bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of continuous glucose monitoring-derived time in range with major amputation risk in diabetic foot osteomyelitis patients undergoing amputation
Authors: Yin Xueyao , Zhu WeiFen , Liu Chao , Yao Huilan , You Jiaxing , Chen Yixin , Ying Xiaofang , Li Lin
Published: May 2022

Objective:

The metrics generated from continuous glucose monitoring (CGM), such as time in range (TIR), are strongly correlated with diabetes complications. This study explored the association of perioperative CGM-derived metrics with major amputation risk in patients with diabetic foot osteomyelitis (DFO).

Methods:

This study recruited 55 DFO patients with grade 3–4 wounds according to the Wagner Diabetic Foot Ulcer Classification System, all of whom underwent CGM for 5 days during the perioperative period. The CGM-derived metrics were defined in accordance with the most recent international consensus recommendations.

Results:

Patients with major amputation had significantly less TIR and higher time below range (TBR) (all p < 0.05). In binary logistic regression analyses, a lower TIR was associated with the risk of major amputation (odds ratio: 0.83 (95% confidence interval: 0.71–0.99), p = 0.039). This association remained statistically significant after adjustments for age, sex, body mass index, type of diabetes, smoking, drinking, durations of diabetes and DFU, ankle-brachial index, albumin, estimated-glomerular filtration rate, Society for Vascular Surgery wound, ischemia, and foot infection (WIfi) stage, multidrug-resistant organisms, and hemoglobin A1c. Further adjustment for the mean amplitude of glycemic excursion (MAGE) reduced this association. TBR was also independently associated with the risk of major amputation (odds ratio: 1.60 (95% confidence interval: 1.17–2.18), p = 0.003); this association persisted after adjustment for MAGE.

Conclusion:

Perioperative TIR (3.9–10.0 mmol/L) and TBR (<3.9 mmol/L) were significantly associated with major amputation in hospitalized patients with DFO.
Perioperative glycemic status is linked to postoperative complications in non-intensive care unit patients with type-2 diabetes: a retrospective study
Authors: Oba Takeshi , Nagao Mototsugu , Kobayashi Shunsuke , Yamaguchi Yuji , Nagamine Tomoko , Tanimura-Inagaki Kyoko , Fukuda Izumi , Sugihara Hitoshi
Published: May 2022

Background:

Perioperative hyperglycemia is a risk factor for postoperative complications in the general population. However, it has not been clarified whether perioperative hyperglycemia increases postoperative complications in patients with type-2 diabetes mellitus (T2D). Therefore, we aimed to analyze the relationship between perioperative glycemic status and postoperative complications in non-intensive care unit (non-ICU) hospitalized patients with T2D.

Materials and Methods:

Medical records of 1217 patients with T2D who were admitted to the non-ICU in our hospital were analyzed retrospectively. Relationships between clinical characteristics including perioperative glycemic status and postoperative complications were assessed using univariate and multivariate analyses. Perioperative glycemic status was evaluated by calculating the mean, standard deviation (SD), and coefficient of variation (CV) of blood glucose (BG) measurements in preoperative and postoperative periods for three contiguous days before and after surgery, respectively. Postoperative complications were defined as infections, delayed wound healing, postoperative bleeding, and/or thrombosis.

Results:

Postoperative complications occurred in 139 patients (11.4%). These patients showed a lower BG immediately before surgery ( P = 0.04) and a higher mean postoperative BG ( P = 0.009) than those without postoperative complications. There were no differences in the other perioperative BG parameters including BG variability and the frequency of hypoglycemia. The multivariate analysis showed that BG immediately before surgery (adjusted odds ratio (95% confidence interval [CI]), 0.91 (0.85–0.98), P = 0.01) and mean postoperative BG (1.11 (1.05–1.18), P < 0.001) were independently associated with postoperative complications.

Conclusion:

Perioperative glycemic status, that is, a low BG immediately before surgery and a high mean postoperative BG, are associated with the increased incidence of postoperative complications in non-ICU patients with T2D.
The impact of technology on the Starbucks experience
Authors: Akcam Bahadir K
Published: May 2022

This case explores the impact of technology on the consumer experience at Starbucks. It starts with an inquiry about why consumers choose Starbucks stores, even when traveling abroad. Consumer experience is a critical strategic goal for the company, and technology has become a driving force in enhancing it. Starbucks uses technologies such as the Starbucks Mobile App, associated rewards and card systems, internet of things enabled machines in the stores, blockchain technologies connecting stakeholders, and reinforcement learning technology to analyze all the data. Students study the role of these technologies in customer experience and explore different order processes.
Female healthcare providers’ knowledge, attitude, and practice towards cervical cancer screening and associated factors in public hospitals of Northwest Ethiopia
Authors: Abebaw Eden , Tesfa Mulugeta , Gezimu Wubishet , Bekele Firomsa , Duguma Abdissa
Published: May 2022

Objective:

Cervical cancer is the fourth most common gynaecological cancer in the world. Its incidence and burden are high in developing regions, especially in sub-Saharan Africa. The World Health Organization plans to increase vaccination, screening, and treatment of cases to 90%, 70%, and 90%, respectively, in developing countries by 2030. Therefore, the aim of this study was to assess knowledge, attitudes, and practices of cervical cancer screening and predictors among female healthcare providers.

Methods:

Institution-based cross-sectional survey was done from 4 March to 20 April 2019. The data were collected using a structured questionnaire. The data were entered into EpiData version 3.1 and analysed with SPSS version 25. Logistic regression analysis was used to identify associations. After controlling for confounders, an independent association was declared at a p-value of 0.05 with a 95% confidence interval.

Results:

Of a total of 404 participants, half were nurses. One hundred seventy-seven (43.8%) had adequate knowledge, 124 (30.7%) had a favourable attitude, and 35 (8.7%) had regular screening practice. The availability of trained personnel in the health facility and regular screening were variables associated with knowledge. Participants’ attitude was shown association with profession, level of education, and knowledge. Moreover, knowledge of the causes of cervical cancer and knowledge of screening were variables significantly associated with screening practice.

Conclusion and recommendations:

Unfortunately, there is low adequate knowledge, low favourable attitude, and irregular screening practice of cervical cancer in the study area. Despite their own effects, their knowledge and attitude may affect the vast majority of their clients. Therefore, this finding calls for prompt action, such as training for participants to increase awareness, to shape their attitudes, and to increase the uptake of screening services.
‘I got to understand what it means to be a cancer patient’: Qualitative evidence from health professional cancer patients and survivors
Authors: Natuhwera Germans , Ellis Peter , Acuda Stanley Wilson , Namukwaya Elizabeth
Published: May 2022

Objective:

The study sought to (1) examine healthcare professionals’ (HCPs) lived experiences of cancer and (2) generate evidence to inform policy and clinical practice for cancer care.

Methods:

This was a qualitative study conducted between January and December 2020 on HCPs who were ill with, or who had survived cancer in Uganda. Purposive sampling was used. A demographic form and an open-ended topic guide were used to collect data. Face-to-face and telephone interviews were conducted in English; audio-recorded data was collected until saturation was reached. Colaizzi’s framework of thematic analysis was used.

Results:

Eight HCP cancer patients and survivors from medical, allied health, and nursing backgrounds participated in the study. Their mean age was 56 years (29–85). Five were female. Four broad themes emerged from the interviews: (1) experience of pre-diagnosis and receiving bad news, (2) impact on self and role identity, (3) healthcare system and treatment experiences, and (4) the gaps and what should be done.

Conclusion:

Cancer patient-hood introduces vulnerability and remarkable disruptions and suffering in nearly all domains of quality-of-life, that is, in professional identity and work, social, emotional, physical, and economic facets of life. Participants identified how they experienced a healthcare system which was costly and staffed by unmotivated staff with limited access to resources, which resulted in many unmet needs and an overall poor experience. Participants identified how, in their view, the healthcare system in Uganda needed to be better resourced, protected by policy and legislation and how cancer awareness among the population needed to be improved.
Midodrine to optimize heart failure therapy in patients with concurrent hypotension
Authors: Shiu Paul , Grewal Gurinder S , Kozik Teri M
Published: May 2022

According to the Centers for Disease Control and Prevention statistics, about 6.2 million adults in the United States have heart failure. Guideline-Directed Medical Therapy (GDMT) involving the use of renin-angiotensin-aldosterone system inhibitors with or without a neprilysin inhibitor, β-blockers, mineralocorticoid-receptor-antagonists, and sodium-glucose cotransporter-2 inhibitors serve as the backbone for heart failure with reduced ejection fraction (HFrEF) therapy. However, in patients with refractory hypotension, the initiation of GDMT may not be possible. We present four cases where the use of midodrine, an alpha adrenergic agonist, serves as bridge therapy for the initiation or continuation of GDMT with marked clinical improvement. These cases illustrate how exacerbations of HFrEF may be ameliorated with outpatient midodrine titration among patients with baseline, persistent hypotension such that GDMT may be better tolerated.
Protest and digital adaptation
Authors: Strauch Rebecca , Weidmann Nils B.
Published: May 2022

Autocratic governments routinely interfere in digital communication technology for political purposes. However, citizens can use different technologies to bypass government interference. This article examines how political protest influences the use of anonymity-preserving digital services in autocracies. Citizens should be more likely to use these tools during high political tension because they fear governmental surveillance or censorship. The analysis combining data on the Tor anonymization network with protest event data demonstrates noticeable increases in Tor usage after days with many protest events but not days with single protest events.
Mutations in CLDN2 Are Not a Common Cause of Pediatric Idiopathic Hypercalciuria in Canada
Authors: Ulrich Emma H. , Harvey Elizabeth , Morgan Catherine J. , Pinsk Maury , Erickson Robin , Robinson Lisa A. , Alexander R. Todd
Published: May 2022

Background:

Hypercalciuria is the most common risk factor for kidney stone formation, including in pediatric patients. However, the etiology is often unknown and children are frequently diagnosed with idiopathic hypercalciuria. Nearly 50% of children with hypercalciuria have a first-degree relative with kidney stones, suggesting a strong genetic basis for this disease. A failure of calcium reabsorption from the proximal nephron is implicated in the pathogenesis of hypercalciuria. Claudin-2 is a tight junction protein abundantly expressed in the proximal tubule. It confers paracellular permeability to calcium that is essential for transport across the proximal tubule where the majority of filtered calcium is reabsorbed.

