bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ASSOCIATION OF HISTORY OF CONCUSSION WITH BASELINE SCORES ON THE SPORT CONCUSSION ASSESSMENT TOOL (SCAT5) IN HIGH SCHOOL RUGBY PLAYERS
Authors: Black Amanda M. , Miutz Lauren N. , Eliason Paul H. , Schneider Kathryn , Yeates Keith O. , Emery Carolyn A.
Published: March 2019

Background:

The Sport Concussion Assessment Tool 5 (SCAT5) is a standardized instrument designed to assist with the clinical and sideline assessment of concussion. Following the 5th International Conference on Concussion in Sport in 2016, the SCAT5 was released. Compared to the previous version (SCAT3), the SCAT5 includes more detailed instructions regarding the symptom checklist and a 10-word list in the immediate memory section to diminish ceiling effects. This study aims to examine the association between having a previous history of concussion and SCAT5 scores in high school rugby players. A second objective is to provide reference values for healthy rugby players for the SCAT5, including typical scores on immediate memory using the 10-word list. Methods: High school rugby players (ages 15-18) from Calgary, Alberta participating in the 2018 high school rugby season (n=388, male=212, female=176) were recruited to a cohort study and asked to complete a baseline SCAT5 assessment administered by trained research assistants at the beginning of the playing season. Outcome measures included baseline symptom evaluation (/22 symptoms)], self-reported rating of percentage of normal (100% perfectly normal) felt at time of testing, immediate memory score using a 10-word list [/30)], digits backward (/4), delayed word memory (/10), and modified Balance Error Scoring System [BESS (/30)]. Players also completed a preseason demographic questionnaire, which assessed their history of concussion.

Results:

A total of 237/388 (61.08%) rugby players reported no history of concussion (NC) and 151/388 (38.92%) reported at least 1 previous concussion (PC). Ninety of the 212 males (42.45%) and 61 of the 176 females (34.66%) reported a history of previous concussion. Median SCAT5 symptom score was 6 (range; 0-21) for NC and 7 (0-22) for PC groups. At the time of baseline testing, only 30.51% of NC players and 21.85% of PC players reported feeling 100% of normal. Median total scores on the immediate memory score (/30) were 21 (range; 9-28) for NC and 21 (range; 9-29) for PC. Median total score on digits backward (/4) was 3 (range; 0-4) and the delayed memory score (/10) was 7 (range; 0-20), for both NC and PC groups. Median total errors made on the BESS were 4 (range; 0-20) for NC players and 5 (range; 0-17) for PC players.

Conclusions:

Players with and without a previous history of concussion obtained similar scores on all components of the SCAT5 at baseline. Many high school rugby players did not report feeling 100% of normal during typical baseline testing sessions. The addition of the 10-word list option in the immediate and delayed memory section reduces the likelihood of a ceiling effect. This study informs the use and interpretation of the SCAT5 in high school rugby players.
RACE INDEPENDENTLY PREDICTS UNSUCCESSFUL HEALING OF OSTEOCHONDRITIS DISSECANS IN THE PEDIATRIC KNEE
Authors: Gandhi Jigar S. , Ganley Theodore J.
Published: March 2019

BACKGROUND:

Previous studies have reported disparities in medical and surgical care along the lines of race and socioeconomic status. The purpose of this study is to evaluate the impact of these factors on successful or unsuccessful healing of juvenile osteochondritis dissecans (OCD) lesions in the knee.

METHODS:

We retrospectively reviewed patients younger than 18 years that were treated for a knee OCD lesion at our urban, tertiary children’s hospital between 2006 and 2017. Demographic data included patient-reported race, median household income for the patient’s zip code, and insurance status. We also collected information regarding clinical history, imaging, treatment course, and post-treatment outcomes. The primary outcome of interest was healing of the OCD lesion based on radiographic and clinical examination. Univariate analysis was followed by purposeful entry multivariate regression to control for confounders.

RESULTS:

A total of 205 children with mean follow-up of 15.8 ± 6.5 months were included in the analysis. The mean age was 12.4 ± 2.8 years and 145 (71%) were male. At their most recent follow-up, 28 subjects (13.7%) did not show radiographic or clinical evidence of healing. In univariate analysis, non-healing lesions were found in 25% of black children compared to 9.4% of white children (p=0.02). There was no difference in insurance status or median household income between patients who successfully and unsuccessfully healed their OCD lesion. After controlling for age, sex, sports participation, lesion size and stability, skeletal maturity, and operative vs. non-operative treatment in a multivariate model, black children had 6.7 times higher odds of unsuccessful healing compared to their white counterparts (95% CI 1.1, 41.7; p=0.04).

CONCLUSION:

In this study, black children with OCD of the knee were less likely to heal than white patients even when accounting for socioeconomic and other factors in a multivariate model.
RISK FACTORS PREVENTING RETURN TO BASELINE ACTIVITY LEVEL AFTER BANKART REPAIR
Authors: Aoyama Julien T. , Simmons Shawn , Young-Hamilton Tyrell , Horn Molly , Ramesh Siddhi , Wells Lawrence
Published: March 2019

Background

As sports specialization continues to grow amongst youth, the prevalence of shoulder instability continues to increase. Bankart repair exists as a primary method to combat these issues, yet a third or more of patients experience recurrent instability following surgery. Currently most studies examining Bankart repair look at surgical technique (open vs arthroscopic) and the original treatment employed; however, there has been a lack of research examining whether demographic, injury history, and perioperative risk factors exist as well. The purpose of this prognostic study was to examine Bankart repair in the pediatric population and identify a wider range of risk factors associated with poor functional outcomes.

