bluuebunny/crossref_metadata_2025 huggingface dataset:
Strong Equity: Repositioning Teacher Education for Social Change
Authors: Cochran-Smith Marilyn , Keefe Elizabeth Stringer
Published: May 2022

Background:

Equity is invoked as a watchword in teacher education—a catch-all connected to an array of issues related to diversity, justice, or gaps in outcomes and opportunities for minoritized groups. This conceptual article argues that equity is often undefined and undertheorized in teacher education, and the complexities involved in addressing the structural inequalities of schooling are seldom acknowledged.

Purpose:

This article unpacks recurring themes in the discourse of equity and teacher education. We suggest that in the teacher education discourse, equity appears frequently, but there is little attention to the structural and systemic policies that reproduce inequity in the first place. Second, we elaborate on the distinction between thin equity and strong equity, suggesting that this can be a powerful tool for clarifying, comparing, and critiquing the differences in meanings of equity. Third, we suggest that although thin conceptions of equity are prominent, some teacher education scholars and practitioners utilize stronger notions of equity in the work of teacher preparation.

Conclusion:

We conclude that notions of strong equity can help reposition teacher education as part of a broader effort to bring about genuine change.
Shakespeare's wavering geography: Religious topographia in Cymbeline
Authors: Del Bello Davide
Published: May 2022

As forms of vivid description, or enargia, the figures of topographia, topothesia, and chorographia feature prominently in Elizabethan rhetoric manuals. This article considers Cymbeline's wavering geography as a confluence of these tropes. It reads the multiple rhetorical constructs of Shakespearean topographia in Cymbeline as instances of dislocation between the strictures imposed by a national identity project and the ever-present longing for a traditional religious past. In this respect, Cymbeline, whose Christian intimations are still the subject of contention, may also be said to dramatise and interrogate the precarious settlements (cultural, religious, and geographical) brought about by the Henrician reformation.
The path between breakfast eating habit, sleep duration and physical activity on obesity status: An epidemiological study in schoolchildren
Authors: Kosti Rena I , Kanellopoulou Aikaterini , Morogianni Konstantina , Notara Venetia , Antonogeorgos George , Kourtesa Triada , Rojas-Gil Andrea Paola , Kornilaki Ekaterina N , Lagiou Areti , Panagiotakos Demosthenes B
Published: May 2022

Background: Although the literature suggests that skipping breakfast, insufficient sleep, and reduced physical activity are associated with childhood obesity their co-influence and their in-between interactions on weight status have rarely been studied. Aim: To examine the co-influence of breakfast eating habits, sleep duration, and physical activity on the weight status of children 10–12 years old from several schools of Greece. Methods: A cross-sectional study was conducted on 1688 students in Greece, during 2014–2016. Children's Body Mass Index (BMI) was calculated and classified according to the International Obesity Task Force (IOTF) classification. Logistic regression models and path analysis were used. Results: Overweight/obesity prevalence was higher in boys (32.5% vs. 20.4%; p < 0.001). Average sleep duration decreased the odds of overweight/obesity [OR (95% CI): 0.86 (0.76, 0.97)] independently of the frequency of breakfast habit. Interaction between sleep duration with breakfast habit ( p = 0.002) and physical activity ( p < 0.001) was observed. Path analysis showed a negative association of BMI with sleep duration (standardized beta = −0.095, p < 0.001). A third-order interaction between breakfast habit, sleep duration, and physical activity revealed that daily breakfast eating along with adequate sleep and moderate/adequate physical activity levels, decreased the odds of over-weight/obesity by 55% [OR 0.45, 95% CI (0.27, 0.72)]. Conclusion: Although sleep duration is inversely associated with weight status independently of breakfast habit, the co-influence of adequate sleep duration with frequent breakfast eating and moderate/adequate physical activity seems to be a profoundly higher associated as a result of synergy against childhood obesity.
Perceptions surrounding the development of personal style in Cantonese opera among artists, connoisseurs, and beginner audiences in Hong Kong
Authors: Leung Bo-Wah , Fung C Victor
Published: May 2022

Cantonese opera is a representative opera genre from Hong Kong, given much attention and support by the territory’s government. However, current artists tend not to develop their own personal style in favor of imitating previous master performers to earn the audience’s applause. This study aims to determine the perceptions surrounding the development of personal styles of Cantonese opera performances among artists, connoisseurs, and beginner audiences in Hong Kong. We surveyed 530 artists, connoisseurs, and beginner audience members about their thoughts about the issue across six dimensions: Value, Possibility, Audience Expectation, Perception of Artists, Artist–Audience Interaction, and Environment. We used a multivariate analysis of variance process to test whether the perception of these three groups of stakeholders varied by age, sex, or educational background. Findings revealed that the artists’ and audience’s age and their knowledge and experience were critical. Older audience members tended to value personal style and creativity more than younger audience members. Younger artists tended to be more confident about developing their personal style, while older artists were generally not so eager. Therefore, early emphasis on developing personal style in both school education and professional training is vital to both audience building and nurturing creative artists.
Urban Railway System Route Selection in Turkey Based on Socio-Economic and Technical Criteria Using the Analytical Hierarchy Process
Authors: İnan Aslan , Kara Huzeyfe
Published: May 2022

