bluuebunny/crossref_metadata_2025 huggingface dataset:
Marx and Sen on incentives and justice: Implications for innovation and development
Authors: Papaioannou Theo
Published: July 2016

The most crucial obstacle to equitable innovation and development is the tension between profit incentives and social justice. In the egalitarian tradition of social and political thought, there have been a number of theorists preoccupied with this tension. Among them Marx and Sen stand out as the most influential figures. This article evaluates their approaches and examines implications for technological innovation and economic development. The argument is that Marx’s needs-based approach is relational and therefore provides a radical resolution to the incentives–justice tension. By contrast, Sen’s approach is informational and therefore provides a policy solution to this tension. Both approaches imply that innovation and development can become more equitable through public action. However, in the case of Marx, public action assumes conflict between social classes; it aims at changing capitalist social relations and eliminating unjust exploitation. In the case of Sen, public action assumes consent between individuals; it aims at reforming public policy and eliminating capability deprivation.
Multilingual communication for whom? Language policy and fairness in the European Union
Authors: Gazzola Michele
Published: July 2016

This article compares the effectiveness and the fairness of four alternative policies aimed at managing multilingual communication in the European Union. The current multilingual regime, based on the formal equality among the official languages of the European Union Member States disenfranchises only a small percentage of residents. On the contrary, an English-only language policy would exclude 45% to 79% of adult residents in the 25 countries for which data are available, depending on the indicator used. A language regime based on English, French and German would disenfranchise 26% to 49% of residents, whereas a regime based on six languages would bring the shares of the excluded population down to 9–18%. In addition, results show that economically and socially disadvantaged individuals are less likely to speak languages other than their own native tongue, and therefore they are much more likely to be adversely affected if the European Union stops using their language. The current full multilingual policy of the European Union based on translation and interpreting not only is (and will be for the foreseeable future) the most effective language policy among the alternatives examined; it is also the only one that is truly inclusive at a relatively reasonable cost. The British withdrawal from the European Union is likely to increase rather than decrease the importance of a multilingual language policy.
A different type of lighting research – A qualitative methodology
Authors: Kelly K
Published: July 2016

As lighting researchers we can learn from our colleagues in the humanities who have progressed qualitative research methods to a high level of rigour. We should consider using qualitative research methods more. Such methods allow exploration of complex issues involving human views and behaviour, and help researchers address difficult to answer questions that otherwise go unanswered. Good quality qualitative research can provide rich explanations of what went on in a given situation. Validity and reliability are considered differently with this type of research methodology. This paper attempts to identify when qualitative research is appropriate, what questions it can answer in lighting research, how it is done, list the features and provide a simple brief example of a post occupancy evaluation case study. It is argued that qualitative research can be used with quantitative research; before quantitative research to inform it or afterwards to explain it; but it can also be extremely informative in itself and act as a catalyst for change to readers who can see the outcomes in a context that applies to them.
Can light emitting diode-based road studs improve vehicle control in curves at night? A driving simulator study
Authors: Shahar A , Brémond R , Villa C
Published: July 2016

Road delineation treatments enhance the ability of drivers to control their vehicle safely on winding roads. A simulator experiment compared night-time driving on a country road under three conditions: on an unlit road, on a road illuminated on curves by typical road luminaires, and on a road with an active lane delineation application, where self-luminous road studs are turned on to outline the lane and road edges as the driver approaches and passes the curves. The unlit condition induces greater lateral position variability and longer crossovers relative to the studs condition, demonstrating better lateral vehicle control in the latter. The luminaires condition induce greater lateral position variability in left curves, and longer crossovers in right curves, relative to the studs condition, which also demonstrates a better lateral vehicle control in the studs condition. At a subjective level, the participants perceived both the studs condition and the luminaires condition as safer, more comfortable and allowing better control than the unlit road. It was concluded that the tested application enhanced the ability of drivers to control the virtual car, as compared to an unlit road or road lighting.
A psychophysical model for visual discomfort based on receptive fields
Authors: Scheir GH , Donners M , Geerdinck LM , Vissenberg MCJM , Hanselaer P , Ryckaert WR
Published: July 2016

Visual discomfort is predicted from a luminance map with a model based on the receptive field mechanism in the human eye. A centre-surround receptive field is described by a Difference of Gaussians. Eight commercially available office luminaires are assessed for visual discomfort in a paired comparison experiment. The correlation between the subjective data and the receptive field model is optimized for three factors: the centre Gaussian width, the surround Gaussian width and the centre-to-surround weighing factor (WF). A centre and surround visual angle of 0.53 and 2.19 min arc, respectively, and a WF of 0.87 result in a coefficient of determination of 0.77. The model is validated independently with magnitude estimation data obtaining a coefficient of determination of 0.82. Where the standard unified glare rating method fails (coefficient of determination of 0.45), the receptive field model ameliorates predictability for visual discomfort. The model based on receptive fields is promising to replace current standard glare metrics, specifically when non-uniform luminaires are to be evaluated.
Controversies That Shaped the Field of Human Resource Development
Authors: Russ-Eft Darlene F.
Published: July 2016

The Problem

There is a dearth of information concerning the various controversies that have arisen within human resource development, as encapsulated within the Town Hall Forums provided at the annual meetings of the Academy of Human Resource Development (AHRD). Turnover and growth in the field result in a loss of institutional memory, which can provide vital context for current practices and decisions.

