bluuebunny/crossref_metadata_2025 huggingface dataset:
Value Orientations and Mental Health: A Theoretical Review
Authors: Heim Eva , Maercker Andreas , Boer Diana
Published: March 2019

Cross-national epidemiological studies show that prevalence rates of common mental disorders (i.e. depression, anxiety disorders, and PTSD) vary considerably between countries, suggesting cultural differences. In order to gather evidence on how culture relates to the aetiology and phenomenology of mental disorders, finding meaningful empirical instruments for capturing the latent (i.e. non-visible) construct of ‘culture’ is vital. In this review, we suggest using value orientations for this purpose. We focus on Schwartz's value theory, which includes two levels of values: cultural and personal. We identified nine studies on personal values and four studies on cultural values and their relationship with common mental disorders. This relationship was assessed among very heterogeneous cultural groups; however, no consistent correlational pattern occurred. The most compelling evidence suggests that the relationship between personal values and mental disorders is moderated by the cultural context. Hence, assessing mere correlations between personal value orientations and self-reported symptoms of psychopathology, without taking into account the cultural context, does not yield meaningful results. This theoretical review reveals important research gaps: Most studies aimed to explain how values relate to the aetiology of mental disorders, whereas the question of phenomenology was largely neglected. Moreover, all included studies used Western instruments for assessing mental disorders, which may not capture culturally-specific phenomena of mental distress. Finding systematic relationships between values and mental disorders may contribute to making more informed hypotheses about how psychopathology is expressed under different cultural circumstances, and how to culturally adapt psychological interventions.
Constructing deficit data doppelgängers: The impact of datafication on children with English as an additional language
Authors: Pierlejewski Mandy
Published: March 2019

In this article, an evaluation of the English early childhood education context reveals children constructed as data. The complex, chaotic and unpredictable nature of the child is reconstituted in numerical form – a form which can be measured, compared and manipulated. Children are reconceptualised as data doppelgängers, ghostly apparitions which emulate the actual embodied child. The focus of early childhood education and care thus moves from child-centred to data-centred education. The author specifically focuses on the impact of this aspect of the performative regime on children who have English as an additional language – an under-researched area in the field. Foucault’s work on governmentality is used as a theoretical lens through which to understand the process of datafication. The author uses a composite child, generated from a number of children from her experience as a teacher, as a starting point for discussion. This reveals children as disadvantaged, as their home languages are no longer used to assess communication skills. Their data doppelgängers are not useful to the teacher as they are unable to demonstrate a Good Level of Development – a key measure of school readiness in English policy. The author argues that in post-Brexit-vote Britain, subtle changes to early childhood education increase disadvantage, promoting white, British culture and thus marginalising those from other cultures.
Elicitation of salient brand emotions in Western and East Asian markets: The role of elicitation context
Authors: Jakubanecs Alexander , Supphellen Magne , Fedorikhin Alexander , Haugen Hege Mathea , Sivertstøl Njål
Published: March 2019

The objective of this article is to show the effects of the use of Free Association Technique on the elicitation of brand emotions and functional associations across a Western and an East Asian culture as well as to identify and test underlying mechanisms. The use of Western techniques for eliciting brand emotions may prove challenging for marketers in East Asian markets because of the different styles of thinking and feeling of consumers in the West versus East Asia. This investigation focuses on the role of visual context (individual vs social), in which brands are presented when eliciting brand associations in the West and in East Asia. The study shows that elicitation context significantly influences the type of brand emotions and functional associations across two distinct cultures: Norway and Thailand. Consumers’ self-construal and thinking style mediate the effects of culture, as interdependent self-construal and holistic thinking explain more context-dependent brand emotions generated by Thai than Norwegian consumers. This research has important implications for studying and managing brand associations and emotions across markets. The traditional view of brands as possessing abstract, stable associations, and emotions should be reconsidered in the East Asian cultural context. Marketing managers should adapt established Western elicitation techniques to the characteristics of East Asian consumers to increase their validity.
Optimization of a columnar vortex generator installed over an aircraft carrier ski-jump ramp
Authors: Bardera Rafael
Published: March 2019

Aircraft performances over aircraft carriers are essential in modern navies. Take-off operation is critical due to the short runway available. The ski-jump ramp is a useful system that allows to operate under safe conditions. However, the sharp edge at the end of the runway provokes a region with recirculation bubble and low velocity producing strong flow disturbances. Hence, the aircraft performances are affected and the pilot’s workload is augmented. Previous researches showed that columnar vortex generator reduces the recirculation bubble generated over the end of flight deck. This article presents an in-depth experimental study performed by wind tunnel testing in order to determine the relation between the columnar vortex generator size and the recirculation bubble reduction. Particle image velocimetry is used to investigate the flow field velocity and flow structure around the ski-jump ramp as a non-intrusive experimental technique. Encouraging results were found for the biggest columnar vortex generator studied.
Prevalence of Telehealth in Nursing: Implications for Regulation and Education in the Era of Value-Based Care
Authors: Rambur Betty , Palumbo Mary Val , Nurkanovic Mirsada
Published: March 2019