Methods

We conducted a retrospective review of all patients who received Bankart repair between 01/01/2010 and 12/31/2015 at the Children’s Hospital of Philadelphia. A range of demographic, injury history, clinical exam, operative, and perioperative variables were abstracted to identify risk factors associated with limited functional outcome as defined by inability to return to baseline sport or activity. Chi square analyses were used to find significant associations between dichotomous variables, and point-biserial analyses were used to find strength of correlations for continuous variables.

Results

118 patients were included with an average age of 15.92 ±2.11 at the time of surgery. The mean OR time was 206.98 ±55.88 minutes. Point-biserial correlations for total OR time, BMI, and age with inability to return to baseline sport or activity were 0.32, .09, and .04 respectively. Chi square analyses found no significant associations for prior non-operative treatment, sulcus sign, and insurance type. For individuals who presented with prior instability, 92/119 (77.3%) with and 27/119 (22.7%) without, this was significantly associated with inability to return to baseline sport or activity (p = 0.04). For presence of a Hill Sachs Lesion 70/145 (48.2%) had a lesion, 75/145 (51.8%) did not, and this was significantly associated as well (p = 0.02). For injury type, 71/98 (72.4%) were contact, 27/98 (27.6%) were noncontact, and this was significantly associated as well (p = 0.01).

Conclusion

Many clinicians have informally found in practice that certain patient characteristics seem to be associated with poor outcomes after Bankart repair. Here we find that a history of prior instability, Hill Sachs lesion presence, and a contact injury mechanism are significantly associated with inability to return to baseline sport or activity post-operatively. The risk factors identified here can be categorized into injury history risk factors and perioperative risk factors. Clinicians can use these identified risk factors to better inform patients receiving Bankart repair of their likelihood of returning to baseline sport or activity.
INCREASED INCIDENCE OF ACUTE PATELLAR INSTABILITY AND PATELLAR INSTABILITY SURGERY ACROSS THE UNITED STATES IN PEDIATRIC & ADOLESCENT PATIENTS
Authors: Milewski Matthew D. , Feldman Lanna , Heyworth Benton E. , Kramer Dennis E. , Miller Patricia E. , Kocher Mininder S. , Yen Yi-Meng
Published: March 2019

Background:

Participation in organized sports has been increasing over the last several decades for pediatric and adolescent athletes in this country. It is hypothesized that the overall incidence of acute patellar dislocation in this population would increase with more sports participation. Newer surgical techniques for patellar stabilization have also become popular and have been adapted for younger populations. The purpose of the current study was to evaluate the trend in the frequency of patellar dislocations treated at pediatric hospitals in the U.S. versus patients receiving surgical intervention for patellar dislocation.

Methods:

The Pediatric Health Information System (PHIS) database was queried for all patients 18 years or younger who underwent orthopaedic surgery between 2004 and 2014. A cohort of patients treated surgically for patellar dislocation was compared to a cohort of patients seen in the Emergency Department for management of a patellar dislocation. Data sets from 25 of the 48 pediatric hospitals participating in the PHIS initiative reported data consistently for the study time period and were included in the analysis. The rate of patellar dislocation surgeries per 1,000 pediatric orthopedic surgeries was analyzed for the 11-year period. Linear modeling was used to assess sex-based and overall trends.

Results:

During the study period, there were 447,285 orthopaedic surgeries at 25 institutions, which included 3,481 patellar dislocation procedures, suggesting a rate of 7.8 per 1,000 orthopaedic surgeries. An additional 5,244 patellar dislocations treated in the emergency room were identified. Over the study period, the number of patellar dislocation procedures increased 2.1-fold (95% CI = 1.4-3.0), while all surgeries increased 1.7-fold (95% CI = 1.3-2.0). There was only a 1.2-fold increase in patellar dislocation procedures relative to total pediatric orthopedic procedures. Emergency Department treatment of patellar dislocation increased 2.8-fold. Females yielded similar trends between operative and Emergency Department treatment of patellar instability (2.2-fold and 2.3 –fold, respectively); while males experienced a higher trend in the need for Emergency Department treatment compared to operative treatment (3.0-fold versus 2.0-fold, respectively).

Conclusion / Significance:

This study shows a significant rise in the rate of acute patellar instability events in pediatric and adolescent patients across the country. Interestingly, surgery for patellar instability increased by only slightly more than the rate of all pediatric orthopaedic procedures. Further research is needed to evaluate the link between increased acute patellar instability and risk for chronic patellar instability along with the potential need for surgical intervention.
EARLY RESULTS OF AN INJURY-PREVENTION PROGRAM IN HIGH SCHOOL TRACK ATHLETES
Authors: Dickason Celeste Quitiquit , Marois Whitney , Santos Hannah , Grace Sadie , Krabak Brian , Bompadre Viviana , Schmale Gregory A.
Published: March 2019

Background

Injury prevention programs have been shown to be effective for adolescent soccer, basketball, and handball athletes. Though injuries are common in high school runners, injury prevention programs have not been described for this population. Our objective was to trial an injury-prevention program styled after those found to be successful in other running and jumping sports to see if a group of running athletes sustained fewer and or less serious injuries during the course of a single high school track season.