The Solution

This article summarizes the Town Hall Forums that have been presented at AHRD from 1995 to 2015. The Forums are grouped into related themes. Following the summary for the Forums within each theme, there is a brief statement as to the current status of that issue. The conclusion section identifies some of the research needs that still exist around some of the topics. By documenting the discussion and resolution of important issues, we can see how AHRD and its members have had an impact on the field and have led the field through research.

The Stakeholders

These include the scholars and scholar-practitioners within AHRD and those undertaking research related to HRD.
Featured Article: Nanoenhanced matrix metalloproteinase-responsive delivery vehicles for disease resolution and imaging
Authors: McCarthy Donald A , Nazem Ahmad A , McNeilan James , Shakerley Nicole L , Clark Ryan R , Idelchik María D , Yigit Mehmet , Melendez J Andrés
Published: July 2016

The wide array of proteases, including matrix metalloproteinases, produced in response to many pathogenic insults, confers a unique proteolytic signature which is often disease specific and provides a potential therapeutic target for drug delivery. Here we propose the use of collagen-based nanoenhanced matrix metalloproteinase-responsive delivery vehicles that display matrix metalloproteinase-specific degradation in diverse in vitro models of proteolysis. We demonstrate that collagen particles comprised of protease substrates (primarily collagen) can be made of uniform size and loaded efficiently with assorted cargo including fluorescently labeled mesoporous silica, magnetic nanoparticles, proteins and antioxidants. We also demonstrate that pathologic concentrations of proteases produced in situ or in vitro display protease-specific cargo release. Additionally, we show that the collagen-based particles display bright fluorescence when loaded with a fluorophore, and have the potential to be used as vehicles for targeted delivery of drugs or imaging agents to regions of high proteolytic activity.
Diverse and Dynamic Interactions: A Model of Suicidal Men’s Help Seeking as It Relates to Health Services
Authors: River Jo
Published: July 2016

There is a striking gender difference in suicide rates worldwide, with men accounting for approximately 80% of all suicide deaths. In contradictory public discussions, suicidal men are presented sometimes as victims of “poor” health services and sometimes as irremediable, “poor” help seekers. A more substantive theory of suicidal men’s help seeking, which moves beyond homogenizing accounts to examine the complex interplay between help seeking and health services, is now required. Eighteen life history interviews were undertaken with men who had engaged in nonfatal suicide. Interviews were analyzed within a theoretical framework of gender relations. The findings challenge static and uniform notions of suicidal men’s help seeking. While a few men actively avoided health services, others actively sought help, and in many cases help-seeking practices were triggered by unsolicited encounters with health services. Responsibility for help-seeking behavior did not rest solely with suicidal men. Men’s help-seeking practices could either be facilitated or blocked by the character of the professional support that was available. Men in this study overwhelmingly rejected services that framed emotional distress and suicidal behavior as mental illness.
Lifestyle Factors Associated With Sunscreen Use Among Young Adults
Authors: Merten Julie Williams , King Jessica L. , Vilaro Melissa J. , Largo-Wight Erin
Published: July 2016

Background. Skin cancer is the most common cancer in the United States with melanoma rates increasing. Sunscreen use is an effective way to protect the skin and reduce skin cancer risk. Limited research has been conducted examining the relationship between sunscreen use and other lifestyle factors. Interventions aimed at multiple lifestyle factors have shown promise for prevention and reduced health care costs. Objective. This study explores the relationship between sunscreen use and lifestyle factors associated with mortality and morbidity among young adults. Lifestyle factors examined included physical activity, substance abuse, smoking, sexual behavior, unintentional injury, and mental well-being. Methods. A convenience sample of 747 college students was surveyed about sunscreen use and other health risks. Data were analyzed using SPSS 19. Results. White, female students older than 21 years were more likely to use sunscreen. Texting while driving, low life satisfaction, and binge drinking were associated with inadequate sunscreen use. Limitations. Convenience sampling limits generalizability and surveys are subject to recall, self-report, and self-selection bias. Conclusions. The findings provide the framework to develop multiple risk factor interventions.
The community pharmacist’s role in cancer screening and prevention
Authors: Havlicek Anthony James , Mansell Holly
Published: July 2016