Value-based care theoretically catalyzes the business case for telehealth. Hence, the purpose of this study was to define the proportion of a statewide nursing workforce who self-reported telehealth or telephonic nursing as their primary work setting in a U.S. state undergoing rapid transitions to value-based care. We conducted a secondary analysis of a 2017 statewide nurse relicensure survey ( n = 10,851), overall response rate 99%. The focus of the analysis was registered nurses who reported that they were currently working in Vermont or serving residents of the state ( n = 8,457). Analysis was limited to descriptive statistics. We found that 18.4% of respondents ( n = 1,556) reported their employment status as “telehealth/ working as a telephonic nurse.” Responding to a different question, 17.2% ( n = 1,458) defined “telehealth/telephonic” as their primary work setting. Thus, nearly one fifth of nurses practicing in the state were employed in telehealth, a role for which there is scant preparation in nursing education. The multistate practice of roughly one third of these nurses highlights the importance of the Enhanced Nurse Licensure Compact and raises questions about global telenurse practice. Taken as a whole, these findings have profound implications for health care policy development and implementation, ongoing workforce development and analyses, nursing regulation, education, and continuing education. New and renewed skills are needed to provide safe, effective, culturally relevant telehealth, and virtual care.
Cervical Cancer Protective Behavioral Patterns Among Mexican Women Living With HPV
Authors: Guerra Rodríguez Gloria Maricela , Champion Jane Dimmitt , Moreno Monsiváis María Guadalupe , Olivares Ornelas Octavio Augusto , Gil Vázquez Héctor Manuel
Published: March 2019

Purpose:

Human papillomavirus (HPV) causes morbidity and mortality worldwide. Evidence-based models addressing health for women who have HPV may prevent development of cervical cancer (CC). We applied Meleis’ transition model to identify barriers and facilitators influencing CC protective behavior for women with HPV.

Method:

Descriptive, correlational design including nonprobabilistic sampling of women with HPV ( N = 201) in Mexico.

Results:

Variables linked to CC protective behavior (cervical cytology, stable partner, condom use, communication) included awareness of HPV/CC as well as attitude toward diagnosis and cytological control of HPV (λ = 890, F[196.00] = 6.057, p = .001). Acceptance of HPV diagnosis related to HPV carrier attitude, stigma, age, education, and length of HPV diagnosis ( R2 = .155 , F[5, 195] = 8.34, p < .05). Knowledge of HPV, attitude toward HPV diagnosis/cytological control, and age had direct effects on self-efficacy for CC protective behavior ( R2 = .239, F[7, 193] = 9.95, p < .05). Coping with HPV diagnosis, self-efficacy for CC protective behavior, and age were also associated with CC protective behavior ( R2 = 14.6, F[3.7] = 12.39, p = .001).

Conclusions:

Identification of factors inhibiting or facilitating transition among women who have HPV decrease progression to CC by increasing CC protective behaviors.
Motivational Interviewing and Home Visits to Improve Health Behaviors and Reduce Childhood Obesity: A Pilot Study
Authors: Early Gayle J. , Cheffer Natalie D.
Published: March 2019

Introduction:

Childhood obesity prevalence is highest among low-income, Hispanic, and Black children. The purpose of this study was to examine the feasibility of using motivational interviewing (MI) with home visits and the 5-2-1-0 Let’s Go! program to improve health behaviors in children. Desirable health behaviors include daily consuming five servings of fruits or vegetables, limiting recreational screen time to 2 hours, exercising for 1 hour, and avoiding sugar-sweetened beverages.

Method:

Of 68 predominantly Hispanic/Latino participants from three clinic sites, 35 completed the study. One site provided usual care (UC). MI was conducted by a nurse practitioner, reinforced with home or clinic visits. Survey and biometric data were obtained three times over 6 months. Analyses included mean difference of behaviors, and matched pairs t test of initial and final visit behaviors.

Results:

Health behavior trends improved in both the MI and UC groups; however, more improvement was evident in the MI group. Home visits were appreciated but challenging as the social context of immigration law in 2017 had an unanticipated effect on the study.

Conclusions:

MI and clinician reinforcement of healthy behaviors may be beneficial for children and families. Home visits cannot be recommended in the undocumented immigrant population at this time.
Opioid Versus Nonopioid Analgesia After Carpal Tunnel Release: A Randomized, Prospective Study
Authors: Grandizio Louis C. , Zhang Hui , Dwyer C. Liam , Goldberg Steven H. , Klena Joel C.
Published: March 2019