Methods

Two suburban high school track coaches volunteered to participate in a program consisting of either injury-prevention exercises or no additional exercises as a part of pre-and in-season practice programs. All runners at each school were invited to participate, with informed consent obtained. The injury prevention program consisted of five jumping and plyometric exercises taught by a physical therapist, with a video of the exercises made available to the coach and team members throughout the season. Surveys pre- and post-season were collected which included demographic information, running history, diet, and injuries. Injuries were reported to coach and trainer at each school. Days of missed practice constituted an injured day, tallied for each runner and each team. A Chi-square analysis compared injury rates by team, and hence by intervention; injury rates by years of experience running; and injury rates by dietary preference.

Results

24 runners, 13 from the intervention school and 11 from the control school participated. There was no significant difference in the number of running injuries reported when comparing the intervention group (4/13 runners) to the control group (3/11 runners, Chi-square = 0.035, p = 0.9). Runners with a greater number of years of competitive running experience trended towards having fewer injuries (p = 0.06). Those describing their diet as vegetarian (3/24) were significantly more likely to sustain an injury (p = 0.002).

Conclusions / Significance

With this limited comparison study examining the impact of an injury-prevention pre-season and in-season training program for running athletes participating on their high school track team, there was no evidence that the addition of a program of jumping and plyometric exercises had an impact on injury rates. However, combining the data from the two schools, we found a trend towards decreased injury likelihood in those with more years of experience running, and a significantly greater incidence of injuries in those who described their diet as vegetarian. These results suggest that novice runners should perhaps have a different set of expectations regarding the pre- and in-season training regimen, and that those whose diet is vegetarian consider review of their nutrition to optimize their energy level and reparative capacity with the increased activity of a high school track running program.
MACHINE-LEARNING IDENTIFIES BEST MEASURES TO PREDICT ACL RECONSTRUCTION OUTCOME
Authors: Potty Anish GR , Potty Ajish S. R. , Punyamurthula Rithesh , Penna Sreeram , Benavides Chris , Chavan Prithviraj , Mistovich R. Justin
Published: March 2019

Introduction:

Knee injury and Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported outcome measurement to track recovery after ACL surgery. This study focuses on the function of daily living subscale (KOOS ADL), which is calculated based on 17 questions. By employing machine learning to predict KOOS ADL scores, we sought to better understand the relative importance of the survey questions and thereby identify its most critical components as well as questions that do not adequately predict outcomes.

Methods:

Pre- and post-operative patient reported KOOS ADL survey responses and outcomes scores following ACL surgery were obtained from the Surgical Outcome System data registry(SOS), an international patient-reported outcomes database sponsored and maintained by Arthrex. Patients with missing KOOS ADL survey responses were excluded from the study. Machine learning (ML) algorithms such as Random Forest and Gradient Boosting were used to identify the most critical survey questions that predict KOOS ADL scores with high accuracy. These decision tree-based algorithms predict patient outcomes using several decision rules and thereby determining the relative value of individual questions at predicting patient deficits (e.g., if patients have “Severe” difficulty in ascending stairs, they are more likely to have globally worse scores than those with difficulty with other tasks).

Results:

4996 patients were initially identified. Based on compliance with the survey, 2407, 2407, 1817 and 1193 patients records for pre-surgery, 3 month, 6 month and 1 year post-surgery responses respectively underwent further analysis. The dataset consisted of 53.9% males and 46.1% females. Mean age was 29 (range 11 to 70 years). Results from the ML models indicated that by 6 key questions, over 80% of the variance in KOOS ADL scores could be explained instead of standard 17 survey questions (Table 1). Interestingly, the analysis provided similar accuracy at both 6 months and 1 year.

Discussion and Conclusion:

Most patients have similar functional deficits that can be captured using a simplified version of the KOOS ADL survey. The abbreviated survey would result in a better patient reporting experience while still obtaining quality data. Additional work on predicting post-surgery scores using ML from pre-surgery responses and other patient information would provide valuable insights; however, predicting outcome scores with high accuracy remains challenging. We advocate for novel methods to identify and measure meaningful data to assist with understanding patient outcomes and thereby proving the true value of orthopaedic interventions on functional status. [Table: see text]
SQUATTING MECHANICS FOLLOWING AN OSTEOCHONDROPLASTY FOR IDIOPATHIC FEMOROACETABULAR IMPINGEMENT
Authors: Ellis Henry B. , Fletcher Amanda L. , Tulchin-Francis Kirsten , Loewen Alex , Anderson Anthony , Stevens Wilshaw , Sucato Dan , Podeszwa David
Published: March 2019

Background:

Femoroacetabular impingement (FAI) is primarily due to the repetitive motion of aberrant bone in provocative positions such as hip flexion and internal rotation (IR). The purpose of this study is to evaluate the kinematic changes that occur in the hip during a squat prior to and following an osteochondroplasty for idiopathic FAI.