As the Canadian population continues to age, the incidence of cancer is on the rise. To help alleviate the burden malignancy imposes on our health care system, a shift toward early cancer detection is necessary. Pharmacists are well positioned and willing to assume a more active role in cancer surveillance. Patients are receptive to pharmacist involvement and seem to prefer a convenient community pharmacy–based location for screening programs. The community pharmacist’s current and potential role in cancer screening and prevention is summarized in this article. A review of screening recommendations and a discussion of opportunities will hopefully inspire pharmacists to consider incorporating malignancy screening initiatives into their practice.
Infusion medication concentrations in UK’s critical care areas: Are the Intensive Care Society’s recommendations being used?
Authors: Titiesari Yovita D , Barton Greg , Borthwick Mark , Keeling Susan , Keeling Peter
Published: July 2016

Following two studies done in 2007 and 2009, a follow-up of the adherence to the suggested guidelines on drug standardisation has been performed with a suggestion for future standards that can be achieved, to complement the recently published Carter report. The Intensive Care Society (ICS) introduced recommendations for infusion concentrations of 16 medications commonly used in critical care areas. The importance being improvement in patient safety and rationalised use of available critical care resources. Five years after publication of these recommendations, a further audit has been undertaken to assess the level of acceptance and application. This revealed that 89.5% of the 133 surveyed units (representing 42.49% critical care units across the UK) have adopted the recommendations. There are further medication concentrations which could also be standardised.
Functional outcome and complications following surgery for Dupuytren’s disease: a multi-centre cross-sectional study
Authors: Rodrigues J. N. , Zhang W. , Scammell B. E. , Chakrabarti I. , Russell P. G. , Fullilove S. , Davidson D. , Davis T. R. C.
Published: July 2016

Variables associated with recurrent Dupuytren’s disease, or a ‘diathesis’, have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year ( p = 0.396, Chi-square test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former’s higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study.

Level of evidence: III
Establishing a reproducible protocol for measuring index active extension strength
Authors: Matter-Parrat V. , Hidalgo Diaz J. J. , Collon S. , Salazar Botero S. , Prunières G. , Ichihara S. , Facca S. , Liverneaux P.
Published: July 2016

The goal of this study was to establish a reproducible protocol to measure active extension strength in the index finger. The secondary objectives consisted in correlating the independent or associated index extension strength to the other fingers force of contraction of the extensor indicis propius with hand dominance. The population studied consisted of 24 healthy volunteers, including 19 women and 20 right-handed individuals. The independent and dependent index extension strength in each hand was measured three times with a dynamometer by three examiners at Day 0 and again at Day 7. Intra and inter-examiner reproducibility were, respectively, >0.90 and >0.75 in all cases. The independent extension strength was lower than the dependent one. There was no difference between the independent index extension strength on the dominant and non-dominant sides. The same was true for the dependent strength. Our results show that our protocol is reproducible in measuring independent and dependent index extension strength. Dominance did not come into account.

Level of evidence: II
Incidence and Cost of Ankle Sprains in United States Emergency Departments
Authors: Shah Shweta , Thomas Abbey C. , Noone Joshua M. , Blanchette Christopher M. , Wikstrom Erik A.
Published: July 2016

Background:

Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments.

Hypothesis:

There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains.

Study Design:

Descriptive epidemiological study.

Level of Evidence:

Level 3.

Methods:

A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains.

Results:

The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P < 0.01). Among complications, pain in the limb (1.92% vs 0.52%, P = 0.03), sprain of the foot (2.96% vs 0.70%, P < 0.01), and abrasion of the hip/leg (1.57% vs 0.35%, P = 0.03) were more common in lateral than medial ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P < 0.01) and less likely to include medications than lateral ankle sprains (0.87% vs 2.79%, P < 0.01). Hospitalizations were more common following high ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P < 0.01).

Conclusion:

Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains.