Objective:

Our objective was to examine the frequency of coding variations in CLDN2 in a cohort of children with idiopathic hypercalciuria.

Design:

Mixed method including retrospective chart review and patient interview, followed by genetic sequencing.

Setting:

Three tertiary care centers in Canada.

Patients:

Children (age 1-18 years) with idiopathic hypercalciuria. Patients with other causes of hypercalciuria were excluded.

Methods:

Data were collected from 40 patients with idiopathic hypercalciuria. Informed consent to collect DNA was obtained from 13 patients, and the final and only coding exon of CLDN2 was sequenced.

Results:

The majority of patients were male, white, and had a positive family history of kidney stones. Parathyroid hormone levels were significantly lower than the reference range ( P < .001). The levels of 1,25-dihydroxyvitamin D were also significantly higher in our patient cohort, relative to the reference range ( P < .001). Sequence analysis of CLDN2 did not identify any coding variations.

Limitations:

Sequencing analysis was limited to the final coding exon and small sample size.

Conclusions:

CLDN2 coding variations are not a common cause of idiopathic hypercalciuria in Canadian children. Further study is needed to determine the causes of hypercalciuria in pediatric patients and develop targeted therapies.
Cross-Directional Hybrid Space: A Non-Locative Approach to Mobile Social Media Studies
Authors: Singh Apte Deepti , Upadhyay Ashwani Kumar
Published: May 2022

The article revisits the theory of hybrid space and looks more closely at the process of integration of physical and virtual spaces. It argues that the formation of hybrid space is not unidirectional but cross-directional. It also aims to address some of the concerns raised by Humphreys about how studies on mobile social networks have mainly been location-based, while increasingly, the use of socializing apps is non-locative. This concern is addressed primarily by offering a non-location-based approach to study mobile spatiality and sociality. This approach involves studying spatial integration afforded by smartphone chat apps with their “ubiquitous connectivity, portability, and fluidity.” While content analysis showed that cross-directional hybrid space exists and that the elements from the physical space migrate to the virtual space, the use of space-event text matrix further helped in unraveling the nature of cross-directionality more closely.
Twice forty years of scholarly pursuits: Robert Reid Howison (1820–1906)
Authors: Stephens Trina D
Published: May 2022

The written artifacts of nineteenth-century Virginian Robert Reid Howison (1820–1906) lend themselves to an analysis of Howison as a self-directed, lifelong learner, and non-traditional educator as evidenced through his scholarship stemming from his vocational roles as lawyer and minister as well as his work as a historian. Howison’s autobiography provides the chronology to examine his life, situated within a tumultuous cultural milieu, and it offers insights into intellectual participation outside of an academic setting. Despite Howison’s prolific career, he is largely unknown in contemporary literature; however, he is a worthy role model of independent scholarship for 21st century educators.
Silver Linings Around the Increased Use of Telehealth After the Emergence of COVID-19: Perspectives From Primary Care Physicians
Authors: McAlearney Ann Scheck , Gaughan Alice A. , Shiu-Yee Karen , DePuccio Matthew J.
Published: May 2022

Introduction/Objectives:

With the emergence of COVID-19, the transition from in-person care to widespread use of telehealth raised many well-described challenges for primary care providers (PCP). The purpose of this study was to improve understanding of how this increased use of telehealth impacted PCPs in positive ways, and specifically focus on any “silver linings” of using telehealth.

Methods:

We interviewed PCPs working at a large Midwestern academic medical center between June and July 2020 and asked for perspectives about the use of telehealth during the pandemic. Verbatim transcripts were coded and analyzed using deductive dominant thematic analysis that allowed for categorization of data and identification of emergent themes.

Results:

PCPs noted 3 main benefits of using telehealth: (1) demonstrated remote care was feasible, (2) patients expressed gratitude; and (3) payers fully reimbursed for telehealth visits. PCPs also described “silver linings” they perceived for patients: (1) easier access to care, (2) more convenient follow-up care, and (3) ability to get quick specialty referrals.