With the increased importance of energy all over the world, new energy sources are needed to meet the energy demand. However, the solution to energy demand is not only finding new energy resources but also using currently consumed energy efficiently. Accordingly, decreasing the energy consumption in urban electric railway transport has become an important issue. Investment in urban railway transport is increasing continually because it is more economical, safe, and sustainable than other modes in local transportation. For new investments related to urban railway transport, decision-makers generally make an assessment that will include economic, demographic, and environmental impacts. In this study, a comprehensive top-down decision-making system for urban railway route selection was engineered by taking into account socio-economic criteria as well as technical criteria. In the context of surveys conducted with experts in the choice of railway system routing, five socio-economic criteria (passenger potential, construction cost, integration-access, zoning-ownership, travel time) and five technical criteria (vehicle energy consumption, regenerative energy, traffic operations, power supply system, efficient driving techniques) were determined. In the analysis, the analytical hierarchy process (AHP) method, one of the multi-criteria decision-making methods, was used to determine the best route among alternative routes based on all criteria.
Cosmopolitanism and Global Ethics
Authors: Zhang Longxi
Published: May 2022

Embracing all humanity as one's own is the core of the modern idea of cosmopolitanism, but the present time with rising tribalism, populism, racism, and narrow-minded nationalism is not propitious for cosmopolitanism. At a time like this, the cosmopolitan effort to see cultures and peoples as close to one another rather than absolutely different becomes all the more important. The comparative study of different cultures and literatures may promote a cosmopolitan stance, and from a comparative perspective, we may draw some ideas from the ancient Chinese philosopher Mencius for a theory of global ethics.
Lead Zirconate Titanate-based bolt looseness monitoring using multiscale singular spectrum entropy analysis and genetic algorithm-based support vector machine
Authors: Wang Tao , Zhang Shizhuang , Yuan Rui , Tan Bohai , Lu Mingge
Published: May 2022

The looseness monitoring of bolted joints is a significant issue to ensure structural integrity and safety in the industrial field. This paper proposes a novel approach to monitor bolt looseness based on piezoelectric active sensing. During the research, piezoelectric material is acted as an exciter to generate ultrasonic signals and a transducer is used to receive ultrasonic signals. In the process of signal processing, singular spectrum analysis (SSA) including phase reconstruction and principal component analysis is adopted to decompose the signal. Multiscale sample entropy (MSE) is employed to map the dynamic characteristics and regularity of the decomposed signals on multiple scales. The proposed strategy, named multiscale singular spectrum entropy analysis, refers to use MSE values of the new time series decomposed and reconstructed by SSA, to extract signal characteristics. Such a strategy can explore the underlying dynamical characteristics of a signal quantitatively in the reconstructed phase space. In our research work, SSA is employed to decompose the signals acquired by Lead Zirconate Titanate (PZT) to matrices, arranged from high to low singular values, and reconstruct the new time series (principal components) by diagonal averaging on determined matrices to characterize the essential dynamic characteristics of signals. MSE values of the principal components are used as damage index and adopted as input of genetic algorithm-based SVM to train a classifier to fulfill accurate monitoring of bolt joints. The theoretical derivation, application researches and comparison analysis can validate the effectiveness and superiority of the proposed approach in the field of bolt looseness monitoring.
‘Regarding the scientific viewpoint in psychiatry’, lecture by Carl Wernicke (1880)
Authors: Heckers Stephan , Kendler Kenneth S , Klee Astrid , Heckers Stephan
Published: May 2022

In 1880 Carl Wernicke gave this plenary lecture at an annual meeting of German physicians and natural scientists. He used principles from his 1874 aphasia monograph to build a neural model of mental illness. He proposed that the brain keeps a record of experiences in distinct areas of the sensory and motor cortices in the form of memory images, which allows for recognition of objects and the planning of motor acts. He conjectured that imperfections, partial defects and complete loss of such memory images lead, respectively, to mild, moderate and severe forms of psychopathology in sensory and motor realms. The lecture is an early presentation of Wernicke’s system of psychiatry. Several of his concepts have remained relevant in contemporary neuroscience.
The abnormalisation of social justice: The ‘anti-woke culture war’ discourse in the UK
Authors: Cammaerts Bart
Published: May 2022

In this article, the so-called ‘anti-woke’ culture war is deconstructed through the notions of metapolitics in fascist discourses – linked to the Gramscian ‘hegemonisation’ and ‘the war of position’ – as well as the Schmittian friend/enemy distinction coupled with theories of deviance and moral panics. The appropriation of the neo-fascist culture war discourse by the mainstream right in the UK is analysed discursively, combining political discourse analysis, the discourse-historical approach and discourse-conceptual analysis. The anti-woke culture war by the British conservative party as well as rightwing media will serve to analyse how social justice struggles like anti-racism, anti-sexism and pro-LGBTQ rights are being abnormalised and positioned as extreme deviant political positions. Linked to this, so-called ‘cancel culture’ is strategically deployed by dominant groups to neutralise contestations against racist, sexist and anti-LGBTQ views. Finally, freedom of speech and the right to offend is weaponised to protect racist and discriminatory language and to position these idea’s as valid opinions worthy of democratic debate.
Guidance in the chaos: Effects of science communication by virologists during the COVID-19 crisis in Germany and the role of parasocial phenomena
Authors: Utz Sonja , Gaiser Franziska , Wolfers Lara N.
Published: May 2022