Clinical Relevance:

The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains.
Just Change the Channel? Studying Effects of Age on Emotion Regulation Using a TV Watching Paradigm
Authors: Sands Molly , Garbacz Adam , Isaacowitz Derek M.
Published: July 2016

Older adults are theorized to benefit from proactive forms of emotion regulation that allow them to avoid negative stimuli. To test this, we examined choices as a form of emotion regulation. In two studies investigating age differences, participants selected affective stimuli using a cable television interface, while choices and mood were recorded. In lab-based Study 1, older adults spent more time watching neutral channels, but younger adults spent more time watching positive ones. Older adults also watched more low-arousal content, while younger adults watched more high-arousal content. Lagged analyses revealed that younger adults’ choices were directed toward increasing positive affect and arousal. Study 2 replicated these findings in a community-based adult life span sample at a local museum. These findings suggest that arousal plays an important role in motivating emotion regulation behavior in the context of selections, and this differs by age.
A recapitulative three-dimensional model of breast carcinoma requires perfusion for multi-week growth
Authors: Goliwas Kayla F , Marshall Lauren E , Ransaw Evette L , Berry Joel L , Frost Andra R
Published: July 2016

Breast carcinomas are complex, three-dimensional tissues composed of cancer epithelial cells and stromal components, including fibroblasts and extracellular matrix. In vitro models that more faithfully recapitulate this dimensionality and stromal microenvironment should more accurately elucidate the processes driving carcinogenesis, tumor progression, and therapeutic response. Herein, novel in vitro breast carcinoma surrogates, distinguished by a relevant dimensionality and stromal microenvironment, are described and characterized. A perfusion bioreactor system was used to deliver medium to surrogates containing engineered microchannels and the effects of perfusion, medium composition, and the method of cell incorporation and density of initial cell seeding on the growth and morphology of surrogates were assessed. Perfused surrogates demonstrated significantly greater cell density and proliferation and were more histologically recapitulative of human breast carcinoma than surrogates maintained without perfusion. Although other parameters of the surrogate system, such as medium composition and cell seeding density, affected cell growth, perfusion was the most influential parameter.
The Intersections of Marginalized Social Identities in the Transition to Adulthood
Authors: Lee JoAnn S. , Waithaka Eric N.
Published: July 2016

Studies focusing on emerging adulthood suggest that young adults from marginalized populations are more likely to assume adult roles earlier or struggle to assume adult roles altogether, both of which increase the likelihood of a challenging transition to adulthood. Demographic profiles of young adults do not simultaneously consider multiple marginalized identities. This study examines how the transition into key adult statuses differs by the intersections of social statuses. We use data from the American Community Survey 2010 to provide population estimates of rates of young adults, ages 18–35, reaching five key adult role statuses (completing school, joining the labor force, establishing independent homes, marriage, or parenting) by race or immigration status, gender, and poverty status. Our analyses reveal complex patterns in the adoption of adult role statuses. The general trends suggest that nonpoor young adults “become adults” at increasingly higher rates than poor young adults throughout the transition period.
Developing a Risk Model to Target High-Risk Preventive Interventions for Sexual Assault Victimization Among Female U.S. Army Soldiers
Authors: Street Amy E. , Rosellini Anthony J. , Ursano Robert J. , Heeringa Steven G. , Hill Eric D. , Monahan John , Naifeh James A. , Petukhova Maria V. , Reis Ben Y. , Sampson Nancy A. , Bliese Paul D. , Stein Murray B. , Zaslavsky Alan M. , Kessler Ronald C.
Published: July 2016

Sexual violence victimization is a significant problem among female U.S. military personnel. Preventive interventions for high-risk individuals might reduce prevalence but would require accurate targeting. We attempted to develop a targeting model for female Regular U.S. Army soldiers based on theoretically guided predictors abstracted from administrative data records. As administrative reports of sexual assault victimization are known to be incomplete, parallel machine learning models were developed to predict administratively recorded (in the population) and self-reported (in a representative survey) victimization. Capture–recapture methods were used to combine predictions across models. Key predictors included low status, crime involvement, and treated mental disorders. Area under the receiver operating characteristic curve was .83–.88. Between 33.7% and 63.2% of victimizations occurred among soldiers in the highest risk ventile (5%). This high concentration of risk suggests that the models could be useful in targeting preventive interventions, although final determination would require careful weighing of intervention costs, effectiveness, and competing risks.
NFL Combine Athletic Performance after ACL Reconstruction
Authors: Marshall Nathan E. , Keller Robert A. , Mehran Nima , Austin William , Moutzouros Vasilios
Published: July 2016

Objectives:

The purpose of this study was to determine the functional performance of NFL combine participants after ACL reconstruction compared with an age-, size-, and position-matched control group. The hypothesis was that there would be no difference between players after ACL reconstruction as compared with controls in functional athletic performance.

Methods:

A total of 98 NFL-caliber athletes who had undergone primary ACL reconstruction and participated in the NFL scouting combine between 2010 and 2014 were reviewed and compared with an age-, size-, and position-matched control group. Data recorded for each player included a 40-yard dash, vertical leap, broad jump, shuttle drill, and 3-cone drill.

