bluuebunny/crossref_metadata_2025 huggingface dataset:
Contextual weighting approach to compute term weight in layered vector space model
Authors: Gadge Jayant , Bhirud Sunil
Published: July 2019

The World Wide Web (WWW) is the largest available repository of information. This huge amount of information put forward the challenges of retrieval of trustworthy information from WWW. It defies researchers with new issues of diversity and complexity while retrieving the web information. Information retrieval from the web demands approaches that span beyond conventional information retrieval. Heterogeneity, complexity and the huge volume of web information requires a unique approach to retrieve information. Besides, end-users introduce some difficulties in the retrieval process. Sometimes queries submitted by the user are subtle and ambiguous. The primary concern in information retrieval is the issue of predicting the relevance of documents. In this article, a new approach is proposed that rationally separates web document into five layers, namely, title, header, hyperlink, meta tag and body layer. The proposed method effectively combines the textual information and structural evidence of web document for retrieving information from Web. In the proposed layered vector space model, each layer has an allocated priority which is used to compute weight factor for these layers. The proposed method deduces equation that effectively combines priority of the layer and length of the layer to calculate the weight of the layer.
The effectiveness of adding a scapular exercise programme to physical therapy treatment in patients with distal radius fracture treated conservatively: a randomized controlled trial
Authors: Gutiérrez-Espinoza Héctor , Araya-Quintanilla Felipe , Gutiérrez-Monclus Rodrigo , Cavero-Redondo Iván , Álvarez-Bueno Celia
Published: July 2019

Objective:

To determine the effectiveness of a scapular exercise programme in addition to a physical therapy treatment in patients with distal radius fracture.

Design:

A single-blinded randomized controlled trial was conducted.

Setting:

Clinical Hospital San Borja Arriaran, Santiago, Chile.

Participants:

A total of 102 patients above 60 years of age with extra-articular distal radius fracture were randomly divided into two groups.

Interventions:

The control group ( n = 51) received a six-week physical therapy treatment; the intervention group ( n = 51) received the same treatment plus a scapular exercise programme.

Outcome measures:

The two groups were assessed at baseline and after the six-week treatment. The arm function was assessed with the disabilities of the arm, shoulder and hand (DASH) questionnaire; secondary outcomes were measured by the patient-rated wrist evaluation (PRWE) questionnaire and visual analogue scale (VAS).

Results:

A total of 102 patients, 51 in the control group (40 women; mean age of 65.3 ± 4.8 years) and 51 in the intervention group (42 women; mean age of 67.2 ± 5.4 years), were analysed. At the end of the treatment, the difference between groups for the DASH was 16.7 points ( P < 0.001), 1.5 points ( P = 0.541) for the PRWE, 0.2 cm ( P = 0.484) for the VAS at rest, and 1.7 cm ( P < 0.001) for the VAS at movement. All differences were in favour of the intervention group.

Conclusion:

In the short term, adding a scapular exercise programme provides a significant clinical benefit in arm function and pain relief with movement in patients above 60 years of age with extra-articular distal radius fracture treated conservatively.
Modulation of the NOP receptor signaling affects resilience to acute stress
Authors: Holanda Victor A D , Pacifico Salvatore , Azevedo Neto Joaquim , Finetti Luca , Lobão-Soares Bruno , Calo Girolamo , Gavioli Elaine C , Ruzza Chiara
Published: July 2019

Background:

The peptide nociceptin/orphanin FQ (N/OFQ) and its receptor (NOP) are implicated in the modulation of emotional states. Previous human and rodent findings support NOP antagonists as antidepressants. However, the role played by the N/OFQ–NOP receptor system in resilience to stress is unclear.

Aims:

The present study investigated the effects of activation or blockade of NOP receptor signaling before exposure to acute stress.

Methods:

The behavioral effects of the administration before stress of the NOP agonists Ro 65-6570 (0.01–1 mg/kg) and MCOPPB (0.1–10 mg/kg), and the NOP antagonist SB-612111 (1–10 mg/kg) were assessed in mice exposed to inescapable electric footshock and forced swim as stressors. The behavioral phenotype of mice lacking the NOP receptor (NOP(-/-)) exposed to inescapable electric footshock was also investigated.

Results:

The activation of NOP receptor signaling with the agonists increased the percentage of mice developing helpless behavior and facilitated immobile posture. In contrast, the blockade of NOP receptor reduced the acquisition of depressive-like phenotypes, and similar resistance to develop helpless behaviors was observed in NOP(-/-) mice. Under the same stressful conditions, the antidepressant nortriptyline (20 mg/kg) did not change the acquisition of helpless behavior and immobile posture.

