bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Diabetic Foot Ulcers With Necrotizing Fasciitis in the Lower Leg Using the STAGE Principles: A Report of 9 Cases With a Literature Review
Authors: Tian Ying , Sun Xu , Zhu Chaojun , Sun Hanchi , Shi Yue , Liu Tingting , Zhang Zhaohui
Published: July 2020

Diabetic foot ulcers (DFUs) combined with necrotizing fasciitis (NF) has rapid onset, involves a wide range of lesions, is difficult to treat, and has a high mortality rate. It has become a clinically critical disease. DFU patients are at high risk for NF. The STAGE principles guide surgical intervention in the treatment of DFU wounds and emphasizes that “based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound.” This work reports the application of the STAGE principles for the treatment of 9 cases of DFUs combined with NF in the lower leg (Wagner grade 3-5). The mean ankle-brachial index was 0.55 (0-0.91, standard deviation [SD] = 0.33), the mean years of smoking were 19.56 years (0-50, SD = 17.83), and the mean cigarette consumption was 9.11 cigarettes/day (0-20, SD = 7.77). The mean duration of ulcers was 45.56 days (3-103, SD = 35.44). Among the 9 patients, only patient no. 9 died, and the mean follow-up time for the other 8 patients was 12 months (3-36, SD = 13.42). In short, the STAGE principles are also applicable to the treatment of DFUs combined with NF in the lower leg.
Heterogeneity in the Continuity and Change of Early and Adult Risk Factor Profiles of Incarcerated Individuals: A Latent Transition Analysis
Authors: Fox Bryanna , Kortright Kelly , Gill Lexi , Mora Daniela Oramas , Moule Richard K. , Verona Edelyn
Published: July 2020

Considerable research has examined risk factors for offending, but far less is known on the constellations of co-occurring risk factors, such as adverse childhood experiences and low self-control, and the overall continuity in risk between childhood/adolescence and adulthood. Using data on 735 adults incarcerated in a county jail in Florida, this study examines the latent heterogeneity in risk profiles using risk factors prominent in early years and adulthood, and whether risk profile severity changes across the early and adult risk models.

Latent Class Analyses revealed three risk profiles (low, medium, high) in both the early and adulthood risk factor models. Transition probabilities indicate continuity in high and low risk in the early and adult models, while escalation was found for those in the low and medium early risk profiles. These findings demonstrate the importance of identifying and addressing risk factors at an early age to disrupt continuity and escalation in risk over the life-course.
Development of Frontal EEG Differences Between Eyes-Closed and Eyes-Open Resting Conditions in Children: Data From a Single-Channel Dry-Sensor Portable Device
Authors: Johnstone Stuart J. , Jiang Han , Sun Li , Rogers Jeffrey M. , Valderrama Joaquin , Zhang Dawei
Published: July 2020

Changes in EEG when moving from an eyes-closed to an eyes-open resting condition result from bottom-up sensory processing and have been referred to as activation. In children, activation is characterized by a global reduction in alpha, frontally present reductions for delta and theta, and a frontal increase for beta. The present study aimed to replicate frontal EEG activation effects using single-channel, dry-sensor EEG, and to extend current understanding by examining developmental change in children. Frontal EEG was recorded using a single-channel, dry-sensor EEG device while 182 children aged 7 to 12 years completed eyes-closed resting (EC), eyes-open resting (EO), and focus (FO) tasks. Results indicated that frontal delta, theta, and alpha power were reduced, and frontal beta power was increased, in the EO compared with the EC condition. Exploratory analysis of a form of top-down activation showed that frontal beta power was increased in the FO compared with to the EO condition, with no differences for other bands. The activation effects were robust at the individual level. The bottom-up activation effects reduced with age for frontal delta and theta, increased for frontal alpha, with no developmental change for top-down or bottom-up frontal beta activation. These findings contribute further to validation of the single-channel, dry-sensor, frontal EEG and provide support for use in a range of medical, therapeutic, and clinical domains.
Effect of cane wood and palm kernel fibre filler on the compressive strength and density of automobile brake pad
Authors: Obika EN , Achebe CH , Chukwuneke JL , Ezenwa ON
Published: July 2020

The study on the effect of cane wood and palm kernel as filler materials on the compressive strength and density of an automobile brake pad has been done. The Central Composite Design tool of the Design Expert 8 software was used to design percentage composition of the test samples for 20 experimental runs. To ascertain how well the factors fit in the design, the lack of fit test was performed. The analysis of variance shows that the developed models are significant and quadratic, showing that both materials affect the responses. On optimization, optimal compressive strength and density of 107.3 MPa and 1.73 g/cm3 were obtained for the composition of 30% resin content, 21.329% palm kernel fibre content and 40% cane wood content. Thus, the combination of cane wood and palm kernel fibre as filler material for brake pad production will give an automobile brake pad with good compressive strength and density.
Unmanned aerial vehicle abstraction layer: An abstraction layer to operate unmanned aerial vehicles
Authors: Real Fran , Torres-González Arturo , Ramón-Soria Pablo , Capitán Jesús , Ollero Aníbal
Published: July 2020