During the COVID-19 pandemic, virologists gained a prominent role in traditional and social media in Germany; several participated in regular podcasts. Using a two-wave survey ( n = 696/361 at Time 1/2), we explore which impact the strong media presence of virologists had on media users and what role parasocial phenomena (asymmetric interactions and relationships with virologists) played. People who favored a specific virologist scored higher on various cognitive, affective, and behavioral outcomes. Exposure to the virologist was related to these outcomes and parasocial phenomena turned out as an intervening variable between exposure and subjective and objective knowledge (time 1), solace, and behavioral engagement (both times). We did not, however, find effects over time when controlling for the time 1 values, which rather speak against more long-term media effects. A higher need for leadership also predicted the formation of parasocial phenomena. We discuss the theoretical implications for the role of parasocial phenomena in science communication via digital media.
Molecular Characterization of ESBLs and QnrS Producers From Selected Enterobacteriaceae Strains Isolated From Commercial Poultry Production Systems in Kiambu County, Kenya
Authors: Ndukui James G , Gikunju Joseph K , Aboge Gabriel O , Mwaniki John K , Maina John N , Mbaria James M
Published: May 2022

Background:

The emergence and spread of Extended-spectrum β-lactamases (ESBLs) in Enterobacteriaceae through the plasmid-mediated exchange have become a major threat to public health by complicating the treatment of severe infections in both animals and humans. Therefore, the current study focused on evaluating the manifestation of ESBLs production from the fecal isolates of E. coli, Shigella spp, Salmonella spp, and Klebsiella spps in commercial poultry production systems of Kiambu County, Kenya.

Materials and methods:

Out of 591 isolates identified as E. coli, Shigella spp, Salmonella spp, and Klebsiella spps from 437 fecal samples, only 78 were phenotypically suggestive to be ESBL producers. The possible ESBL producers were screened for the presence of blaTEM, blaCTX-M, blaOXA, and blaSHV using the PCR technique. These isolates were also screened for carriage of the QnrS gene that confers resistance to the fluoroquinolone class of drugs.

Results:

The most detected ESBL gene from the isolates was blaOXA (n = 20; 26%), followed by blaTEM (n = 16, 21%), with the majority of them detected in E. coli. The blaCTX-M was identified in all the 4 enteric’s bacteria-type isolates tested. Three E. coli and Salmonella spp respectively were found to harbor all the 5 antimicrobial resistance (AMR) gene types. The blaTEM, blaOXA, blaSHV, and QnrS genes were not detected from Klebsiella and Shigella spps. Additionally, most of the AMR gene co-carriage was detected in both E. coli and Salmonella spps as follows blaTEM + blaOXA (n = 4); blaTEM + QnrS (n = 3); blaTEM + blaOXA + QnrS (n = 3), concurrently.

Conclusion:

Our findings highlight the significance of commercial poultry production in disseminating transferable antibiotic resistance genes that act as potential sources of extensive drug resistance in livestock, humans, and the environment, leaving limited therapeutic options in infection management.
The security mindset: Corrections officer workplace culture in late mass incarceration
Authors: Schoenfeld Heather , Everly Grant
Published: May 2022

Prison officers’ behavior is one of the most consequential features of the modern prison. In this article, we introduce an organizational culture conceptual framework and build on previous prison scholarship to develop a model of prison officer workplace culture. We then apply the proposed model to original research in a US prison to investigate the relational aspects of prison officer culture during early 21st-century penal reforms. We find a set of collective norms and beliefs among officers consistent with the “traditional” prison officer culture historically documented by penologists, including high levels of distrust of prisoners, avoidance of relationships, and distancing from rehabilitation goals. We name this culture the “security mindset” because officers use multiple conceptions of “security” to rationalize their behavior. Our findings suggest that prison officer culture in late mass incarceration may work against the positive and supportive relationships necessary for rehabilitation.
The Fascinating History of Wound Healing Through Fine Arts
Authors: Papi Massimo , Fiscarelli Ersilia
Published: May 2022

Visual art images narrate the evolution of humankind including different and specific wound managing strategies. Through the observation of some notable art works we explore the empiric historical progress in wound healing and the main reasons they may have been represented. We briefly examine the cultural, symbolic, magical or religious beliefs that have conditioned the approach to a fundamental vital need of humanity: to heal a wound.
Utilization of keratin hydrolysate of wool waste fiber for free-salt dyeing of viscose fabric
Authors: Abo El-Ola Samiha M , Elsayed Naglaa AA
Published: May 2022

Viscose dyeing is one of the major pollutants of water due to the large amount of salt in the dyeing effluent. This study paves the way for improving environmentally sustainable wool waste and highlights a promising invaluable application through salt-free viscose dyeing. The keratin hydrolysate (KH) was obtained using microwave (MW) alkaline hydrolysis then applied on the viscose fabric in the finishing bath formulation using the pad-cure technique. The rheology of the hydrolyzed wool fibers and the amino acids composition using high-performance liquid chromatograph (HPLC) was estimated; furthermore, the fourier transform infrared spectroscopy (FTIR) of freeze-drying keratin hydrolysate was evaluated. Microwave-assisted keratin hydrolysis leads to the breakdown of peptide bonds and the release of low molecular weight proteins and peptides. The color strength (K/S) of the dyed post-finished viscose fabric increased 75% compared with that dyed by conventional technique. FTIR, scanning electron microscopy (SEM) and energy disperse x-ray spectroscopy (EDX) demonstrated and confirmed the effective finishing of keratin hydrolysate. The tensile strength and elongation of viscose fabric did not change after finishing with KH, while the air permeability improved and the light fastness properties for the modified viscose fabrics.
An analysis report on the application of immune checkpoint inhibitors after liver transplantation
Authors: Xie Man , Dang Zhi-ping , Sun Xue-guo , Zhang Bei , Zhang Qun , Tian Qiu-ju , Cai Jin-zhen , Rao Wei
Published: May 2022