Background: The purpose of this investigation was to compare pain control and patient satisfaction for conventional postoperative opioid analgesia and nonopioid multimodal analgesia after elective open or endoscopic carpal tunnel release (CTR). Methods: As part of a randomized, prospective study, patients undergoing primary, elective CTR were randomized to receive either postoperative opioids or nonopioid medications as part of a multimodal pain control strategy. Patients currently taking opioids were excluded. Patients completed a postoperative pain journal and completed the shortened version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), Boston Carpal Tunnel Questionnaire, Numeric Pain Rating Scale (NPRS), and satisfaction ratings at their 2-week visit. Results: A total of 68 patients were included. Preoperatively, there were no statistically significant differences between the 2 groups with respect to pain scores, coping skills, or carpal tunnel symptoms. At 2 weeks postoperatively, patients in the nonopioid group had lower average NPRS and QuickDASH scores. Patients who took opioids consumed an average of 5 pills. No patient randomized to the nonopioid group required any opioids. Patients in the nonopioid group demonstrated lower early postoperative NPRS scores. Patient satisfaction with their pain control regimen and outcome was not significantly different between the 2 groups at any time point. Conclusions: Nonopioid medications as part of a perioperative pain control strategy demonstrate improved pain scores compared with opioid medications with similar patient satisfaction and functional outcomes. Considering the risks associated with the use of opioid analgesics, we recommend against prescribing opioids after CTR, particularly in patients not currently taking narcotic medications.
Finite-time control for double-layer Peltier system based on finite-time observer
Authors: Chen Congyan , Ding Shichen , Li Shihua
Published: March 2019

The Peltier is a refrigeration device and usually used in the form of single layer. Sometimes single-layer Peltier may not have sufficient refrigerating capacity with deeper application. To this end, a double-layer Peltier system is proposed in this article. With the increasing layers, the nonlinearity of the system is enhanced and the multiple variables are coupled, bringing about control difficulty. To solve these control problems and promote the disturbance rejection performance, a composite controller is presented, consisting of feedback regulation based on finite-time control and feed-forward compensation based on finite-time disturbance observer. Then, finite-time Lyapunov stability analysis is shown to prove that this control scheme can converge to the equilibrium point in finite time. Last but not least, simulation and experiment are conducted to verify that the proposed strategy has not only a rapid convergence performance but also a prominent disturbance rejection property.
Outsiders’ Thoughts on Generating Self-Regulatory-Depletion (Fatigue) Effects in Limited-Resource Experiments
Authors: Wright Rex A. , Mlynski Christopher , Carbajal Ivan
Published: March 2019

We offer thoughts pertaining to purported conceptual and replication crises that have been discussed in relation to the limited-resource model (LRM) of self-control, functioning as crisis outsiders who have been conducting related research concerned with determinants and cardiovascular correlates of effort. Guiding analyses in our laboratory convey important lessons about experimental generation of the now-classic LRM self-regulatory-fatigue effect on control. They do so by drawing attention to conditions that must be met in fatigue-induction and fatigue-influence phases of relevant experiments. One fundamental lesson is that even highly standardized fatigue-induction protocols cannot be expected to consistently allow definitive tests of this effect. Another is that the effect might emerge consistently only in a behavioral-restraint “sweet spot” of sorts—a multidimensional motivational space wherein rested study participants view restraint as possible and worthwhile and fatigued participants do not. Implications are identified and discussed.
Citizenship education in the United Kingdom and the adult migrant
Authors: Shah Qasir
Published: March 2019

This article explores the policy reasons behind Adult ESOL Citizenship Education in the United Kingdom and then examines whether Adult ESOL Citizenship Education adequately prepares migrants for active citizenship in T.H. McLaughlin’s ‘ maximal’ sense: involving active political participation premised upon a shared concept of democratic culture underpinned by rights and obligations. It argues that Adult ESOL Citizenship Education, as envisaged by Bernard Crick and Terence McLaughlin, has fallen short of its maximal conceptualisation due to the watering down of citizenship education and Adult ESOL Citizenship Education in preference to Fundamental British Values, and the Crick reports’ ‘light touch’ to their implementation. The article calls for a need to reassert the reality of the modern nation as pluralistic and rejects the current drive towards monism. It also argues that Adult ESOL Citizenship Education is unlikely to deliver social cohesion and integration, or an actively participatory citizenry, unless issues of social justice and equity are addressed.
Radiomics: a novel feature extraction method for brain neuron degeneration disease using 18F-FDG PET imaging and its implementation for Alzheimer’s disease and mild cognitive impairment
Authors: Li Yupeng , Jiang Jiehui , Lu Jiaying , Jiang Juanjuan , Zhang Huiwei , Zuo Chuantao
Published: March 2019

Background:

Alzheimer’s disease (AD) is the most common form of progressive and irreversible dementia, and accurate diagnosis of AD at its prodromal stage is clinically important. Currently, computer-aided diagnosis of AD and mild cognitive impairment (MCI) using 18F-fluorodeoxy-glucose positron emission tomography (18F-FDG PET) imaging is usually based on low-level imaging features or deep learning methods, which have difficulties in achieving sufficient classification accuracy or lack clinical significance. This research therefore aimed to implement a new feature extraction method known as radiomics, to improve the classification accuracy and discover high-order features that can reveal pathological information.

Methods:

In this study, 18F-FDG PET and clinical assessments were collected in a cohort of 422 individuals [including 130 with AD, 130 with MCI, and 162 healthy controls (HCs)] from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and 44 individuals (including 22 with AD, and 22 HCs) from Huashan Hospital, Shanghai, China. First, we performed a group comparison using a two-sample Student’s t test to determine the regions of interest (ROIs) based on 30 AD patients and 30 HCs from ADNI cohorts. Second, based on two time scans of 32 HCs from ADNI cohorts, we used Cronbach’s alpha coefficient for radiomic feature stability analyses. Pearson’s correlation coefficients were regarded as a feature selection criterion, to select effective features associated with the clinical cognitive scale [clinical dementia rating scale in its sum of boxes (CDRSB); Alzheimer’s disease assessment scale (ADAS)] with 500-times cross-validation. Finally, a support vector machine (SVM) was used to test the ability of the radiomic features to classify HCs, MCI and AD patients.

Results:

As a result, we identified brain regions which were mainly distributed in the temporal, occipital and frontal areas as ROIs. A total of 168 radiomic features of AD were stable (alpha > 0.8). The classification experiment led to maximal accuracies of 91.5%, 83.1% and 85.9% for classifying AD versus HC, MCI versus HCs and AD versus MCI.

Conclusion:

The research in this paper proved that the novel approach based on high-order radiomic features extracted from 18F-FDG PET brain images that can be used for AD and MCI computer-aided diagnosis.
Chain substitution and successive approximation method: Throughput analysis at SMEs
Authors: García-Vidal Gelmar , Pérez-Campdesuñer Reyner , Sánchez-Rodríguez Alexander , Martínez-Vivar Rodobaldo
Published: March 2019

The purpose of this research work is to illustrate that using the logic of theory of constraints (TOC) concerning the Throughput is adequate in management decisions to improve performance in the context of small and medium enterprises. The TOC approach assumes the use of Throughput as an indicator of performance, and in this paper the method of chain substitution and successive approximation is proposed to analyze this indicator. After the implementation of the Throughput per hour analysis, the owner-manager changed her perspective about what her priorities should be in the exercise of the administrative process. The identification of the restriction of what prevented him from obtaining more money allowed him to make the decisions or courses of action that maximized the Throughput per hour, thus improving his performance as owner-manager, the performance of his enterprise and the economic situation of his employees. The originality of this article consists in the application of TOC approach through the design of the indicator Throughput per hour to analyse the performance of an entrepreneur and the application of the chain substitution and successive approximation method for the study of the restrictions that inhibit it.
A Critical Analysis of Colour–Shape Correspondences: Examining the Replicability of Colour–Shape Associations
Authors: Dreksler Noemi , Spence Charles
Published: March 2019

Research on the topic of colour–shape correspondences started in the early 20th century with the Bauhaus artist Wassily Kandinsky. However, more recently, the topic has been examined using the empirical framework of crossmodal correspondences research. The field remains one in which consistent results and generalisable hypotheses about the existence and nature of colour–shape correspondences are lacking. The replicability and consistency of findings concerning colour–shape correspondences are examined in three online colour–shape matching experiments using the same procedure and study design while varying the sets of shape stimuli that are evaluated. Participants matched one of 36 colours to each shape as well as made preference and arousal appraisal ratings for each of the shapes and colours. The complexities of analysing colour–shape correspondence data are discussed and illustrated by classifying and analysing shape and colours in a variety of different ways, including using continuous perceptual and objective measures. Significant colour–shape associations were found. However, as hypothesised, limited consistent results in regard to what perceptual shape characteristics predicted colour choices were documented across the three stimuli sets. This was the case both within and across different analysis methods. The factors that may be responsible for these inconsistencies are critically discussed. Intriguingly, however, evidence for emotional mediation, whereby shape and colour liking and arousal appraisals appear to influence the colour–shape correspondences made by participants, was found across all three experiments.
A practical guide to episode groupers for cost-of-illness analysis in health services research
Authors: Peterson Cora , Grosse Scott D , Dunn Abe
Published: March 2019

Despite the prominence of episode groupers for analysis and reimbursement in US payer settings, peer-reviewed articles using episode groupers for cost-of-illness analysis that informs public health research and decision-making are uncommon. This article provides a brief practical guide to episode-based cost analysis and offers some examples of episode grouper products. It is intended for an audience of health services researchers and managers in public health settings who perform or commission cost-of-illness studies with the US healthcare claims fee-for-service data but lack familiarity with episode groupers.
Cardiac gene expression and function in a mouse model of community-acquired methicillin-resistant Staphylococcus aureus sepsis: Role of inflammatory caspases 1 and 11
Authors: Hume Janet R , Zhang Yuan , Zhang Lei , Peterson Marnie , Carlson Deborah L
Published: March 2019

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an important cause of invasive infections, including sepsis associated with myocardial dysfunction. Caspases 1 and 11, involved in activation of the inflammasome, have been shown to be critical in response to sepsis as well as myocardial dysfunction of numerous etiologies. We examined the survival, myocardial function, and production of inflammatory mediators in mice lacking caspases 1 and 11. Cas 1/11 KO mice demonstrated no significant difference in mortality or in cardiac shortening fraction relative to control mice. Cas 1/11 KO mice had significantly reduced upregulation of expression of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in the heart relative to control mice after CA-MRSA infection, as well as reduced serum production of IL-1β, TNF-α, and IL-6, with no difference in IL-10 production. Other inflammatory mediators beyond IL-1β, TNF-α, and IL-6 may be involved in myocardial dysfunction in CA-MRSA sepsis.
Rekeying Cultural Scripts for Youth Suicide: How Social Networks Facilitate Suicide Diffusion and Suicide Clusters Following Exposure to Suicide
Authors: Abrutyn Seth , Mueller Anna S. , Osborne Melissa
Published: March 2019