Conclusions:

These findings support the view that NOP activation during acute stress facilitates the development of depressive-related behaviors, whereas NOP blockade has a protective outcome. This study showed for first time that NOP antagonists are worthy of investigation as preemptive treatments in patients with severe risk factors for depression.
Aortic endovascular stenting in patients with systemic connective tissue disorders: does the prohibitive dogma still stand tall?
Authors: Harky Amer , Iqbal Rizwan , Giordano Vincenzo , Al-Adhami Ahmed
Published: July 2019

Endovascular repair of thoracic aortic diseases can provide satisfactory outcomes in elective and certain emergency cases involving the descending thoracic and aortic arch. However, open repair remains the gold standard method of aortic root pathologies and certain aortic arch pathologies, such as extended dissection. Nevertheless, the use of endovascular stenting in patients with connective tissue disorders has not been fully explored because the aortic tissues are fragile and the likelihood of keeping the stent in place is low because of its progressive dilatation and subsequent requirement for open repair at a later stage when the stent graft fails. Our brief review focuses on current evidence of the use of stents in patients with connective tissue disorders and whether such practice can be expanded further.
Command of the skies: An air power dataset
Authors: Saunders Richard J. , Souva Mark
Published: July 2019

We introduce a dataset on air power. Air power is the ability to inflict damage on an adversary through the air, and its successful application depends on achieving command of the skies. To achieve command of the skies, countries invest in a variety of types of military hardware and training, especially fighter aircraft. Our dataset contains information on the number, type and technological characteristics—including weaponry, avionics, speed, maneuverability and stealth characteristics—of each country’s fighter and attack aircraft for the period 1973–2013. We also introduce two new air power variables based on this data. The first is Country Air Power, a country-year measure of air power. The second is Expected Air Superiority, a dyad-year measure of which actor is likely to achieve air superiority in a military conflict. We illustrate the utility of this dataset by examining the relationship between air power and militarized dispute initiation, the duration and success of coercive bombing campaigns, and coercive behavior more generally. We find that command of the skies significantly affects conflict and coercive behavior.
Collaboration of doctoral researchers with industry: A critical realist theorization
Authors: Moghadam-Saman Saeed
Published: July 2019

This article proposes a heuristic theoretical framework for identifying the main areas of policy improvement needed to enhance the engagement of doctoral researchers with industry. A critical realist approach is adopted in order to identify the factors underlying collaborations of doctoral researchers with industry. Following the initial three steps proposed by Danermark et al.’s Explanatory Model of Social Sciences, these factors are first identified at one level of abstraction and based on the findings of previous scholarly works on the external engagement of academics. They are comprised of academic disciplinary and contextual (regulatory and organizational) elements. After reviewing the prominent literature on each factor, a critical realist evaluation framework known as context–mechanism–outcome is implemented to integrate these underlying factors into an integrative and heuristic theoretical framework. Finally, the article discusses the research and policy implications of an interactive relationship between the disciplinary and contextual mechanisms that can shape different configurations for policy intervention to boost learning outcomes from collaboration.
3D-printed Futures of Manufacturing, Social Change and Technological Innovation in China and Singapore: The Ghost of a Massless Future?
Authors: Heemsbergen Luke , Daly Angela , Lu Jiajie , Birtchnell Thomas
Published: July 2019

This article outlines preliminary findings from a futures forecasting exercise where participants in Shenzhen and Singapore considered the socio-technological construction of 3D printing in terms of work and social change. We offered participants ideal political-economic futures across local–global knowledge and capital–commons dimensions, and then had them backcast the contextual waypoints across markets, culture, policy, law and technology dimensions that help guide towards each future. Their discussion identified various contextually sensitive points, but also tended to dismiss the farthest reaches of each proposed ideal, often reverting to familiar contextual signifiers. Here, we offer discussion on how participants saw culture and industry shaping futures for pertinent political economic concerns in the twenty-first century.
Behavioural Red Flags of Fraud: An Ex Post Assessment of Types and Frequencies
Authors: Sandhu Namrata
Published: July 2019

A number of researchers and professional fraud examiners have emphasized the need for early detection of frauds. Though there are many ways in which frauds can be detected, a particularly effective and inexpensive way is to identify fraudsters by scrutinizing personnel behaviour for peculiarities typical of fraudsters. Towards this end, the present study compiles a checklist of behavioural red flags of fraud based on data collected with the help of 41 semi-structured interviews. The interviewees constitute people who have personally investigated or closely observed a fraud in the last 3 years. A mixed methods triangulation approach is used to quantify the qualitative data collected from the interviews. Data analysis reveals 16 different behavioural red flags exhibited by fraudsters. An examination of frequencies indicates that strong ambition, extended working hours, social aloofness, dissatisfaction with current job and living standard disproportionate to current means are the most frequently displayed behavioural red flags of fraud. The study also shows that fraudsters exhibit three or four behavioural red flags in a majority of cases. Implications for anti-fraud practitioners are discussed.
Trustworthy Small and Medium-sized Enterprise Network Partners: Small and Medium-sized Enterprise Partnerships in the International Entrepreneurial Process
Authors: Schreier Claus , Scherrer Sylvie , Udomkit Nuntana , Farrar Jillaine
Published: July 2019