Up to now, a variety of immune checkpoint inhibitors (ICIs) have been proved to have good therapeutic effects in the treatment of hepatocellular carcinoma (HCC). However, the effects of their applications in liver transplant (LT) recipients are still unclear. In this analysis report, the clinical applications and therapeutic effects of ICIs on LT recipients with hepatic tumor recurrence or de novo carcinoma based on eight databases, including PubMed, EMBASE, Web of Science, Google Scholar, China National Knowledge Infrastructure, Wanfang Data, and CQVIP, were investigated. And the prior treatment, disease response, adverse reactions, and prognosis of patients with malignant tumors after LT and receiving ICI treatments were analyzed. After screening, a total of 28 articles with 47 recipients on the application of ICIs after LT were included. In these patients, their median age was 57 (14–71) years and the main type of tumor after LT was HCC (59.6%). The overall remission rate following ICI treatment was 29.8% (14/47) and the disease progression rate was 68.1% (32/47). Among all these patients, 31.9% (15/47) of patients had immune rejection; the median survival time was 6.5 (0.3–48) months, and the fatality rate was 61.7% (29/47). Considering that the therapeutic effect of ICIs in LT recipients with HCC recurrence or de novo carcinoma is not ideal, ICI treatment should be carefully considered for LT patients, and further research is needed.
Distance to Neurovascular Bundle During Iliotibial Band Acl Graft Passage: A Cadaveric Study
Authors: Thomas Nicholas , Sanchez Mark , Gupta Anshal , Rohde Matt , Ayala Sal , Tompkins Marc , Wilson Phil , Ellis Henry , Sherman Seth , Green Daniel , Ganley Ted , Shea Kevin G
Published: May 2022

Background:

For patients with significant growth remaining, the Micheli-Kocher (iliotibial band) ACL reconstruction technique has proven to be a reliable procedure with minimal risk for growth disturbance. Recent cadaveric studies have demonstrated that graft passage over the top of the femur may bring the graft and instrument close to the critical neurovascular structures.

Purpose:

The purpose of this study was to evaluate the over-the-top graft passage technique using pediatric cadaveric knees, and measure the distance between instruments and the peroneal nerve, tibial nerve, popliteal artery.

Methods:

Seventeen skeletally immature cadaveric knees between the ages of 4 and 12 years old were dissected and prepared for visualization of iliotibial band graft passage procedure. A curved hemostat clamp was used, creating a path through the posterior capsule. To avoid neurovascular injury, the tip of the instrument was kept close to the posterior and lateral cortex of the femur. Once the clamp was safely positioned in the posterior knee joint, photographs were taken. Digital imaging software was used to measure the distance in centimeters from clamp tip to peroneal nerve laterally, and the popliteal artery and tibial nerve medially for all specimens, FIGURE 1. Distances were averaged and stratified to assess differences in age, FIGURE 2.

Results:

The average distances from clamp to neurovascular bundle were 0.875cm (range: 0.468-1.737cm), 0.968cm (range: 0.312-1.819cm), and 1.149cm (range: 0.202-2.409cm) for tibial nerve, popliteal artery and peroneal nerve, respectfully. Means were further calculated for age groups ≤8, 9-10, and 11-12 years old.

Conclusion:

Iliotibial band graft ACL reconstruction is one of the best options in the skeletally immature, as it has the lowest risk of growth plate complications and growth arrest. The neurovascular structures are very close to the path for over-the-top graft clamp placement with distances <1 cm in many subjects. The current study provides detailed measurements of instrument proximity to the neurovascular bundle in the posterior compartment of the knee. This knowledge is important to help surgeons who perform the Micheli-Kocher pediatric ACL reconstruction avoid damage to the nerves and vessels in this region. Careful instrument and graft passage, with awareness of proximity to critical structures, are important to reduce the risk of neurovascular injury. [Figure: see text][Figure: see text]
Demographic, Injury Characteristics, and Comorbidity Differences Between Youth with >28 Day and >90 Day Recovery from Concussion
Authors: Young Julie A. , Maki Aaron , Feiss Robyn , Yang Jinzhen , Cuff Steven C.
Published: May 2022

Background:

The identification and comparison of risk factors between concussed children with symptom resolution >28 days and those with symptom resolution >90 days may aid in clinical care.

Purpose:

The objective of this study was to identify demographic, comorbidity, and injury factors associated with prolonged (>28 days) and extended (>90 days) concussion recovery among children aged 10 to 18 years with concussions.

Methods:

Demographics, injury characteristics and comorbidities were recorded in patients aged 10-18. We assessed the associations of patients’ demographics, comorbidities, and injury characteristics with the outcome variable of concussion symptom resolution >28 days post-injury using two-level, Generalized Linear Mixed model (GLMM). We repeated the analysis for concussion symptom resolution >90 days post-injury. Odds ratios(OR) and 95% confidence intervals(CI) were reported.

