bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxygen in the Setting of Acute Myocardial Infarction
Authors: Loomba Rohit S. , Nijhawan Karan , Aggarwal Saurabh , Arora Rohit R.
Published: August 2015

Introduction:

Supplemental oxygen has been used in the setting of acute myocardial infarction (AMI). Once an official recommendation in the guidelines for the management of acute ST-segment elevation myocardial infarction, it is now mentioned as an intervention to be considered. Data for the use of supplemental oxygen or AMI are limited, and some data have suggested associated harm.

Methods:

We performed a systematic review of the literature and a subsequent meta-analysis of the data to determine the effect of high concentration oxygen versus titrated oxygen or room air in the setting of AMI. The following end points were studied: in-hospital mortality, opiate use, percentage of infarcted myocardium by magnetic resonance imaging (MRI), and mass of infarcted myocardium by MRI.

Results:

No significant difference was noted with end points when comparing those randomized to high-concentration oxygen versus those randomized to titrated oxygen or room air in the setting of AMI. No significant publication bias was identified although this could not be assessed for all end points.

Conclusion:

High-concentration oxygen may not offer any benefit when compared to titrated oxygen or room air. A large, randomized trial is warranted to further delineate these differences with respect to multiple end points.
Climate as Comedy
Authors: Brewer Paul R. , McKnight Jessica
Published: August 2015

Two satirical television news programs, The Daily Show and The Colbert Report, cover climate change in ways that affirm the existence of global warming. This study uses data from an experiment ( N = 424) to test whether exposure to these programs’ coverage can influence viewers’ certainty that global warming is happening. It also examines whether viewers’ political beliefs predict their interpretations of the programs’ messages about climate change, whether such interpretations are related to viewers’ climate change perceptions, and whether the effects of the programs vary depending on viewers’ political beliefs.
Racial and Ethnic Disparities in Patients’ Experience With Skilled Home Health Care Services
Authors: Smith Laura M. , Anderson Wayne L. , Kenyon Anne , Kinyara Elizabeth , With Sarah K. , Teichman Lori , Dean-Whittaker Debra , Goldstein Elizabeth
Published: August 2015

Racial and ethnic disparities are found in many health care settings; however, there is little prior research on such disparities among patients receiving home health care services. This study used 2012 Home Health Care CAHPS® data to identify any overall patient-level disparities in self-reported experience of care and to decompose these disparities according to whether they result from within-agency versus between-agency differences. Although patient experience of care ratings were high across all groups, the study identified consistently lower ratings for all minority groups on two of three Home Health Care CAHPS measures, with Asians reporting the greatest disparities. Three quarters of disparities were found to be within-agency disparities, which were primarily related to care processes and provider/patient communications rather than to specific health care services received. Despite high ratings in general, home health agencies may need to focus on cultural competency initiatives to address racial and ethnic disparities within their agencies.
Retrospective assessment of peripheral nerve block techniques used in cats undergoing hindlimb orthopaedic surgery
Authors: Vettorato Enzo , Corletto Federico
Published: August 2015

Objectives

The aim of this study was to assess retrospectively the efficacy and complication rate of hindlimb peripheral nerve blocks (PNBs) in cats.

Methods

Clinical records of cats that received PNBs and underwent hindlimb orthopaedic surgery from February 2010 to October 2014 were examined. Type of PNB, type and dose of local anaesthetic used, end-expiratory fraction of isoflurane (FE′Iso) administered, additional intraoperative analgesia, incidence of hypotension, postoperative opioid requirement, postoperative contralateral limb paralysis and neurological complications at the 6 week re-examination were investigated.

Results

Eighty-nine records were retrieved but only 69 were analysed. Four combinations of PNBs were used: 34 lateral preiliac (LPI) approach to lumbar plexus (LP) associated with lumbar paravertebral approach to sciatic nerve (SN); 20 LPI–LP associated with the lateral approach to SN; three LPI–LP associated with gluteal approach to SN; 12 dorsal-paravertebral (DPV) approach to LP associated with lateral SN. Levobupivacaine was used for the majority of PNBs. The mean intraoperative FE′Iso was 1.15%; hypotension was documented in 55.1% of anaesthetics, while 31.8% of cats received fentanyl and/or ketamine intraoperatively. Postoperatively, 72.7% of cats received at least one dose of opioid, while five cats required further postoperative analgesia (ketamine constant rate infusion and/or gabapentin). No cats showed contralateral limb paralysis and neurological complications at the 6 week re-examination. No differences were found when comparing the different PNBs used.

Conclusions and relevance

PNBs contributed to perioperative anaesthesia/analgesia in cats undergoing hindlimb orthopaedic surgery. However, the clinical relevance of intraoperative hypotension needs further investigation.
Arsenic Keratosis in a Patient from Newfoundland and Labrador, Canada
Authors: Pratt Michelle , Wadden Patricia , Gulliver Wayne
Published: August 2015

Background and Objective:

Millions of people worldwide suffer from chronic arsenic poisoning due to contaminated drinking water. The devastating effects of chronic arsenic ingestion are multisystem, but depending on the dose and frequency of exposure, may take many years to become clinically apparent. The earliest and most common manifestations are dermatological, and therefore, recognition of hallmark lesions is key. In this report, we describe a suspected case of palmoplantar arsenical keratosis in a patient from Newfoundland, Canada.