This study explores how 40 decision-makers from Swiss and Thai small or medium-sized enterprises (SMEs) engage and develop international partnerships to discover, create, evaluate and exploit entrepreneurial opportunities across borders. Despite the growing importance of international entrepreneurship research, there is little research considering how entrepreneurial SMEs from different cultural contexts interact with international partners to develop international entrepreneurial opportunities. The findings show how Thai and Swiss entrepreneurs engage in the development of international partnerships to create, explore and exploit opportunities. The empirical study further emphasizes the importance of trustworthy and close interpersonal relationships. The meaning of friendship in culturally different countries is also explored as it pertains to the process of SME internationalization. The findings show important cultural differences. In the collectivistic Thai context, personal and professional networks are closely intertwined. In the development of new partnerships, Thai SMEs pursue the clear objective of developing friendships. In the individualistic Swiss context, partnerships mostly originate from opportunities in the professional context and relationships tend to develop more coincidentally into a trusted friendship.
Social Network Factors and Anxiety Among Adolescents With Type 1 Diabetes and Their Parents
Authors: Shah Lisa L. , Ersig Anne L. , Paik Anthony
Published: July 2019

Stressors generated by chronic illnesses in adolescents are experienced in the broader social context of their lives. The purpose of this study was to examine the social networks of 15 adolescents with type 1 diabetes and 25 parents and evaluate associations of social support and kinship type with state and trait anxiety. Social network data were collected through individual interviews. Participants completed self-reported measures of anxiety. Adolescents with lower anxiety had greater overlap with their parents’ networks and more network members with whom they would not share their feelings. Parents with increased anxiety had more network members who provide support for everyday stressors, or with whom they lose their temper. The type of support provided by biological and social kin differed for adolescents versus parents. Tailored interventions leveraging existing social networks could be a key mechanism for supporting family responses to stress-provoking situations in the context of childhood chronic illness.
It’s Complicated: Improving Undergraduate Nursing Students’ Understanding Family and Care of LGBTQ Older Adults
Authors: Henriquez Nadine , Hyndman Kathryn , Chachula Kathryn
Published: July 2019

Research has identified the need for improved cultural competence of health care providers regarding the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community’s needs. This article articulates the teaching approach and methodology of an unfolding LGBTQ family case study for undergraduate nursing students. This method provided a forum for exploration of personal biases and gender-affirming techniques, and addressed the challenges of aging for a transgender woman and family within the context of societal stigma and discrimination. Students gained knowledge concerning shifts in family structures and understanding of the nurses’ role encouraging inclusiveness and equitable access in health care settings, advocating for vulnerable populations, and addressing specific health concerns for transgender older adults. Student responses demonstrated increased knowledge of family diversity, and critical thought regarding the intersectionality of discrimination and aging. The findings revealed the case study methodology facilitated student understanding of the unique health and social issues for LGBTQ older adults within a family context.
Simple adaptive control to attenuate bridge’s seismic responses considering parametric variations
Authors: Soares Rachel W , Barroso Luciana R , Al-Fahdawi Omar AS
Published: July 2019

Parametric variations occur throughout a bridge’s service life as a result of temperature variations, cracking, localized damage, and fatigue. Existing bridge’s parameters are difficult to estimate precisely and implemented control schemes may perform unsatisfactorily depending on how sensitive they are to parametric change. In this study, an adaptive control approach is developed utilizing the simple adaptive control algorithm and designed aiming to mitigate seismic responses of bridges considering realistic implementation. Adaptive control is a viable alternative to control bridge structures as it is able to calculate control gains that vary over time based on sensed responses, sustaining performance in face of parametric variations. The proposed approach allows the choice of a model reference of significantly low order and it does not require full-state feedback or the use of observers. The effectiveness and robustness of the control approach are investigated when controlling a seismically excited two-span highway bridge considering systematic parametric variations. Evaluation of relevant performance criteria indicates that the adaptive scheme is effective in reducing seismic responses and sustains well the overall performance when systematic parametric variations are introduced. The proposed approach requires a small and reasonable number of sensors to present effectiveness and performs satisfactorily even when in the presence of measurement noise.
A Red-State View of Religious Liberty and Non-Discrimination Protection for LGBT People
Authors: Burke Kelsy , Kazyak Emily
Published: July 2019

Kelsy Burke and Emily Kazyak on Nebraskan attitudes.
Serum uric acid as a marker of disease risk, severity, and survival in systemic sclerosis‐related pulmonary arterial hypertension
Authors: Simpson Catherine E. , Damico Rachel L. , Hummers Laura , Khair Rubina M. , Kolb Todd M. , Hassoun Paul M. , Mathai Stephen C.
Published: July 2019