Methods:

Subjects were prospectively enrolled when scheduled to undergo hip preservation surgery for primary CAM hip impingement by one of 3 surgeons. Prior to the procedure, subjects were evaluated in the movement science lab while performing a standardized bilateral limb gravity squat. Kinematic data of the trunk, pelvis and lower limbs were analyzed during the descent phase of the squat. Statistical comparison of the operative and non-operative hips was performed prior to and at a minimum of one year following surgery.

Results:

Twenty-seven hips with a mean age of 16.3 years (12.4 – 19.9 years, 8 males) underwent an osteochondroplasty (8 arthroscopic, 19 surgical hip dislocation) resulting in a decrease in the alpha angle (60.8° versus 46.8°, p<0.001) and a significant improvement in HOOS and UCLA scores. When combining the entire cohort, no statistical difference was seen in side to side nor pre-operative to post-operative kinematic or kinetic data. Asymmetry was seen in the transverse plane hip rotation with 6/27 subjects demonstrating an average reduction of 9.4° in ROM on the affected side and a decrease in both peak IR and external rotation (ER) (average decrease 4.7°). Following osteochondroplasty, asymmetry resolved in 4/6 patients. Also, 16/27 subjects demonstrated asymmetry in rotation at 40° of hip flexion during the squat (11 more ER, 5 more IR) in which 37.5% had resolution of the asymmetry following an osteochondroplasty.

Conclusion:

Asymmetry in squatting mechanics in patients with FAI is not consistent with all subjects. Those with asymmetry in rotation at 40° of hip flexion during the squat or reduction in overall hip rotation may see a resolution in asymmetry following an osteochondroplasty. Dynamic impingement may present as asymmetry during different positions of hip flexion in a squat.
DEMOGRAPHICS OF PEDIATRIC AND ADOLESCENT PATIENTS WITH DISCOID MENISCI
Authors: Pandya Nirav K. , Robinson Sean P. , Merriman Jarrad
Published: March 2019

BACKGROUND

There has been an increase in the understanding of meniscus tears in pediatric and adolescent patients particularly with the rise of intensive sport training in this age group. Yet, discoid menisci represent a congenital entity for which there exists controversy as to the optimal workup, treatment, and long-term outcomes. Although there have been multiple reports on the surgical treatment of these patients, there is limited examination of these patient’s demographic characteristics and presentation. The purpose of this study is to define the demographics, presentation, and treatment patterns of discoid menisci in a single surgeon’s patient cohort

METHODS

We performed a retrospective review of all discoid meniscus patients from a single institution from 2012 to 2017. Demographics, history and physical examination notes, and intra-operative findings were reviewed.

RESULTS

Eighty-one patients were identified. Patients identifying as Hispanic (38%) and Caucasian (23%) made up the most common ethnic group. The average age at the time of presentation was 12.5 years old. Ninety-eight percent of patients reported pain upon presentation; however, this was commonly in conjunction with other symptoms. Most patients (48%) reported only short duration of symptoms (0 to 3 months) prior to presentation. In about one half of patients, tears were identified in 44 (54%) patients, and nearly 2/3 of patients (52) elected to undergo surgical intervention. Patients undergoing operative intervention had a high proportion of range of motion deficits (69% v 17%, p<0.001), meniscal tears (77% v 17%, p<0.001) and cartilage damage (33% v 3%, p=0.002). Nearly 2/3 of patients who required intervention necessitate meniscal repair with or without concomitant cartilage procedures.

CONCLUSIONS / SIGNIFICANCE

Unlike prior studies, the vast majority of patients with discoid menisci in our population were Hispanic or Caucasian. Although congenital, the vast majority of patients presented with a short duration of complaints (less than 6 months) in the second decade of life. A complex constellation of symptoms was present with isolated knee pain seen less commonly as well as athletic participation. Loss of range of motion drives surgical intervention with meniscal repair being more commonly performed regardless of symptom duration as opposed to saucerization. Nearly 1/3 of patients demonstrated cartilage damage intra-operatively; demonstrating the need for surgeons to not only counsel patients pre-operatively but also be prepared to repair and/or treat cartilage rather than perform saucerization.
THE UTILITY OF PUPILLARY LIGHT REFLEX AS AN OBJECTIVE BIOMARKER OF ACUTE CONCUSSION IN THE ADOLESCENT ATHLETE
Authors: Podolak Olivia E. , Joshi Nabin , Ciuffreda Kenneth , Mohamed Fairuz , Sharma Shelly , Kessler Ronni , McDonald Catherine , Arbogast Kristy B. , Grady Matthew , Master Christina L.
Published: March 2019

Background:

Visual deficits and autonomic dysfunction have been well recognized following pediatric concussion. Testing of the pupillary light reflex (PLR) is a simple, non-invasive, and objective approach to examine the autonomic nervous system by accessing the brain pathways. The aim of this study was to objectively evaluate adolescent pupillary responses to a light stimulus after a physician-diagnosed concussion and compare them to baseline responses.