Results:

With regard to speed and acceleration, the mean 40-yard dash time for ACL-reconstructed players was 4.74 seconds (range, 4.33-5.55 seconds) compared with controls at 4.74 seconds (range, 4.34-5.38 seconds; P = .96). Jumping performance was also similar, with a mean vertical leap for ACL-reconstructed players of 33.35 inches (range, 23-43 inches) and broad jump of 113.9 inches (range, 96-136 inches) compared with respective values for the controls of 33.22 inches (range, 23.5-43.5 inches; P = .84) and 113.9 inches (range, 92-134 inches; P = .99). Agility and quickness testing measures also did not show a statistically significantly difference, with ACL-reconstructed players performing the shuttle drill in 4.37 seconds (range, 4.02-4.84 seconds) and the 3-cone drill in 7.16 seconds (range, 6.45-8.14 seconds), respectively, compared with respective times for the controls of 4.37 seconds (range, 3.96-5.00 seconds; P = .91) and 7.18 seconds (range, 6.64-8.24 seconds; P = .75).

Conclusion:

This study suggests that after ACL reconstruction, high-caliber athletes can achieve equivalent levels of perfor- mance with no statistically significant differences compared with matched controls. This information is unique when advising high-level athletes on athletic performance after ACL reconstruction, suggesting that those who fully recover and return to play appear to have no decrement in athletic performance.
Spontaneous Healing of the Ruptured Anterior Cruciate Ligament
Authors: Roe Justin , Salmon Lucy , Waller Alison , Linklater James , Pinczewski Leo
Published: July 2016

Objectives:

It is widely believed that ACL tears are incapable of healing. However, there are anecdotal experiences of the healed ACL and sporadic case reports and series documenting either clinical or radiographic evidence of healed ACL tears. A truly healed ACL would demonstrate a clinically stable knee on Lachman and pivot shift testing, normal return to function and MRI and/or arthroscopic documentation of a continuous ligament. This is in contrast to “copers” who have an ACL deficient knee but lack instability either because of good neuromuscular control or non-participation in activities which are heavily ACL dependent. In this prospective series we report on the presentation and 5 year follow-up of patients with both clinical and radiographically healed ACLs.

Methods:

19 patients who presented between July 2007 and April 2010 within 6 weeks of injury with clinical laxity and MRI confirmed ACL rupture. Patients subsequently demonstrated clinical knee stability at 8-12 weeks after pre-habilitation to obtain a pain free mobile joint. Prospective data was collected on these patients with MRI at 12 months, IKDC clinical and subjective scores, KT1000 instrumental laxity testing and Lysholm knee score at 12, 24 and 60 months.

Results:

At one year follow-up MRI 18/19 patients demonstrated a healed ACL with normal signal, normal trajectory and continuity of fibres. Remainder 1 patient demonstrated bridging of ACL tear with scar tissue and abnormal trajectory of fibers. 5 of 19 patients re-ruptured within 5 years of follow-up. At 5 years follow-up, intact healed ACL patients had a mean IKDC score of 88, mean Lysholm score of 92 and mean KT1000 score of 1.7 mm. 100% reported regular participation in strenuous sport.

Conclusion:

Although rare, spontaneous healing of the ACL is possible. The mechanism by which this occurs in unknown. It is recommended that reassessment of knee stability should be performed in the non-acute phase after an appropriate prehabilitation program prior to ACL reconstruction to ensure spontaneous healing of the ACL has not occurred.
Quality of life assessment scores after ACL reconstruction. 223 patients from the Unisports clinic
Authors: Rosenfeldt MP , Stanley J , Walsh SJ , Twaddle BC , Tietjens BR
Published: July 2016

Objective:

Determination of the effectiveness of ACL reconstruction requires outcome measures. Traditionally these have been based on a clinical assessment by the surgeon. The most important outcomes to measure are those that are important to the patient themselves.

Methods:

Over a 5-year period all eligible patients completed a validated ACL-QOL outcome measure. This proved to be a very difficult group to follow with only 22% of eligible patients completing all data forms.

Results:

ACL provided improved function across of categories on 1 year ACL-QOL scores. There remained a significant deficit to a “normal” knee score.

Conclusion:

Highlighting the importance of prospective data collection, patients had worse retrospective scores at 1 year than they had prospectively.
Graft Diameter matters in Hamstring ACL reconstruction
Authors: Clatworthy Mark
Published: July 2016

Objective:

Recently techniques have been developed to increase graft diameter in hamstring ACL reconstruction with the hope to decrease graft failure. To date there is limited evidence to show that a smaller graft diameter results in a higher ACL failure rate.

Method:

The factors for failure in 1480 consecutive single surgeon hamstring ACL reconstructions were evaluated prospectively. Patients were followed for 2-15 years. A multivariate analysis was performed which looked at graft size, age, sex, time to surgery, meniscal integrity, meniscal repair and ACL graft placement to determine whether graft diameter matters in determining the failure of hamstring ACL reconstruction.