Conclusions:

Study participants offered encouraging feedback regarding the potential for telehealth to offer a convenient and patient-centric alternative to in-person care. As a healthcare delivery mode, telehealth can remove personal and social barriers to care for many patients, but reimbursement parity and more evidence is needed to inform best practices for ongoing telehealth use in primary care. With the continuing use of telehealth, it will be important to monitor health outcomes as well as consider how these modalities may need to be adapted to mitigate potential care disparities.
The Personal is Political and so is Discomfort: Intersectional, Anti-Racist Praxis in Feminist Criminology
Authors: Rajah Valli , Palmer Jane E. , Duggan Marian
Published: May 2022

The phrase “the personal is political” is commonly associated with 1970s feminists, for whom it denoted the relationship between personal experiences and broad systems of inequality. However, considering bell hooks’ argument that feminists have lost the power analysis fundamental to the relationship between the personal and the political, we assess the relevance of the notion the ‘personal is political,’ to our work as feminist criminologists. Building on hooks’ insight, we argue there is a need to take up an intersectional and anti-racist feminist praxis that centers multiple forms of oppression in scholarship and seeks greater accountability for sexism, racism, and transphobia both within and beyond academic spaces. We elaborate our ideas by, first, outlining the intellectual history and evolution of feminist criminology. Second, we examine how the relationship between the personal and political figures in the work of minoritized scholars. Third, we discuss the necessary discomforts associated with working towards an intersectional and antiracist feminist criminology.
Examining the Effect of Organizational Leadership, Organizational Structure, and Employee Technological Capability on the Success of Electronic Human Resource Management
Authors: Amoako Richard , Jiang Yuanchun , Frempong Michelle Frempomaa , Tetteh Stephen , Adu-Yeboah Stephen Sarfo
Published: May 2022

The advancement in usage of information technology in past decades have revolutionized the business environment. For instance, the introduction and widely acceptance of e-commerce technologies have transformed the retail landscape. Same as the emerging of streaming services and platforms like Netflix has change the entertainment especially the movie sector drastically. Like other sectors of the economy, the adoption of technology has transformed the functional activities of diverse organizations and organizational units. Specifically, the adoption of eHRM is argued to enrich organizational effectiveness. The study attempts to investigate the effect of organizational leadership, organizational structure, and employee technological capabilities on the implementation success of e-HRM system. Data is collected from a novel dataset that is based on list of human resource practitioner/professional that was made available by the Chartered Institute of Human Resource Practitioners, Ghana. The outcome of the study indicates organizational structure and employee technological efficacy/competence have a positive and significant influence on the successful implementation of e-HRM. Conversely, organizational leadership did not have significant influence on the success of e-HRM. However, it must be acknowledging internal marketing plays critical role in aligning organizational goals, employee’s capabilities, and expectation.
The Effect of Undergraduate Students’ Perceived Service Quality on Student Commitment
Authors: Cinkir Sakir , Yildiz Sevgi , Kurum Gul
Published: May 2022

Higher education institutions are eager to attract more qualified students in a competitive environment. In this direction, they strive to increase the commitment of the students to the university by improving the quality of the offered service. Thus, students continue their higher education with great satisfaction and talk positively about their universities and recommend it to the next generations. This research aimed to identify the effect undergraduate students’ perceived quality of service had on their commitment. A mixed methods research methodology with an explanatory sequential design was used. The research sample composed of 1,782 students, and the quantitative data were collected through scales developed by the researchers. The qualitative data were collected through a semi-structured interview and critical incidents technique forms. The findings have pointed out that the quality of service in higher education positively affects student commitment; as the perception of service quality improves, student commitment increases. Students’ commitment to the university is mainly affected by the quality of education, the image of the university/faculty, and the quality of facilities. While research related to service quality and student commitment exists in the literature, this research has pointed out the underlying reasons for students’ commitment and perceptions of university services with direct quotations. Students’ views should be taken into consideration by the management to improve quality in the university. This research is limited to public university undergraduate students’; future researchers can conduct studies with private university students and state their findings.
Perspectives on the Factors Affecting Students’ Dropout Rate During COVID-19: A Case Study From Pakistan
Authors: Shuja Anita , Ali Akhtar , Khan Sana Shuja Ahmad , Burki Shafiqa Bilal , Bilal Shaham
Published: May 2022

Education has always been considered as the linchpin for a country’s economic and social development. The dropout rate in schools especially in developing countries has always been a problematic issue and the situation has further been worsened by the COVID-19 pandemic. This study primarily aims at studying the factors affecting the school dropout rate during the pandemic. Lockdown is the first step that any country starts to adopt for the safety of its general public. This severely affects the masses’ financial conditions, especially for the parents of students at risk, as the dropout rate increases with financial pressures. The slogan “stay home stay safe” has further aggravated the fear of the parents to send their children out and attend schools. The data for the study was collected from 20 public and private schools of two divisions, including seven districts of the province of Punjab, Pakistan, using interviews of policymakers, parents of dropouts, teachers, and students. The study is a corollary to several issues already highlighted in various other articles to transpire the details of drop-out rates in developing countries in general and Pakistan in particular. The study revealed financial conditions, lockdown effects, mode of learning, government policies, fear of death, the psyche of the parents, socio-cultural effects, the role of teachers and administrators, most affected level, and some contributory factors amongst the major factors. Finally, the study analyzes the effects of dropout and will help suggest measures to control the dropout rate in Pakistan in particular and developing countries in general.
Exploring Understandings of Sexuality Among “Gay” Migrant Filipinos Living in New Zealand
Authors: Adams Jeffery , Manalastas Eric Julian , Coquilla Rommel , Montayre Jed , Neville Stephen
Published: May 2022