Research suggests that suicide can socially diffuse through social relationships and social contexts; however, little is known about the mechanisms that facilitate this diffusion. Using data from an in-depth case study of a cohesive community with an enduring youth suicide problem (N = 118), we examine how, after repeated exposure to suicide, the community’s cultural script for suicide may have been rekeyed such that suicide became a more imaginable option for some community youth. Essentially, we found evidence that a series of sudden, shocking, suicide deaths of high-status youth may have triggered the formation of new locally generalized meanings for suicide that became available, taken-for-granted social facts. The new meanings reinterpreted broadly shared adolescent experiences (exposure to pressure) as a cause of suicide facilitating youth’s ability to imagine suicide as something someone like them could do to escape. We conclude by discussing the implications of our findings for the scientific understanding of (1) suicide and suicide clusters, (2) social diffusion processes, and (3) suicide prevention.
Innovations in Worksite Diagnosis of Urinary Tract Infections and the Occupational Health Nurse
Authors: O’Keefe Louise C. , Koelle Paula , McGee Zac , Dewberry L. Savannah , Wright Carter , Stallings J. Ethan , Gates Elizabeth , Chittur Krishnan
Published: March 2019

Occupational health nurses play a key role in evaluating innovative technologies that can aid in providing safe and rapid care and reduce lost work time. A nurse-led employee health clinic participated in a validation study of a novel pathogen detection technique developed by GeneCapture, Inc. Their proposed portable urinary tract infection (UTI) in vitro diagnostic test was challenged with discarded, deidentified urine samples from patients presenting with typical UTI symptoms collected at two university clinics and two multiphysician practices. GeneCapture’s panel for this study was designed to rapidly identify the genetic signature of seven organisms: gram-negative Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa; gram-positive Enterococcus faecalis and Staphylococcus aureus; and fungal Candida species. The results from 40 clinical samples were in 95% agreement (90% specificity, 100% sensitivity) with traditional urine culture results from routine analysis. This successful occupational health nursing collaboration and validation study shows promise for point-of-care diagnoses and earlier treatment for workers with UTIs.
FAI SURGERY IN THE ADOLESCENT POPULATION: MILD DEFORMITIES AND LACK OF SPORTS PARTICIPATION ARE ASSOCIATED WITH AN INCREASED RISK OF TREATMENT FAILURE
Authors: Nepple Jeffrey J. , Yen Yi-Meng , Zaltz Ira , Podeszwa David , Sink Ernest L. , Kim Young-jo , Sucato Dan , Group Anchor , Clohisy John
Published: March 2019

Background:

Femoroacetabular impingement (FAI) is as prevalent in adolescents as in adults, yet few studies have analyzed treatment outcomes in the adolescent population. The purpose of this study was to determine the clinical outcomes of FAI surgery in adolescent patients and to identify predictors of treatment failure.

Methods:

A cohort of 126 adolescent patients (<18 years) undergoing surgery for symptomatic FAI were prospectively assessed among a larger multicenter cohort. The adolescent subgroup included 74 (58.7%) males and 52 (41.3%) females, had a mean age of 16.1 years (range 11.3-18.0), and a mean follow-up of 3.7 years. Mild cam FAI was defined by an alpha angle less than 55 degrees. Clinical outcomes were analyzed with the mHHS, HOOS (5 domains), and UCLA activity score. Failure was defined as revision surgery or clinical failure (failure to reach MCID (minimally clinically important difference) or PASS (patient acceptable symptoms state) for modified Harris Hip score. Statistical analysis was performed to identify factors significantly associated with failure.

Results:

There was clinically important improvement in all PROs (mHHS, all HOOS domains) for the overall cohort and 81% of patients met criteria for a successful outcome. The failure rate (revision surgery or clinical failure) of the overall cohort was 19%, including revision surgery in 8.7%. Female patients were significantly more likely than male patients to be classified as a failure (25.7% vs. 9.1%, p=0.017, OR 2.6), in part because of a lower preoperative mHHS (59.1 vs. 67.0, p<0.001). Mild cam FAI (alpha less than 55 degrees) was present in 31.5% of cases including 39.1% of females and 14.5% of males. Maximal alpha angle was significantly inversely associated with the failure rate (37.5% for alpha<55, 19.2% for alpha 55-63, and 6.8% for alpha>63, p<0.005). Non-athletes were at a significantly greater risk of failure compared to athletes (26.5% vs. 10.3%, p=0.043, OR 2.3). Multivariable logistic regression identified mild cam FAI and lack of participation in sports as predictive of failure (p=0.005 and p=0.04), while gender was no longer significantly associated with failure after controlling for other variables.