This article presents a software layer to abstract users of unmanned aerial vehicles from the specific hardware of the platform and the autopilot interfaces. The main objective of our unmanned aerial vehicle abstraction layer (UAL) is to simplify the development and testing of higher-level algorithms in aerial robotics by trying to standardize and simplify the interfaces with the unmanned aerial vehicles. Unmanned aerial vehicle abstraction layer supports operation with PX4 and DJI autopilots (among others), which are current leading manufacturers. Besides, unmanned aerial vehicle abstraction layer can work seamlessly with simulated or real platforms and it provides calls to issue standard commands such as taking off, landing or pose, and velocity controls. Even though unmanned aerial vehicle abstraction layer is under continuous development, a stable version is available for public use. We showcase the use of unmanned aerial vehicle abstraction layer with a set of applications coming from several European research projects, where different academic and industrial entities have adopted unmanned aerial vehicle abstraction layer as a common development framework.
Representing school arson in Kenya: An analysis of newspaper reporting
Authors: Oburu Hildah , Coetzee Bronwyné , Swartz Leslie
Published: July 2020

Arson is a recurrent problem in Kenyan secondary schools. Although school violence – notably gun violence – has received significant attention, there has been less academic attention paid to school arson, especially in Africa. This study explores how newspaper reports in Kenya framed school arson and links these framings to broader questions about the understanding and production of Kenyan identity. A thematic analysis of 334 newspaper reports revealed multiple understandings of school arson. Print media discourse afforded journalists an opportunity to make a commentary on the post-colonial globalized Kenyan society. We discuss the implications of this for understanding post-colonial media in Africa.
Hatred versus tolerance: The effect of the media on the notion of citizenship in Kuwait and Oman
Authors: Dashti Ali A , Johar Hasan A , Al-Maamari Saif Nasser , AlAbdullah Hamed H
Published: July 2020

The wars in Syria, Iraq and Yemen, the crisis in Bahrain and the confrontation with Iran have created an environment of sectarianism in the region. This hostility has challenged the media to deal with the issue of citizenship ( Al-Muwatana) in a responsible manner. This study applies Social Responsibility Theory to shed light on the role of print media in shaping the concept of citizenship in the Arabian Gulf, with reference to states that enjoy full or partial freedom, especially Kuwait and Oman. The results of this study show that Omani newspapers deal with citizenship positively when reporting news from Syria, Bahrain, Iraq, Yemen and Iran despite press censorship, while Kuwaiti print media, with its greater freedom of the press, is more negative on the topic of citizenship.
Comparison of the effect of clarithromycin triple therapy with or without N-acetylcysteine in the eradication of Helicobacter pylori: a randomized controlled trial
Authors: Chen Chieh-Chang , Luo Jiing-Chyuan , Fang Yu-Jen , Lee Ji-Yuh , Kuo Chia-Chi , Yang Tsung-Hua , Chiu Min-Chin , Yu Jian-Jyun , Bair Ming-Jong , Chen Po-Yueh , Chou Chu-Kuang , Chen Chi-Yi , Chang Chi-Yang , Hsu Yao-Chun , Tseng Cheng-Hao , Hsu Wen-Feng , Hu Wen-Hao , Tsai Min-Horn , Hsieh Cheng-Lin , Chen Mei-Jyh , Shun Chia-Tung , Liu Tzeng-Ying , Lee§ Yi-Chia , Liou§ Jyh-Ming , Wu§ Ming-Shiang ,   and for the Taiwan Gastrointestinal Disease and Helicobacter Consortium
Published: July 2020

Background:

Whether adjunctive N-acetylcysteine (NAC) may improve the efficacy of triple therapy in the first-line treatment of Helicobacter pylori infection remains unknown. Our aim was to compare the efficacy of 14-day triple therapy with or without NAC for the first-line treatment of H. pylori.

Material and methods:

Between 1 January 2014 and 30 June 2018, 680 patients with H. pylori infection naïve to treatment were enrolled in this multicenter, open-label, randomized trial. Patients were randomly assigned to receive triple therapy with NAC [NAC-T14, dexlansoprazole 60 mg four times daily (q.d.); amoxicillin 1 g twice daily (b.i.d.), clarithromycin 500 mg b.i.d., NAC 600 mg b.i.d.] for 14 days, or triple therapy alone (T14, dexlansoprazole 60 mg q.d.; amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d.) for 14 days. Our primary outcome was the eradication rates by intention to treat (ITT). Antibiotic resistance and CYP2C19 gene polymorphism were determined.

Results:

The ITT analysis demonstrated H. pylori eradication rates in NAC-T14 and T14 were 81.7% [276/338, 95% confidence interval (CI): 77.5–85.8%] and 84.3% (285/338, 95% CI 80.4–88.2%), respectively. In 646 participants who adhered to their assigned therapy, the eradication rates were 85.7% and 88.0% with NAC-T14 and T14 therapies, respectively. There were no differences in compliance or adverse effects. The eradication rates in subjects with clarithromycin-resistant, amoxicillin-resistant, or either clarithromycin/amoxicillin resistant strains were 45.2%, 57.9%, and 52.2%, respectively, for NAC-T14, and were 66.7%, 76.9%, and 70.0%, respectively, for T14. The efficacy of NAC-T14 and T14 was not affected by CYP2C19 polymorphism.