Results:

A total of 4,937 concussions were analyzed. Of these, 32.6% had resolution >28 days and an additional 20.1% had resolution >90 days after injury. Risk factors for symptom resolution >28 days included female sex, (OR=1.22, 95% CI=1.03, 1.44), ADD/ADHD diagnosis (OR=1.31, 95% CI=1.00, 1.72), those with one (OR=1.41, 95% CI=1.17, 1.71), two (OR=1.41, 95% CI=1.02, 1.95), or three or more previous concussions (OR=2.08, 95% CI=1.42, 3.05), higher initial symptom score (OR=1.04, 95% CI=1.04, 1.05), and greater days from injury to first visit (OR=2.80, 95% CI=2.53, 3.09). Risk factors for >90 days to recovery included older age group (OR=1.66, 95% CI=1.18, 2.32) in 15-18 year olds compared to 10-14 year olds, two (OR=1.84, 95% CI=1.10, 3.07), or three or more (OR=2.30, 95% CI=1.27, 4.19) previous concussions, history of headaches (OR=0.65, 95% CI=0.46, 0.93), anxiety disorder diagnosis (OR=1.66, 95% CI=1.04, 2.64), higher symptom scores at first visit, (OR=1.01, 95% CI=1.00-1.01), and a greater number of days from injury to first visit (OR=1.29, 95% CI=1.20-1.39).

Discussion:

Female sex and ADD/ADHD diagnosis were unique risk factors for >28 day recovery and history of headaches, anxiety diagnosis, and age were unique risk factors for >90 day recovery. For both groups, higher initial symptom scores and longer time to initial evaluation resulted in longer recovery. Future studies are needed to screen and detect children at risk for prolonged recovery during the acute phase post-injury so that appropriate clinical care can be provided to expedite concussion recovery.
Quantifying Head Impact Exposure, Mechanisms and Kinematics Using an Instrumented Mouthguard in Female High School Lacrosse
Authors: Huber Colin M. , Patton Declan A. , Margulies Susan S. , Master Christina L. , Arbogast Kristy B.
Published: May 2022

Background:

There is growing concern for the neurological effects of repetitive head impacts in sports, and girls’ lacrosse represents a popular but understudied sport regarding head impact exposure. Current debate exists over the need for enhanced protective equipment, and it is important to quantify head impact exposure and biomechanics to inform policy discussions and rule changes for improved protection.

Purpose:

To quantify the head impact biomechanics, by impact mechanism and direction, of female high school lacrosse players during games using an instrumented mouthguard.

Methods:

A female high school varsity lacrosse team wore the Stanford Instrumented Mouthguard during competitive games for the 2019 season. Video footage was reviewed to confirm head impact events and remove false-positive recordings. For each impact event, the mechanism was coded as stick contact, player contact, fall, or ball contact, and the site was coded as face/jaw, forehead, crown, side, rear or indirect (i.e. body impact with no head contact). Head impact rates were calculated per athlete exposure (AE, defined as a single player participating in a game).

Results:

Sensor data were recorded for 15 players for 14 games and 97 AEs. During games, 31 sensor-recorded head impacts were video-confirmed resulting in a pooled average head impact rate of 0.32 impacts/AE. The 31 video-confirmed impacts were distributed among stick contacts (17, 54.8%), player contacts (12, 38.7%), and falls (2, 6.5%). There were no ball impacts. The associated peak kinematics are presented in Figure 1.1. The most common impact site was the side (11, 35.5%), followed by face/jaw (8, 25.8%), forehead (2, 6.5%), and crown (2, 6.5%). There were no impacts to the rear of the head and 8 (25.8%) impacts were indirect. The associated peak kinematics are presented in Figure 1.2.

Conclusion:

Stick impacts were the most common impact mechanism and resulted in the highest peak linear and angular kinematics, which may help explain why they are the most common cause of head injury in female lacrosse. By quantifying the head impact exposure, kinematics and mechanisms in female high school lacrosse, targeted injury preventions can be developed, such as rule changes and protective equipment. [Figure: see text][Figure: see text]
Clinical Features and Operative Treatments of Discoid Medial Meniscus in Children
Authors: Anderson Kathryn G. , Carsen Sasha , Stinson Zachary , Kushare Indranil , Finlayson Craig , Nault Marie-Lyne , Lee R. Jay , Haus Brian ,   PRiSM Meniscus Research Interest Group, Schmale Gregory A.
Published: May 2022

Background:

The discoid medial meniscus is a rare congenital anomaly of the knee. The literature on discoid medial menisci is limited, with few reported cases in children.

Purpose:

To report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America.

Methods:

A retrospective review of medical records including operative reports was performed to identify patients diagnosed with a discoid medial meniscus confirmed via direct surgical observation across eight children’s hospitals between January 2000 and March 2020.