Methods:

Case report and review of relevant literature via PubMed search.

Results:

A 64-year-old fisherman from rural Newfoundland presented with a 12-year history of hyperkeratotic palmoplantar papules/plaques. The lesions first appeared on the sole of his left foot but gradually extended to involve the sole of his right foot and palms. Numerous violaceous keratotic papules with erosions were observed. Both the patient and his wife were found to have elevated blood arsenic levels, and the arsenic concentration in their artesian well was 14.2 ug/L (maximum acceptable concentration: 10 ug/L). Interestingly, biopsy showed a lichen-sclerosis-like inflammatory pattern that seems to deviate from the classic histologic description. The patient is being treated with oral acitretin, and minor improvement has been noted.

Conclusion:

It is important to consider arsenic exposure whenever a patient presents with acral hyperkeratosis. Further research is needed to develop more effective treatments for chronic arsenicism and to determine the effects of very low-dose exposure and what truly constitutes a safe level.
Sex-specific predictors of improved walking with step-monitored, home-based exercise in peripheral artery disease
Authors: Gardner Andrew W , Parker Donald E , Montgomery Polly S
Published: August 2015

The aim of this study was to determine whether baseline clinical characteristics and the duration and intensity of ambulation during our step-monitored home-based exercise program were predictive of changes in ambulatory outcomes at completion of the program in symptomatic patients with peripheral artery disease (PAD). Twenty-two men (ankle–brachial index (ABI) = 0.71 ± 0.19) and 24 women (ABI = 0.66 ± 0.23) completed the home exercise program, consisting of intermittent walking to mild-to-moderate claudication pain for 3 months. Ambulatory outcome measures were peak walking time (PWT) and claudication onset time (COT) during a treadmill test, and the distance recorded during a 6-minute walk distance test (6MWD). Men experienced significant increases ( p<0.01) in COT, PWT, and 6MWD following the home exercise program, and women had significant increases in 6MWD ( p<0.01) and PWT ( p<0.05). In women, average exercise cadence during the home exercise sessions was the only predictor that entered the model for change in COT ( p=0.082), and was the first predictor in the model for change in PWT ( p=0.029) and 6MWD ( p=0.006). In men, the ABI was the only predictor that entered the model for change in 6MWD ( p=0.002), and ABI was a predictor along with metabolic syndrome in the model for change in COT ( p=0.003). No variables entered the model for change in PWT. Faster ambulatory cadence during the step-monitored home-based exercise program may predict greater improvements in ambulatory function in women, whereas having less severe PAD and comorbid burden at baseline may predict greater improvements in ambulatory function in men. ClinicalTrials.gov Identifier: NCT00618670
Experience of sexual self-esteem among men living with HIV
Authors: Rohleder Poul , McDermott Daragh T , Cook Rachel
Published: August 2015

Much of the focus on sexual health for people living with HIV has been on promoting safe sex behaviours. However, also important for sexual health is a positive sexual self-esteem. This article reports on an interpretative phenomenological analysis of interviews with seven men about the impact that having HIV has had on their sense of sexual self. Five overarching themes were identified: the ‘destruction’ of a sexual self; feeling sexually hazardous; sexual inhibition; reclaiming a sexual self and finding a place through sero-sorting. With HIV now being a chronic illness, interventions are required to support people to lead sexually satisfying lives.
Not entirely at home: Upward social mobility and early family life
Authors: Mallman Mark
Published: August 2015

Current research on socio-economic mobility documents difficulties upwardly mobile people encounter at university and in professional work environments. However, early-life experiences of family, home and community are largely overlooked as a primary point of inquiry. This article examines accounts of early family life given by upwardly mobile Australians to consider the ways class processes impact family beginnings and life trajectories. The in-depth interviews discussed here reveal that the negotiation of differing class cultures begins during childhood, in the home and community. This is illustrated most clearly through reflections on a sense of belonging (or not), and on material and cultural dynamics of youth. These narratives challenge widely accepted notions of homogeneous working-class socialisation, and require a broader understanding of the complex ways in which the upwardly mobile negotiate relationships and identity. These are narratives of what happens when origins and ambitions are seemingly at odds.
Fatigue life and damage evolution of glass fiber/epoxy laminates containing interacting circular holes
Authors: Bhaskara Rao P , Rama Krishna A , Ramji K , Satya Devi A
Published: August 2015

The behavior of woven glass fiber reinforced plastic laminates containing interacting circular holes off the loading axis under cyclic loads in tension–tension has been investigated with a fiber volume fraction of 0.65. The tests were conducted in load control mode from 80% of the ultimate tensile strength to the threshhold to draw the stress–life curves. For the unnotched, central holed, and off-center interacting holed specimens, the damage pattern and its evolution are extensively discussed. The damage development in interacting holed specimens occurs in four different stages namely matrix cracking, edge delamination, matrix splitting, and final fracture. The damage pattern depends on the location of the interacting circular hole and stress level. The sectioned parts of laminates fatigued at different stress levels were examined on scanning electron microscope for the damage evaluation.
Study on the effects of nano-aluminum-oxide particulates on mechanical and tribological characteristics of chopped carbon fiber reinforced epoxy composites
Authors: Dass Kali , Chauhan SR , Gaur Bharti
Published: August 2015

