bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term visual, anterior and posterior corneal changes after crosslinking for progressive keratoconus
Authors: Salman Abdelrahman , Ali Ali , Rafea Shaaban , Omran Rana , Kubaisi Buraa , Ghabra Marwan , Darwish Taym
Published: October 2021

Aim

To evaluate the long-term outcomes of corneal cross-linking (CXL) in patients with progressive keratoconus.

Method

In this retrospective non-comparative study, forty-five eyes of 31 patients with progressive keratoconus were treated with 30 min “epi-off” corneal cross-linking. The visual, refractive, topographic and tomographic outcomes were evaluated preoperatively and at least 10 years after cross-linking.

Results

Ten years post-corneal cross-linking, the mean anterior maximum keratometry decreased (−2.10 ± 3.25 D, P = 0.0001). Conversely, the posterior maximum keratometry increased (6.38 ± 9.79 D, P = 0.065). Both uncorrected and corrected distance visual acuity improved (LogMAR −0.08 ± 0.30) and (LogMAR −0.05 ± 0.21), respectively (P > 0.05, both). A statistically significant hyperopic shift was observed postoperatively (0.70 ± 1.31 D, P = 0.0009). The anterior topographic cylinder values revealed no change (−0.17 ± 1.31 D, P = 0.3), whereas the mean posterior cylinder values decreased (absolute value increased) significantly compared to baseline from −1.31 ± 0.97 D to −1.82 ± 1.78 D, (P < 0.05). The minimum corneal thickness values decreased significantly (−35.11 ± 48.63 µm, P = 0.0001). Four eyes (8.8%) showed more than 1 D increase in the anterior maximum keratometry.

Conclusion

This protocol and duration of Epi-off corneal cross-linking was found to be effective in halting keratoconus progression over the follow up period (10 years). Anterior corneal flattening and a hyperopic shift were observed. A statistically significant increase in the posterior corneal cylinder was observed. Although, not reaching statistical significance, the logMAR uncorrected and corrected visual acuity were improved.
Does governance quality matter for FDI-led tourism development? A supply-side perspective
Authors: Sou Joey Pek U , Vinnicombe Thea
Published: October 2021

This study examines the relationship between governance, foreign direct investment (FDI), and tourism demand. Rather than treating governance as a direct determinant in a tourism demand model, the multifaceted nature of this concept is recognized and nested in the broader supply-side environment of a destination. Reducing five World Governance Index (WGI) dimensions into one holistic governance measure, which is then utilized as an instrument and operates through FDI, this study incorporates the indirect impact of governance on tourism demand in a two-stage least square (2SLS) regression model. The key findings demonstrate that governance is positively associated with FDI accumulation and that this effect is positively conducive to tourism demand. The results suggest a development strategy for building a competitive and sustainable tourism industry should be encompassed in a broader project of enhancing the political-economic environment of the destination.
Clinician and healthcare managers’ perspectives on the delivery of secondary and tertiary pediatric weight management services
Authors: Cohen Jennifer , Alexander Shirley , Signorelli Christina , Williams Kathryn , Sim Kyra A , Chennariyil Lenina , Baur Louise A
Published: October 2021

Clinician and healthcare managers' (HCMs) views on weight management service delivery are imperative for informing the nature of future services to treat children with obesity. This qualitative study used semi-structured focus groups and one-on-one semi-structured interviews. Participants were 27 clinicians (medical, nursing, or allied health) and nine HCMs (senior executives in the hospital) who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. Clinicians reported that using a combination of group and individual sessions improved engagement with families and reduced attrition rates. Clinicians and HCMs recommended integrating clinics into community centers and providing specific programs for sub-groups, such as children from culturally and linguistically diverse communities or children with developmental delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. To improve the likelihood of future funding for pediatric weight management clinics and to optimize models of care, centers must embed research into their practice. Addressing common barriers to current pediatric weight management services and designing future models of care based on key stakeholders’ preferences is critical to achieving optimal care provision for this high-risk population.
A comprehensive optimal design method for magnetorheological dampers utilized in DMU power package
Authors: Xu Fanghui , Dong Dawei , Huang Yan , Zhang Rui , Song Shizhe , Zheng Dong
Published: October 2021