Methods:

In this prospective cohort study, PLR was assessed in 135 adolescent athletes (ages 14-18) during their sport pre-season. All of the athletes were not recovering from a concussion at the time of their baseline assessment. Within this cohort, seven athletes (ages 14-17) sustained a concussion during their sport season and had longitudinal post-injury assessments of PLR through their recovery. The PLR was obtained in response to a brief step-input (0.8 seconds) white light stimulus using a hand-held pupillometer (stimulus recording duration= 5 seconds, light intensity= 150 lux). Pre-set and automated device-generated parameters used for analysis include the minimum and maximum pupil diameter, response amplitude and latency, mean constriction and dilation velocities and the maximum constriction velocity of the eye in response to a light stimulus. During each assessment, three monocular trials were performed in each eye alternatively, and the responses for each eye were subsequently averaged.

Results:

Six out of the seven concussed adolescents showed response enhancement of about 20% (IQR 11-33%). Enhancement was noted in the steady state diameter with a mean of 24% (median 18%), minimum pupil diameter mean of 17% (median 11%) and maximum constriction velocity mean of 28% (median 33%) following concussion, which decreased during the recovery process (days to weeks post-injury) to pre-injury or below initial pre-injury baseline measurements. Pupillary responsivity was found to be significantly enhanced after concussion compared to baseline measurements, waning over time. Maximum constriction velocity better highlighted the enhancement compared to the baseline pupil diameter.

Conclusions/Significance:

Pupil responsivity was found to be significantly enhanced after concussion compared to baseline measurements which waned over time during recovery. Assessment of dynamic PLR responses has potential utility as an objective biomarker to aid in concussion diagnosis on the sidelines or in the office, allowing physicians to quantify function (and dysfunction) of the autonomic nervous system under parasympathetic and sympathetic control after concussion.
MENISCUS REPAIR VERSUS DEBRIDEMENT FOR MENISCAL TEARS IN PEDIATRIC PATIENTS – PREDICTORS FOR TREATMENT BASED ON DEMOGRAPHICS
Authors: Agatstein Lauren , Skaggs Alton W. , Brown Matthew J. , Friel Nicole , Haus Brian
Published: March 2019

BACKGROUND:

Pediatric and adolescent patients with meniscus tears have a relatively high rate of healing after meniscus repair – up to greater than 80% in the literature. Despite this fact, many patients undergo meniscus debridement for treatment of their meniscus tears. In this study, we investigated the demographic factors predictive of whether a pediatric patient would receive a meniscal repair or a meniscal debridement for their meniscal tear.

METHODS:

The California statewide ambulatory surgery database (OSHPD) was queried for all patients under 18 years old who underwent meniscus debridement or meniscus repair from 2008-2016. The effect of age, hospital setting (adult versus pediatric hospital), injury chronicity, gender, insurance type, race, and year of service was assessed using logistic regression.

RESULTS:

A total of 13,906 pediatric patients had meniscal surgery during the timeframe. 83% (11,561/13,906) underwent meniscal debridement and 17% (2,345/13,906) underwent meniscal repair. Age, hospital type, nature of injury, gender, private insurance, being Hispanic, and year of service were statistically significant in predicting the odds of having meniscus repair versus meniscus debridement. Surgery at a children’s hospital increases the odds of having meniscus repair (p < 0.001). Of the 82.6% of pediatric patients (11,491/13,906) treated at non-children’s hospitals, 16% (1839) had repair and 84% underwent debridement (9,652). Of the 17.4% (2,415) treated at children’s hospitals, 21% (506) had repair and 79% (1,909) underwent debridement. As patients age, the odds of receiving a meniscus repair decrease (p < 0.001). Acute meniscus injury (p < 0.001) or private insurance (p < 0.05) increase the odds of having meniscus repair. However, females (p < 0.05) and Hispanics (p < 0.01) had decreased odds of having meniscus repair. As time between injury and surgery progressed, the odds of having meniscus repair versus meniscus debridement increased (p < 0.001).

CONCLUSIONS:

There is increasing evidence that pediatric patients have successful outcomes after meniscal repair surgery. The results of this study demonstrate that the majority of pediatric patients with meniscus tears undergo a meniscal debridement rather than a repair. Treatment at a children’s hospital, private insurance, and a short time frame between injury and surgery were positive predictors of meniscus repair over debridement. The results of the study may help inform patients, families, and referring physicians about what type of treatment a patient may receive for a meniscus tear, based on their demographic profile.
Minority Patients Have a Higher Number of Shoulder Dislocations and More Frequent Cartilage Lesions: Data from the MOON-Shoulder Instability Group
Authors: Hettrich Carolyn M. , Zacharias Anthony J. , Ortiz Shannon , Cronin Kevin J. ,   Shoulder Group MOON, Wolf Brian R. , Jacobs Cale A.
Published: March 2019

Objectives:

Previous investigations have shown decreased utilization and outcomes based on racial status in total knee arthroplasty (TKA) and total shoulder arthroplasty (TSA) cohorts; however, the impact of racial status in patients undergoing shoulder stabilization is poorly understood. The purpose of the current study was to compare how minority status affects surgical timing as well as pre- and intraoperative findings in patients undergoing operative treatment of shoulder instability.