Results:

Graft diameters ranged from 6-10 mm. The mean graft diameter for all patients was 7.75 mm. 83 ACL reconstructions failed. The mean size of graft failures was 7.55 mm ACL reconstructions that failed had a significantly smaller hamstring graft diameter p=0.001. The Hazard Ratio for a smaller diameter graft is 0.517 p=<0.0001. For every 1 mm decrease in graft diameter there is a 48.3% higher chance of failure. The multivariate analysis showed a hazard ratio of 0.543 p=0.002. For every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure.

Conclusion:

Smaller diameter hamstring grafts do have a higher failure rate. Grafts ≤ 7.5 mm had twice the failure rate of grafts ≥8 mm using a multivariate analysis for every 1 mm decrease in graft diameter there is a 45.7% higher chance of failure.
Fifteen Year Prospective Comparison of Patellar & Hamstring Tendon Grafts for ACL Reconstruction
Authors: Roe Justin , Salmon Lucy , Kok Alison , Linklater James , Pinczewski Leo
Published: July 2016

Objective:

This prospective longitudinal study compares isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to clinical outcomes and the development of osteoarthritis.

Method:

90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10 and 15 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, kneeling pain, and clinical outcomes.

Results:

Subjects who received the PT graft had significantly worse outcomes at 15 years for the variables of radiologically detectable osteoarthritis (p=0.001), motion loss (p=0.02), single leg hop test (p=0.002), participation in strenuous activity (p=0.03), knee related decrease in activity level (p=0.002) and kneeling pain (p=0.03). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.28). ACL graft rupture occurred in 16% of HT group and 8% of the PT group (p=0.10). Contralateral ACL rupture occurred in significantly more PT patients (24%) than HT patients (12%) (p=0.03).

Conclusion:

Significant differences have developed at 15 years after surgery which were not seen at earlier reviews. Compared to the HT Group, the PT group had significantly worse outcomes with respect to radiological osteoarthritis, range of motion and functional tests but no significant difference in laxity was identified. There was a high incidence of ACL injury after reconstruction, to both the reconstructed and the contralateral knee.
Tranexamic Acid Administration in Total Knee Arthroplasty Without Tourniquet
Authors: Bohler Iain R M , Howse Louise , Baird Andrew , Giles Nigel
Published: July 2016

Objective:

There are multiple documented advantages of undertaking total knee arthroplasty (TKA) without tourniquet, however, increased rates of blood loss and transfusion are often cited as contraindications to this approach. The aim of this study was to examine the effect of intra-operative TA administration on blood loss and transfusion rates in TKA without pneumatic tourniquet, using Rivaroxaban as thrombo-embolic prophylaxis.

Method:

120 patients split into two continuous data sets, (A+B), underwent TKA without application of above knee tourniquet, receiving a post-operative dose of oral Rivaroxaban within 8 hours. Group B patients received an intra-operative dose of 1 gram of Tranexamic Acid intravenously before the first cut, whilst those in group A did not. Haemoglobin and Haematocrit levels were recorded peri-operatively. A revised Gross formula was used to calculate blood loss. Four patients were excluded from the study for incomplete data.

Result:

58 patients (M34F24) in Group A, average age 6, had a mean Haemoglobin drop of 33gram/litre, Haematocrit drop of 0.097litre/litre (9.7%), with an average calculated blood loss of 1393 ml. 58 (M34, F24) patients in group B, average age 67, had a Haemoglobin drop of 25.2gram/litre, Haematocrit drop of 0.076litre/litre (7.6%) with an average calculated blood loss of1079 ml. Thus Group A patients were seen to sustain significantly more blood loss without TA administration, with a 29.1% larger calculated blood loss, a 25.5% larger drop in Haemoglobin and a 27.6% larger fall in Haematocrit. Transfusion rate was 5.2%(3 patients) per group.

Conclusion:

TA was shown to be effective in reducing blood loss in TKA without tourniquet using Rivaroxaban. Transfusion rates of 5.2% across both groups is close to 1/10th of the transfusion rate reported for major studies of TKA using Rivaroxaban with tourniquet application, and 1/8th of the transfusion rate in studies of TKA with administration of TA and use of tourniquet.
The Impact of Patient and Surgical Factors for Primary Knee Arthroplasty Infection
Authors: Young S W , Tayton E R , Frampton C , Hooper G J
Published: July 2016

Objective:

The aim of this study was to identify risk factors for Prosthetic joint infection (PJI) following TKA.

Method:

The New Zealand Joint Registry database was analyzed, using revision surgery for PJI at 6 and 12 months as primary outcome measures. Statistical associations between revision for infection, with common and definable surgical and patient factors were tested. 64,566 primary TKAs have been recorded on the registry between 1999 and 2012 with minimum 12 months follow-up.