Conclusion:

Add-on NAC to triple therapy was not superior to triple therapy alone for first-line H. pylori eradication [ClinicalTrials.gov identifier: NCT02249546].
An intelligent approach for improving printed circuit board assembly process performance in smart manufacturing
Authors: Fung Vincent WC , Yung Kam Chuen
Published: July 2020

The process of printed circuit board assembly (PCBA) involves several machines, such as a stencil printer, placement machine and reflow oven, to solder and assemble electronic components onto printed circuit boards (PCBs). In the production flow, some failure prevention mechanisms are deployed to ensure the designated quality of PCBA, including solder paste inspection (SPI), automated optical inspection (AOI) and in-circuit testing (ICT). However, such methods to locate the failures are reactive in nature, which may create waste and require additional effort to be spent re-manufacturing and inspecting the PCBs. Worse still, the process performance of the assembly process cannot be guaranteed at a high level. Therefore, there is a need to improve the performance of the PCBA process. To address the aforementioned challenges in the PCBA process, an intelligent assembly process improvement system (IAPIS) is proposed, which integrates the k-means clustering method and multi-response Taguchi method to formulate a pro-active approach to investigate and manage the process performance. The critical process parameters are first identified by means of k-means clustering and the selected parameters are then used to formulate a set of experimental studies by using the multi-response Taguchi method to optimize the performance of the assembly process. To validate the proposed system, a case study of an electronics manufacturer in the solder paste printing process was conducted. The contributions of this study are two-fold: (i) pressure, blade angle and speed are identified as the critical factors in the solder paste printing process; and (ii) a significant improvement in the yield performance of PCBA can be achieved as a component in the smart manufacturing.
Visitor’s Experiences of an Evidence-Based Designed Healthcare Environment in an Intensive Care Unit
Authors: Sundberg Fredrika , Fridh Isabell , Lindahl Berit , Kåreholt Ingemar
Published: July 2020

Objectives:

The objective of the research was to study the visitors’ experiences of different healthcare environment designs of intensive care unit (ICU) patient rooms.

Background:

The healthcare environment may seem frightening and overwhelming in times when life-threatening conditions affect a family member or close friend and individuals visit the patient in an ICU. A two-bed patient room was refurbished to enhance the well-being of patients and their families according to the principles of evidence-based design (EBD). No prior research has used the Person-centred Climate Questionnaire—Family version (PCQ-F) or the semantic environment description (SMB) in the ICU setting.

Methods:

A sample of 99 visitors to critically ill patients admitted to a multidisciplinary ICU completed a questionnaire; 69 visited one of the two control rooms, while 30 visited the intervention room.

Results:

For the dimension of everydayness in the PCQ-F, a significantly better experience was expressed for the intervention room ( p < .030); the dimension regarding the ward climate general was also perceived as higher in the intervention room ( p < .004). The factors of pleasantness ( p < .019), and complexity ( p < 0.049), showed significant differences favoring the intervention room in the SMB, with borderline significance on the modern factor ( p < .061).

Conclusion:

Designing and implementing an enriched healthcare environment in the ICU setting increases person-centered care in relation to the patients’ visitors. This could lead to better outcomes for the visitors, for example, decreasing post-traumatic stress disorder symptoms, but this needs further investigations.
Diarrhea and associated factors among under-5 children in Ethiopia: A secondary data analysis
Authors: Fetensa Getahun , Fekadu Ginenus , Tekle Firew , Markos Jote , Etafa Werku , Hasen Tahir
Published: July 2020

Objectives:

Diarrhea is a major contributing factor for preventable childhood morbidity and death. Despite the occurrence of diarrhea is decreasing, its effect is increasing at an alarming rate among under-5 children particularly in developing countries. The survey was aimed to assess diarrhea and associated factors among children less than 5 years (0–59 months) in Ethiopia with nationally representative data.

Methods:

The data were extracted from the Ethiopian National Survey of 2016. A logistic regression model was undertaken to identify the contributing factors for childhood diarrhea. Variables with p < 0.05 were considered as independent predictors of childhood diarrhea.

Results:

From a total of 10,641 under-5 children, 5483(51.5%) were males and most of the children (62.3%) were above 24 months. About 10.2% had diarrhea 14 days before data collection, and the majority (93.1%) were born to married mothers. Receiving no treatment or advice for fever/cough (adjusted odd ratio (AOR) = 0.170, 95% confidence interval (CI): 0.139–0.208, p = 0.001), being permanent residence (AOR = 0.583, 95% CI: 0.347–0.982, p = 0.043), initiating breastfeeding after 24 h of birth (AOR = 1.553, 95% CI: 1.197–2.015, p = 0.001), and lack of prenatal care (AOR = 2.142, 95% CI: 0.624–0.875, p = 0.001) were independent predictors of diarrhea among under-5 children’s in Ethiopia.