Ethnicity, sexuality, and health are inextricably linked. This study reports on individual interviews carried out with 21 “gay” migrant Filipinos living in New Zealand to understand sexual identity and identify how they manage the disclosure of their identity. The participants provided both simple and complex accounts of sexuality. For many, these aligned with Western notions of how gay and bisexual are understood as categories; but for others, their understandings and use of such terms was influenced by Filipino cultural and contextual meanings. This included the use of “gay” as a catch-all category, including for those who identify as transgender. Active and careful management of their diverse identities was reported by participants. While disclosure to family was reasonably common, this was couched in terms of sexuality being tolerated rather than fully accepted. Disclosing identity was comparatively easier in New Zealand, but nonetheless there was active control over disclosure in some work and medical situations. Such findings add a degree of complexity within health promotion and public health, as identity cannot be regarded as static and common understandings do not exist. However, the strong community orientation and relative openness of “gay” Filipinos in relation to sexuality and gender afford opportunities for targeted interventions among this group.
Preconception Care Utilization and Its Associated Factors Among Women in Debre Tabor Town Northwest Ethiopia: Community Based Cross-Sectional Study
Authors: Degu Ayele Alemu , Temesgen Ayenew Netsanet , Getnet Kassa Bekalu , Getie Teffera Adanech , Nibret Mihretie Gedefaye , Dagnew Yehuala Eenyew , Gebrehana Belay Habtamu
Published: May 2022

Although preconception care is a key element of motherhood health care services, the package is ignored in developing countries including Ethiopia and has not been generally adopted and applied since its aim and purposes are not broadly unstated and incorporated. Therefore, the objective of the current study was to determine the level of preconception care use and its determinants among women in Debre Tabor Town Northwest Ethiopia. From November 1 to 30, 2020, a Community-based cross-sectional study was undertaken in Debre Tabor Town. Overall, 79 (15.8%) with 95% CI [12.6, 19] of women had a good level of practice on preconception care utilization. Age (35–49; AOR = 5.12, 95% CI [2.14, 9.98]), ante natal care (AOR = 8.78, 95% CI [2.66, 28.97]), history of adverse birth outcome (AOR = 4.89, 95% CI [3.09, 17.00]), presence of chronic disease (AOR = 7.51, 95% CI [2.33, 12.13]), and knowledge on preconception care (AOR = 3.55, 95% CI [1.57, 8.02]) were significantly associated with utilization of preconception care. Hence, the government and respective stakeholders must give establish on preconception care strategies and plan that covers all aspects of preconception care. Incorporation of the service with other maternal and child health service will be crucial when developing actual employment policies to scale up acceptance of preconception care.
Mediating Role of Risk Perception Between Behavioral Biases and Investor’s Investment Decisions
Authors: Ahmed Zeeshan , Rasool Shahid , Saleem Qasim , Khan Mubashir Ali , Kanwal Shamsa
Published: May 2022

This study aims to examine the direct and indirect links between behavioral biases and investor’s investment decisions via the mediating role of risk perception through structural equation modeling. The study is conducted among individual investors who are engaged in investment for several years in Pakistan Stock Exchange. Purposive sampling technique was used for data collection and the sample size was consisted of 450 questionnaires. The findings contribute that risk perception mediates between blue-chip stocks and investment decisions. Furthermore, risk perception does not play the mediating role between herding bias, disposition effect, and investment decisions. However, the disposition effect has a strong direct relationship with risk perception. The study is beneficial to individual investors who can make investment decisions by self-estimation rather than to follow the others’ opinion. The proper training and education to the investors is also an appropriate path to overcome these biases. Risk is the major factor that discourages investment decisions but blue-chip stocks are a major risk eliminating factor while building investment decisions. Most of the prior studies focused on behavioral biases and investment decisions of individual investors but this study contributed to the mediating effect of risk perception. Human capital, anomalies, computer literacy, and artificial technology could also be used as a mediator and moderator for future orientation.
Ascitic Fluid Analysis Leading to the Diagnosis of Constrictive Pericarditis in 2 Patients
Authors: Barbina Sarah , Kavin Umakanthan , Sutton Michael M. , Heincelman Marc , Thomas Meghan K.
Published: May 2022