Results:

Multivariate analysis showed significant associations with revision for PJI (p<0.05) between male gender (odds ratio (OR) 1.85), previous surgery (osteotomy OR 2.45, ligament reconstruction OR 1.85), the use of laminar flow (OR 1.6) and the use of antibiotic-laden cement OR 1.93). There was a trend towards significance (p=0.052) with the use of surgical helmet systems (SHS) at 6 months (OR 1.53).

Conclusion:

These findings show patient factors remain the most important in terms of predicting early PJI following TKA. Furthermore, we found no evidence that modern SHSs reduce PJI risk and laminar flow systems may actually increase risk in TKA. The use of this registry data assists estimation of potential risk of PJI for individual patients, which is important for both informed consent and interpretation of institutional infection rates.
National joint registry data underestimates the burden of prosthetic joint infection
Authors: Young Simon , Zhu Mark , Ravi Saiprasad , Luey Chris
Published: July 2016

Objective:

Joint registries are powerful tools for tracking outcomes following joint arthroplasty. However recent literature has exposed deficiencies in data accuracy when reporting re-operations for prosthetic joint infections (PJI), particularly when no components are changed. The aim of this study was to compare accuracy of data from the New Zealand Joint Registry (NZJR) to a multi-centre audit of hospital records to establish the rate of capture for PJI reoperations.

Methods:

We followed 4009 patients undergoing total knee or hip arthroplasty performed at the three tertiary referral hospitals from January 2006 to December 2008 for two years. The reoperation rate for PJIs was extracted from the NZJR. In addition, an audit of hospital records for the same patients was carried out to identify reoperations for PJI. The audit data was then compared to the NZJR data.

Results:

The NZJR reported a reoperation rate of 0.67% for PJI within two years of the primary arthroplasty compared to 1.1% from the audit of hospital records, giving the NZJR a sensitivity of 63%. Only 36% of washout only procedures and 58% of modular exchange procedures were captured. Surgeons were more likely to report PJIs to NZJR if they performed the primary procedure.

Conclusion:

National joint registry data significantly underestimates the rate of reoperation for PJI. Strategies for improving data accuracy may include revising the registry forms to include reoperation without change of components and frequent validation of national data with other databases.
Unexplained Pain Following Total Knee Arthroplasty – Is Rotational Malalignment the Problem?
Authors: Young Simon , Roberts Catherine , Bauman Alicia , Sperlak Cynthia , Spangehl Mark , Clarke Henry
Published: July 2016

Objective:

Malrotation of both tibial and femoral components has been suggested as a potential source of pain following total knee arthroplasty (TKA). However previous studies have been small, with variable control groups. The aim of this study was to compare component rotational alignment in TKA patients with unexplained pain to a control group with well-functioning TKA.

Method:

Seventy-one patients presenting with unexplained pain following primary TKA were included in this retrospective, comparative study. Diagnostic work-up included clinical examination, blood tests, x-rays, long-leg films, and CT scan. Patients with an identifiable diagnosis or with initially well-functioning TKAs were excluded. A control group of 41 patients with well-functioning TKAs also underwent CT scans. Femoral component rotation was measured relative to the surgical epicondylar axis, and tibial component rotation relative to the medial third of the tibial tubercle using a previously validated method involving 3D-image reconstruction. Findings were compared between painful and control TKA groups.

Results:

We found no difference in femoral component rotation between the painful and control groups (mean 0.6° vs 1.0° external rotation (ER), p=0.4), and no difference in tibial component rotation (mean 11.2° vs 9.5° internal rotation(IR), p=0.3). Fifty-nine percent of patients in the painful group had tibial component rotation >9°IR versus 49% in the control group. 6% of patients in the painful group and 2% in the control group had femoral component rotation >3°IR. There was no difference in overall coronal alignment between groups (mean 1.3° varus vs 0.5° varus, p=0.23).

Conclusion:

In this the largest study yet reported on component rotation in TKA, we found no difference in the incidence of tibial or femoral component malalignment in painful versus well-functioning TKAs. Tibial component IR in particular appears to be a common finding, and its significance when evaluating the painful TKA should be interpreted with caution.
Ten-Year Comparison of Oxidized Zirconium and Cobalt-Chromium Femoral Components in Total Knee Arthroplasty
Authors: Roe Justin , Vioreanu Mihai , Salmon Lucy , Waller Alison , Pinczewski Leo
Published: July 2016

Objective:

The purpose of this study was to determine if oxidized zirconium femoral components had better outcomes than cobalt-chromium in vivo at medium and long term and if the use of oxidized zirconium components had clinical adverse effects.