Results:

Twenty-one patients (9 female, 12 male) with 22 discoid medial menisci were identified, one with bilateral discoid medial menisci. The mean age at time of diagnosis was 12.7 years (range, 3-18 years). One patient had discoid medial and discoid lateral menisci in the same knee. The most common symptoms and signs of patients with a discoid medial meniscus were locking and/or clunking, present in over 50% of patients. Twelve discoid medial menisci were complete (55%), 8 were incomplete (36%), and two were indeterminate (9%). Tears were present in 13 knees. Of those with tears, 7 were horizontal tears (4 posterior, 1 anterior, and 2 mid-body), 5 were complex (3 posterior, 1 anterior, and 1 mid-body), and 1 was a posterior vertical tear. Five of these discoid medial menisci were unstable (23%). The average time between initial diagnosis and treatment was 13 months (range, 0-121 months). All knees underwent arthroscopic saucerization, and of the 13 torn discoid medial menisci, 7 were repaired (54%). The mean length of clinical follow-up postoperatively was 24 months (range, 1-82 months). Four of these discoid medial menisci underwent re-operation, most commonly for persistent symptoms. All knees which required re-treatment initially presented with a tear, all of which had been repaired. There was a significant association between initial presence of a tear and need for re-operation, [χ2 = 4.1, p = 0.044].

Conclusions:

In this multicenter study of patients treated for a discoid medial meniscus, symptoms and signs at presentation and findings at arthroscopy were similar with those commonly seen in patients with a discoid lateral meniscus. Tears were present in more than half of knees, and reoperation was more common in knees identified with tears of their discoid medial menisci than those without tears. Future studies should seek to determine the long-term functional and patient-reported outcomes following treatment of discoid medial menisci.
Reliability of a Qualitative Movement Assessment Tool During a Single Leg Triple Hop
Authors: Epstein Eli , Huse Casey , Link Meredith , Witte Katherine , Pontis Veronica , Verdoni Ryder , Greenberg Elliot
Published: May 2022

Background:

Single leg hop tests are commonly used to determine readiness for return to sport following anterior cruciate ligament reconstruction (ACLR). A common criticism of hop tests is their inability to account for quality of movement errors, which may be associated with increased risk of re-injury. The Qualitative Analysis of Single Leg Squat (QASLS) tool was originally developed to score quality of movement during a single leg squat. The usefulness of this tool for identifying quality of movement errors during single leg hopping has not been assessed.

Hypothesis/Purpose:

The purpose of this study was to determine the inter and intra-rater reliability of the QASLS tool during a single leg triple hop and explore if differences in reliability existed between novice and experienced clinicians.

Methods:

Subjects 10-24 years-old and ≥6-months post ACLR were eligible for this study. Subjects were recorded performing a maximal effort single leg triple hop on each limb. Recordings were viewed individually by five raters, two board-certified sports clinical specialists, and three doctor of physical therapy students in their 2nd year of education. All raters were trained in the use of the QASLS tool during a single online training presentation. Raters were blinded to surgical limb and utilized the QASLS to rate the final landing of the triple hop task. Intraclass correlation coefficient (ICC) was calculated to measure reliability of the QASLS on the surgical limb. Wilcoxon signed-rank test was utilized to assess if differences in QASLS scores existed between limbs.

Results:

20 subjects (mean age 16.5, 60% female) participated in this study. The cumulative inter-rater reliability of the surgical limb was moderate (ICC: 0.703) and little difference was seen between experienced and novice raters with ICCs of 0.703 and 0.603, respectively. Intra-rater reliability was better, with a cumulative ICC of 0.857 and with experienced clinicians demonstrating slightly higher reliability (ICC 0.891) than novice clinicians (ICC 0.831). The mean QASLS scores for the surgical limb and nonsurgical limbs were 5.2 and 5.4, respectively, and there was no statistically significant difference between scores (P=0.64).

Conclusions:

The QASLS tool offers moderate to good inter and intra-rater reliability for evaluating quality of movement errors during a single leg triple hop, regardless of rater experience level. Interestingly, surgical limb did not show any difference in quality of movement compared to the nonsurgical limb. [Table: see text][Table: see text]
Sex and Age Comparisons of Pediatric Track & Field Hurdle Injuries
Authors: Jones Jacob , Radel Luke , Garcia Kyle , Soma David , Sugimoto Dai
Published: May 2022

Background:

Track & field has more participants compared to any other high school sport and continues to gain popularity among middle school aged kids. Among many events, hurdles is unique because there is continued running with repeated jumping over an apparatus. Although serious injury has been anecdotally reported, there are few studies describing pediatric hurdle injuries including sex and age differences.

Purpose:

To investigate hurdle-related injury types and body locations based on age and sex among children and adolescents.

Methods:

Hurdle related injury data was extracted from the National Electronic Injury Surveillance System (NEISS), which represents emergency room visits. The search period was a 10-years (2008-2017). The eligibility criteria was < 18 years of age. Injuries were then classified based upon injury type and body location(s) involved. A chi-square (x2) analysis was employed to assess proportional differences of top three hurdle related injury types and body locations by age (<14 years vs. >15 years) and sex (male vs. female). Statistical significance was set as p<0.05.

Results:

A total of 749 cases related to hurdle injuries were extracted. Among recorded 749 injuries, traumatic fractures (N=218, 29.1%), joint sprain (N=191, 25.5%), and contusion/hematoma/bruise (N=78, 10.4%) were found as the top three most commonly sustained injuries. Chi-square (x2)analysis found more traumatic fractures in <14 years (34.1%) compared to >15 years (21.5%, p=0.001) while more joint sprain was identified in >15 years (29.6%) than <14 years (22.8%, p=0.036). Regarding sex comparisons, males had more traumatic fractures (35.1%) than females (24.3%, p=0.001). Conversely, females sustained more joint sprains (29.1%) and contusion/hematoma/bruise (12.7%) than males (joint sprain, 21.0%, p=0.012; contusion/hematoma/bruise, 7.5%, p=0.020). The top 3 injured body locations were ankle (N=140, 18.7%), knee (N=120, 16.0%), and wrist (N=69, 9.2%). No differences were found between body locations and age; however, statistical differences were detected by sex comparisons. Ankle injury was more common in females (24.0%) than males (12.0%, p=0.001). Yet, injury at wrist was more prevalent in males (11.7%) compared to females (7.2%, p=0.034).

