and adolescents. Patient-Reported Outcomes Measurements Information System (PROMIS) computer adaptive testing (CAT) has demonstrated to be a valid and reliable means to assess PROs in the pediatric population. Currently, all studies looking at the performance of PROMIS in the ACL-R population have utilized adult cohorts.

Purpose:

To characterize the recovery after pediatric ACL-R utilizing PROMIS including (1) changes in PROMIS domains during 1-year postoperative period and (2) to investigate if PROMIS scores can identify patients with early signs of arthrofibrosis at 6 weeks postoperatively and deficits in return to play testing at 6 months.

Methods:

Pediatric patients that underwent ACL-R were prospectively assessed with PROMIS at each clinical visit. PROMIS CAT domains included Mobility and Pain Interference. Inclusion criteria included patients <18 years old who underwent ACL-R with both pre-operative and >6 month PROMIS scores. Time points were as followed: baseline, 1 week, 1 month, 3 months, 6 months, and 1 year. Time points were compared utilizing a mixed-linear regression model. Significance was set at p<0.05. Early signs of arthrofibrosis were identified at 6 weeks postoperatively and defined as flexion less than 90° and lack of full extension greater than 5° regarding best values at physical therapy visits and/or office physical exam. Return to play was assessed via hop testing at 6 months postoperatively with deficits defined as greater than 10% compared to contralateral.

Results:

The study included 62 ACL-R with a mean age of 14.6±1.9 years. Patients demonstrated significant increases in Mobility and Pain Interference compared to pre-operative values by 3 months postoperatively and continued to significantly improve through 6 months (Figure 1 and 2). Significant improvements from 6 months to 1 year were not seen in either domain (all p>0.05). At 6 weeks postoperatively, 24% of patients had signs of early arthrofibrosis (none ultimately requiring surgical intervention). Significant differences in PROMIS Mobility (29.1 v. 35.1, p=0.001) were present between patients with and without early arthrofibrosis, while differences in Pain Interference were not significant (53.0 vs. 49.4, p=0.15). Patients with deficits on hop testing at return to play had lower PROMIS mobility (48.2 vs. 54.4, p=0.04) and higher PROMIS pain interference (38.9 vs. 33.8, p=0.02) than without deficits.

Conclusions:

PROMIS domains are easily obtained and demonstrate utility in monitoring pediatric patients after ACL-R including early signs of arthrofibrosis and deficits at return to play testing. [Figure: see text][Figure: see text]
A Return to Sport Test Battery does not Predict Second Injury After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes
Authors: Butler Lauren , Martinez Alexa , Gupta Apeksha , Hayden Kristin
Published: May 2022

Background:

There is mixed evidence on the effectiveness of return to sport test (RTST) batteries and their ability to predict second Anterior Cruciate Ligament (ACL) injury. The majority of tests in the literature include objective measures of strength, hop test distance, knee range of motion and laxity, and measures of psychological readiness to return. Few RTST batteries include movement quality assessments.

Purpose:

To determine the effectiveness of a RTST test battery, including qualitative movement assessments, to predict second ACL injury in adolescent athletes after primary Anterior Cruciate Ligament Reconstruction (ACLR).

Methods:

A retrospective chart review of 77 adolescent athletes who underwent primary ACLR between 2014 and 2018 (55 males, age at surgery 16 + 2 years, BMI 25 ± 5) was conducted. All athletes completed a RTST battery consisting of psychological assessment with the Tampa Scale of Kinesiophobia (TSK-11), lateral step down test (LSDT), Tuck jump assessment (TJA), single leg hop testing (SLHT) including the single, triple, and triple crossover hop for distance, and an evaluation of cutting performance. The LSDT, SLHT’s and cutting task were evaluated using a qualitative movement assessment checklist, which awarded a point for each movement fault identified. Athletes passed the RTST if they scored <19 on the TSK-11, <2 on the LSDT, <3 on all SLHT’s with a Limb Symmetry index > 95%, < 5 on the TJA and, < 2 on the cutting assessment. All variables were analyzed descriptively. For continuous variables, median and interquartile ranges (IQR) were reported and Wilcoxon rank sum test was used to assess the differences. For categorical variables, frequency and proportion were reported and chi-square or Fisher’s exact test was used to assess differences between “no second ACL injury” and “second ACL injury” groups.