The object of this paper is to assess associations between serum uric acid (UA) and pulmonary arterial hypertension (PAH) risk, disease severity, and mortality in a well‐characterized cohort of systemic sclerosis (SSc) patients referred for evaluation of possible PAH. Consecutive SSc patients aged >18 years with serum UA drawn within two weeks of a diagnostic right heart catheterization (RHC) were included. Associations between baseline serum UA and PAH at RHC were examined using logistic regression and receiver operating characteristic curves. Relationships between UA levels and metrics of disease severity were assessed using Pearson and Spearman correlation. Associations between UA and survival were assessed using Kaplan–Meier analysis and Cox proportional hazard modeling. A total of 162 SSc patients were included; 82 received a diagnosis of PAH at RHC. Patients found to have PAH had significantly higher UA than those without PAH. Elevated baseline UA was associated with significantly increased odds of PAH diagnosis at RHC (odds ratio [OR] = 4.07, 95% confidence interval [CI] = 2.11–7.87, P < 0.001). Each mg/dL higher UA was associated with a 14% increase in mortality (hazard ratio [HR] = 1.14, 95% CI = 1.02–1.28, P < 0.05). In multivariable models adjusting for potential confounders of the relationship between UA and survival, UA > 6.3 mg/dL remained significantly associated with increased mortality (HR = 1.84, 95% CI = 1.02–3.32, P < 0.05). Among SSc patients with suspected PAH, elevated serum UA is associated with increased risk of SSc‐PAH. Among individuals diagnosed with SSc‐PAH by RHC, UA is associated with disease severity and survival. These results indicate UA is a useful predictor of PAH risk and prognosis in SSc.
Mechanical circulatory support in cardiogenic shock from acute myocardial infarction: Impella CP/5.0 versus ECMO
Authors: Karami Mina , den Uil Corstiaan A , Ouweneel Dagmar M , Scholte Niels TB , Engström Annemarie E , Akin Sakir , Lagrand Wim K , Vlaar Alexander PJ , Jewbali Lucia S , Henriques José PS
Published: July 2019

Background:

Short-term mechanical circulatory support devices are increasingly used in cardiogenic shock after acute myocardial infarction. As no randomised evidence is available, the choice between high-output Impella or extra-corporeal membrane oxygenation (ECMO) is still a matter of debate. Real-life data are necessary to assess adverse outcomes and to help guide the treatment decision between the different devices. The purpose of this study was to compare characteristics and clinical outcomes of Impella CP/5.0 with ECMO support in patients with cardiogenic shock from myocardial infarction.

Methods:

A retrospective, two-centre study was performed on all cardiogenic shock from myocardial infarction patients with Impella CP/5.0 or ECMO support, from 2006 until 2018. The primary outcome was 30-day mortality. Potential baseline imbalance between the groups was adjusted using inverse probability treatment weighting, and survival analysis was performed with an adjusted log-rank test. Secondarily, the occurrence of device-related complications (limb ischaemia, access site-related bleeding, access site-related infection) was evaluated.

Results:

A total of 128 patients were included (Impella, N=90; ECMO, N=38). The 30-day mortality was similar for both groups (53% vs. 49%, P=0.30), also after adjustment for potential baseline imbalance between the groups (weighted log-rank P=0.16). Patients with Impella support had significantly fewer device-related complications than patients treated with ECMO (respectively, 17% vs. 40%, P<0.01).

Conclusions:

Patients treated with Impella CP/5.0 or ECMO for cardiogenic shock after myocardial infarction did not differ in 30-day mortality. More device-related complications occurred with ECMO compared to Impella support.
A Retrospective Review on Atypical Femoral Fracture: Operative Outcomes and the Risk Factors for Failure
Authors: Lai Yuen Shan , Chau Jackie Yee Man , Woo Siu Bon , Fang Christian , Lau Tak Wing , Leung Frankie
Published: July 2019

Background:

Atypical femoral fractures have been demonstrated to have high risks of reoperation and nonunion. The aim of this study is to evaluate whether the quality of reduction following operative fixation of atypical femoral fracture predicts failure.

Methods:

This is a 6.5-year retrospective review of atypical femoral fractures from 2 centers in a high-income region. A total of 56 patients with 66 fractures met our inclusion criteria. The quality of reduction was evaluated from postoperative films according to Hoskins’ modification of Baumgartner criteria for subtrochanteric fractures. Our primary outcome measure was failure of treatment, defined as either reoperation or nonunion at 12 months.

Results:

There were a total of 8 reoperations (12% of all fractures) and 8 nonunion (12% of all fractures), affecting a total of 12 fractures (18%) in 12 patients (21%). Closed reduction ( P = .04) and poor quality of reduction ( P = .0227 Fisher exact test) are statistically significant risk factors for failure.

Conclusions:

An aim for anatomical reduction with both <4 mm maximal cortical displacement and <10° angulation can improve the operative outcome of atypical femoral fractures. The addition of open reduction may be beneficial.
Lateral Extra-Articular Tenodesis Reduces Failure of Hamstring Tendon Autograft ACL Reconstruction -Two Year Outcomes from the STABILITY Study Randomized Clinical Trial
Authors: Getgood Alan M. , Bryant Dianne , Litchfield Robert B. , McCormack Robert Gordon , Heard Mark , MacDonald Peter B. , Spalding Tim , Verdonk Peter CM , Peterson Devin , Bardana Davide , Rezansoff Alex J. ,   Stability Study Group
Published: July 2019

Objectives:

Persistent anterolateral rotatory laxity following anterior cruciate ligament reconstruction (ACLR) has been correlated with poor outcome and graft failure. We hypothesized that anterolateral complex reconstruction by way of a Lateral Extra-articular Tenodesis (LET) in combination with single bundle ACLR would reduce the risk of persistent rotatory laxity in young individuals who are deemed as being at high risk of failure.