Conclusions:

Adolescent patients undergoing surgical treatment of FAI demonstrate significant improvement at early followup. However, mild cam FAI deformities (which are common in adolescent female patients) and lack of participation in sports are independently associated with higher rates of treatment failure. These factors associated with treatment failure should be considered in surgical treatment decision-making and patient counseling.
DOES DISCOID MORPHOLOGY AFFECT PERFORMANCE ON RETURN-TO-SPORT TESTING AFTER MENISCUS REPAIR?
Authors: Kuba Megan , Snetselaar Jordan , Gupta Andrew , Bompadre Viviana , Saper Michael
Published: March 2019

BACKGROUND

Return-to-Sport (RTS) after knee surgery involves the return of strength and dynamic knee stability, which can be assessed with isometric strength and functional performance testing. There is little evidence-based data to assist with RTS decision-making after meniscus repair. Furthermore, there is limited RTS data comparing patients with discoid meniscus tears and instability from those with non-discoid tears. The purpose of this study was to compare the performance on functional RTS tests between pediatric patients with discoid and non-discoid meniscus tears.

METHODS

A retrospective review was performed of pediatric patients that underwent isolated meniscus repair by a single pediatric orthopaedic surgeon from 2010-2016. Thirty patients (14 discoid, 16 non-discoid) were identified who underwent a postoperative RTS assessment consisting of isometric strength testing, the Lower Quarter Y-balance Test (YBT-LQ), and single-leg hop testing (single hop for distance, triple hop for distance, crossover triple hop for distance, and timed hop). Demographic information and RTS data were compared between groups. Recovery of muscle strength was defined by a limb symmetry index (LSI) =90%. Statistical significance was set at P = 0.05.

RESULTS

The mean age of the patients was 13.95 years (range, 8-19 years). Patients in the discoid group were younger than those with non-discoid meniscus tears (12.9 vs 15.1 years, respectively) (P =0.05). There was a statistically significant difference in the average time from surgery to RTS test between the discoid (269 days) and non-discoid (184 days) groups. (P =0.02). For isometric strength testing, both groups had mean LSIs greater than 90% for quadriceps, hamstring, and hip abduction. There were no statistically significant differences between groups in isometric strength or performance on the YBT-LQ or any of the single-leg hop tests.

CONCLUSIONS

Pediatric patients who undergo repair of a discoid meniscus may require prolonged rehabilitation to achieve satisfactory completion of RTS testing. In our study, an additional 3 months on average were required to allow adequate recovery of muscle strength and dynamic functional stability when compared to those with a non-discoid meniscal repair. However, upon completion of a structured physical therapy program with stringent RTS guidelines, at the time of testing, there was no significant difference in performance on any of the RTS tests between patients with discoid and non-discoid meniscus tears. The findings of this study can assist orthopedic surgeons in safely returning pediatric patients back to sporting activities following meniscus repair.
MENISCUS ROOT TEARS IN CHILDREN AND ADOLESCENTS
Authors: Willimon S. Clifton , Christino Melissa , Busch Michael , Perkins Crystal
Published: March 2019

Background:

The medial and lateral menisci function to optimize force transmission across the knee by increasing contact area between the femur and tibia, absorbing shock, and transmitting loads. Injuries to the meniscus root attachments result in extrusion of the meniscus, impaired distribution of hoop stresses, and degenerative articular wear. The purpose of this study is to describe meniscus root tears, associated injuries, and treatment in a series of pediatric patients

Methods:

A single-institution retrospective review was performed of consecutive pediatric patients treated for meniscus root tears from 2013 – 2017. Inclusion criteria were patients less than 19 years of age, arthroscopic evidence of a meniscus root tear, and minimum 6 months clinical follow-up. The primary outcome was surgery for revision of the meniscus repair.

Results:

Twenty-seven patients were identified to fit inclusion criteria. There were 15 males and 12 females with a mean age of 15.2 years (range 7 – 18 years). Basketball, soccer, and football accounted for the majority (56%) of injuries. The lateral meniscus was involved in 21 patients (78%) and the medial meniscus in 6 patients (22%). The posterior meniscus root was torn in 25 patients (93%) and anterior meniscus root in 2 patients (7%). The most common injury pattern was a lateral meniscus posterior root tear (19 patients, 70%). Associated injuries included an ACL tear (19 patients, 70%), PCL tear (6 patients, 22%), and a tear of the opposite meniscus (7 patients, 26%). Two root tears occurred in isolation, and both were of the posterior root of the medial meniscus. All patients were treated surgically with an arthroscopic transosseous root repair in addition to simultaneous treatment for their associated injuries. Mean follow-up was 14 months (range 6 – 37 months). No patients required additional surgery for their meniscus root tear. Two patients had a second surgery on the affected knee: one for revision ACL reconstruction 2 years following the primary procedure and the other for chondroplasty of the patella 2.5 years following the primary procedure.