Conclusion:

The result of this survey indicated that diarrhea is a significant health challenge among under-5 children. To tackle this illness, sufficient education on child and maternal health has to be provided for mothers focusing on predictive factors.
Feeling Asian Together: Coping With #COVIDRacism on Subtle Asian Traits
Authors: Abidin Crystal , Zeng Jing
Published: July 2020

Since the onset of COVID-19, incidents of racism and xenophobia have been occurring globally, especially toward people of East Asian appearance and descent. In response, this article investigates how an online Asian community has utilized social media to engage in cathartic expressions, mutual care, and discursive activism amid the rise of anti-Asian racism and xenophobia during COVID-19. Specifically, we focus on the 1.7-million-strong Facebook group “Subtle Asian Traits” (SAT). Throughout the COVID-19 pandemic, the 1,200 new posts it publishes daily have swiftly pivoted to the everyday lived experiences of (diaspora) East Asians around the world. In this article, we reflect on our experiences as East Asian diaspora members on SAT and share our observations of meaning-making, identity-making, and community-making as East Asians collectively coping with COVID-19 aggression between January and May 2020.
Evaluation of radiologist’s knowledge about the Artificial Intelligence in diagnostic radiology: a survey-based study
Authors: Tajaldeen Abdulrahman , Alghamdi Salem
Published: July 2020

Background

Advanced developments in diagnostic radiology have provided a rapid increase in the number of radiological investigations worldwide. Recently, Artificial Intelligence (AI) has been applied in diagnostic radiology. The purpose of developing such applications is to clinically validate and make them feasible for the current practice of diagnostic radiology, in which there is less time for diagnosis.

Purpose

To assess radiologists’ knowledge about AI’s role and establish a baseline to help in providing educational activities on AI in diagnostic radiology in Saudi Arabia.

Material and Methods

An online questionnaire was designed using QuestionPro software. The study was conducted in large hospitals located in different regions in Saudi Arabia. A total of 93 participants completed the questionnaire, of which 32 (34%) were trainee radiologists from year 1 to year 4 (R1–R4) of the residency programme, 33 (36%) were radiologists and fellows, and 28 (30%) were consultants.

Results

The responses to the question related to the use of AI on a daily basis illustrated that 76 (82%) of the participants were not using any AI software at all during daily interpretation of diagnostic images. Only 17 (18%) reported that they used AI software for diagnostic radiology.

Conclusion

There is a significant lack of knowledge about AI in our residency programme and radiology departments at hospitals. Due to the rapid development of AI and its application in diagnostic radiology, there is an urgent need to enhance awareness about its role in different diagnostic fields.
Counseling Opportunity Structures: Explaining College-Going Using a Typology of School-Level Opportunity Structures
Authors: Rangel Virginia Snodgrass , Arámbula Turner Tracy
Published: July 2020

This article contributes to our understanding of the gap in college access by examining (a) the extent to which and (b) how high school counseling focused on college broadens access. We extend Engberg and Gilbert’s typology of schools based on high school counseling norms and resources. Using recent data from the High School Longitudinal Study of 2009, we identified three types of schools: norm-driven, resource-rich, and divergent.
Leadership Roles for School Counselors in Identifying and Supporting Twice-Exceptional (2E) Students
Authors: Renzulli Sara J. , Gelbar Nicholas
Published: July 2020

School counselors have a variety of opportunities to serve as advocates and leaders for students identified as twice exceptional (2E). We explore these opportunities and discuss the academic and social/emotional challenges 2E students face and current operational definitions for this population. We also discuss strategies school counselors can use to help students increase their academic and social success. We introduce strengths-based educational approaches as a best practice for working with this unique population, including the use of support strategies, enrichment clusters, and extracurricular activities.
Emergence and Structure of Urban Centralities in a Medium-Sized Historic City
Authors: Miranda Eduardo , Batista e Silva Jorge , Ricardo da Costa António
Published: July 2020

Within the last 20 years, medium-sized cities in Portugal’s interior have been subject to a process of “desertification.” They have progressively lost in terms of economic activity, value and vitality, with the corresponding erosion of their heritage value. One exception to this general trend is the town of Évora. Of particular note is the vitality of its historic center (designated as a World Heritage Site in 1986) and the balance achieved between the center and a number of subcenters outside the walls. Here, urban centralities have proven to be an essential component of the urban structure in the fight against urban failure. This research project analyzes the relationship between town planning and the emergence of urban centralities. Historic towns are a very particular case, with subcenters emerging as a town grows and the historic center co-evolving with the entire urban area and surrounding urban centralities. The rise of centralities testifies to the vitality of the town. This article seeks to understand what factors have led to the balance of urban centralities in Évora by examining their structure and how they have emerged in the context of planning policies and urban growth. The methodology adopted crosses the results of three different approaches to highlight the emergence of urban centralities: identification and assessment of urban centralities, analysis of urban areas based on a space syntax approach, and the study of urban planning and management policies focused on centralities. The results help to characterize urban centralities that coexist with a strong historic center.
Intervening in Indigenous Gambling: A Systematic Review of the Literature
Authors: Whiteside Mary , Heyeres Marion , Maltzahn Kathleen , Griffin Tiffany , MacLean Sarah
Published: July 2020