Conclusion:

Findings of this study suggest that hurdle injury types seen in the emergency room differ by sex and age: more fractures are seen in males and younger pediatric populations while more sprains are seen in females and older adolescents. These findings may be helpful in event planning and may also play a role in injury prevention.
Diagnostic and Predictive Ability of Reaction Time Assessments for Adolescent Concussion
Authors: Wingerson Mathew J. , Seehusen Corrine N. , Wilson Julie C. , Smulligan Katherine L. , Reinking Sarah E. , Magliato Samantha N. , Howell David R.
Published: May 2022

Background:

Concussed individuals demonstrate significantly slower reaction time than that of healthy controls, particularly in the acute post-injury timeframe. In addition, post-injury reaction time may predict concussion recovery timing. Given that multiple measurement methods exist to assess reaction time post-injury, clinicians treating concussion may desire more information regarding the clinical utility of these methods.

Purpose:

To determine the clinical utility of two reaction time assessments and identify the ability of each to predict persistent post-concussion symptoms (PPCS), defined as symptoms lasting >28 days post-concussion.

Methods:

Concussed participants, within 14 days of injury, and healthy controls aged 12 to 18 years completed measures of clinical and smartphone-recorded reaction time. For clinical reaction time testing, participants completed 8 trials of a drop-stick protocol in which participants caught a weighted measuring stick dropped from a standard height between the thumb and palm of the dominant hand. Reaction time was calculated as the distance the stick fell before being caught. Three clinical reaction time outcomes were calculated: mean time, fastest trial, and coefficient of variance among all 8 trials. Smartphone reaction time was assessed through a smartphone application (Reaction Test Pro), which measured the speed at which patients responded to a simple on-screen stimulus. Participants were instructed to tap the phone as quickly as possible when an on-screen button changed color for 30 trials, an approximate test time of 2-3 minutes. Smartphone reaction time was output automatically by the application as the mean of all completed trials.

Results:

Concussion participants (n=54; 15.1±1.68 years of age; 50% female) assessed 7.0±3.05 days post-injury demonstrated worse performance than healthy controls (n=17; 16.3±1.13 years of age, 47% female) on all measures of reaction time (Table 1). Smartphone-recorded reaction time provided the largest mean difference between groups to distinguish concussed vs control participants. After controlling for age and concussion history, measures of mean clinical and smartphone reaction time were significant predictors of developing PPCS (Table 2).

Conclusion:

Smartphone-recorded reaction time within 2 weeks of concussion provide the greatest mean difference between concussed and control participants and predicted PPCS development in adolescents. Given the simplicity of smartphone-based measurements in comparison to other options for assessing reaction time, as well as the ubiquity and accessibility of smartphone technology, this technique may be preferred by physicians looking for direct measures of post-concussion reaction time. These assessments may also be used for early identification of patients at increased risk of developing PPCS. [Table: see text][Table: see text]
Long-Term Minimum 15-Year Follow Up After Lateral Discoid Meniscal Preservation Surgery in Children and Adolescents
Authors: Lins Laura A.B. , Feroe Aliya G. , Yang Brian , Williams Kathryn A. , Kocher Sophia D. , Sankarankutty Saritha , Micheli Lyle J. , Kocher Mininder S.
Published: May 2022

Background:

Discoid meniscus is a congenital variant typically affecting the lateral meniscus of the knee. Historically, surgical intervention when symptomatic consisted of total meniscectomy; however, after degenerative changes were observed, current treatments now focus on rim preservation with arthroscopic saucerization and meniscal repair for instability, when indicated.

Purpose:

The aim of this study was to examine long-term patient-reported outcomes of lateral discoid menisci (LDM) treated with meniscal-preserving techniques.

Methods:

Ninety-eight patients treated arthroscopically for LDM at a single institution at a minimum of 15 years ago were retrospectively identified and contacted by mailers and telephone to participate. Subjective functional outcomes and patient satisfaction data were collected using a questionnaire that included the validated IKDC Subjective Knee Evaluation Form, Lysholm Score, Marx Activity Rating Scale, Tegner Activity Score, and WOMAC Osteoarthritis Index. Patient and surgical characteristics and patient-reported outcomes were summarized by mean and standard deviation (SD), median and interquartile range (IQR), or frequency and percent, as appropriate.

Results:

Of the 46 patients contacted (response rate of 46/98 eligible), 25 (54%) completed the questionnaires. The mean (± SD) age at initial surgery was 10.8 (± 3.4) years and 30.3 (± 3.7) years at final follow-up. The mean (± SD) follow-up time from initial surgery was 19.5 (± 2.8) years (range, 16–27). Patient-reported outcomes included: IKDC 77.4 ± 17.2, Lysholm 78.6 ± 21, WOMAC 7.6 ± 11.3, Tegner Activity 7 (out of 10), and Marx Activity Rating Scale 8 (out of 10) (Table 1). Eleven (44%) cases underwent subsequent LDM-related surgery on the ipsilateral knee(s). There were no cases of total knee replacement (Table 2).