Although well documented, constrictive pericarditis is a rare entity and an uncommon cause of heart failure. A stiff and noncompliant pericardium creates the disease’s unique hemodynamics and leads to elevated venous pressures, hepatic sinusoidal congestion, and draining of protein-rich fluid into the peritoneal cavity presenting as ascites. The low incidence in addition to its varied and subtle clinical presentations can often lead to a delay in diagnosis. Here, we present 2 clinical cases of constrictive pericarditis in which ascitic fluid analysis was important—one patient who presented with new-onset ascites with concern for cirrhosis and another patient who presented with symptoms concerning for heart failure with ascites. Through their hospital course and workup, we highlight the importance of diagnostic sampling of ascitic fluid to prompt the consideration of constrictive pericarditis followed by utilizing advanced diagnostics, such as echocardiogram and cardiac catheterization to reach the correct diagnosis in an otherwise often overlooked pathology.
Quadriceps Tendon Autograft in Pediatric Anterior Cruciate Ligament Reconstruction: Graft Dimensions and Prediction of Size on Preoperative Mri
Authors: Baghdadi Soroush , Williams Brendan A , Lawrence J Todd R , Maguire Kathleen J , Wells Lawrence , Ganley Theodore J
Published: May 2022

Background:

There has been a growth of interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population.

Hypothesis/Purpose:

The goal of this study was to evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and MRI measurements in predicting the graft size preoperatively.

Methods:

A retrospective IRB-approved database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded and graft measurements were abstracted from the operative note. Knee magnetic resonance images (MRI) were reviewed to measure the quadriceps tendon thickness on sagittal cuts (Figure 1). Graft length and diameter were then correlated with anthropometric and radiographic data.

Results:

A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17). A tendon length of 65mm or more was harvested in 159 (94%) patients. The mean final graft diameter was 8.4 ± 0.7mm (range, 7 – 11mm) (Table 1). All patients had a graft diameter of 7mm or more, and 139 (82%) had a diameter of 8mm or larger. Preconditioning decreased the graft diameter by a mean of 0.68 ± 0.23mm. Age (P=0.04) and quadriceps thickness on MRI (P<0.001) were significant predictors of the final graft diameter. An MRI sagittal thickness of >6.7mm was 97.4% sensitive for obtaining a graft of ≥8mm in diameter.

Conclusion:

Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in the pediatric ACL reconstruction, yielding a graft of ≥8mm in diameter in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness of >6.7mm being highly predictive of a final graft size ≥8mm. [Table: see text][Figure: see text]
Can the Posterior Cruciate Ligament (Pcl) Predict Anterior Cruciate Ligament (Acl) Size For Planning During Acl Reconstruction?
Authors: Strada Nicholas A. , Vutescu Emil Stefan , Mojarrad Mohammadali , Harrington Ryan , Orman Sebastian , Evangelista Peter , Cruz Aristides I.
Published: May 2022

Background:

Pediatric Anterior Cruciate Ligament reconstruction (ACLR) has increased over the past several years. Estimating the native ACL size on pre-op imaging would ideally inform graft size during surgery and make it possible to individualize ACL graft size to each patient.

Hypothesis/Purpose:

To establish a correlation between the ACL and PCL size in normal pediatric knees, with the goal of informing appropriate graft size for ACL reconstruction.

Methods:

MRIs of 540 patients ages 8-18 years were assessed. Measurements included: ACL and PCL length, thickness and width (Figure 1). ACL footprint thickness and width at the tibial insertion was also measured. Inter-rater reliability was assessed with a random set of 25 patients. Pearson correlation coefficients were used to assess the correlation between ACL and PCL measurements. Linear regression models were used to test whether the relationship between ACL and PCL measurement differed by sex or age.

Results:

Demographic data for 540 patients are shown in Table 1. Inter-rater reliability was high for all measurements except PCL thickness at midsubstance. ACL length was most strongly correlated with PCL length (r=0.57, p<0.0001). ACL origin thickness was most strongly correlated with PCL mid-thickness (r=0.26, p<0.0001). ACL origin width was most strongly correlated with PCL insertion width (r=0.49, p<0.0001). ACL insertion thickness was most strongly correlated with PCL insertion thickness (r=0.27, p<0.0001). ACL insertion width was most strongly correlated with PCL mid-width (r=0.39, p<0.0001). Sample equations for estimating ACL size from each sex and age category are as follows: ACL Origin Thickness = 3.21 + 0.26PCL Origin Thickness (R2=0.07; 8-12yo males), ACL Origin Width = 1.35 + 0.15PCL Insert Width (R2=0.23; 8-12yo females), ACL Insert Thickness = 7.02 + 0.22PCL Mid Thickness – 0.17PCL Insert Width, (R2=0.10; 13-18yo males), ACL Insert Width = 2.31 – 0.09PCL Length + 0.39PCL Mid Thickness + 0.27PCL Mid Width + 0.25PCL Insert Width (R2=0.31; 13-18yo females).