Conclusions:

Meniscus root tears occur in pediatric and adolescent patients, most commonly affecting the posterior root of the lateral meniscus and occurring in association with ACL tears. The adolescent meniscus root injury pattern is unique compared to the adult population in which the medial meniscus posterior root is often injured in isolation. Inspection of the meniscus root attachments with deliberate probing to assess the meniscus roots should be a routine part of every knee arthroscopy. In our case series, transosseous root repair resulted in successful outcomes in all patients without need for any additional meniscus treatment.
SAFETY IN OUTPATIENT SURGICAL PROCEDURES – A REVIEW OF EARLY COMPLICATION RATES OF AMBULATORY SPORTS MEDICINE CASES
Authors: Iyinbor Angelina , Bernard Johnathan A. , Johnson David C. , Ismaeli Zahra , Coleman Nathan , Johnson Timothy S. , Mason Bonnie
Published: March 2019

Background:

Due to rising health care costs, attention has been dedicated to understanding both outcomes and expenditure as it relates to improving value. There is an increasing trend to perform inpatient hospital procedures in the ambulatory setting to lower costs. Complications to surgical procedures are costly. However, there is a paucity of data reporting early complications. This study aims to determine the 30-day postoperative complication rate of ambulatory surgical procedures in a sports medicine practice.

Methods:

A retrospective review of four Sports Fellowship trained orthopaedic surgeons at a single institution was conducted for all procedures performed over a 29-month period. The inclusion criteria consisted of all ambulatory surgical cases. Surgeon completed infection control surveys were reviewed from the included patients which contained information on intra-operative complications, post-operative infections, emergency room (ER) visit or hospitalization related to the procedure. Demographics on the patients were collected via the institutional electronic medical record (EMR). Descriptive statistics were performed on case type and frequency (Microsoft Excel).

Results:

From January 1, 2015 through May 31, 2018, 571 surgical procedures performed in the ambulatory setting met inclusion criteria. There was a total of six surgical complications reported (three dermatologic, two deep vein thrombosis, one hemarthrosis). There were no intra-operative complications reported and no surgical site infections reported.

Conclusions/Significance:

During the two year and five months study period, the sports medicine, orthopaedic surgery institution had an overall complication rate of 0.51%. This rate is within the historical norm for the majority of the procedures performed. There were no intra-operative complications and no surgical site infections. Only one patient required an ER visit in over 2 years. Ambulatory surgery performed by Sports Fellowship trained, Board Certified Orthopaedic Surgeons in select patients can be performed safely with minimal complications thus lowering costs and improving value.
CONCOMITANT POSTEROLATERAL CORNER INJURIES IN SKELETALLY IMMATURE PATIENTS WITH ACUTE ANTERIOR CRUCIATE LIGAMENT INJURIES
Authors: Kinsella Stuart D. , Rider Sean M. , Tepolt Frances , Ecklund Kirsten , Kocher Mininder S.
Published: March 2019

Background:

Missed and/or untreated posterolateral corner (PLC) injuries are a known cause of anterior cruciate ligament (ACL) reconstruction failure in the adult population. Failed ACL reconstruction causes significant morbidity in the skeletally immature pediatric population. There is little literature on the character and potential significance of posterolateral corner injuries in skeletally immature patients.

Methods:

Magnetic resonance imaging (MRI) studies of the knee performed at a single tertiary care pediatric hospital between 01/01/2010 and 12/31/2015 for patients who underwent an ACL reconstruction were retrospectively reviewed. Demographic variables were obtained via medical record review, and MRI studies were evaluated for PLC (popliteus, fibular collateral ligament (FCL), popliteofibular ligament (PFL), arcuate ligament) injury, as well as ACL, medial collateral ligament (MCL), bone bruise, fracture, and meniscal pathology by an experienced pediatric musculoskeletal radiologist.

Results:

Fifty-two patients, 65% of whom were male, with a mean age of 13.8 years at injury were analyzed. PLC injuries were found in 28 patients (54%), with 7 patients (14%) having a complete tear of a component of the PLC. MCL injuries were found in 13 patients (25%). Meniscus tears were found in 25 patients (48%); 17 were of the medial meniscus (33%), and 10 were of the lateral meniscus (19%). A Segond fracture was seen in four patients (8%). The most common injury pattern involved the PFL only (9, 32% of patients with PLC injuries). There was no association between sex (p=0.29), Segond fracture (p=0.09), meniscus injury (p=0.93), or MCL injury (p=0.32) with the risk of PLC injury. There was an association between patient age and PLC injury (p=0.02). For each additional year of age, the odds of PLC injury increased by 1.7 times (OR=1.7 (1.1, 2.8)). Patients were an average age of 14.0 years at ACL reconstruction, and 9 patients went on to re-tear. There was no association between PLC injury and ACL graft failure (p=0.72).

Conclusions:

This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the skeletally immature patient population. Age was found to predict the odds of PLC injury, which was significantly higher in older skeletally immature patients. No other concomitant injury predicted likelihood of PLC injury.
RECOVERY OF LOWER EXTREMITY STRENGTH AND FUNCTION FOLLOWING ACL RECONSTRUCTION IN SKELETALLY IMMATURE PATIENTS
Authors: Sugimoto Dai , Heyworth Benton E. , Davis Farren , Kocher Mininder S. , Micheli Lyle J.
Published: March 2019

BACKGROUND:

Following anterior cruciate ligament reconstruction (ACLR) surgery, lower extremity recovery of the uninjured limb >90% is commonly recommended for clearance to return-to-play (RTP). However, evidence regarding the timing of achieving such a recovery is lacking, especially in skeletally immature populations. Therefore, the purpose of this study was to examine the proportion of pediatric ACLR patients (<15 years) who achieve >90% of lower extremity recovery at 6-9 months following ACLR surgery.