An experimental study has been carried out to investigate the mechanical and tribological characteristics of chopped carbon fiber (CCF) reinforced epoxy composites filled with nano-Al2O3 particulates, as a function of fiber and filler contents. The experiments were conducted using a pin-on-disc wear test apparatus under dry sliding conditions. The coefficient of friction and specific wear rate of these composites was determined as a function of applied normal load, sliding velocity, sliding distance, and reinforcement content. The tensile, flexural, and compression strengths of ortho cresol novalac epoxy and chopped carbon fiber (OCNE/CCF) filled composites are found to be within the ranges of 48–58.54 MPa, 115–156.56 MPa, and 48–61.15 MPa. Whereas the tensile, flexural, and compression strengths of OCNE/CCF/Al2O3-filled composites are found to be within the ranges of 96–110 MPa, 176–204.66 MPa, and 72–85.65 MPa, respectively. It has been observed that the coefficient of friction decreases and specific wear rate increases with increase in the applied normal loads. Further increases in the fiber (6 wt%) and particle (3 wt%) contents in the epoxy matrix resulted in a decrease of both the mechanical and tribological properties, but remains above that of the CCF reinforced epoxy composites. The worn surfaces of composites were examined with scanning electron microscopy equipped with energy dispersion X-ray analyzer and X-ray diffraction analysis technique to investigate the wear mechanisms.
Book review: Van Koppen, B., Smits, S., Rumbaitis del Rio, C. and Thomas, J.B. 2014: Scaling up Multiple Use Water Services: Accountability in the Water Sector
Authors: Damkjaer Simon
Published: August 2015

Van Koppen, B., Smits, S., Rumbaitis del Rio, C. and Thomas, J.B. 2014: Scaling up Multiple Use Water Services: Accountability in the Water Sector. Rugby, UK: Practical Action Publishing. xii + 89 pp. £19.95 hardback, £9.95 paper. ISBN: 9781853398292 hardback, 9781853398308 paperback.
Book review: Darnell, Simon C. 2012: Sport for development and peace: A critical sociology
Authors: Fontefrancesco Michele Filippo
Published: August 2015

Darnell, Simon C. 2012: Sport for development and peace: A critical sociology. London and New York: Bloomsbury Academic. 182 pp. £50.00 hardcover. ISBN: 9781849663441.
Book review: Studwell, Joe. 2014: How Asia works: Success and failure in the world’s most dynamic region
Authors: Rajewska Natalia
Published: August 2015

Studwell, Joe. 2014: How Asia works: Success and failure in the world’s most dynamic region. London, UK: Grove Press. 322 pp. paperback £9.99. ISBN: 9781846682438.
Book review: Dyson, Jane. 2014: Working childhoods: Youth, agency and the environment in India
Authors: Bhattacharyya Rituparna
Published: August 2015

Dyson, Jane. 2014: Working childhoods: Youth, agency and the environment in India. Cambridge, United Kingdom: Cambridge University Press. 186 pp. £50.00 hardback. ISBN: 9781107058385.
Confronting the white elephant: International volunteering and racial (dis)advantage
Authors: Lough Benjamin J. , Carter-Black Janet
Published: August 2015

This retrospective study with nine volunteer-sending organizations from six countries assesses how race influences the aid recipients’ internalized sense of power and agency. Methods include a combination of 24 structured staff-member interviews, 59 community-member interviews, and 83 quantitative surveys. From the perspective of intended aid recipients, there is a strong association between race and: (i) resources, (ii) knowledge and expertise, and (iii) trust. Practice implications recommend strategies to shift the power balance and to change disempowered racial perceptions, including critical conscious-raising, strengths-based dialogue, and polemic discourse about the mutuality of exchange.
Creation of property rights in planning by contract and edict: Beyond “Coasian bargaining” in private planning
Authors: Lai Lawrence WC , Davies Stephen NG , Lorne FT
Published: August 2015

This article advances the proposition that the creation of property rights, whether by contract-upon-negotiation or edict, is far more significant than what has been described as “ Coasian bargaining” in effecting sustainable development. By “creation” we intend the neo-institutional economist’s sense of establishing a degree of exclusive property rights for common property or devising new contractual arrangements in which private property rights are entrenched. This is sometimes mistakenly confused with the assignment of property rights. “Sustainable development” is understood as the transformation of negative into positive externalities or a state of the tragedy of the commons into a vibrant resource nourishing industry. Two real-world cases involving government planning are used to illustrate this proposition.
Factors in the cross-cultural adaptation of African students in Chinese universities
Authors: Akhtar Nadeem , Pratt Cornelius B , Bo Shan
Published: August 2015