Results:

Overall, 14.2% of athletes (N=11) suffered a second ACL injury (81.8% males). Median Tegner score in both groups was 7 (IQR: 7-9). Median time to RTS clearance was significantly different between the no second ACL injury and second ACL injury groups (10 [IQR: 8-12] vs 8[IQR:8-9] months; p=0.017). A total of 66.2% of athletes (N= 51) passed the RTST. Of those who suffered a second ACL injury, 63.6% passed the RTS. There was no statistically significant difference between those who passed the RTST and those that did not on the occurrence of second ACL injury.

Conclusion:

A RTST battery including qualitative movement assessments does not predict second ACL injury in adolescent athletes after ACLR.
Differences in the Course of Rehabilitation and Outcomes for Publicly Insured Pediatric Patients After Anterior Cruciate Ligament Reconstruction
Authors: Greenberg Elliot , Butler Lauren , Giampetruzzi Nicholas , Link Meredith , Prati Victor , Weaver Adam , Saper Michael
Published: May 2022

Background:

Previous research has demonstrated individuals with public insurance may encounter delays accessing care and experience different orthopedic management for musculoskeletal injuries. Rehabilitation after anterior cruciate ligament reconstruction (ACLR) is critical to optimize outcomes. The effect of insurance status on rehabilitation practice and patient outcomes among youth athletes has not been explored.

Purpose:

To examine the effect of insurance type (public vs private) on physical therapy (PT) visit utilization and outcomes within pediatric and adolescent patients after ACLR.

Methods:

This was a sub-analysis of a larger retrospective dataset of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a battery of return to sport (RTS) tests which included single-legged hop testing. PT visit frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6+ months). PT visits were recorded up until the time of last recorded hop test within 12 months post-surgery. The average number of visits attended per week during the observed time was calculated for each patient. The effect of insurance status on PT management was analyzed using T-tests. The effect of insurance status on the odds of passing hop tests was assessed using multivariable logistic regression with a random effect of site. Adjusted models controlled for time to test in months. An alpha level of p<0.05 was used to determine significance.

Results:

281 (15.7 ± 1.9 years, 58% male) patients were included in this analysis. The groups were demographically similar, with 45.5% classified as having public insurance. (Table 2) Patients with public insurance experienced a longer delay from surgery to the time of hop test (8.3±2.2 vs 7.7±1.5 months, p=0.009) and had a lower number of PT visits per week (0.92±0.37 vs 1.04±0.38, p=0.005). Publicly insured subjects attended fewer PT visits from week 7-3 months (1.06±0.50 vs 1.26±0.52, p=0.001) and 3-6 months (0.88±0.45 vs 0.99±0.45, p=0.04). Insurance status had a statistically significant effect (p=0.01) on the odds of passing the single leg hop test (OR, 2.72; 95% CI, 1.27-5.81) and was nearly significant (p=0.06) for all hop tests (OR, 1.74; 95% CI, 0.98-3.07).

Conclusion:

Publicly insured youth athletes average a lower number of weekly PT visits, experienced a longer delay from surgery to hop test and were 2.7 times less likely to pass the single leg hop test. [Table: see text][Table: see text]
Using Machine Learning to Identify the Optimal Limb Symmetry Index Cut-Off Threshold in Paediatric Patients with ACL Injury
Authors: Romanchuk Nicholas J. , Bel Michael J. Del , Girard Celine I. , Flaxman Teresa , Carsen Sasha , Benoit Daniel L.
Published: May 2022

Background:

The risk for a subsequent ACL injury following a primary paediatric ACL reconstruction is extremely high, with 17-30% of paediatric patients sustaining a second ACL injury within two years. It is possible that this risk is associated with a lack of evidence for identifying return-to-activity (RTA) measures to guide postoperative decision-making. Limb symmetry indices (LSI) derived from functional and strength tasks are commonly used, however LSIs used by paediatric orthopaedic surgeons can range from 75-95%, with no objective evidence to support these values.