Conclusions:

Correlations exist between ACL and PCL measurements with some moderated by sex and/or age. This study is the first step in potentially informing normal ACL size in pediatric patients based on an intact PCL on MRI. [Table: see text][Figure: see text]
ACL Graft Growth in Pediatric Patients After ACL Reconstruction
Authors: Mendez Hanna E , Hovater Whitney L , Schuster Julia , Howell David R , Mayer Stephanie W , Albright Jay C
Published: May 2022

Background:

The native anterior cruciate ligament (ACL) changes in diameter and cross-sectional area throughout growth and up until age 18. The size and morphology of the native ACL continues to change throughout skeletal maturation. While ACL autografts have been shown to increase in size following ACL reconstruction in adults, there have been no similar studies to evaluate the change in ACL autografts in skeletally immature patients.

Purpose:

The primary aim of this study was to measure changes in ACL graft diameter in pediatric patients based on subsequent magnetic resonance imaging (MRI) after ACL reconstruction surgery. The second aim was to determine if there is evidence of ACL autograft growth after ACL reconstruction in skeletally immature patients.

Methods:

This was a retrospective review of 21 skeletally immature patients (mean age 14 years, range 12-16 years, 76% female) who underwent ACL reconstruction from January 2009 to July 2020 and had a subsequent MRI following surgery. We excluded patients who were treated with an allograft or underwent subsequent MRI for ACL re-injury. We measured the mid-substance ACL cross-sectional area and the post-operative graft diameter on subjects’ subsequent MRI. The recorded intra-operative graft diameter was compared to the post-operative graft diameter to determine the change in graft size.

Results:

76% (n=16) of subjects were treated with a quadriceps autograft. Follow-up MRIs were performed at a mean of 1.7 years (range 0.3 – 3.8 years) post-operative. Post-operative grafts increased 2.2mm (p<0.001, 95% CI = 1.8-2.7) in diameter compared to the intra-operative graft diameter (Figure 1).

Conclusions:

In our study population, there was a significant increase of 2.2mm in ACL graft diameter an average of 1.7 years after ACL reconstruction in skeletally immature patients. Our results are similar to previous studies demonstrating an increase in graft size post-operatively in adults. These results suggest that it may be useful for surgeons to take the likely changes in graft size into account when determining appropriate autograft size in skeletally immature patients. [Figure: see text]
A Functional Near Infrared Spectroscopy Investigation of the Physiological Underpinnings of Visual Cognitive Workload After Concussion
Authors: Master Christina , Storey Eileen , Wang Lei , Grady Matthew , McDonald Catherine , Margulies Susan , Arbogast Kristy , Ayaz Hasan
Published: May 2022

Background:

In concussion, functional near infrared spectroscopy (fNIRS) has been shown to detect differences in cortical oxygenation during neurocognitive testing, with concussed adults manifesting less task-based cortical activation compared to controls. In addition, fNIRS has identified significantly reduced interhemispheric coherence in adult concussions relative to controls. In addition, adults with greater post-concussive symptom burden demonstrate lower task-related oxygenation in the frontal and dorsolateral prefrontal cortex (DLPFC) and reduced connectivity compared to controls.

Hypothesis:

The goal of this study was to use fNIRS to identify any differences in visual task-related cortical activation between concussed adolescents and healthy controls while performing a the King-Devick (KD) test.

Methods:

We enrolled 112 adolescents, ages 12-18 years, with recent concussion and 165 healthy controls as part of a large observational prospective cohort. Participants were provided standardized instructions to read the KD cards while wearing the fNIRS sensor pad. The relative changes in the difference of oxy-and deoxy-hemoglobin concentrations over each task condition for each optode were calculated via the Modified Beer-Lambert Law using local baselines for each task condition period as its beginning. The averaged oxy-hemoglobin concentration changes for each task period were used for statistical analysis of group (e.g., concussed vs healthy) effect.

Results:

The concussed adolescents (n=112) and healthy controls (n=165) were demographically comparable with respect to age, sex, and race/ethnicity. The concussed group was more likely to have a history of prior concussion (p = <.0001) and migraine (p = .0001) compared to the healthy control group (Table 1). The concussed adolescents were assessed with fNIRS while performing a visual task a median of 10 days after injury (IQR 4-16). The concussed group had significantly lower oxygenation changes that are the difference between oxygenated and deoxygenated hemoglobin as an indicator of task-evoked response, on left lateral prefrontal area (p<.005, FDR q<.005). As expected, there was also a main effect for task condition (cards) at right lateral prefrontal cortex (p<.001, FDR q<.005).