The diesel multiple unit (DMU) has been widely used in high-speed railway service due to its flexibility and economy. Considering the broadband and complex vibration generated by DMU power package, the advanced semi-active suspension with magnetorheological (MR) dampers is introduced to promote anti-vibration performance. In this work, a comprehensive optimal design approach for MR damper used in DMU power package is proposed. Quasi-static modeling process is conducted to obtain MR damper's low-frequency outputs, while its high-frequency damping forces are calculated by physical modeling considering the fluid compressibility and piston assembly inertia. Then the objective functions and optimization variables are determined. Based on response surface and linear correlation analysis, the influence of the optimal variables on the objective functions is discussed. Using reference-point based nondominated sorting approach (NSGA-III), the evolutionary many-objective optimization is conducted. In addition, magnetic design is incorporated into the optimal process to ensure the magnetic flux density in the effective working area. Finally, an optimized MR damper prototype is manufactured and tested. By comparing the experimental damping force with calculated results in both low-frequency and high-frequency ranges, the effectiveness of the presented optimal method for MR dampers is validated.
On the Association Between Trauma-Related Shame and Symptoms of Psychopathology: A Meta-Analysis
Authors: DeCou Christopher R. , Lynch Shannon M. , Weber Shelby , Richner Danielle , Mozafari Ahva , Huggins Holly , Perschon Bailey
Published: October 2021

Background

A number of studies have identified significant associations between trauma-related shame and psychopathology including posttraumatic stress disorder (PTSD), dissociation, and depression. The aim of this paper was to assess the extent to which trauma-related shame is associated with psychological distress across populations (e.g., veterans, college students, women, clinical samples) and offer via meta-analyses a preliminary conclusion about the importance of assessing trauma-related shame.

Methods

Records in Academic Search Complete, MedLine, MedLine Complete, PILOTS, PsycINFO, PsychTests, and PubMed were reviewed. Authors identified 25 studies that met the following inclusion criteria: (1) reported findings of an empirical study with quantitative results; (2) included any measurement of a trauma-related shame; and (3) included any measure of psychological distress or psychological symptoms. Data were extracted using a structured protocol, and random effects meta-analyses were calculated.

Findings

There were moderate weighted mean correlations between trauma-related shame and symptoms of psychopathology (r = 0.44), trauma-related distress (r = 0.49), and depression (r = 0.35). There was significant heterogeneity among studies. Neither study quality nor sample characteristics were significant moderators.

Conclusion

This meta-analysis demonstrated robust associations between trauma-related shame and symptoms of psychopathology broadly as well as trauma-related distress and depression. The findings underscore the importance of explicitly assessing trauma-related shame as part of standard care for trauma survivors who present for treatment. Several treatments explicitly address the role of shame and have demonstrated efficacy for reducing symptoms of trauma-related distress.
Quantum-based wireless sensor networks: A review and open questions
Authors: Rivero-Angeles Mario E
Published: October 2021

Applications of quantum computing are growing at a very fast pace, for example, from quantum computers to quantum algorithms and even to the development of the quantum Internet. However, the use of quantum technology in wireless sensor networks has not been thoroughly investigated just yet. This is in part due to the complexity of using big, costly, and highly energy-consuming machines that are quantum computers to this date, compared to the nodes used in wireless sensor networks which are small, inexpensive, and operate with very low energy consumption requirements. However, we can expect that in the future (possibly in the next decade) quantum computers will be commercial and reduced in size, and hence, they can be used for sensor network applications which are the basis of the Internet of Things. In this review, we study the road from quantum computing to quantum wireless sensor networks and how the analysis and design of these systems have to change to accommodate quantum capabilities in sensors, processors, communication links, and overall performance of these monitoring networks.
Journaling: A More Mindful Approach to Researching a Mindfulness-Based Intervention in a Junior School
Authors: Crawford Andrea , Sellman Edward , Joseph Stephen
Published: October 2021

Mindfulness, often defined as present-moment awareness, has in recent years become a topic of multidisciplinary interest. This article addresses methodological issues for researching mindfulness and education. It is argued that there are advantages to coherence between ontological and epistemological positions when designing research studies. The limitations of positivistic methods for researching mindfulness are discussed. We then advocate the qualitative method of journaling as a more holistic means of providing in-depth access to the unique and often underexplored inner life of those experiencing a mindfulness intervention. Drawing upon pupils and teachers’ views at a junior school receiving low-intensity mindfulness training, we show how journaling illuminates both its impact upon individuals alongside implementational issues for the school, in a manner more consistent with mindfulness’ emphasis on such terms as “awareness” and “being.”
A video inpainting method for unmanned vehicle based on fusion of time series optical flow information and spatial information
Authors: Zhao Rui , Li Hengyu , Liu Jingyi , Pu Huayan , Xie Shaorong , Luo Jun
Published: October 2021

In this article, the problem of video inpainting combines multiview spatial information and interframe information between video sequences. A vision system is an important way for autonomous vehicles to obtain information about the external environment. Loss or distortion of visual images caused by camera damage or pollution seriously makes an impact on the vision system ability to correctly perceive and understand the external environment. In this article, we solve the problem of image restoration by combining the optical flow information between frames in the video with the spatial information from multiple perspectives. To solve the problems of noise in the single-frame images of video frames, we propose a complete two-stage video repair method. We combine the spatial information of images from different perspectives and the optical flow information of the video sequence to assist and constrain the repair of damaged images in the video. This method combines the interframe information of the front and rear image frames with the multiview image information in the video and performs video repair based on optical flow and a conditional generation adversarial network. This method regards video inpainting as a pixel propagation problem, uses the interframe information in the video for video inpainting, and introduces multiview information to assist the repair based on a conditional generative adversarial network. This method was trained and tested in Zurich using a data set recorded by a pair of cameras mounted on a mobile platform.
Do principals really know what their teachers believe about evaluation? Exploring principals' reactions to teachers’ beliefs in the United States
Authors: Derrington Mary Lynne , Jackson Toni , Campbell John W
Published: October 2021

This study explored principals’ reactions to findings from a survey regarding their teachers’ evaluation beliefs. As participants in a longitudinal study, these principals were invited to focus group meetings to discuss the teacher survey data, which were sent to them for review prior to the meetings. They were asked to consider data that were puzzling, surprising, inconsistent, or consistent with their perceptions of conducting teacher evaluation. The focus group data were analyzed using the Johari Window, consisting of four domains of awareness. Based on the Johari Window analysis, principals shared teachers’ awareness of a checklist approach to observations but maintained different beliefs about a checklist's intentions and efficiencies. Principals were unaware of or disagreed with the following teacher beliefs: (a) principal feedback is marginally effective for teachers’ instructional improvement, (b) the evaluation ratings are applied unfairly, and (c) too much of principals’ time is allotted to the evaluation process. This study illustrates that principals and teachers have contradictory beliefs regarding the practice and value of teacher evaluation. The researchers suggest that principals should consider applying the Johari Window construct to reveal and explore teacher perceptions that could hinder an effective supervision and evaluation process.
To get vaccinated or not? Social psychological factors associated with vaccination intent for COVID-19
Authors: Baeza-Rivera María José , Salazar-Fernández Camila , Araneda-Leal Leslie , Manríquez-Robles Diego
Published: October 2021

Pandemic control not only requires effective COVID-19 vaccines but also that they are accepted by at least 80% of the population. For this reason, understanding the social psychological variables associated with vaccination intent is essential to achieve herd immunity. Drawing on the theory of reasoned action, this study seeks to analyze vaccination intent using the beliefs about vaccine effectiveness, conspiracy theories, and injunctive norms as predictors. A non-probabilistic national online survey was conducted during December 2020. A sample of 1,033 people in Chile answered a questionnaire with the study variables. Using structural equation models, it was found that vaccination intent was explained in 62.1% by beliefs about vaccine effectiveness and injunctive norms, controlling for age, political orientation, socioeconomic status, educational level, and gender. Specifically, beliefs about vaccine effectiveness are based on people's experience with previous immunization processes, which predict vaccination intent. Regarding injunctive norms, they act by influencing and encouraging vaccination by seeking the approval of significant others. Contrary to expected, conspiracy beliefs were not directly associated with the intention to receive a COVID-19 vaccine but were highly related to lower beliefs about vaccine effectiveness. This study suggests that to enhance the vaccination intent, socio-psychological and structural variables need to be considered.
In vitro Study of Radiosensitivity Effects of Galbanic Acid on Ovarian Tumor Cells (OVCAR-3 Cell Line)
Authors: Hashemi Raziyeh , Farahi Mojtaba , Bagheri Ramin , Iranshahi Mehrdad , Torabinejad Sepehr , Gharedaghi Shahin , Soleymanifard Shokouhozaman
Published: October 2021

Background and aims: Radiotherapy ranks among the most important procedures in ovarian cancer therapy. However, radioresistance is becoming more prevalent and is one of the main causes of poor clinical outcomes. To overcome this problem, radiosensitizers may be used. The present study aimed to evaluate the radiosensitizing properties of galbanic acid (GBA) on ovarian cancer cells in vitro. Materials and methods: OVCAR-3 cells, an ovarian cancer cell line, were treated with increasing concentrations of GBA (5, 10, 20, and 40 μg/mL) for 24, 48, and 72 h to determine its half-maximal inhibitory concentration (IC50). Cell viability was assessed by alamar Blue assay. The cells treated with 10 μg/mL GBA for 24 h were exposed to increasing doses of radiation (1, 2, and 4 Gy) and the survival fraction was investigated by clonogenic assay. Results: Assessment of cell viability indicated that GBA caused toxicity in a dose-dependent manner. Additionally, GBA pretreatment significantly improved the radiosensitivity of the cells, and survival fraction data indicated synergy between GBA and radiation. Conclusion: Taken together, the current findings highlight GBA as a potent radiosensitizing agent; however, further research is required to determine the molecular mechanisms of the observed effect both in vitro and in vivo. It is also suggested that the radiosensitization effect of GBA on other cell types should be studied in the future.
Bioactive Properties and Metabolite Profiles of Endolichenic Fungi in Mangrove Ecosystem of Negombo Lagoon, Sri Lanka
Authors: Weerasinghe Ramani H. , Maduranga Kasun , Attanayake Renuka N. , Shevkar Chaitrali , Kate Abhijeet S. , Weerakoon Gothamie , Kalia Kiran , Paranagama Priyani A.
Published: October 2021