Conclusions:

Overall, patient-reported outcomes were favorable at a minimum of 15-year follow-up after rim-preserving saucerization of lateral discoid meniscus. While two-thirds of patients were satisfied with their surgical outcomes, nearly half of patients underwent revision saucerization with or without meniscal repair. Subsequent long-term follow-up studies with radiographs will be important to determine how meniscus-preserving procedures may curb the development of arthritis. [Table: see text][Table: see text]
Physician Preferences on Bone Age Determination for Anterior Cruciate Ligament (ACL) Reconstructions for Pediatric Patients with Acl Injuries
Authors: Nice Emily , Franklin Corinna C , Heidel Eric ,   Shriners Sports Medicine Consortium, Uquillas Carlos
Published: May 2022

Introduction:

The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Currently, there is no standardized skeletal maturity determination for pediatric and adolescent patients that present with an ACL tear.

Hypothesis/Purpose:

This study aims to evaluate physicians’ preferences for obtaining bone age studies for pediatric and adolescent patients with an ACL injury.

Methods:

A survey link was sent to the members of Pediatric Research in Sports Medicine (PRiSM). Participation in the survey was voluntary. Consent was obtained by the participants taking part in the survey.

Results:

Forty-five physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty physicians had completed a pediatric orthopaedic fellowship, six had completed a sports medicine fellowship, and nineteen had completed both. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. When asked about the number of ACL reconstructions performed each year on skeletally immature patients, 15.6% (n=7) report less than 5, 11.1% (n=5) said 5-9, 44.4% (n=20) said 10-34, 20.0% (n=9) report 35-49, and 8.9% (n=4) said they perform 50 or more. A majority of the participants (n=32) said that they routinely obtain a skeletal age study. Of the participants that routinely order a skeletal age study, 100% (n=32) get a bone age for patients 11 and 12 years old. Seventeen (n=17) obtain a bone age study for patients 8-14 years of age. When asked about bone age determination method, 100% (n=45) said one method they use is hand bone age and twenty-four (n=24) only use hand bone age. Thirty-four (n=34) report they sometimes see a significant difference (2 or more years) between bone age radiographs and chronological age while eleven (n=11) report they almost never see a significant difference. Thirty-one report that a patient’s skeletal age sometimes changes their technique or graft preference.

Conclusion:

Results of this survey suggest that bone age studies are used to treat pediatric and adolescent patients with ACL injuries. Hand bone age, in particular the Greulich-Pyle method, is the most widely used among the respondents. Obtaining bone age radiographs can help physicians to formulate a proper treatment plan for their patients. Further research is needed to identify the true impact of bone age studies on the treatment of ACL injuries in pediatric and adolescent patients. [Table: see text]
Knee Strength Outcomes in Adolescents by Age and Sex During Late-Stage Rehabilitation After Anterior Cruciate Ligament Reconstruction
Authors: Roman Dylan P. , Ness Brandon M. , Giampetruzzi Nicholas , Cleland Joshua A. , Weaver Adam
Published: May 2022

Background:

The incidence of anterior cruciate ligament (ACL) injuries have been consistently increasing in adolescents, with those who return to competitive sport having up to a 32% risk of a secondary ACL injury. There is limited evidence regarding knee strength outcomes in young adolescents following ACL reconstruction during late-stage rehabilitation when compared to older patient groups.

Purpose:

The purpose of this study was to 1) establish normative knee strength values according to age group in adolescent female and male patients during late-stage rehabilitation following ACLR and 2) determine whether strength differences exist between age groups.

Methods:

A retrospective review of adolescent patients who underwent primary ACL reconstruction was performed. Patients completed a standardized isokinetic (60°/sec) knee extension and flexion strength assessment during late-stage rehabilitation. Peak torque was normalized to the patient’s body mass (Nm/kg) and used to calculate Limb Symmetry Index (LSI). Analyses were conducted separately for female and male cohorts and grouped by early (11-14 years) and middle (15-17 years) adolescence. An independent samples t-test examined strength differences between age groups.

Results:

130 females (age=15.4 ± 1.4 years; days since surgery=239.0 ± 84.4) and 112 males (age=15.4 ± 1.5 years; days since surgery= 232.6 ± 91.2) were included. Normalized knee extension peak torque on the involved limb was reported for female (1.5 Nm/kg) and male (1.8 Nm/kg) cohorts. Differences between age groups in knee extension peak torque were found on the surgical and nonsurgical limbs in female (p = 0.02 – 0.05) and male (p<0.001 – 0.002) cohorts. No differences were found between age groups for either cohort when normalized to body mass (p = 0.30 – 0.89). Post hoc power analyses revealed 67% statistical power in the female cohort and 97% in the male cohort with an alpha level set to 0.05 based on the observed effect size for the differences in isokinetic knee extension/flexion peak torque between age groups.

Conclusion:

Early adolescents produced less knee extension and flexion peak torque compared to middle adolescents after ACLR, but no differences were found between age groups when normalized to body mass for female or male cohorts. Normalized knee extension strength in young adolescents may differ from older patients and should be considered in the rehabilitation process. [Table: see text][Table: see text][Table: see text][Table: see text]