Methods:

Forty consecutive patients (eighty knees) underwent simultaneous bilateral cruciate-retaining total knee arthroplasty for primary osteoarthritis from January 2002 to December 2003. For each patient, the knees were randomized to receive the oxidized zirconium femoral component, with the contralateral knee receiving the cobalt-chromium component. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, Knee Society score, and British Orthopaedic Association patient satisfaction scale. Radiographic outcomes include the Knee Society total knee arthroplasty roentgenographic evaluation and scoring system and measurement of radiographic wear. Patients and assessors were blinded to the treatment groups and results.

Results:

There were no significant differences in clinical, subjective, and radiographic outcomes between the two implants at ten years postoperatively. Ten years following surgery, 36% of the patients preferred the cobalt-chromium knee compared with 11% who preferred the oxidized zirconium knee (p = 0.02) and 53% had no preference.

Conclusions:

Ten-year outcomes after total knee arthroplasty with oxidized zirconium and cobalt-chromium femoral components showed no significant differences in clinical, subjective, and radiographic outcomes. Patients had no preference or preferred the cobalt chromium prosthesis to the oxidized zirconium prosthesis. There were no adverse effects associated with the use of oxidized zirconium femoral implants.
Cruciate Retaining Versus Cruciate Stabilising Total Knee Arthroplasty – A Prospective Randomised Kinematic Study
Authors: Godwin T L , Bayan A
Published: July 2016

Objective:

While there is a large body of research in regards to cruciate retaining(CR) and cruciate sacrificing total condylar knee replacement, the literature is spars in regards to highly conforming polyetheylene such as the triatholon cruciate stabilising tibial insert (CS).The aim was to determine whether there is a difference in the range of motion, kinematics as well as the functional outcome for Triathlon CS and CR TKJR.

Methods:

A single hospital consecutive series of one surgeon between 2011 and 2013 were enrolled. Kinematic data recorded prospectively at the time of surgery utilizing imageless navigation included preoperative and post-replacement extension, gravity flexion, passive flexion and rotation. Intraoperative femoral and tibial cuts and definitive implants were also recorded. Statistically analysis performed to compare CS and CR TKJR range of motion, deformity correction, and rotation pre and post-operatively. Oxford functional scores were obtained at the final follow up. 124 patients were randomised to 71 CS and 53 CR TKJR. The demographics were comparable between the two groups.

Results:

No significant difference was found between the groups’ preoperative range of motion. The net gain in extension for the CS group was 5.65 degrees (4.14-7.17) and for CR 5.64 degrees (4.24-7.04, p=0.99) with no significant difference shown. Post-operative gravity flexion significantly increased in CS TKJR with 129.01 degrees (127.37130.66) compared with 126.35 degrees (124.39-128.30, p =0.04) for CR. A weak positive correlation was shown between the size of distal femoral cut and post-operative extension for both CS and CR TKJR. A weak positive correlation was also shown for the difference between the intraoperative cuts (tibial and femoral) and the size of the implants used, in relation to post-operative extension. Post-operative oxford scores at average of 3.4 year follow up comparable between groups.

Conclusion:

The kinematics of CS and CR TKJR are comparable. The post-operative gravity flexion achieved with CS TKJR was statistically greater than for CR TKJR. Patients perceptions at an average 3.4 year follow up were comparable.
Causes and incidence of 30 day hospital re-admissions after primary TKJR
Authors: Mortimer John , van Dalen John
Published: July 2016

Objective:

30 day re-admission of patients following TKJR is estimated between 0.9-9.9%. It’s a cause of significant cost to the healthcare system and marks significant patient morbidity.

Aim:

The aim of this study is to describe the causes and incidence of patient re-admission to hospital within 30 days of a primary total knee joint replacement between 2009-2015 in a single centre.

Methods:

In a retrospective cohort study, computerized records were used to evaluated the causes and incidence of patient re-admission within 30 days of discharge following primary TKJR.

Results:

The total 30 day Re-admission rate was 5.0%. Medical causes for re-admission accounted for 29% of re-admissions. 34% were attributed to non-specific pain/swelling. Infection was attributed to 26%. 29% of patients presented with wound problems, either infective or non-infective. The total incidence of re-operation at 30 days was 0.77%.

Conclusions:

Our rate of re-admission is consistent with previous studies in the literature. Many patients were found to have no specific cause for re-admission. This suggests it may be possible to further reduce re-admission rates with improved patient education and management of common post-operative symptoms such as pain and swelling. Infection remains a common complication; fortunately the majority superficial infections are successfully treated with antibiotics and few requiring a washout operation. Medical complications account for almost a third showing the importance of good management of patient medical co-morbidities and risk factors.