Endolichenic fungi (ELF) serve as a novel source of natural products with distinctive bioactivities. A total of 58 ELF isolated from 29 lichens collected from mangrove and mangrove-associated plants of Negombo lagoon, Sri Lanka were identified using morphological and DNA barcoding techniques. Ethyl acetate extracts of 18 such identified ELF isolates were subjected to in vitro assays to determine antioxidant, anti-inflammatory, tyrosinase inhibitory and antibacterial potency. Liquid chromatography–mass spectrometry (LC–MS) dereplication was conducted on the crude extracts in order to detect the secondary metabolites present. The extracts of Daldinia eschscholtzii and Hypoxylon lividipigmentum had the highest radical scavenging activity with SC50 values 14.27 ± 0.24 µg/mL and 18.34 ± 1.37 µg/mL, respectively. D. eschscholtzii also exhibited remarkable anti-inflammatory activity (IC50 7.97 ± 0.09 µg/mL). Tyrosinase inhibitory activity was highest in Cytospora xylocarpi (IC50 68.50 ± 0.34 µg/mL), while the highest activity against aerobic bacterial species Escherichia coli, Bacillus subtilis, Staphylococcus aureus and the anaerobic bacterial strain Streptococcus mutans was observed in the extracts of Xylaria feegenesis and Curvularia lunata. After a thorough study of the LC–MS profiles, it was found that the chemical profiles of Neofusicoccum occulatum, H. lividipigmentum and Myramaececium rubricosum were previously poorly explored in the literature.
Oxygenated Sesquiterpenes From the Indo-Pacific Nudibranch Ardeadoris rubroannulata: Structure Revision of Pu’ulenal
Authors: Narbutas Patrick T. , Pierens Gregory K. , Clegg Jack K. , Garson Mary J.
Published: October 2021

Seven oxygenated sesquiterpenes 1 to 7 each with a drimane framework were isolated from an organic extract of the nudibranch Ardeadoris rubroannulata collected from Eastern Australia. The structure of pu’ulenal 2 was revised by 1D NOESY, providing a 9Z configuration, while isopu’ulenal 3 has the 9 E configuration previously ascribed to pu’ulenal.
Biopolitics, citizenship, and inequalities in HIV assemblages
Authors: Young Ingrid
Published: October 2021

Di Feliciantonio and Brown offer an important overview of key research areas for the geographies of PrEP, TasP, and undetectabitily, and they consider what matters for the lives of gay and bisexual men. I offer two areas of further consideration. Firstly, I suggest that rather than setting the biopolitical critiques of PrEP and TasP as at odds with grassroots activism, sexual pleasure, and subjectivities, that these particular forms of biosexual activism are indeed central to subject formation and sexual practices and are constitutive of the other within HIV assemblages. Secondly, I highlight the need to consider inequalities more directly both within the context of national borders in relation to jurisdictional health policy, implementation, and access, and within gay communities themselves in relation to intersectional and embodied identities.
Plastic and aesthetic surgery among medical students: A cross-sectional study
Authors: Alyahya Tareq , Zakaria Ossama Mohamed , Al Jabr Faisal Ali , Alshaikhmubarak Saif Fahad , Nidal Abdulla , Abdulwahab Ahmed , Sakan Noor , Alarfaj Ahmad Sami , Al Furaikh Bashayer Fawaz
Published: October 2021

Objectives:

The wide variety of operations that a plastic surgeon can deal with creates confusion regarding its proper scope. This confusion was observed in primary physicians as well as medical students. Increasing the perception of medical students toward plastic surgery can aid in career decision-making and early referral patterns. The aim of this study is to gauge a holistic overview of how medical students and interns perceive the plastic and aesthetic surgical specialty in King Faisal University and to suggest a recommended plan.

Methods:

An online questionnaire was distributed equally to male and female medical students and interns in a local medical institute. The questionnaire constituted three sections; the first included the biographical data. The second is concerned with the different case scenarios and specialties to be chosen. The third is concerned with the previous clinical exposures. The data were analyzed by SPSS version 21. Between comparison, chi-square tests, Mann–Whitney U-test, and Kruskal–Wallis tests were applied. Normality tests were conducted using the Shapiro–Wilk’s test.

Results:

Two hundred ninety-two students and interns have participated and completed the questionnaire. There were 189 males and 103 females. Plastic surgery was most commonly chosen in the following case scenarios; burn of the hand (74%), broken nose (64.7%), and cosmetic nose reshaping (80.8%). However, plastic surgery was infrequently chosen (selected by <30% of students) in many areas of hands and peripheral neuropathies (severed finger extensor tendon (26.4%), fractured scaphoid (12.7%), carpal tunnel syndrome (14.4%), brachial plexus injury (16.1%)). The most common source of information was the social media, and the least one is meeting with doctors and professors.