Methods:

This is a pragmatic, multicenter, randomized clinical trial comparing standard hamstring tendon ACLR with combined ACLR and LET, utilizing a strip of iliotibial band (Modified Lemaire). Patients aged 25 years or less with an ACL deficient knee were included. They also had to have two of the following three criteria: 1) Grade 2 pivot shift or greater; 2) Returning to high risk/pivoting sports; 3) Generalized ligamentous laxity. The primary outcome was graft failure defined as either the need for revision ACLR or symptomatic instability associated with a positive asymmetric pivot shift, indicating persistent rotational laxity. Secondary outcome measures included the P4 pain scale, KOOS, IKDC. Patients were followed for two years with visits at 3, 6, 12 and 24 months postoperatively. A sample size of 300 per group was calculated based on a relative reduction in graft failure by 40%, with type 1 error of 5%, 80% power and 15% loss to follow-up rate.

Results:

624 patients were randomized with a mean age of 18.9 (range: 14-25), 293 male. 436 (87.9%) patients presented pre-operatively with high-grade rotatory laxity (grade 2 pivot or greater) and 215 (42.1%) were diagnosed as having generalized ligamentous laxity (Beighton Score of 4 or greater). 523 of the 624 patients are at least 2 years postoperative; 29 lost to follow-up (˜5%). In the ACLR group 104/252 (41%) of patients suffered the primary outcome compared to 61/242 (25%) of the ACLR+LET patients (RR=0.61, 95%CI 0.47 to 0.79), p<0.0001. 39 patients suffered graft rupture, 28/252 (11%) in the ACLR group compared to 11/242 (4.5%) in the ACL+LET group (RR=0.41, 95%CI 0.21 to 0.80, p<0.001). At 3 months postoperative, patients in the ACLR group had less pain (p=0.004); at 3 and 6 months all KOOS subdomains, the IKDC favored the ACLR alone group (p=0.03). At 12 and 24 months, no important between-group differences were observed in any patient reported outcome.

Conclusion:

The addition of LET to a hamstring autograft ACLR in young active patients significantly reduces graft failure and persistent anterolateral rotatory laxity at 2 years post operatively.
Athletic Hip Injuries in Major League Baseball Pitchers Associated with UCL Pathology
Authors: Kantrowitz David Eric , Trofa David P. , Woode Denzel R. , Ahmad Christopher S. , Lynch Thomas Sean
Published: July 2019

Objectives:

Ulnar collateral ligament (UCL) reconstruction is a reliable treatment for elite overhand throwers with UCL pathology. In recent years, this operation has become increasingly common among Major League Baseball (MLB) pitchers. Predisposing factors and associated comorbidities, however, have not been well elucidated in the literature. The purpose of this investigation is to determine if professional baseball pitchers who underwent UCL reconstruction had an increased incidence of hip or groin injuries 4 years prior to or following their surgery. We hypothesized that MLB pitchers who sustained hip or groin injuries may have been more likely to develop UCL pathology due to kinetic chain alterations and overcompensation at the distal upper extremity during overhand throwing.

Methods:

This case controlled study utilized a comprehensive list of all 247 MLB players who underwent UCL reconstruction between 2005 and 2017, through aggregation of online publicly accessible data. Application of inclusion criteria yielded a final sample size of 145. These athletes’ injury histories were identified using systematic online searches and cross referenced with the official MLB disabled list. Age, playing time, and ERA-matched controls were generated for comparison of results.

Results:

Of the 145 MLB pitchers who underwent UCL reconstruction between 2005 and 2017, 40 (27.6%) endured a proximal lower extremity injury within 4 years of their surgery. Specifically, 16 pitchers sustained hip injuries, 13 suffered hamstring injuries, and 14 experienced groin injuries. A significantly lower rate of hip and groin related injuries, 18%, was identified in matched controls during a similar timeframe (p = 0.049). This represents an odds ratio of 1.74, indicating that players who underwent a UCL reconstruction were 74% more likely to have sustained a hip, groin or hamstring injury within an eight-year timeframe compared to matched controls. Hip injuries, specifically, were independently associated with UCL reconstruction compared to matched controls (p = 0.027).

Conclusion:

The results of this study demonstrate that MLB pitchers who required UCL reconstruction sustained a higher frequency of hip injuries both before and after surgery compared to matched controls. This association is significant as treatment of antecedent hip pathology, as well as emphasis on hip and core muscle mobility and strengthening, may help reduce the UCL injury burden in MLB pitchers.
Comparison of the Rate of Nonunion or Delayed Union in Fifth Metatarsal Fractures Receiving Anti-Inflammatory Medications
Authors: Barnds Brandon , Heenan G. Matthew , Tarakemeh Armin , Mullen Scott M. , Schroeppel John Paul , Vopat Bryan George
Published: July 2019

Objectives:

Controversy exists regarding the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing. Our retrospective study uses a private payer database to isolate patients diagnosed with 5th metatarsal (MT) fractures and compare the rate of delayed open reduction and internal fixation (ORIF) or non/malunion repair as a surrogate for nonunion or delayed union, in those prescribed anti-inflammatories and those not prescribed anti-inflammatories.

Methods:

Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD-10 codes. All patients included had a diagnosis of 5th MT fracture and did not receive ORIF or repair of non/malunion within 60 days of diagnosis. Two groups were then created based on the presence or absence of insurance claim records for anti-inflammatory medications within 60 days of diagnosis. The number of patients in each group who underwent ORIF or non/malunion repair after 60 days post-diagnosis was determined, and the rates were compared using a chi-square analysis.

Results:

10,626 patients had a diagnosis of 5th MT fracture and did not undergo early repair/ORIF (within 60 days). 1,615 had records of insurance claims for anti-inflammatories within 60 days of diagnosis, leaving 9,011 who did not receive these medications. 18 (1.11%) patients who received an anti-inflammatory medication underwent ORIF or repair of non/malunion after 60 days post-diagnosis. 44 (0.49%; p=0.0055) subjects who did not receive an anti-inflammatory prescription underwent ORIF or repair of non/malunion at after 60 days post-diagnosis.

Conclusion:

The rate of delayed ORIF or non/malunion repair of 5th MT fractures, a surrogate for delayed union or nonunion in an insurance database study, was significantly higher in subjects receiving anti-inflammatories within 60 days of diagnosis. This study isolates a specific fracture and finds a negative correlation between NSAIDs and fracture healing. Further, this provides valuable information to help guide future higher level studies.
The Histopathology of the Degenerative Proximal Biceps Tendon
Authors: Dekker Travis John , Chen Angel , Kwon Nicholas J. , Steele John , Eward William C. , Garrigues Grant , Adams Samuel Bruce , Toth Alison P.
Published: July 2019

Objectives

Surgical treatment of proximal biceps tendinopathy remains a source of great controversy. Current surgical treatment debates center around the fixation location and not the quality of the tendon because little is known about the intra-tendinous pathology to guide this debate. Therefore, this study aims to evaluate two distinct anatomic regions of pathologic biceps tendons with regard to intra-tendinous architecture, painful neurotransmitters, and inflammatory modulators: the intra-articular portion and the extra-articular portion lying in the bicipital groove.

Methods

Eleven human degenerative biceps tendons were obtained post-tenodesis. They were divided into intra- and extra-articular portions. They underwent histologic staining with hematoxylin and eosin and Alcian blue as well as immunohistochemistry staining for substance P, tyrosine hydroxylase, and neurofilament. Tendon architecture was assessed according to the modified BONAR tendon score. Immunohistochemistry staining was quantified using ImageJ density analysis. Portions of the tendon sections were cultured for 48 hours and the resultant secretome was assessed for Substance P secretion with ELISA analysis.

Results

Composite BONAR scores demonstrated pathologic tendons with no significant difference between the intra-articular biceps tendon and the portion of the tendon within the bicipital groove (p= 0.31). Immunohistochemistry (IHC) analysis demonstrated significantly (p<0.05) increased uptake of substance P in the bicipital groove tendon compared to the intra-articular tendon while tyrosine hydroxylase did not (p>0.05). Stained substance P and tyr hydroxylase was intimately associated with intra-tendinous vascularity. ELISA results demonstrated significantly increased secretion of substance P in the bicipital groove tendon compared to the intraarticular portion.

Conclusion

This study shows abnormal architecture, increased release and staining of painful neurotransmitters, and secretion of substance P from the proximal biceps tendon up to the distal aspect of the bicipital groove. Despite varied surgical techniques for tenodesis, this study supports the removal of the entirety of the long head of the biceps to the distal portion of the bicipital groove. [Figure: see text][Figure: see text]
Predictors of Radiographic Osteoarthritis 2-3 Years after ACL Reconstruction: Data from MOON Onsite Nested Cohort
Authors: Jones Morgan H. , Oak Sameer R. , Andrish Jack T. , Brophy Robert H. , Cox Charles L. , Dunn Warren R. , Flanigan David C. , Fleming Braden C. , Huston Laura J. , Kaeding Christopher C. , Kolosky Michael , Lynch Thomas Sean , Magnussen Robert A. , Matava Matthew J. , Parker Richard D. , Reinke Emily K. , Scaramuzza Erica , Smith Matthew V. , Winalski Carl S. , Wright Rick W. , Zajichek Alex , Spindler Kurt P.
Published: July 2019

Objectives:

Multiple studies have shown patients are susceptible to post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) injury even with ACL reconstruction (ACLR). Prospective studies using multivariate analysis to identify risk factors for PTOA are lacking. This study aims to identify baseline predictors of radiographic PT OA after ACLR at an early time point and hypothesizes that meniscal injury and cartilage lesions will be associated with worse radiographic OA using the Osteoarthritis Research Society International (OARSI) atlas criteria.

Methods:

421 patients who underwent ACLR returned onsite for standardized posteroanterior metatarsophalangeal radiographs a minimum of 2 years after surgery. At baseline, demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up.

Results:

The mean age was 19.8 years with 51.3% females. Higher age (odds ratio (OR) 1.06) and BMI (OR 1.05) were statistically significantly associated with higher OARSI grade in the medial compartment. Patients with a meniscal repair and a partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR 1.92 and meniscectomy OR 2.11) and in the lateral compartment (meniscal repair OR 1.96 and meniscectomy OR 2.97). Graft type, cartilage lesion, sex, and Marx activity scales had no significant association with OARSI grade.