Since 2006, the enrollment of African students in Chinese universities has been increasing steadily. A majority of the students have been recruited through the China Scholarship Council. Cast against that background of growth in the number of African students in Chinese universities, it is important that their educational experience in a country whose cultural landscape and political orientation are significantly different from those of their homelands be examined for evidence on their overall well-being. A total of 110 students from 32 African countries enrolled in six public Chinese universities responded to a questionnaire on their satisfaction with and adjustment and adaptation to their new cultural and academic environments. Results indicated that the students’ over-expectation of China and natural factors, particularly China’s weather as a barrier to adjustment, had negative associations with their overall satisfaction and with their adaptation to their environment. A broad network of friends, prior cross-cultural experience, and prior knowledge of cultural differences had positive associations with satisfaction and adaptation. The implications of these results for developing campus programs for acculturating the students, as well as other international students in Chinese universities, are presented.
Autoethnography as a Legitimate Approach to HRD Research
Authors: Grenier Robin S.
Published: August 2015

I believe the field of human resource development (HRD) is missing out on the opportunity to expand our methodological approaches and ignoring the calls from others to be rebellious and look beyond our standard operating procedures. The purpose of this article is to provide an evocative “conversation” on autoethnography and to explain how HRD researchers might conduct and represent autoethnographic work. Autoethnographic methods are highly suited to the task of exploring organizational and everyday work phenomenon that can lead to the development of new theories of HRD. Through talking about the challenges associated with using an autoethnographic approach and how HRD scholars might assess such reflexive ethnography, I hope to encourage the use of rich, but neglected sources of less traditional approaches to qualitative inquiry.
Combating Superbug Without Antibiotic on a Postamputation Wound in a Patient With Diabetic Foot
Authors: Sun Shuyao , Wang Chun , Chen Dawei , Cen Shiqiang , Lv Xiaoju , Wen Xiaorong , Liu Min , Lu Wusheng , Zhao Jichun , Ran Xingwu
Published: August 2015

Diabetic foot is a kind of limb- and life-threatening complication that is difficult to treat with conventional therapy, especially when accompanied with peripheral arterial insufficiency and severe infection. We present a diabetic patient with a postamputation wound infected by multidrug-resistant Acinetobacter baumannii/haemolyticus, which was resistant to almost all antibiotics. As the clinical response to antimicrobial therapy was poor, antibiotic was discontinued. Autologous platelet-rich gel with anticoagulation, negative pressure wound therapy, and improvement of microcirculation were used successfully to eradicate infection of the superbug and achieve final wound closure.
Women’s Perception of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Authors: Gerntke Carina Isabel , Kersten Jan Felix , Schön Gerhard , Mann Oliver , Stark Michael , Benhidjeb Tahar
Published: August 2015

Objective. Over the past 8 years, natural orifice transluminal endoscopic surgery (NOTES) has developed from preclinical to routine clinical practice. However, there are still concerns regarding the transvaginal approach. In our survey, we were interested in females with a professional medical background, thus having at least a basic medical understanding, which might discriminate between objective and subjective concerns. Material and Methods. A questionnaire with 14 items was distributed among 1895 female physicians and nursing and administration staff of the University Medical Center Hamburg-Eppendorf. In addition, a qualitative literature review was performed. Data analysis was carried out using statistical package R version 2.15.0. Results. The questionnaire was answered anonymously by 553 employees (29%). Fifty-seven percent were nurses, 18.6% belonged to administration, and 17% were physicians. A total of 63.1% of our respondents would choose the transvaginal NOTES technique for an assumed ovariectomy, while only 30.4% would choose this access for cholecystectomy. Doubts regarding transvaginal NOTES were related to sexual dysfunction (44.8%), its experimental nature (43.8%), future pregnancies (36.8%), and ethical reasons (30.3%). The literature review showed that women’s perception of the transvaginal access is documented very heterogeneously and therefore difficult to compare. Conclusions. Despite the good reported results of NOTES and the medical background of the surveyed female employees, our study and the literature review clearly shows that there are  fears regarding the transvaginal access, which might be a result of limited information. More accurate explanation of the available methods by the attending surgeon can lead to a better choice of the patient’s preferred method.
A new remote intelligent diagnosis system for marine diesel engines based on an improved multi-kernel algorithm
Authors: Yuan Yupeng , Yan Xinping , Wang Kai , Yuan Chengqing
Published: August 2015

Due to heavy work load of marine diesel engines, the failure in their mechanical components may result in serious accidents. Existing condition monitoring methods for marine diesel engines usually adopt warning after the failure occurred. In order to predict potential faults, this work has put forward a remote intelligent monitoring system for marine diesel engines. The global system for mobile communication mode was employed to construct the basis of data remote transmission, and a new multi-kernel extreme learning machine algorithm was proposed to diagnose the early faults in an intelligent method. Experimental tests were carried out in the marine diesel engine fault diagnosis set-up. The analysis results show that the proposed remote intelligent monitoring system can accurately, timely and reliably detect the potential failures. Meanwhile, the proposed multi-kernel extreme learning machine was compared with the existing methods. The comparison indicates that the multi-kernel extreme learning machine outperforms its rivals in term of fault detection rate by an increase of 3.4%. Therefore, the proposed remote intelligent monitoring system has good prospects for engineering applications.
A copula-based reliability modeling for nonrepairable multi-state k-out-of-n systems with dependent components
Authors: Li Xiang-Yu , Liu Yu , Chen Chu-Jie , Jiang Tao
Published: August 2015