Conclusion:

Medical students and interns lack a full view of plastic and reconstructive surgery, especially in hand and peripheral neuropathies. Improving the education of medical students and interns is recommended and needed.
Impact attenuation provided by older adult protective headwear products during simulated fall-related head impacts
Authors: Martel Daniel R , Tanel Michelle R , Laing Andrew C
Published: October 2021

Introduction

While protective headwear products (PHP) are designed to protect older adults from fall-related head injuries, there are limited data on their protective capacity. This study’s goal was to assess the impact attenuation provided by commercially available PHP during simulated head impacts.

Methods

A drop tower and Hybrid III headform measured the decrease in peak linear acceleration ( g atten) provided by 12 PHP for front- and back-of-head impacts at low (clinically relevant: 3.5 m/s) and high (5.7 m/s) impact velocities.

Results

The range of g atten across PHP was larger at the low velocity (56% and 41% for back and frontal impacts, respectively) vs. high velocity condition (27% and 38% for back and frontal impacts, respectively). A significant interaction between impact location and velocity was observed ( p < .05), with significantly greater g atten for back-of-head compared to front-of-head impacts at the low impact velocity (19% mean difference). While not significant, there was a modest positive association between g atten and product padding thickness for back-of-head impacts ( p = .095; r = 0.349).

Conclusion

This study demonstrates the wide range in impact attenuation across commercially available PHP, and suggests that existing products provide greater impact attenuation during back-of-head impacts. These data may inform evidence-based decisions for clinicians and consumers and help drive industry innovation.
E-learning for Students With Disabilities During COVID-19: Faculty Attitude and Perception
Authors: Mohammed Ali Alkahtani
Published: October 2021

Faculty at the special education department of the University held mixed concerns about e-learning opportunities for Students with Disabilities (SWD) during the COVID-19 pandemic. This research investigated their attitude using a questionnaire survey. The sample was 70 faculty members who specialized in tutoring students with disabilities. The Pearson regression (0.655) established the reliability of the data collection instrument. The results showed that faculty members held a positive attitude toward the application of e-learning technologies for SWD and supported its ability to allow for cognitive, social, and education interaction during the pandemic. While faculty agreed the method was no more time-consuming than regular classroom sessions, they were reluctant to invest the time in training. The research concluded the views of department members in the design of appropriate systems/curricula would help to eliminate barriers and encourage more support for e-learning of SWDs during the pandemic. The faculty had several recommendations for the successful application of online learning during the pandemic for special needs students. Most suggested the need for adequate educational resources within the departments, and appropriate software and hardware to enable teaching appropriate skills to the learners with disabilities. There was a further recommendation that e-learning should be incorporated into the curricular programs.
The First Case Report of Endocarditis Caused by Serratia fonticola
Authors: Espinoza Valerie , Valdez Michael , Burcovschii Serghei , Fong Isabel , Petersen Greti , Heidari Arash
Published: October 2021

The cases of human infections caused by Serratia fonticola are relatively rare. The few cases that have been reported primarily describe skin and soft tissue, urinary, and biliary tract infections. We describe a case of a 59-year-old man with infected bilateral lower extremity wounds who developed endocarditis due to S fonticola confirmed with transesophageal echocardiogram. The patient was treated with 6 weeks of antibiotic therapy and had an uneventful recovery. After a thorough review of the literature using PubMed and Google Scholar, we concluded that this is the first reported case of endocarditis caused by S fonticola.
Gender Disparity Among NBA and WNBA Team Physicians (112)
Authors: Mulcahey Mary , Hinkle Andrew , Brown Symone
Published: October 2021

Objectives:

Female physicians are underrepresented across a broad range of medical specialties, especially at senior levels. Previous research demonstrated poor representation of women in sports medicine leadership roles in the National Collegiate Athletic Association (NCAA) compared to their male colleagues. The purpose of this study was to evaluate the distribution of men and women among team physicians on the medical staffs of National Basketball Association (NBA) and Women’s National Basketball Association (WNBA) teams in the last 10 years and assess regional differences in representation of female physicians.

Methods:

A Google search of publicly available data regarding team physician gender, medical specialty, and medical degree was conducted in October 2019 for team physicians in the NBA and WNBA over the last 10 years. Descriptive statistics were used to analyze the data. This data was then stratified by region of country in which NBA/WNBA franchises are located to provide regional comparison of team physician characteristics.

Results:

We identified 125 team physicians for NBA franchises. 122 (97.6%) were male and 3 (2.4%) were female. In the WNBA, a total of 28 physicians were identified. 20 (71.4%) were male and 8 (28.6%) were female. Osteopathic physicians accounted for 5 (4%) and 2 (7.1%) of the physicians associated with NBA and WNBA franchises, respectively. Demographic findings of NBA and WNBA team physicians are demonstrated in Table 1. The Northeast had the highest proportion of female team physicians, with 5 of 18 (27.8%).

Conclusions:

This study demonstrates a substantial difference in the number of female physicians with leadership roles in both the NBA and WNBA compared to male physicians. It is important to try to understand what barriers female physicians face in their pursuit of leadership positions in sports medicine and to implement strategies to provide equal opportunities to both male and female physicians.
How Well Does MRI Predict Chondral Lesions in Patients with Femoroacetabular Impingement? An Analysis of 545 Cases (137)
Authors: Hagen Mia , Hannay William , Saluan Quinn , Lynch T. Sean , Westermann Robert , Rosneck James
Published: October 2021

Objectives:

Articular cartilage injury has been identified as a risk factor for poor outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAI). The purpose of this study was to evaluate the efficacy of magnetic resonance imaging (MRI) in detecting cartilage defects, and to identify specific MRI findings associated with cartilage injury.

Methods:

All patients undergoing hip arthroscopy between February 2015 and May 2017 at one institution were enrolled in a prospective cohort. Intra-articular findings were documented at the time of surgery. MRI reports were retrospectively reviewed for radiologist-reported articular cartilage, osseous or synovial abnormalities. Sensitivity and specificity of MRI findings were calculated; multivariate logistic regression analysis determined which findings were associated with high-grade chondral damage at time of arthroscopy and used to create an online risk calculator, https://orthop.washington.edu/hiprisk/.

Results:

Out of a total of 598 patients who underwent hip arthroscopy, 550 had MRI reports available for review (92%). Grade III and IV cartilage injuries were reported on arthroscopy in 70 patients (13%) of average age 33 ± 13 years. On univariate analyses, individual MRI findings were not found to be sensitive in detection of articular cartilage injury (mean 22%, range 1.4% – 46%), but positive findings were highly specific (mean 90%, range 76% – 99%). Multivariate analysis revealed that older age (OR 1.09 [1.06-1.11], p < .001) and osseous findings such as subchondral cyst or edema (OR 4.77 [2.51-9.05], p <.001) were most predictive of grade III and IV defects (p < .001). An example of use of the online calculator is in Figure 1.

Conclusions:

MRI was a specific but not sensitive tool in diagnosing articular cartilage injury. Surgeons should be aware that osseous findings such as cysts or edema are highly predictive of full-thickness cartilage loss in FAI.
Soft Tissue CAM Impingement in Adolescents: MRI reveals impingement lesions underappreciated on x-ray (138)
Authors: Johnson Benjamin , Youngman Tyler , Ellis Henry , Morris William , Sucato Daniel , Podeszwa David
Published: October 2021

Objectives:

The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI.

Methods:

A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test.

Results:

Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome.

Conclusions:

In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.
Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pathology (166)
Authors: DeVries Clarabelle , Bomar James , Pennock Andrew
Published: October 2021

Objectives:

Patellar instability is a common condition of adolescents with an incidence of 29 to 43 per 100,000. Trochlear dysplasia has been found in up to 85% of those with recurrent patellar instability and has been found in association with ACL rupture. However, the prevalence of trochlear dysplasia in the general population has not yet been defined. The purpose was to define the prevalence of trochlear dysplasia as defined by ultrasound in a skeletally mature population and characterize associations of trochlear dysplasia with patellofemoral pathology.

Methods:

Skeletally mature adolescents and parents aged 50 and under presenting to orthopedics clinics were recruited from 2019 to 2020. Those with a history of intra-articular fracture, total knee arthroplasty, and syndromic ligamentous laxity or neuromuscular disease were excluded. Surveys were collected detailing any history of knee symptoms and surgery as well as an abbreviated Anterior Knee Pain Score (AKPS) with a score of 4 or greater being considered positive. Ultrasounds were obtained of bilateral knees and the osseous sulcus angle of the trochlea as well as the trochlear depth were measured (Figure 1). Basic descriptive statistics are reported.

Results:

One hundred and two patients (203 knees) were studied. The mean osseous sulcus angle was 144.1±6.8° and the mean trochlear depth was 5.5±1.4mm. The distribution of outcomes of interest can be found in Table 1. High grade trochlear dysplasia was defined as two standard deviations from the mean which was shown to be a sulcus angle ≥158˚ or a trochlear depth of ≤3mm. Prevalence of high grade trochlear dysplasia based on sulcus angle was 3.0% and 5.9% based on trochlear depth. In the presence of high grade trochlear dysplasia as defined by osseous sulcus angle, there was a 32 times increased risk of previous patellar instability (p=0.007) and 10 times increased risk of a positive AKPS (p=0.016). All those with high grade trochlear dysplasia as defined by osseous sulcus angle had a history of, or current, patellofemoral pain.

Conclusions:

The prevalence of trochlear dysplasia in the general population is approximately 6%. There are significant associations of trochlear dysplasia not only with patellar instability but also with patellofemoral pain. Use of ultrasound to diagnose trochlear dysplasia may prove to be a rapid and useful tool in guiding patient education and treatment decisions.
Outcomes following Medial Patellofemoral Ligament Reconstruction with Allograft (177)
Authors: Markus Danielle , Hurley Eoghan , Shontz Edward , Campbell Kirk , Jazrawi Laith , Strauss Eric
Published: October 2021

Objectives:

Medial patellofemoral ligament reconstruction (MPFLR) using allograft tissue has several potential benefits including the absence of donor site morbidity, ability to predict graft parameters, and decreased operative time. The purpose of this study was to evaluate the outcomes of patients following MPFLR with allograft. Our hypothesis was that there would be a low rate of recurrent instability, and excellent clinical outcomes reported.

Methods:

A retrospective review of athletes who underwent MPFL Reconstruction, with a minimum of 12-month follow-up was performed. Recurrent instability (including re-dislocation and subluxation), Visual Analogue Scale (VAS) score, Kujala score, satisfaction, and whether they would undergo the same surgery again, were evaluated.

Results:

Overall, follow up was attained for 131 patients with 141 knees (73.4%). The mean patient age of 25.0 years, 67.4% females, and mean time to follow-up was 46.8 months (12-111). At final follow up, the mean VAS score was 1.4 ± 2.0, the mean Kujala score was 84.8 ± 15.6, the mean satisfaction score was 84% ± 26.0, and 117 (83.0%) would undergo the same procedure again if required. There was 17 (12.0%) patients that had recurrent instability, with 2 being re-dislocations (1.4%). A further procedure was performed in 14 patients (9.9%). There were no intra-operative complications in our series.

Conclusions:

There was a low rate of recurrent instability following MPFLR with allograft, with excellent patient reported outcomes, and a low complication rate.
Return to Play (RTP) and Performance in the Women’s National Basketball Association (WNBA) Following Anterior Cruciate Ligament (ACL) Reconstruction (194)
Authors: Tramer Joseph , Khalil Lafi , Ziedas Alexander , Abbas Muhammad , Mehran Nima , Okoroha Kelechi
Published: October 2021

Objectives:

The incidence of ACL injuries in WNBA athletes has been on the rise, despite the high rates of ACL injury there is a paucity of recent research examining the effect of ACL reconstruction on RTP and performance in these athletes. This cohort study seeks to quantify the effect of ACL reconstruction on RTP and performance on WNBA athletes.

Methods:

All ACL tears sustained in the WNBA from 1997-2018 were identified. BMI, age and position at the time of injury were collected for each player. RTP rates were calculated and performance data was collected for each player before and after injury to determine changes in playing time and statistical performance. Players who successfully RTP after ACL reconstruction were compared to a group of healthy controls who were matched by age, years of experience, position, height, and BMI. Statistics at one year and three years’ post-injury were compared to assess acute and longitudinal changes in performance relative to pre-injury baseline.

Results:

A total of fifty-nine WNBA players sustained an isolated ACL tear during the study period. Forty-one (69.5%) were able to RTP. There was no difference in demographic characteristics between forty-one players and matched controls. Following RTP athletes played an average of 7.5±12.8 fewer games, 5.1±9.2 fewer minutes per game, and scored 3.7±5.0 less points per game in their first year compared to the year prior to injury. (Table1) When compared to matched controls, WNBA players returning from ACL reconstruction demonstrated a significant decline in games played, games started, minutes per game, rebounds, assists, and blocks per game in their first season after RTP. These differences resolved by year three post-surgery (Table 2).

Conclusions:

There is a high RTP rate following ACL reconstruction in WNBA athletes. Players may experience a decrease in playing time and performance initially when returning to play, however these variables were found to return to baseline over time.
Application of Machine Learning Algorithms in the Prediction of Prolonged Postoperative Opioid Use in Patients Undergoing Elective Shoulder Arthroscopy (215)
Authors: Lu Yining , Lavoie-Gagne Ophelie , Karhade Aditya , Forlenza Enrico , Schwab Joseph , Cole Brian , Verma Nikhil , Forsythe Brian
Published: October 2021

Objectives:

Recovery after shoulder arthroscopy can be impaired by sustained postoperative opioid use, yet there are few validated risk calculators for this outcome. The purpose of this study is to develop and validate a machine learning algorithm that can reliably and effectively predict sustained opioid use in patients following elective shoulder arthroscopy.