Conclusion:

Older patients with a higher BMI who have an ACL tear with concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic OA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at increased risk of developing radiographic knee OA at 2-3 years following ACLR.
Return To Sport Testing At 6 Months After Arthroscopic Shoulder Stabilization Demonstrates Residual Functional Deficits
Authors: Wilson Kevin W. , Li Ryan Tianran , Popchak Adam , Lin Albert , Kane Gillian
Published: July 2019

Objectives:

A good outcome after arthroscopic stabilization for recurrent shoulder instability is often characterized by a successful return to sport while minimizing complications. While many physicians use a minimum of 5 months as a time to return, there is currently no consensus regarding timing or objective criteria for return to sport. The objective of this study is to evaluate the ability of postoperative patients to meet expected goals of achieving appropriate strength and using standardized objective evaluations of strength and physical function.

Methods:

33 consecutive patients who underwent arthroscopic shoulder stabilization surgery from 2012 until 2018 and completed their postoperative rehabilitation with the same institution were subjected to functional testing to evaluate their readiness for return to sport. Isometric unilateral external rotation to internal rotation (ER/IR) ratio was measured using a hand held dynamometer at 0 and 90 degrees of shoulder abduction. Posterior rotator cuff activation was evaluated using a repetition to failure technique with 5% body weight at 0 and 90 degrees of abduction. Prone trapezius activation was measured in repetitions to failure with a prone Y exercise. A subset of throwing athletes (N= 11) were evaluated for total arc of motion.

Results:

Isometric testing at revealed that 18% (6/33, mean ratio 71%) patients met the expected goal of 80% ER/IR strength at both 0 and 90 degrees of abduction, with mean ratios of 71% and 62%, respectively. 73% (24/33) and 42% (14/33) of patients met goal of 90% of the contralateral ER repetitions to failure in rotator cuff activation testing at 0 and 90 degress of abduction, respectively. 55% (18/33) of patients met goal of 90% of contralateral prone Y repetitions to failure on lower trapezius activation testing, with mean. Mean total arc of postoperative motion for the 11 throwers was 91.6% of the contralateral shoulder. Thirty-six percent (4/11) patients did not reach 90% of the total arc of motion of the uninvolved shoulder.

Conclusion:

A substantial number of athletes in our cohort do not meet the expected goals for their operative shoulder in achieving appropriate strength, particularly in ER, nor arc of motion compared to the contralateral shoulder.
Insulin Dependence Predicts Risk of Complications Following Shoulder and Knee Arthroscopy
Authors: Traven Sophia A. , Reeves Russell Abbott , Walton Zeke J. , Woolf Shane K. , Slone Harris S.
Published: July 2019

Objectives:

Diabetes mellitus is a growing health concern in the U.S. affecting an estimated 23.1 million citizens. While diabetes is a risk factor for complications following total joint arthroplasty, it is unclear whether this risk holds true for arthroscopy and, whether this risk is stratified by insulin-dependence (IDDM) and non-insulin dependent diabetes (NIDDM). The goal of this study is to evaluate complications following shoulder and knee arthroscopy in patients with IDDM and NIDDM.

Methods:

A retrospective analysis of the American College of Surgeon’s National Surgical Quality Improvement Program’s (ACS-NSQIP) database for the years 2005-2016 was conducted. Logistic regression analyses were used to assess the relationship between diabetic status and outcomes. Adjusted odds ratios (AOR) and confidence intervals (CIs) were calculated. Multivariate models were established to adjust for age, sex, BMI, hypertension, congestive heart failure, chronic obstructive pulmonary disease, smoking status, functional status, and ASA classification. A post-hoc power analysis was performed based on the observed variances between groups using an alpha equal to 0.05 and power equal to 0.8.

Results:

86,023 patients undergoing knee arthroscopy and 58,442 patients undergoing shoulder arthroscopy were identified. Patients with IDDM undergoing knee arthroscopy were at a much higher risk for surgical complications, AOR 2.186 (95% CI: 1.226 -1.157, p = 0.001), including deep infections (AOR 3.082, 95% CI: 1.753-5.419, p < 0.001) and return to OR (AOR 1.933, 95% CI: 1.280-2.919, p = 0.002), as well as unplanned hospital admission (AOR 1.770, 95% CI: 1.289-2.431, p = 0.002). Patients with IDDM undergoing shoulder arthroscopy were at a much higher risk for medical complications (AOR 1.524, 95% CI: 1.082-2.147), hospital readmission (AOR 1.581, 95% CI: 1.153-2.169), and 30-day mortality (AOR 3.821, 95% CI: 1.243-11.750). However, NIDDM was not an independent risk factor for subsequent medical or surgical complications, unplanned hospital admission, or 30-day mortality in either group.

Conclusion:

Patients with IDDM undergoing knee arthroscopy were more likely to have surgical complications, whereas those undergoing shoulder arthroscopy were more likely to have medical complications, hospital readmission, and mortality. These risks diminished among those with NIDDM, with their risks comparable to those without diabetes. Physicians and hospitals should keep these issues in mind when counseling patients regarding their risks for shoulder and knee arthroscopy.
Predicting the Need for Surgical Intervention Prior to First Encounter for Individuals with Knee Complaints: A Novel Approach
Authors: Vega Jose F. , Student Medical , Bena James , Strnad Greg , Spindler Kurt P.
Published: July 2019

Objectives:

Orthopedic complaints, particularly those relating to the knee, are some of the most common conditions that bring patients to the hospital. Many patients bypass their primary care physician to seek the care of an orthopedic surgeon without a referral, leaving the surgeon to manage an increasingly large number of patients, many of which will never require surgery. We set out to develop a brief questionnaire that can be administered via phone/web at the time of appointment request to predict an individual patient’s probability of requiring a surgical intervention.

Methods:

All patients (N=1307) seeking an appointment for a new knee-related complaint completed a branching-logic questionnaire. A retrospective chart review was conducted following the conclusion of each patient’s episode of care to determine whether or not surgery was recommended. Logistic regression models were used to predict the risk of surgery based on triage question responses, basic demographics (age, gender), and laterality (unilateral vs. bilateral). The ability of the models to discriminate between those who did and did not receive a surgical recommendation was measured using a concordance index (C-index).

Results:

The model developed provided a high level of discrimination between surgical and nonsurgical patients (C-index = 0.69). Recent injury with inability to walk, and no recent injury with no pain were both associated with increased probability of receiving a recommendation of surgical intervention compared to patients that reported pain without recent injury (OR=3.51, p<0.001; OR=2.78, p=0.008, respectively). A unilateral complaint was associated with needing surgical intervention (OR=4.52, p<0.001). Age has a significant, non-linear relationship with odds of needing of surgery, with middle age patients (20-50) having the greatest odds.

Conclusion:

Our model was able to accurately predict the probability of receiving a recommendation for surgical intervention as high as 65% and as low as 5%. Our model can quickly and easily triage patients at the time of appointment request to ensure that those with the highest likelihood of receiving a recommendation for surgical intervention are seen by surgical providers while those that are unlikely to receive such a recommendation can be seen by nonsurgical providers. To our knowledge, this represents the first attempt at developing an evidence-based scheduling algorithm.
Radiographic Prevalence Of Sacroiliac Joint Abnormalities And Clinical Outcomes In Patients With Femoroacetabular Impingement Syndrome
Authors: Krishnamoorthy Vignesh Prasad , Kunze Kyle , Cancienne Jourdan M. , Beck Edward , O’Keefe Lauren Elizabeth , Nho Shane Jay
Published: July 2019

Objectives:

Patients with femoroacetabular impingement syndrome (FAIS) typically present with a gradual onset of groin pain. They may also presentwith gluteal pain, which can be related to posterior acetabular impingement or posterior joint degeneration secondary to FAIS or more commonly aberrant gait mechanics secondary to abnormal hip morphology. Gluteal pain is also a common presenting symptom in patients with sacroiliac joint (SIJ) problems. The date, the literature on the correlation between SIJ pathology and FAIS has been limited. As such, the purpose of the current study id to quantify the prevalenceof SIJ abnormalities FAIS patients using imaging modalities and to compare outcomes based on SIJ abnormalities.

Methods:

Radiographs, CT and MRI scans of 1,009 consecutive patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. Exclusion criteria included patients undergoing bilateral or revision surgery, history of dysplasia, and less than two-year follow-up. On radiographs, SIJ joints were graded using modified New York criteria for spondyloarthropathy. CT scans and MRIs were reviewed for joint surface erosions, subchondral sclerosis, joint-space narrowing, pseudo-widening, bone marrow edema, and ankylosis. Patients with SIJ abnormalities were matched 1:2 to patients without SIJ abnormalities by age and BMI. Outcomes included the hip outcome score- activities of daily living (HOS-ADL), sports-subscale (HOS-SS), modified Harris hip score (mHHS), and visual analog scales (VAS) for pain and satisfaction.

Results:

743 patients were included; 187 (25.2%) demonstrated SIJ changes. 164 (87.7%) had radiographic changes, 88 (63.3%) on CT, and 125 (66.8%) on MRI. SI changes on any imaging modality were correlated with pain to palpation (PTP) of the SI joint (r=0.11; p=0.004) on physical exam. History of SI pain was correlated with PTP of the SI joint (r=0.21; p<0.001). After matching, patients without SIJ abnormalities had significantly greater HOS-ADL (95.4 vs. 90.6;p=0.001), HOS-SS (91.1 vs. 77.5;p<0.001), and mHHS (91.3 vs. 84.5;p<0.001) scores and significantly less VAS pain (10.9 vs. 25.7;p<0.001) than those with abnormalities. Patients without SIJ abnormalities had greater odds of achieving the MCID for the HOS-ADL (Odds ratio [OR]=2.91, 95%confidence interval [95% CI]=1.5-5.5;p=0.001) and for the HOS-SS (OR=2.83, 95% CI = 1.6-4.9;p<0.001), but not for the mHHS (OR=1.73, 95% CI = 0.93-3.2; p=0.081).

Conclusion:

There is a high prevalence of SIJ abnormalities in patients with FAIS. Patients with abnormalities may expect inferior outcomes and persistent post-operative pain. [Table: see text]