Conclusions:

fNIRS is able to distinguish concussed adolescents from healthy controls while performing a visual-cognitive task, the K-D test. Injured adolescents with concussion demonstrated a compensatory pattern of cortical activation, suggesting localized brain dysfunction, recruiting from both hemispheres, distinguishing it from the pattern of cortical activation in healthy controls. fNIRS, as a modality, is not only able to differentiate concussion from healthy controls, but also captures the compensatory mechanisms of cortical activation that underlie visual cognitive function after injury.
Effects of a Medial Unloader Brace on Gait Mechanics in Patients with Osteochondritis Dissecans
Authors: Loewen Alex , Ulman Sophia , Erdman Ashley , Cooper Savannah , Tulchin-Francis Kirsten , Wilson Philip , Ellis Henry B.
Published: May 2022

Background:

Non-operative treatment for osteochondritis dissecans (OCD) of the knee traditionally includes casting, bracing, and activity restrictions. An unloader brace is an option that may result in improved compliance due to the ability of the patient to continue daily activities while maintaining brace wear, and it may have biomechanical advantages for lesion healing. However, the biomechanical efficacy of a medial unloader brace has not been confirmed in a pediatric population.

Hypothesis/Purpose:

To determine whether the use of a medial unloader brace alters gait mechanics in patients with medial femoral condyle OCD. We hypothesized that while knee alignment in the coronal plane will remain unaltered, the valgus moment will decrease due to the applied tension of the adjusted unloader brace.

Methods:

Fifteen medial femoral condylar OCD patients (14 male, 12.7±2.6 years, 156.9±14.8 cm, and 52.0±16.2 kg) were tested utilizing a medial Ossur Unloader One knee brace. All patients performed over-ground walking at a self-selected speed under three brace conditions: no brace (NB), unadjusted (U), and adjusted (A; prescribed tension applied). Pelvis and lower extremity kinematic and kinetic data were computed in the sagittal, coronal, and transverse planes during single-limb stance phase (SLS). Wilcoxon signed-rank tests were performed to identify statistical differences between brace conditions ( α=0.05), and clinical significance was only determined when statistically significant joint angle and moment differences were greater than 3° and 0.1Nm/kg, respectively.

Results:

Between braced conditions, mean knee valgus was not statistically significant, however, peak internal knee valgus moment consistently decreased with each brace condition (NB-A: 0.06 Nm/kg, p=0.017). Similarly, hip abduction moment at the second peak of SLS decreased while wearing the brace (NB-U: p=0.061, NB-A: 0.07 Nm/kg, p=0.009).

Conclusion:

Peak knee valgus moment was decreased during walking with an adjusted medial unloader brace. These results highlight potential biomechanical advantages of a medial unloader brace for medial femoral condylar OCD. Future work will measure compliance of brace wear and compare additional brace designs. [Table: see text][Figure: see text]
Musculoskeletal Ultrasound of the Patellar Tendon in Adolescent Athletes
Authors: Boucher Laura C. , DeLuca Meridith K. , Newman Makalya , Tatarski Rachel , Young Julie , Duerson Drew , Napolitano Jonathan
Published: May 2022

Background:

Patellar tendinopathy is a common chronic condition caused by mechanical loading that leads to patellar tendon (PT) degeneration, with an estimated incidence of 13% across all sports in adolescents. Musculoskeletal ultrasound (MSK-US) evaluation is becoming more common in the diagnostic process, but normative data are extremely rare for the adolescent population. These normative data are needed to aid in proper interpretation of the MSK-US image.

Purpose:

The purpose of this study was to determine standard reference values for thickness, width, and cross-sectional area (CSA) of the PT using MSK-US in asymptomatic adolescent athletes.

Methods:

IRB approval, parental consent, and athlete assent were obtained prior to data collection. Bilateral PT were scanned using a portable US unit with a 12-4MHz linear array transducer. Long axis images were captured at the apex and 1cm distal to the patella, 1 cm proximal to the insertion and at the PT insertion (Figure 1a & 1b). Short axis images were captured 1 cm proximal and distal to the attachments. PT thickness, width, and CSA were measured using ImageJ by a single evaluator. Additional exploratory analyses were also conducted.

Results:

Seventy-one adolescent athletes (27 males, 44 females) between 11-18 years old (13.8 ±1.8 years) volunteered. Mean values for PT thickness, width, and CSA are found in Table 1. Significant differences in PT thickness and CSA between sex were identified at each measurement location (P<.05), with males ranging 4.0-9.9 mm thicker than females. PT width was not significantly different proximally or distally. The left proximal PT was significantly wider than right (P<.0001), but no other side differences were found. Lastly, significant weak positive correlations were present in distal tendon CSA with height (left PT: r(52)=.348, P=.014, right PT: r(49)=.369, P=.007) and weight (left PT: r(50 )=.290, P=.041). There was no correlation with age.

Conclusion:

These data represent one of the largest healthy cohorts of adolescent athletes from which normative data have been collected. This preliminary analysis reveals some interesting trends, such as the thickness of the PT is greatest at the insertion and origin, while thinner at mid-tendon, with the insertion the thicker of the two. Age was not correlated with PT size, but distal PT CSA was larger with taller and heavier individuals. These data will contribute to the paucity of adolescent PT MSK-US data, which should aid clinicians in interpretation, diagnostic accuracy, and management of active adolescent patients with patellar tendinopathy. [Figure: see text][Table: see text]