Internationally, Indigenous people have higher rates of problem gambling than other population groups, yet the uptake of gambling help services is thought to be low. This may be due to the lack of culturally appropriate services and staff. This study aimed to systematically search and review the literature relating to interventions designed for Indigenous populations that seek to prevent or address gambling harm, to support the design of new programs. Peer-reviewed articles and gray literature that described programs of this nature and/or which reported outcomes for Indigenous participants were included in the review. Included studies were published between January 2000 and May 2019 and available in English. Only four articles were identified for inclusion: two described programs in Australia and two in New Zealand. Only one article provided outcome data, which was inconclusive, and one described three separate interventions. Three of the four described involved community-led approaches informed by cultural and emancipatory principles. There is currently insufficient evidence to guide interventions aiming to prevent and address gambling harm for Indigenous peoples. This review identified an urgent need for new intervention research in this area.
Dr Patricia Clugston—A Spirit of Determination
Authors: Sardiwalla Yaeesh , Weber Christina , Morris Steven F.
Published: July 2020

Dr Patricia Clugston was a British Columbia native who completed her plastic surgery residency training in Vancouver in 1993 before pursuing a fellowship in Nashville with Dr Patrick Maxwell in 1994. When Dr Clugston returned to Vancouver, she helped to establish a comprehensive and renowned breast reconstruction program. She spent her career advocating for and working towards better treatment options for women seeking breast reconstruction. As a determined surgeon and accomplished athlete, Dr Clugston was truly a tour de force in all aspects of her life. Patty, as she was affectionately known by her colleagues, loved her job. Dr Clugston was an avid advocate for medical education and an outstanding clinical researcher and speaker that established her as a shining star in Canadian plastic surgery. Patty had always lived life to the fullest and was determined that scleroderma would not change this. Her sharp wit, intellectual curiosity, and pragmatism masked an incredible courage as she fought bravely against a cruel disease. Dr Clugston died on March 1, 2005, at the age of 46 surrounded by the loving company of her husband, friends, and family at the Vancouver General Hospital. The Dr Patricia Clugston Chair in Breast Reconstruction was established in her name to honour her legacy and continue to improve the care of patients with breast cancer.
Which Variables Predict Osteochondral Allograft Failure?
Authors: Bugbee William
Published: July 2020

Objectives:

Osteochondral allograft (OCA) transplantation is a valuable treatment option for chondral and osteochondral lesions of the knee. Understanding the impact of clinical variables on the outcome of OCA transplantation would be useful for counseling patients on the relative risk of the procedure. The purpose of this study was to determine which variables predicted treatment failure in a large cohort of patients undergoing OCA transplantation of the knee.

Methods:

OCA transplantation was performed in 673 knees from 1997 to 2016; 489 had a minimum follow-up of two years. Average age was 32 years and 63% were male. Mean graft size was 8.9 cm2. Reoperations following the OCA transplantations were assessed, and treatment failure was defined as any procedure that involved removal of the allograft. Variables associated with treatment failure in univariate analyses (age, diagnosis, anatomic location, and graft size) were included in a logistic regression model.

Results:

Treatment failure occurred in 78 knees (16%); 58 conversions to arthroplasty, 19 revision allografting, and 1 patellectomy. Age, diagnosis, and graft size independently predicted a higher risk of failure (Table 1). Patients who were ≥30 years old were 2.4 times more likely than younger patients to experience a treatment failure. Compared to patients with osteochondritis dissecans or traumatic chondral injury, patients with degenerative chondral lesions, avascular necrosis, or osteoarthritis were more likely to have allograft failure. Grafts >8 cm2 were 2.1 times more likely to fail than grafts ≤8 cm2. Anatomic location and number of grafts were associated with failure in univariate analyses, but not after controlling for other variables in the multivariate analysis.

Conclusion:

Older age, diagnosis of avascular necrosis or degenerative joint disease, and larger graft size were associated with higher risk of treatment failure. This data is useful in counseling individual patients on the risk of osteochondral allograft surgery. [Table: see text]
Novel MRI Measurements of Extensor Mechanism Containment Can Predict Recurrent Patellar Instability
Authors: Chan Calvin , Mistovich Justin , Urwin John , Gajewski Christopher , Fabricant Peter , Lawrence John , Weltsch Daniel
Published: July 2020

Objectives:

Identifying risk factors for recurrent patellar dislocation (PD) following the first dislocation may help guide treatment. Tools for assessing the relationship of the extensor mechanism can distinguish dislocators from regular patients, but their usefulness in predicting the risk of re-dislocation has not been assessed. The purpose of this study was to determine the association of several novel MRI measures of patellar containment with recurrence in patients presenting with a first-time PD.

Methods:

An IRB approved query was conducted at a tertiary care children’s hospital (2005-2014) for patients (aged 8-19 years) diagnosed with a first-time PD. Patients were classified as either non-recurrent or recurrent-dislocators based on the review of the medical record. Next, MRI measurements were made by two independent raters. Interobserver reliability was assessed for all measurements via an intraclass correlation coefficient (ICC). Only measurements with ICC > 0.8 were included for further analysis. Univariate and multivariate regression analysis was used to evaluate variables associated with recurrence.