METHODS:

Retrospective case series study design was employed. Following inclusion criteria were used: 1) those who had ACLR surgery, 2) their chronological ages were under 15 years, and 3) growth plates remains open. Status of physis (growth plates) was examined through radiographs and MRI images by orhtopaedic physicians. ACLR patients who had previous ACL surgery in either ipsilateral or contralateral limb were excluded. During RTP tests, bilateral strength (quadriceps, hamstrings, hip abductor, and hip extensor), Y-balance (anterior, posteromedial, and posterolateral reach), and hop (single, triple, cross-over, and 6 meter timed) tests were assessed. Main outcome variables were number of skeletally immature ACLR patients whose limb symmetry index (LSI) were >90% during RTP tests. Descriptive statistics were used to analyze frequency, mean, standard deviation, and percentages (%).

RESULTS:

A total of 106 skeletally immature ACLR patients were enrolled (Table 1). Hamstrings and iliotibial band grafts were commonly used for ACLR surgery (Table 2). Mean time from ACLR to RTP testing was 6.8±3.4 months (Table 2). The proportion of skeletally immature ACLR patients, overall, achieving >90% of LSI in strength was: 74.5% in quadriceps, 39.0% in hamstrings, 81.0% in hip abductors, and 82.9% in hip extensors. Y-balance test results indicated 79.5% in anterior reach, 84.8% in posteromedial reach, and 86.7% in posterolateral reach. Hop test showed 65.3% in single hop, 69.1% in triple hops, 59.1% in cross-over hops, and 74.2% in 6 meter timed hops. Proportion of skeletally immature ACLR patients who passed all four strength, three Y-balance, and four hop tests were 19.8%, 64.8%, and 27.8%. Only 4.2% of skeletally immature ACLR patients demonstrated >90% of LSI in all tests at RTP tests.

CONCLUSION/SIGNIFICANCE:

Approximately 7 months following ACLR, approximately 3/4 of the patients achieved >90% of quadriceps, hip abductor, and hip extensor strength, but not hamstrings strength. While over 4/5 of the patients performed >90% in Y-balance, less than 3/4 achieve >90% on hop tests. These results suggest approximately 7 months following ACLR may be too early for returning competitive sports in skeletally immature population. Future studies are warranted to find an association between those RTP test batteries and subsequent ACL tear risks. [Table: see text][Table: see text]
“RELATIVE” RISK OF ACL RE-INJURY
Authors: Bram Joshua T. , Talathi Nakul S. , DeFrancesco Christopher J. , Patel Neeraj M. , Ganley Theodore J.
Published: March 2019

Background

Several studies have examined ACL injury history among relatives of patients undergoing ACL reconstruction, but they have primarily analyzed adult populations with variable results. Additionally, few studies have examined concomitant injuries or post-operative outcomes among pediatric patients with a family history of ACL tear. Therefore, the purpose of this study was to identify the proportion of pediatric ACL patients with a first degree relative who had suffered an ACL tear while also examining concomitant meniscal or ligamentous injuries and subsequent complication rates.

Methods

1009 patients who underwent ACL reconstruction at an urban tertiary care children’s hospital between January 2009 and May 2016 were contacted via email and/or telephone and asked to complete a follow-up survey. Data collected included subsequent complications – including graft rupture, contralateral ACL injury, and meniscus tears – along with information regarding any relatives who had suffered an ACL tear. Patient medical records were reviewed to determine the age of the patient at the time of surgery as well as concomitant meniscus and ligamentous injuries at the time of injury.

Results

425 patients who underwent primary ACL reconstruction completed the survey. The mean age at surgery was 15.0? 2.4 years with a mean follow-up time of 4.6? 2.1 years. Patients were stratified into three groups by the number of first degree relatives (parent or sibling) who had an ACL tear history: no relatives, one relative, or more than one relative. 101 respondents (23.8%) reported at least one first degree relative who had previously torn an ACL. 15 (3.5%) had more than one first degree relative with an ACL tear. There were no differences in the age at time of surgery or the number of concomitant meniscus and ligamentous injuries suffered across the three stratified groups. While children with zero or one affected first degree relative had similar rates of graft failure (11.4% and 9.3%, respectively), those with two or more affected first-degree relatives had a significantly higher graft failure rate (40.0%, p=0.003). There were no differences in the number of post-operative contralateral ACL tears (p=0.438) or meniscus tears (p=0.477) across the groups. When these complications were analyzed together as one outcome, patients with more than one affected first-degree relative suffered more combined graft ruptures, contralateral ACL tears, and meniscal tears (53.3%) than patients with zero (21.9%) or only one affected first degree relative (22.1%, p=0.02). This group of patients also suffered more total complications that required surgical intervention (66.7%) than patients with zero (21.0%) or only one affected first degree family member (22.1%, p<0.001).

Conclusion/Significance

Patients undergoing primary ACL reconstruction who have a strong family history of ACL tear appear more likely to suffer a post-operative graft rupture and suffer a complication requiring surgery.