Methods:

As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, 1010 patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative patient-reported outcome scores (PROs), and radiologic and intraoperative findings were then compared between Caucasian and minority patients undergoing surgical shoulder stabilization. In addition, the Economic Innovation Group’s 2017 Distressed Communities Index (DCI) was recorded for each patient’s home zip code. DCI Scores are based on percentages of adults without a high school education, percentage living under the poverty line, unemployment rates, and the overall housing and business climate in a given area. DCI Scores range from 0 to 100, with higher scores indicative of greater economic distress, and DCI Scores ≥ 80 are considered to be highly distressed regions. Continuous variables were compared between groups using two-tailed independent t-tests and categorical variables were compared using chi-square tests.

Results:

Of the 1010 patients, 988 patients (97.8%) had complete preoperative and intraoperative data. The cohort was largely Caucasian (851, 86.1%), with 137 minority patients, including 71 African American, 49 Asian, 13 Native American, and 4 Hawaiian or Pacific Islander. DCI scores were significantly worse for minority patients than Caucasians (39.4 vs. 28.1, p<0.001), as were preoperative expectations (p=0.02). A greater percentage of minority patients had 2 or more dislocations (69.1% vs. 57.7%, p=0.01) which corresponded with more frequent articular cartilage lesions (64.2% vs. 51.0%, p=0.004).

Conclusion:

Racial minorities were found to have more preoperative dislocations, higher rates of articular cartilage lesions, and worse preoperative expectations. DCI scores were lower in the racial minority group; however, this was not found to be an independent predictor of pre- and/or intraoperative findings. These findings identify a need to identify barriers in an action to reduce racial disparities in the treatment of shoulder instability.
Comparative Stability of Oral Vitamin K Liquids Stored in Refrigerated Amber Plastic Syringes
Authors: Lawson Sarah , Lewis Paul , Peacock Gina , Brown Stacy
Published: March 2019

Background: Compounded vitamin K oral liquids may be useful in some patient populations, or when an appropriate solid dosage form is not available. While vitamin K oral liquid is typically prepared with sterile water for injection (SWFI), other compounding agents may be more palatable. Objective: To evaluate stability of compounded vitamin K liquids in SWFI, Ora-Sweet, simple syrup, cherry syrup, and SyrPalta stored in amber plastic oral syringes. Methods: Five types of compounded vitamin K liquids were prepared in triplicate—Ora-Sweet, simple syrup, cherry syrup, SyrPalta, and SWFI without flavoring; aliquoted into amber plastic oral syringes; and stored in a laboratory refrigerator (4.9°C to 5.4°C). On study days, 3 syringes from each batch were removed, diluted to assay concentration, and compared with a freshly prepared US Pharmacopeia reference solution. The samples and reference were analyzed using a previously validated high-performance liquid chromatography–ultraviolet method. Product stability was defined as 90% to 110% labeled amount. Results were further compared using a 2-way ANOVA (analysis of variance; P = .05) with post hoc Tukey’s correction for multiple comparisons. Results: Vitamin K in SWFI, SyrPalta, and cherry syrup was stable for 21 days, 7 days, and 24 hours, respectively, under refrigeration in amber plastic oral syringes. Vitamin K in Ora-Sweet and simple syrup demonstrated high within-day variability and low potency. Statistically significant differences were detected between the SWFI formulation and all other vehicles. Conclusion: Vitamin K in SWFI is appropriate for longer-term storage of unit-dosed vitamin K; however, SyrPalta and cherry syrup may be used for short-term storage or immediate administration of vitamin K.
Addition of Docetaxel to Oral Fluoropyrimidine Improves Efficacy in Patients With Stage III Gastric Cancer: Interim Analysis of JACCRO GC-07, a Randomized Controlled Trial
Authors: Yoshida Kazuhiro , Kodera Yasuhiro , Kochi Mitsugu , Ichikawa Wataru , Kakeji Yoshihiro , Sano Takeshi , Nagao Narutoshi , Takahashi Masazumi , Takagane Akinori , Watanabe Takuya , Kaji Masahide , Okitsu Hiroshi , Nomura Takashi , Matsui Takanori , Yoshikawa Takaki , Matsuyama Jin , Yamada Makoto , Ito Seiji , Takeuchi Masahiro , Fujii Masashi
Published: March 2019

PURPOSE

S-1 is a standard postoperative adjuvant chemotherapy for patients with stage II or III gastric cancer in Asia. Neoadjuvant or perioperative strategies dominate in Western countries, and docetaxel has recently shown significant survival benefits when combined with other standard regimens in advanced cancer and perioperative settings.

PATIENTS AND METHODS

This randomized phase III study was designed to prove the superiority of postoperative S-1 plus docetaxel over S-1 alone for R0 resection of pathologic stage III gastric cancer. The sample size of 1,100 patients was necessary to detect a 7% increase in 3-year relapse-free survival as the primary end point (hazard ratio, 0.78; 2-sided α = .05; β = .2).

RESULTS

The second interim analysis was conducted when the number of events reached 216 among 915 enrolled patients (median follow-up, 12.5 months). Analysis demonstrated the superiority of S-1 plus docetaxel (66%) to S-1 (50%) for 3-year relapse-free survival (hazard ratio, 0.632; 99.99% CI, 0.400 to 0.998; stratified log-rank test, P < .001), and enrollment was terminated as recommended by the independent data and safety monitoring committee. Incidences of grade 3 or greater adverse events, particularly neutropenia and leukopenia, were higher in the S-1 plus docetaxel group, but all events were manageable.