Results:

One hundred sixty-five patients were identified with a median follow up the length of 12.2 months. Median patients age was 14 years, and 57.6% were females. A second instability event or significant subluxation episode was documented in 98 (59.4%) patients. MRI measurements with excellent correlation (ICC>0.8) were Tibial tuberosity to trochlear groove distance (TT-TG), Tangential axial width of the patella (TAWP), Tangential axial trochlear width (TATW), Axial width of patellar tendon beyond lateral trochlear ridge (PT-LTR), and Lateral trochlear ridge to tibial tuberosity distance (LTR-TT). In univariate analysis, all mentioned MRI measurements had significant differences when comparing the group of RD to those that did not have a recurrent instability event. However, following both backward and forward stepwise regression analysis, LTR-TT was the only independent predictor of RD (p=0.003 in both). Patients with an LTR-TT value greater than -1 had a significantly higher rate of recurrent dislocation (72%) with Odds Ratio 2.4 (95% C.I. 1.2-4.7); p=0.011).

Conclusion:

Assessment of the relationship of the lateral trochlear ridge to the tibial tubercle had greater predictive value for recurrent instability than the relationship of the tibial tubercle to the trochlear groove. Patients with a tibial tubercle even with or outside of the lateral trochlear ridge have a significantly increased risk of re-dislocation compared with patients with a tibial tubercle inside the lateral trochlear ridge. This novel measurement (LTR-TT) can help predict recurrent patellar instability and may thus aid surgeons and patients when deciding on a treatment strategy. [Table: see text]
Comparison of Joint Space Measurements between Supine and Weightbearing Anteroposterior Pelvis Radiographs for Patients Undergoing Hip Arthroscopy
Authors: Bodendorfer Blake , Mehta Vishal , Tepper Kenneth , Looney Austin
Published: July 2020

Objectives:

Osteoarthritis and joint space narrowing of the hip have been correlated with poor outcomes and conversion to arthroplasty after hip arthroscopy. However, a standardized protocol for radiographic measurement of minimal joint space width of the hip has not been developed. We hypothesized that minimal joint space width would be significantly lower on the affected side in weightbearing anteroposterior pelvis radiographs versus supine radiographs. We also hypothesized that radiographs with single-leg stance would show the lowest minimal joint space width.

Methods:

Thirty-one consecutive adult patients with hip pain were prospectively enrolled and each had single-leg and double-leg weightbearing and supine anteroposterior pelvis radiographs in a standardized position. Two independent investigators determined minimal joint space width. Differences between minimal JSW as well as intra- and interobserver reliability were calculated. One and 2-way analyses of variance (ANOVA) were used to compare the measurements. Power analysis determined that recruitment of 30 patients was necessary to achieve 90% power. P<0.05 was considered significant.

Results:

No significant differences in joint space width were found between supine or weightbearing radiographs for any pelvis site (Figure 1). Comparing those under 50 years of age to those older than 50 years of age, mean joint space width was 3.5±0.5 vs. 3.0±0.9 in the supine position, 3.2±0.8 vs. 3.0±1.0 during double-leg stance, and 3.5±0.5 vs. 3.0±1.1 during single-leg stance (P=0.002).

Conclusion:

Our data showed no significant difference in joint space width among anteroposterior single-leg or double-leg weightbearing or supine radiographs at any location measured. These findings suggest that either weightbearing or supine radiographs can be used to evaluate hip joint space width and that all locations provide a similar indication of joint space width. These findings support the use of a single view for the evaluation of JSW in patients with hip pain, which may allow for a less burdensome clinical workflow. [Table: see text]
The Ulnar Collateral Ligament Responds to Stress in Professional Pitchers
Authors: English Joy , Cushman Daniel , Zhang Chong , Presson Angela , Yoon Steve , Schulz Brian , Li Bernard , Chalmers Peter
Published: July 2020

Objectives:

It remains unknown whether the frequently injured ulnar collateral ligament (UCL) responds to the stress of baseball pitching. Our purpose was to determine the response of the UCL in professional pitchers to pitching and rest.

Methods:

In a prospective study supported by Major League Baseball, all pitchers within a single professional baseball club were enrolled. Surgical and pitching history were recorded. An ultrasound (US) of the ligament was then performed by a single fellowship-trained ultrasonographer with extensive UCL US experience at the beginning of the season (T1), the end of the season (T2), and the beginning of the following season (T3). We measured UCL thickness and ulnotrochlear joint opening at 30° of flexion with and without valgus stress. Two US images were saved. Inter- and intra-rater reliability were determined. A multivariable analysis was conducted.

Results:

185 total pitchers were included: 94 pitchers at T1, 83 at T2, and 118 pitchers at T3. Excluding player movement, follow-up rate was 70% between T1 and T2 and 91% between T2 and T3. These pitchers were 23 [21, 25] years old (median [inter-quartile range]), had 12 [7, 15] years pitching experience, and had peak velocity of 95 [93, 97] miles per hour. Intra- and inter-rater reliability was excellent. Baseline UCL thickness was associated with peak velocity (p=0.031) and prior UCL reconstruction (UCLR, p=0.024). After accounting for years of pitching experience, peak velocity and time, UCL thickness was greater in those with prior UCLR (p<0.001). After accounting for pitching experience, peak velocity, and prior UCLR, thickness increased during the season (p=0.002) and decreased during the offseason (p=0.001). After accounting for these same variables, valgus laxity at 30° increased during the season (p=0.002) and decreased during the off season (p=0.029).

Conclusion:

The ulnar collateral ligament responds to stress in professional pitchers by becoming thicker and more lax and to rest by becoming thinner and less lax.
Outcomes of talar osteochondral and transchondral lesions using an evidence-based algorithmic approach based on size, location and subchondral plate integrity: a 10-year study on 204 lesions
Authors: Saxena Amol
Published: July 2020

Objectives:

Treatments outcomes for articular lesions of the talus are variable based on size. MRI has been used to assess size and location, and base treatment. We prospectively analyzed talar lesions and the outcomes of surgical procedures based on lesion size, which are typically measured two-dimensionally, intact cartilage/subchondral plate and activity level. We propose following a treatment algorithm will yield favorable results and outcomes.

Methods:

Over a ten-year period, transchondral and osteochondral lesions of the talus were measured tri-dimensionally on pre-operative MRI, location noted based on a nine-region grid pattern of the talar dome, and patients’ activity level documented. Procedures were performed based on lesion size, integrity of cartilage and lesion location. They were assessed with pre- and post-operative AOFAS scores, post-operative Roles Maudsley score and time to return to activity. Lesions below 125 mm³ were treated with microfracture or retrograde drilling, lesions less than 1500 mm³ were treated with autogenous bone graft, and larger lesions were treated with fresh allograft.

Results:

204 talar lesions were analyzed. The following surgeries were performed: arthroscopy with microfracture or retrograde drilling (with or without bone graft) N =159, arthrotomy (with or without osteotomy) with autogenous bone graft N = 60, and fresh allograft with osteotomy N =7. The average follow-up post-index surgery was 82.53± 34.62 (range 24-132) months for the entire cohort. The average time to return to activity was 7.93 ± 5.00 (range 2-36) months. The average pre-AOFAS score was 76.44 ± 10.98 (range 52-86) and average post-AOFAS score was 96.12 ± 3.46 (range 81-100), P=.0001. Post-surgery RM score was 1.28 ± 0.49 (range 1-3). There were no differences in outcomes based on lesion size.

Conclusion:

Similar outcomes were able to be achieved regardless of talar lesion size using the treatment algorithm.Clinicians should consider using three-dimensional measurements when determining the best treatment approach to talar lesions.Microfracture, while successful for certain talar lesions, may not have a role for larger lesions. Other techniques such as retrograde drilling, autogenous bone grafting and allograft can yield good results, along with microfracture when used appropriately based on lesion size.
Differences in articular hip cartilage gene expression between femoroacetabular impingement (FAI) and end-stage hip osteoarthritis
Authors: Reuter John , Soles Gillian , Ackert-Bicknell Cheryl , Giordano Brian , Kuhns Benjamin
Published: July 2020

Objectives:

The morphological deformities in Femoroacetabular Impingement (FAI) have been associated with hip osteoarthritis (OA), however the molecular mechanisms for OA initiation and progression are poorly understood. The purpose of this study was to use whole genome RNA sequencing to characterize differences in gene expression articular cartilage samples isolated from patients undergoing surgery for FAI and idiopathic OA. We hypothesized that there would be significant differences in genes expression in pathways related to inflammation as well as cartilage and bone turnover.

Methods:

20 patients undergoing either hip arthroscopy for FAI (5 male, 5 female) or total hip arthroplasty (5 male, 5 female) for end-stage osteoarthritis were included in the study. FAI patients required a Cam deformity with an Alpha Angle greater than 55 while patients with dysplasia (LCEA<25) or prior hip surgery were excluded. Exclusion criteria for the THA cohort included dysplasia, and post-traumatic OA or inflammatory OA. Cartilage samples were obtained over the Cam deformity prior to femoroplasty in the FAI group or over anterosuperior femoral head-neck junction in the OA group following extraction of the femoral head. Following RNA isolation, Next Generation RNA sequencing was performed to evaluate gene expression. Differential expression data was incorporated into the Ingenuity Pathway Analysis (IPA) platform to identify differences in canonical signaling pathways associated with osteoarthritis.

Results:

There were 3531 genes that were significantly differentially expressed between the FAI and OA cohorts. Of these, there were 27 genes that were upregulated by a greater than 2 log-fold change in the OA cohort and 524 genes that were upregulated by a greater than 2 log-fold change in the FAI cohort. There was significant differential expression in genes related to cartilage metabolism (Table 1) and canonical osteoarthritis pathways involving BMP, TGFβ, and Wnt signaling. (Table 2). Additionally, FAI samples had significant upregulation of EGF-ERBB mediated signaling which compared to osteoarthritic tissue.

Conclusion:

The results of the present study support our hypothesis that there are significant differences in gene expression between FAI and OA samples in multiple pathways that are implicated in osteoarthritis. Osteoarthritis samples had increased expression of cartilage breakdown and inflammation while femoroacetabular impingement samples had greater expression of chondroprotective genes. Further study of cartilage samples from FAI patients may provide insight into the molecular mechanisms of osteoarthritis progression. [Table: see text][Table: see text]
Lower Extremity Musculoskeletal Injury Is Associated with Increased Risk of Concussion in High School Athletes
Authors: Lutz Adam , Thigpen Charles , Gilliland R. Gil , Thorpe John , Kissenberth Michael , Shanley Ellen
Published: July 2020

Objectives:

Previous research indicates that concussion increases the risk of lower extremity injuries (LE) after return to sport. However, no study has examined the risk of precedent lower extremity injuries and their relationship to the development of a sport related concussion (SRC). To determine if the risk of combined injuries (LE injury-SRC) is elevated in high school athletes accounting for athlete sport and gender.

Methods:

33,386 high school athletes were monitored over 4 seasons. 4223 LE injuries and 1132 concussions were reported. Injured athletes were identified by their school athletic trainer (AT) time-loss injury during a team-sponsored practice or game. ATs documented the date, mechanism, and sport of injury. Injured athletes were referred to a board-certified sports medicine physician for diagnoses and follow up care. Cumulative injury rates were calculated with 95% confidence intervals. Rate ratios were used to compare frequency of SRC after RTS following a LE injury. Comparisons were made overall cohort between those participating athletes with and without isolated and combined injuries as well as by gender. (α=0.05).

Results:

A cumulative incidence for athletes sustaining an isolated SRC was 2.3/100 athletes (95% CI= 2.1-2.5) and for isolated LE injury was 11.5/100 (95% CI=11.2-11.9) athletes. Athletes presenting with a LE injury had an increased risk (RR= 4.7; 95% CI = 4.2-5.2) of sustaining a subsequent SRC within 1 year when compared to athletes that did not suffer precedent LE injuries. Male athletes presenting with a LE injury had an increased risk (RR= 4.9; 95% CI = 4.2-5.7) of sustaining a subsequent SRC within 1 year when compared to male athletes that did not suffer precedent LE injuries. Female athletes presenting with a LE injury had an increased risk (RR= 4.4; 95% CI = 3.6-5.2) of sustaining a subsequent SRC within 1 year when compared to female athletes that did not suffer precedent LE injuries. In football, presenting with a LE injury had an increased risk (RR= 5.8; 95% CI = 4.5-7.4) of sustaining a subsequent SRC within 1 year when compared to football athletes that did not suffer precedent LE injuries.

Conclusion:

Our results are the first to show that high school athletes who suffer a time-loss LE injury are at 4.4-5.8 times increased risk to suffer a sports related concussion within the next year. Additional studies are warranted to confirm these findings.
Defining Meaningful Functional Improvement on the Visual Analog Scale for Satisfaction at 2-years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Authors: Beck Edward , Nwachukwu Benedict , Mehta Nabil , Jan Kyleen , Okoroha Kelechi , Drager Justin , Nho Shane , Rasio Jonathan
Published: July 2020

Objectives:

Patient satisfaction is being increasingly reported in orthopaedic sports medicine and the field of hip preservation surgery. The Visual Analog Scale (VAS) for Satisfaction is most commonly utilized. Currently there is limited understanding for what should be considered as clinically important improvement on the VAS Satisfaction. The purpose of this study is to 1) define Substantial Clinical Benefit (SCB), Patient Acceptable Symptomatic State (PASS), and Minimal Clinically Important Difference (MCID) for the VAS Satisfaction in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and 2) identify preoperative predictors of achieving each outcome end-point.

Methods:

Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and January 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome (PRO) scores were recorded at 2-years postoperatively. In order to quantify clinical significance of outcome achievement on the VAS Satisfaction we calculated MCID, PASS and SCB for this outcome measure. A multivariate logistic regression analysis was used to identify preoperative predictors of achieving SCB, PASS, and MCID satisfaction.

Results:

A total of 335 patients were included in the final analysis, with an average age and body mass index (BMI) of 32.8(SD+12.4) years and 25.2(SD+5.3) respectively. The values on the VAS satisfaction were identified to represent MCID, PASS and SCB respectively: 12.3, 80.9 and 89.7. The rates of achieving clinically significant improvement on the VAS Satisfaction was 97.1%, 68.1% and 56.9% for MCID, PASS and SCB respectively. A larger preoperative alpha angle was predictive for achieving SCB (OR:1.076; p =0.046), while lower BMI (OR:0.955; p =0.047) and larger preoperative alpha angle (OR:1.12; p-value=0.025) were predictors for achieving PASS.

Conclusions:

This study identifies scores on the VAS Satisfaction that can be used to define clinically significant outcome after arthroscopic treatment of FAIS. Specifically, an improvement of 12.3 points is a clinically important improvement in satisfaction, while an absolute score above 89.7 represents the upper threshold of Satisfaction performance. Almost all patients (97.1%) demonstrated a clinically important improvement in satisfaction. Additionally, there are both modifiable and non-modifiable factors that predict achieving a clinically significant level of post-operative satisfaction on the VAS Satisfaction.