As k-out-of- n systems have widespread applications in engineering practices, their reliability modeling and evaluation are a great concern of reliability community. However, most reported works on k-out-of- n reliability modeling and evaluation are based on the premise that all the components are s-independent. Such simplified treatment may not be realistic as components in a system often suffer the same working or environmental conditions and/or interact with one another, resulting in dependency between their failure processes. To characterize such dependency in reliability modeling and evaluation, a copula-based reliability modeling for dependent multi-state k-out-of- n systems is developed in this work using copula functions and minimal paths of system states. The state probability and reliability functions of dependent multi-state k-out-of- n systems with identical components, nonidentical components, and partially dependent components are formulated. Two illustrative examples and a port oil transportation system are presented to demonstrate the implementation of the proposed method, and a sensitivity analysis is also conducted to examine how sensitive the reliability measures are with respect to the degree of dependency.
Learning and the diffusion of regime contention in the Arab Spring
Authors: Bamert Justus , Gilardi Fabrizio , Wasserfallen Fabio
Published: August 2015

The Arab Spring has become a prominent example of the spread of cross-national regime contention. It is widely accepted that successful regime contention (in Tunisia and Egypt) triggered protests in other countries. Both scholars and other observers have suggested that protesters learned from successful regime contention. Thus far, available evidence has been either anecdotal or qualitative. This article provides a quantitative analysis of the diffusion of regime contention in 20 countries in the Middle East and North Africa (MENA) region between December 2010 and April 2011. Results show that protests that led to a regime change were much more likely to be imitated elsewhere, but especially in the first couple of weeks and without taking the specificity of the context into account. Our analysis thus suggests that regime contention diffused through bounded learning during the Arab Spring.
Knee Kinematics Are Related to Patient-Reported Outcomes 6 Months After Anatomic ACL Reconstruction
Authors: Kalawadia Jay , Thorhauer Eric , Arilla Fabio Vicente , Azar Amir Ata Rahnemai , Zhang Caiyan , Fu Freddie H. , Tashman Scott , Irrgang James J.
Published: August 2015

Objectives:

Anterior cruciate ligament (ACL) reconstruction is among the most common procedures performed in orthopaedics. Patient reported outcomes (PRO) are widely utilized to evaluate symptoms, activity, and participation in sport after ACL reconstruction. Although altered in vivo knee kinematics after ACL reconstruction have been reported, the association with PRO has not been established. The purpose of this study was to determine the relationship between PRO and dynamic knee kinematics as tracked by a Dynamic Stereo X-ray system (DSX system).

Methods:

Fifty subjects (33 males, age: 24.2 years ± 7.6, BMI: 24.7 ± 2.97) participating in a randomized clinical trial to compare anatomic single- and double-bundle ACL reconstruction underwent surgery using quadriceps tendon bone block autograft. Six months post-operatively, patients performed downhill treadmill running (3.0 meters/second, 10° slope) within a DSX system (150 hertz). Knee kinematics, determined using a validated process of matching DSX images and subject-specific tibiofemoral bone models derived from computed tomography scans, were expressed as a function of the gait cycle. Involved limb and differences in side-to-side kinematics were analyzed from foot-strike to mid-stance phase (0-15% gait cycle corresponding to the loading phase). Subjects also completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Correlation coefficients were calculated to determine the associations between PRO and knee kinematics.

Results:

Greater post-operative knee flexion and more symmetric restoration of knee flexion and axial rotation in comparison to the contralateral knee had the highest correlations with the IKDC-SKF and KOOS Sports and Recreation and Knee-Related Quality of Life subscales (p < 0.05). Symmetry of anterior tibial translation and varus-valgus rotation of the surgical knee were less strongly associated with PRO.

Conclusion:

Knee kinematics when running 6 months after ACL reconstruction were associated with patient-reported symptoms, activity, and participation levels. Therefore, clinicians should strive for anatomic precision during ACL reconstruction to optimally restore knee kinematics so as to achieve optimal PRO.
The Degree of Knee Extension Does Not Affect Postoperative Stability or Subsequent Graft Tear Rate after Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft
Authors: Benner Rodney W. , Shelbourne K. Donald , Gray Tinker
Published: August 2015

Objectives:

To compare graft tear and failure rates and subjective scores between patients of varying degrees of knee extension after anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft.

Methods:

Of 2329 patients who underwent ACL reconstruction with patellar tendon autograft between 1998 and 2008, 625 patients met the inclusion criteria of having primary ACL surgery, no bilateral ACL injuries, no existing osteoarthritis, and having either 6⁰ or more of knee hyperextension before and after surgery (Group A; n=318; mean 8⁰ + 2⁰, range 6⁰ to 15⁰) or 3⁰ or less of knee hyperextension before and after surgery (Group B; n=307; mean 0⁰ + 3⁰, range 3⁰ hyperextension to -4⁰ extension). As part prospective follow-up, patients were evaluated with KT-1000 arthrometer for objective stability, range of motion measurements, and subjective follow-up with International Knee Documentation Committee (IKDC), Cincinnati Knee Ratings Scale (CKRS), and Activity Rating surveys. Subsequent graft tear related to specific injury within 5 years of surgery was recorded. Graft failure was defined as a KT-1000 manual maximum difference between knees of > 5mm.