Methods:

A retrospective review of an institutional outcomes database was performed at a tertiary academic medical center to identify adult patients who underwent shoulder arthroscopy between January 1, 2014 and October 1, 2019. Extended postoperative opioid consumption was defined as opioid consumption at least 150 days following surgery. Five machine learning algorithms were developed to predict this outcome. Performance of the algorithms were assessed through discrimination, calibration, and decision curve analysis.

Results:

Overall, of the 1504 patients included, 132 (8.8%) demonstrated sustained postoperative opioid consumption. The factors determined for prediction of prolonged postoperative opioid prescriptions were preoperative opioid use, age, median percentage of population in patient zip code living at the federal poverty line, preoperative pain score, duration of symptoms, BMI. The random forest model achieved the best performance based on discrimination (AUC = 0.78), calibration, and decision curve analysis. This model was integrated into a web-based open-access application able to provide both predictions and explanations.

Conclusions:

If externally validated in independent populations, the algorithm developed presently could effectively guide preoperative screening in patients at high risk for extended postoperative opioid prescriptions. Early identification and interdisciplinary counseling in high-risk cases can optimize both resource allocation and surgical outcomes.
Update On Performance And Return To Sport After Biceps Tenodesis In Professional Baseball Players (226)
Authors: Erickson Brandon , Chalmers Peter , Dangelo John , Ma Kevin , Rowe Dana , Ciccotti Michael , Romeo Anthony
Published: October 2021

Objectives:

Determine the return to sport (RTS) rate and performance upon RTS in professional baseball players who underwent biceps tenodesis.

Methods:

All professional baseball pitchers who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the biceps tenodesis and matched control (no history of biceps tenodeses) groups.

Results:

14 players (average age 27±4 years; 12 pitchers, 2 position outfielders) were included. Most (79%) were open subpectoral tenodeses while one was an arthroscopic biceps transfer and one was arthroscopic suprapectoral. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%) and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent SLAP repair). Among the 14 players, 2 were unable to RTS, 5 RTS but to a lower level, and 7 RTS at the same or a higher level. Thus, overall, while 86% (12/14) were able to RTS, 50% (7/14) were able to return to the same or a better level and 50% were either unable to return or returned to a lower level. Among pitchers specifically, 100% (12/12) were able to return to play, but only 50% (6/12) were able to return to the same or a higher level. For those players who did return to play, it took 245±84 days, their performance was unchanged and did not differ from matched controls.

Conclusions:

While 86% of professional baseball players returned to sport following biceps tenodesis, only 50% returned at the same or higher level. No decline in performance was noted in players who successfully returned. Open subpectoral tenodesis is the most common tenodesis technique performed on professional baseball players.
All-Suture and Solid Medial Row Anchors Produce Similar Clinical Outcomes for Double Row Suture Bridge Rotator Cuff Repair (227)
Authors: Feldman John , Ochsner Mims , Fleisig Glenn , Tatum Rob , Grosz Lindsay , Hart Karen , Dugas Jeffrey , Emblom Benton , Cain E. Lyle
Published: October 2021

Objectives:

All-suture anchor use for rotator cuff repair is increasing. Potential benefits of these anchors include less bone loss from anchor hole drilling and decreased injury to the chondral surface with anchor pullout. Minimal evidence exists comparing clinical outcomes of all suture to solid medial row anchor fixation in double row suture bridge rotator cuff repair. The purpose of this study was to compare patient-reported outcomes for rotator cuff tears treated with all-suture medial row anchors to those treated with more traditional solid anchors. The null hypothesis was that there is no difference in outcomes between the all-suture and solid anchor rotator cuff repairs.

Methods:

Three sports medicine fellowship trained surgeons performed rotator cuff repairs using the double row suture bridge technique with minimum 3 years of follow up. Patients were separated into two groups based on whether or not they received all-suture or solid anchor fixation for the medial row of their repair. All lateral row fixation was performed with solid anchors. Primary outcomes were evaluated with telephone follow-up and included the American Shoulder and Elbow Surgery Score (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS). The Rehabilitation protocol was the same for all subjects in the study.

Results:

3 sports medicine fellowship trained orthopaedic surgeons performed 153 rotator cuff repairs. 91 of these subjects had all-suture fixation of the medial row and 62 received solid anchor fixation. Follow up was 3.6 years ± 0.6 for the all-suture group and 3.7 years ± 0.6 in the solid anchor group (p= 0.28). ASES scores were 92 ± 16 in the all-suture group and 90 ± 17 in the solid group (p =0.35). SANE scores were 91 ± 13 in the all-suture and also 91 ± 13 in the solid anchor cohort (p = 0.97). VAS scores were 1.1 ± 2.0 in the all-suture and 0.7± 1.8 in the solid anchor group (p=0.17). There were no significant differences between groups with regards to re-operation rate or anchor configuration.

Conclusions:

All suture anchors used in medial row fixation for double row suture bridge rotator cuff repairs have similar clinical outcomes to rotator cuff tears treated in similar fashion with solid medial row anchors.