CONCLUSION

Addition of docetaxel to S-1 is effective with few safety concerns in patients with stage III gastric cancer. The present findings may also be applicable in countries in which perioperative adjuvant chemotherapy or chemoradiation is not standard.
Thirty-Day Readmissions in Patients With Metastatic Cancer: Room for Improvement?
Authors: Solomon Rachel , Egorova Natalia , Adelson Kerin , Smith Cardinale B. , Franco Rebeca , Bickell Nina A.
Published: March 2019

Purpose:

Cancer, with readmission rates as high as 27%, has thus far been excluded from most readmission reduction efforts. However, some readmissions for patients with advanced disease may be avoidable. We assessed the prevalence of potentially preventable readmissions and associated factors in patients with metastatic cancer.

Patients and Methods:

Using a merged longitudinal data set of New York State hospital discharges and vital records, we measured 30-day readmissions for anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, and sepsis among patients with metastatic cancer between 2012 and 2014. We used competing-risk models to assess the effects of demographics, comorbidities, hospital type, payer, and discharge disposition.

Results:

A total of 11,275 patients had 19,307 hospitalizations. The 30-day readmission rate was 24.5%; 11.9% (n = 565) of readmissions were potentially preventable. Higher readmission rates occurred in black (hazard rate [HR], 1.26; 95% CI, 1.17 to 1.35), Hispanic (HR, 1.19; 95% CI, 1.09 to 1.31), and younger patients (HR per 10 years, 0.94; 95% CI, 0.90 to 0.97). Lower rates were associated with female sex (HR, 0.95; 95% CI, 0.91 to 0.99), private insurance (HR, 0.87; 95% CI, 0.87 to 0.81), teaching hospitals, and hospice discharge (HR, 0.62; 95% CI, 0.42 to 0.91). Discharge home with services (HR, 1.21; 95% CI, 1.14 to 1.27) or to a skilled nursing facility (HR, 1.11; 95% CI, 1.01 to 1.23) increased readmission likelihood. Potentially preventable readmissions were associated with younger age (HR per 10 years, 0.98; 95% CI, 0.98 to 0.99) and discharge home with services (HR, 1.25; 95% CI, 1.04 to 1.50). Likelihood decreased if care was received at a teaching hospital (HR, 0.76; 95% CI, 0.59 to 0.99). Payer, sex, race, and comorbidities did not contribute.

Conclusion:

Although the overall rate of potentially preventable readmissions among patients with metastatic cancer is low, higher readmission rates among those discharged home with help suggest that services supplied may not be sufficient to address health needs.
A Contemporary Medicolegal Analysis of Outpatient Interventional Pain Procedures: 2009–2016
Authors: Abrecht Christopher R. , Saba Ramsey , Greenberg Penny , Rathmell James P. , Urman Richard D.
Published: March 2019

BACKGROUND:

Closed malpractice claim studies allow a review of rare but often severe complications, yielding useful insight into improving patient safety and decreasing practitioner liability.

METHODS:

This retrospective observational study of pain medicine malpractice claims utilizes the Controlled Risk Insurance Company Comparative Benchmarking System database, which contains nearly 400,000 malpractice claims drawn from >400 academic and community medical centers. The Controlled Risk Insurance Company Comparative Benchmarking System database was queried for January 1, 2009 through December 31, 2016, for cases with pain medicine as the primary service. Cases involving outpatient interventional pain management were identified. Controlled Risk Insurance Company–coded data fields and the narrative summaries were reviewed by the study authors.

RESULTS:

A total of 126 closed claims were identified. Forty-one claims resulted in payments to the plaintiffs, with a median payment of $175,000 (range, $2600–$2,950,000). Lumbar interlaminar epidural steroid injections were the most common procedures associated with claims (n = 34), followed by cervical interlaminar epidural steroid injections (n = 31) and trigger point injections (n = 13). The most common alleged injuring events were an improper performance of a procedure (n = 38); alleged nonsterile technique (n = 17); unintentional dural puncture (n = 13); needle misdirected to the spinal cord (n = 11); and needle misdirected to the lung (n = 10). The most common alleged outcomes were worsening pain (n = 26); spinal cord infarct (n = 16); epidural hematoma (n = 9); soft-tissue infection (n = 9); postdural puncture headache (n = 9); and pneumothorax (n = 9). According to the Controlled Risk Insurance Company proprietary contributing factor system, perceived deficits in technical skill were present in 83% of claims.