Purpose:

To create knowledge that could be used to inform RTA and to determine if a machine learning approach could objectively identify LSI thresholds from functional tasks that classify paediatric individuals as injured or healthy.

Methods:

Forty-two patients (30 females) who had suffered an ACL injury (ACLi) and 69 matched uninjured controls (36 females; CON) performed isometric knee extension and flexion, and single-leg hopping tasks. LSIs were calculated as injured/uninjured limb for ACLi and non-dominant/dominant limb for CON. LSIs with significant between-group (ACLi vs CON) differences (independent t-tests), were used in a machine learning algorithm. A classification tree (CT) was used to classify ACLi and CON participants using LSI percentages. Ten-fold cross-validation was used to determine optimal tree complexity. LSIs were then converted from percentage to categorical ‘pass/fail’ grades according to cut-off thresholds ranging from 70-100%. CTs were then fit to the converted categorical data at each cut-off threshold and the model accuracies were compared.

Results:

Anterior, lateral, triple, and timed 6m hop tasks, and knee extension strength LSIs were used in the machine learning algorithm. The CT using the raw LSI percentages correctly classified 85.9% of participants. When data were converted from percentage to categorical ‘pass/fail’ grades, a plateau in classification accuracy occurred between LSIs cut-off thresholds of ˜83-90%. The most accurate LSI cut-off threshold was 89%, which correctly classified 84.4% of participants.

Conclusion:

Based on our preliminary analysis, the 90% LSI cut-off is an appropriate threshold for separating the hopping and strength performance of ACLi and CON paediatric participants. It is nevertheless important to recognize that this threshold can identify those with ACL injury, and not those who are ready for return to activity. A 90% LSI is therefore only a minimum criterion to reach as part of an RTA evaluation, and not a threshold that identifies when an individual is ready to return.
Correlation of Tanner Stage and Hypermobility with Meniscal and Articular Cartilage Injury in the Pluto Cohort
Authors: Matava MJ , Gibian J , Hutchinson LE , Miller PE ,   PLUTO Study Group, Kocher MS
Published: May 2022

Background:

ACL injuries in adults are frequently accompanied by meniscal and articular cartilage damage. However, little is known regarding the correlation of Tanner stage and hypermobility in ACL-deficient skeletally immature patients and the risk of these associated injuries.

Hypothesis/Purpose:

The relationship between hypermobility and meniscal and/or articular cartilage injury varies by stage of pubertal development. Patients with hypermobility will have a lower risk of meniscal and articular cartilage injury than patients with normal laxity.

Methods:

At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Beighton score was collected at the preoperative physical exam; bone age was determined from a hand/wrist radiograph; and the presence of meniscal tears and articular cartilage injuries was collected from the surgical assessment. Tanner stage was documented at time of surgery. Univariable and multivariable logistic regression analysis was used to assess the effect of Tanner stage and Beighton score on the likelihood of cartilage injury and meniscal tear.

Results:

Seven hundred forty-seven skeletally immature patients with complete ACL tears were analyzed with an average age at surgery of 12.3 years; the cohort was 62% male. Eighty-five patients had documented cartilage injuries for an event rate of 11.4%. Bivariate analysis found that those with cartilage injuries had a slightly higher bone age (13.9 versus 13.1 years; p=0.001) and a higher Tanner stage (p=0.009). For each additional Tanner stage, the odds of cartilage injury increased by approximately 1.6 (p<0.001). No association was detected between hypermobility and the likelihood of a cartilage injury. Four hundred twenty-three patients had documented meniscal tears for an event rate of 56.6%. Bivariate analysis found that those with meniscal tears were slightly older (12.6 versus 12.0 years; p<0.001), had a slightly higher bone age (13.5 versus 12.8 years; p<0.001) and a higher Tanner stage (p=0.002). For each additional Tanner stage, the odds of a meniscal tear increased by approximately 1.3 times (p<0.001). No association was detected between hypermobility and the likelihood of a meniscal tear.

Conclusion:

There is a high rate of concomitant articular cartilage and meniscal injuries in skeletally immature patients who sustain ACL tears. The risk of concurrent injury is associated with increasing bone age and Tanner score. There was no association between these concurrent injuries and hypermobility. [Figure: see text][Figure: see text]