Results:

Follow-up was obtained from 278 (87%) in Group A and 275 (90%) in Group B at a mean of 4.1 + 1.1 years after surgery. The KT1000 arthrometer manual/maximum difference between knees was 2.0 + 1.4 in Group A and 2.1 + 1.6 in Group B (p=.701). Within 5 years after surgery, subsequent ACL graft tear/failure occurred in 22 patients (6.9%) in Group A and 30 patients (9.8%) in Group B (p=.246.) Further sub-analysis of Group A showed that the graft tear/failure rate was 6 of 81 (7.4%) for patients with ≥ 10⁰ of hyperextension versus 16 of 237 (6.8%) for patients with 6⁰ to 9⁰ of hyperextension. The percentage of patients who participated in jumping and pivoting sports before surgery was 85% in Group A and 86% in the Group B before surgery and 87% in Group A and 90% in Group B after surgery. The mean activity rating score was 8.4 + 1.1 in both groups after surgery. There was no statistically significant difference in the IKDC giveway or CKRS stability scores between groups after surgery (p=.174 and p=.107 respectively). Similarly, there was no difference in IKDC total score or CKRS total score between groups after surgery (p=.933 and p=.155 respectively).

Conclusion:

Obtaining full hyperextension that is anatomically normal for most patients does not affect postoperative objective stability, ACL graft tear/failure rates, or subjective scores after ACL reconstruction with patellar tendon autograft.
Low Risk of Physeal Damage from a Medial Patellofemoral Ligament (MPFL) Reconstruction Technique that Uses an Epiphyseal Socket in Children
Authors: Haskel Jonathan D. , Uppstrom Tyler J. , Gausden Elizabeth Bishop , Green Daniel W.
Published: August 2015

Objectives:

The purpose of this study was to assess short-term distal femoral growth plate safety associated with femoral sockets for hamstring autograft fixation in pediatric MPFL reconstruction.

Methods:

We retrospectively reviewed a consecutive series of 31 patients (22 females, 9 males) that underwent MPFL reconstruction by one surgeon at a tertiary care academic medical center between 2008 and 2014. Study inclusion criteria consisted of patients who were skeletally immature at the time of surgery, who had greater than 1 year radiographic follow-up and who had a femoral socket introduced during their procedure. Femoral socket location was verified by intraoperative fluoroscopy. All patients received a post-operative x-ray and a clinical follow-up. For the 12 patients that obtained post-operative MRI, growth plate safety was assessed by examining the location of the femoral socket relative to the physis to rule out growth plate injury (Figure 1). Development of lower limb angular deformities or limb length discrepancies was evaluated by examining post-operative standing hip-to-ankle anteroposterior radiographs, patient records, and clinical assessments.

Results:

The average age at surgery of 13.0 years. The average length of radiographic follow-up was 1.5 years and the average length of clinical follow-up was 1.78 years. At most recent clinical follow-up, 90% (28/31) of patients reported no subsequent patellar dislocations in the treated knee. No patients showed evidence of an angular deformity or limb length discrepancy. Of the 12 patients with postoperative MRI, all showed femoral sockets positioned distal to the physis without growth plate disturbance.

Conclusion:

The use of an epiphyseal femoral socket for graft fixation presents minimal risk of physeal violation and ensures patellar stability in the majority of pediatric patients. We have demonstrated that using fluoroscopic assistance to place the femoral socket distal to the distal femoral physis is a reliable and safe method for avoiding physeal injury in children with patellar instability.
Extra-articular Drilling for Adolescents with Osteochondritis Dissecans of the Talus
Authors: Edmonds Eric W. , Roocroft Joanna Helena , Bastrom Tracey P. , Pennock Andrew T.
Published: August 2015

Objectives:

To determine the radiographic outcome and need for further surgery in children with osteochondritis dissecans (OCD) of the talus treated with extra-articular drilling. Children requiring further surgery for pre-operative risk factors of the initial failure were also evaluated.

Methods:

Fifty-six ankles were identified between August 2006 and August 2012 with talus OCD that underwent extra-articular talar drilling. Demographic data, mechanism of injury, conservative treatment history, surgical details of initial treatment and subsequent treatment, if necessary, was collected. Pre-operatively, radiographs were evaluated for physeal status, signs of osteoarthritis according the Kellgren and Lawrence Scale, location of the lesion, border, and size of the lesion. Each lesion was classified according to the Berndt and Harty classification for radiographs, Hepple classification for MRI, and Ferkel and Sgaglione for CT. Radiographs at each follow-up visit were evaluated by a Healing matrix that assessed serial changes in lesion length, lesion depth, perilesional sclerosis, or density of the lesion. At final follow-up, lesion size, border, Berndt and Harty classification, and signs of osteoarthritis were recorded.

Results:

At final follow-up, all but one lesion showed radiographic improvement but no lesion reached complete radiographic resolution. The mean Healing matrix score at final follow-up was 59/100. Risk factors for reaching statistical significance for poor healing included closed physes (p = 0.025) and lesions with a distinct border (p = 0.029). Age, size of lesion, and length of follow-up did not correlate with healing. Comparison of pre-operative and final follow-up radiographs showed no significant change in the size or border of the lesion. For the 23% of children who underwent a second surgery, they were found to have a lower Healing matrix score after index surgery compared to those without repeat surgery, p < 0.001). Moreover, patients with closed physes were more likely to have second surgery, 38% vs. 14% (OR 3.7). After a second extra-articular talar drilling surgery, the mean Healing matrix score improved to match the mean of the entire cohort.

Conclusion:

Extra-articular talar drilling of OCD does not appear to improve radiographic outcomes as compared with other reported techniques of intra-articular drilling. As with other joints, successful radiographic resolution is associated with open physes - highlighting that children have better OCD healing potential. Other modalities of talus OCD treatment should be explored, especially for higher-grade lesions at risk for instability, since the radiographic results of current drilling techniques are disappointing.
The Cost-Effectiveness of Utilizing Platelet-Rich Plasma During Rotator Cuff Repair
Authors: Samuelson Eric M. , Fleischli James E.
Published: August 2015

Objectives:

A certain percentage of repaired rotator cuffs do not heal postoperatively. There has been significant interest in enhancing the healing potential of repaired rotator cuffs using biologic factors such as cytokines, gene therapy, scaffolds, mesenchymal stem cells, etc. Platelet-rich plasma (PRP) has been one of the most studied of these biologic factors. The purpose of this study was to determine whether or not PRP augmentation of rotator cuff repair (RCR) is cost-effective.

Methods:

Utility values, retear rates, and transition probabilities were derived from the best evidence available in the literature regarding rotator cuff tears, their repair, and the augmentation of the repair with PRP. Costs were determined by examining the typical patient undergoing treatment for a full-thickness rotator cuff tear in a private orthopaedic clinic and outpatient surgery center. (Table 1) A Markov decision model was constructed using this data to perform a cost-effectiveness analysis. (Figure)

Results:

The cost per quality-adjusted life year ($/QALY) of RCR with and without PRP was $6775/QALY and $6612/QALY respectively. In the base case scenario, the use of PRP to augment RCR was not cost-effective as it had exactly the same ‘effectiveness’ as RCR without PRP augmentation while being associated with a higher cost (additional $750). Sensitivity analysis revealed that in order to achieve a willingness-to-pay threshold of $50,000/QALY, the addition of PRP would need to be associated with a 9.1% reduction in retears. If the cost of PRP were increased to $1000, the retear rate would need to be reduced 12.1% in order to reach this same threshold. This compared to a reduction of only 6.1% if the additional cost of PRP was $500. (Table 2)

Conclusion:

This cost-effectiveness analysis reveals that, currently, the use of PRP to augment RCR is not cost-effective. Sensitivity analysis evealed that PRP augmented repairs would have to show a reduced retear rate of at least 9.1% before its additional cost would be considered cost-effective. Future research needs to show a significant and reliable reduction in retear rates or improvement in outcomes before PRP augmented RCR can be considered cost-effective.
The Fate Of Meniscus Tears Left in situ At The Time Of Anterior Cruciate Ligament Reconstruction
Authors: Duchman Kyle R. , Westermann Robert W. , Spindler Kurt P. , Amendola Annunziato , Wolf Brian R. , Parker Richard D. , Andrish Jack T. , Withrow Laura J. , Reinke Emily , Kaeding Christopher C. , Wright Rick W. , Marx Robert G. , McCarty Eric C. , Wolcott Michelle Lora , Dunn Warren R.
Published: August 2015

Objectives:

Meniscus tears frequently accompany acute anterior cruciate ligament ruptures. Management of meniscus tears is highly variable and includes repair, meniscectomy, and non-treatment of tears identified at the time of ACL reconstruction. The purpose of this study is to determine the rate of subsequent reoperation and clinical outcome of meniscal tears left in situ without treatment at the time of ACL reconstruction with a minimum follow-up of 6 years.

Methods:

Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group between 2002 and 2004 with minimum 6-year follow-up. Patient demographic variables, comorbidities, meniscus tear characteristics, and information on subsequent surgery were obtained. The primary endpoint of the study was need for reoperation for meniscal pathology. Univariate and multivariate analyses were used in order to determine patient demographic variables and meniscus tear characteristics that served as risk factors for reoperation.

Results:

There were 1440 primary ACL reconstructions performed during the timeframe of the study. There were 955 patients (66.3%) with concomitant meniscal tears identified. Of these, 143 (15.3%) had meniscal tears left in situ at the time of surgery. There were 11 patients (7.9%) who underwent reoperation for meniscal pathology within the same compartment as the meniscal tear left in situ (Table 1). Reoperation was performed more frequently for medial meniscus tears as compared to lateral meniscus tears (17.6% vs. 4.3%, p = 0.048). Medial meniscus tears and tears ≥10 mm in length were identified as risk factors for reoperation.

Conclusion:

Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at minimum 6-year follow-up in 95.7% and 82.4% of patients, respectively. Our results suggest that surgeons should consider alternative treatment for medial meniscus tears and tears ≥ 10 mm in length at the time of ACL reconstruction.
A Comparison of Non-Operative and Operative Treatment of Complete Proximal Hamstring Ruptures
Authors: Olsen Joshua , Kellum Ethan L. , Lacerte Edward , Miller Suzanne Laura
Published: August 2015

Objectives:

Early repair of acute proximal hamstring ruptures provides better clinical results than delayed repairs. However, it is unclear how the non-operative treatment compares to the operative treatment of these injuries. We compare the clinical results of non-operative and operative treatment of acute proximal hamstring ruptures.

Methods:

A retrospective case-control study of patients with a complete, retracted, proximal hamstring rupture was performed from 2007 to 2013. All patients were given the option of a proximal hamstring repair at the time of initial evaluation. Patients at least 12 months from the time of surgery or injury were included for evaluation. Acute proximal hamstring injuries were included; and partial proximal hamstring tears and chronic injuries repaired were excluded. The primary outcome measure was the lower extremity functional score (LEFS). Secondary outcome measures included the SF-12 physical and mental component scores, a single leg hop (average of three jumps), the patient's perception of strength (0-100%), and ability to return to activity.

Results:

A total of 25 patients were enrolled. The 14 patients treated surgically sustained injuries at 46.98 ± 9.73 years of age, were repaired at 28.14 ± 14.06 days, and evaluated at 50.62 ± 10.11 years of age. The 11 patients treated non-operatively sustained injuries at 55.6 ± 10.45 years of age (p = 0.05), attempted therapy an average of 4.6 ± 3.22 months, and were evaluated at 58.4 ± 8.31 years of age (p= 0.06). The LEFS for the surgical and non-surgical groups was 74.71 ± 5.38 and 68.5 ± 7.92 (p = 0.04), respectively. SF-12 mental and physical components scores were similar between groups. The average single leg hop of the injured extremity in the surgical and non-surgical groups was 119.1 ± 27.68 cm and 56.1 ± 31.2 cm (p = 0.0001), respectively. When compared to the uninjured leg, the average single leg hop in the injured leg was 5.1 ± 12.1 cm and 1.2 ± 17.2 cm (p = 0.51) shorter in both the surgical and non-surgical groups, respectively. The LEFS had a weak correlation with the average single leg hop and age in the surgical (R2 = 0.2478 and 0.0664, respectively) and non-surgical (R2 = 0.0023 and 0.052, respectively) groups. The patient's perception of strength was similar between the surgical and non-surgical groups (86.07 ± 12.12% and 83.6 ± 14.15%, p = 0.64). All patients in the operative group were able to return to pre-injury activities whereas three were unable to in the non-operative group (chi-square stat = 4.33, p = 0.03).

Conclusion:

Patients with acute proximal hamstring ruptures treated surgically have better lower extremity function and a higher likelihood of returning to pre-injury activities than patients treated non-surgically.
Epidemiology of Isolated Meniscus Tears in Young Athletes
Authors: Masini Brendan David , Dickens Jonathan F. , Tucker Christopher J. , Cameron Kenneth L. , Svoboda Steven J. , Owens Brett D.
Published: August 2015

Objectives:

Meniscus tears are common in athletic populations; however, there are few studies of the epidemiology of meniscal tears in a stable knee, and particularly tears in young populations. The purpose of this study was to define the incidence of isolated meniscus tears and to determine demographic and athletic risk factors.

Methods:

A longitudinal cohort study was performed to determine the incidence and characteristics of isolated meniscus tears at the United States Military Academy between 2005 and 2012. Injuries identified in the Cadet Illness and Injury Tracking System (CIITS) were confirmed by clinic, surgical, and radiographic data for inclusion. Cooper's classification was used to localize meniscus tears. Incidence rates (IR) per 1000 person-years and per 1000 athlete-exposures (AE) were determined for sport and level of competition. Demographic, injury characteristic and time loss data were also evaluated.

Results:

There were 79 instances of meniscus tears in stable knees in a cohort of 9086 subjects from 2005-2012. Of these, 68 (86%) were in males and 11 (14%) in females. Right (40) and Left (39) knees were equally affected. The lateral meniscus (70%) was torn at a greater rate than medial meniscus (30%). Body mass index (BMI) of the meniscus injured population was 25.7 vs. 24.6 for the uninjured cohort (p less than .05). BMI was also greater in subjects with lateral (26.4) vs. medial (23.9) meniscus tears (p less than .05). The average time lost from activity was 102 days. Surgically managed injuries lost 112.7 days vs. 36.1 for non-operative cases (p less than .05). Of the operative cases, repairs lost 150.8 days vs. 101.0 for debridement (p less than .05). There was no significant difference in time lost from medial (90.9 days) vs. lateral (106.9 days) injuries. The greatest percentages of meniscus tears were found in football (19%), wrestling (13%) and rugby (9%) activities. Military combative training accounted for 5% of meniscus tears. The IR per 1000 AE for intercollegiate athletes was greatest in wrestling (0.157) and rugby (0.150). This was mirrored in the intramural population with rates of 0.125 and 0.138 respectively. Rates per AE in football were lower at 0.045 and 0.062 for intercollegiate and intramural competition.

Conclusion:

Isolated meniscus tears are relatively common in young athletes and cause significant loss of time from athletic pursuits with meniscus repair causing greater loss than debridement. Lateral meniscus tears are more prevalent in this population. A significantly greater BMI was seen in those with vs. without isolated meniscus tear in this cohort, and between those with lateral vs. medial meniscus tear among the injured. Wrestling and rugby carry the greatest risk of meniscus injury per exposure at both the intercollegiate and intramural level of competition.