CONCLUSIONS:

Epidural steroid injections are among the most commonly performed interventional pain procedures and, while a familiar procedure to pain management practitioners, may result in significant neurological injury. Trigger point injections, while generally considered safe, may result in pneumothorax or injury to other deep structures. Ultimately, the efforts to minimize practitioner liability and patient harm, like the claims themselves, will be multifactorial. Best outcomes will likely come from continued robust training in procedural skills, attention paid to published best practice recommendations, documentation that includes an inclusive consent discussion, and thoughtful patient selection. Limitations for this study are that closed claim data do not cover all complications that occur and skew toward more severe complications. In addition, the data from Controlled Risk Insurance Company Comparative Benchmarking System cannot be independently verified.
Seasonal upsurge of pneumococcal meningitis in the Central African Republic
Authors: Crellen Thomas , Rao V. Bhargavi , Piening Turid , Zeydner Joke , Siddiqui M. Ruby
Published: March 2019

A high incidence of bacterial meningitis was observed in the Central African Republic (CAR) from December 2015 to May 2017 in three hospitals in the northwest of the country that are within the African meningitis belt. The majority of cases were caused by Streptococcus pneumoniae (249/328; 75.9%), which occurred disproportionately during the dry season (November-April) with a high case-fatality ratio of 41.6% (95% confidence interval [CI] 33.0, 50.8%). High rates of bacterial meningitis during the dry season in the meningitis belt have typically been caused by Neisseria meningitidis (meningococcal meningitis), and our observations suggest that the risk of contracting S. pneumoniae (pneumococcal) meningitis is increased by the same environmental factors. Cases of meningococcal meningitis (67/328; 20.4%) observed over the same period were predominantly group W and had a lower case fatality rate of 9.6% (95% CI 3.6, 21.8%). Due to conflict and difficulties in accessing medical facilities, it is likely that the reported cases represented only a small proportion of the overall burden. Nationwide vaccination campaigns in the CAR against meningitis have been limited to the use of MenAfriVac, which targets only meningococcal meningitis group A. We therefore highlight the need for expanded vaccine coverage to prevent additional causes of seasonal outbreaks.
Progression of the canonical reference malaria parasite genome from 2002–2019
Authors: Böhme Ulrike , Otto Thomas D. , Sanders Mandy , Newbold Chris I. , Berriman Matthew
Published: March 2019

Here we describe the ways in which the sequence and annotation of the Plasmodium falciparum reference genome has changed since its publication in 2002. As the malaria species responsible for the most deaths worldwide, the richness of annotation and accuracy of the sequence are important resources for the P. falciparum research community as well as the basis for interpreting the genomes of subsequently sequenced species. At the time of publication in 2002 over 60% of predicted genes had unknown functions. As of March 2019, this number has been significantly decreased to 33%. The reduction is due to the inclusion of genes that were subsequently characterised experimentally and genes with significant similarity to others with known functions. In addition, the structural annotation of genes has been significantly refined; 27% of gene structures have been changed since 2002, comprising changes in exon-intron boundaries, addition or deletion of exons and the addition or deletion of genes. The sequence has also undergone significant improvements. In addition to the correction of a large number of single-base and insertion or deletion errors, a major miss-assembly between the subtelomeres of chromosome 7 and 8 has been corrected. As the number of sequenced isolates continues to grow rapidly, a single reference genome will not be an adequate basis for interpretating intra-species sequence diversity. We therefore describe in this publication a population reference genome of P. falciparum, called Pfref1. This reference will enable the community to map to regions that are not present in the current assembly. P. falciparum 3D7 will be continued to be maintained with ongoing curation ensuring continual improvements in annotation quality.
Environmental research methods
Authors: Рязанова Наталья , Ryazanova Natal'ya , Аковецкий Виктор , Akoveckiy Viktor , Зубалий Анастасия , Zubaliy Anastasiya , Бурвикова Юлиана , Burvikova Yuliana , Гайкович Борис , Gaykovich Boris , Занин Владислав , Zanin Vladislav , Шокина Ольга , Shokina Ol'ga
Published: March 2019

The content of the textbook corresponds to the State educational standard of higher education for bachelors in the field of Ecology and environmental management.
The textbook describes the methodology, basic methods and techniques of environmental research, in particular, the study of atmospheric air, water bodies, soil, biological and geological environments. The most up-to-date information on the use of marine robotics and the application of remote environmental research methods are also included in a systematic form.
The textbook is designed for the level of "bachelor" of natural Sciences.
Continuous Variable Neighborhood Search (C-VNS) for Solving Systems of Nonlinear Equations
Authors: Pei Jun , Dražić Zorica , Dražić Milan , Mladenović Nenad , Pardalos Panos M.
Published: March 2019

In this paper, we propose the continuous variable neighborhood search method for finding all the solutions to a nonlinear system of equations (NSEs). We transform the NSE problem into an equivalent optimization problem, and we use a new objective function that allows us to find all the zeros. Instead of the usual sum-of-squares objective function, our objective function is presented as the sum of absolute values. Theoretical investigation confirms that our objective function provides more accurate solutions regardless of the optimization method used. In addition, we achieve a trade-off (i.e., increased precision at the expense of reduced smoothness). Computational analysis of standard test instances shows that the proposed method is more precise and much faster than two recently developed methods. Similar conclusions are drawn by comparing the proposed method with many other methods in the literature.

The online supplement is available at https://doi.org/10.1287/ijoc.2018.0876 .
The impact of brief lifestyle self-management education for the control of seizures
Authors: Edward Karen-leigh , Cook Mark , Stephenson John , Giandinoto Jo-Ann
Published: March 2019

Aim:

this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years.

Background:

most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies.

Design:

a cohort study with control design.

Method:

sixty participants were purposively sampled and allocated to an intervention or a control group.

Results:

moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life.

Conclusion:

the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping.