bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of the LumiraDx Platform INR Test in an Anticoagulation Clinic Point-of-Care Setting Compared With an Established Laboratory Reference Method
Authors: Tait Robert Campbell , Hung Annielle , Gardner Roy S.
Published: November 2019

Vitamin K antagonists, such as warfarin, have a narrow therapeutic window; patients on these therapies therefore require regular international normalized ratio (INR) monitoring to maintain optimal dosing. This involves periodic checks and laboratory testing using venepuncture, which are often perceived as a burden. This study aimed to determine the accuracy and precision of the LumiraDx INR Test, a new point-of-care in vitro diagnostic platform, in an anticoagulation clinic setting. In this observational, cross-sectional study, precision of the LumiraDx INR Test was assessed using paired replicate samples (n = 366) and 3 test strip lots. Accuracy was determined by comparing capillary blood INR, ascertained by the LumiraDx INR Test, with venous plasma INR, measured by the laboratory reference instrument, the IL ACL ELITE Pro. Furthermore, INR was assessed across a range of hematocrit (25%-55%). In addition, feedback was collected from health-care professionals via a self-completed questionnaire. This trial was registered at ClinicalTrials.gov (NCT03682419). The precision (% coefficient of variation) of the LumiraDx INR Test was <4 when samples were applied by direct application or via a capillary transfer pipette, as well as between test strip lots. Accuracy of the LumiraDx INR Test, across the INR range of 0.8 to 7.5, was confirmed by a strong correlation of 0.965 (95% confidence interval: 0.959-0.970) when compared with the IL ACL ELITE Pro, which was maintained across the hematocrit range. Feedback from health-care professionals indicated that the instructions given by the system were easy to follow. In conclusion, the strong agreement between the LumiraDx Platform INR point-of-care test and the IL ACL ELITE Pro laboratory reference system, as well as between the different application methods and test lots, indicates that it can provide a rapid, accurate, and reliable INR analysis.
Estimating the Heritability of Experiencing Child Maltreatment in an Extended Family Design
Authors: Pittner Katharina , Bakermans-Kranenburg Marian J. , Alink Lenneke R. A. , Buisman Renate S. M. , van den Berg Lisa J. M. , Block Laura H. C. G. C. Compier-de , Voorthuis Alexandra , Elzinga Bernet M. , Lindenberg Jolanda , Tollenaar Marieke S. , Linting Mariëlle , Diego Vincent P. , van IJzendoorn Marinus H.
Published: November 2019

Child-driven genetic factors can contribute to negative parenting and may increase the risk of being maltreated. Experiencing childhood maltreatment may be partly heritable, but results of twin studies are mixed. In the current study, we used a cross-sectional extended family design to estimate genetic and environmental effects on experiencing child maltreatment. The sample consisted of 395 individuals (225 women; M age = 38.85 years, rangeage = 7–88 years) from 63 families with two or three participating generations. Participants were oversampled for experienced maltreatment. Self-reported experienced child maltreatment was measured using a questionnaire assessing physical and emotional abuse, and physical and emotional neglect. All maltreatment phenotypes were partly heritable with percentages for h 2 ranging from 30% ( SE = 13%) for neglect to 62% ( SE = 19%) for severe physical abuse. Common environmental effects ( c 2) explained a statistically significant proportion of variance for all phenotypes except for the experience of severe physical abuse ( c 2 = 9%, SE = 13%, p = .26). The genetic correlation between abuse and neglect was ρg = .73 ( p = .02). Common environmental variance increased as socioeconomic status (SES) decreased ( p = .05), but additive genetic and unique environmental variances were constant across different levels of SES.
Terror attacks, issue salience, and party competence: Diagnosing shifting vote preferences in a panel study
Authors: Aytaç S Erdem , Çarkoğlu Ali
Published: November 2019

How does a dramatic shift in political context that renders security concerns the most salient electoral issue influence voting? To address this question, we take advantage of the peculiar timing of elections and heightened terror attacks in Turkey with the use of original panel data. The June 2015 Turkish general election resulted in a hung parliament, and a snap election was held in November. While the period before June was relatively calm, the inter-election period witnessed an upsurge of terror attacks and casualties. A three-wave panel enables us to track how voters’ electoral preferences changed over this period. Our analyses suggest that the terror attacks led voters to prioritize parties’ perceived competence in addressing security concerns at the ballot box. The abrupt change in issue salience has bolstered support for the incumbent Justice and Development Party which was evaluated by voters as more competent than other parties.
Does telerehabilitation result in inferior clinical outcomes compared with in-person care for the management of chronic musculoskeletal spinal conditions in the tertiary hospital setting? A non-randomised pilot clinical trial
Authors: Cottrell Michelle A , O'Leary Shaun P , Raymer Maree , Hill Anne J , Comans Tracy , Russell Trevor G
Published: November 2019

Introduction

Clinical guidelines recommend multidisciplinary non-surgical management for most musculoskeletal spinal conditions. Access to such services continues to be a barrier for many individuals residing outside metropolitan regions. The primary aim of this study was to determine whether clinical outcomes achieved via telerehabilitation are as good as those achieved via in-person care.

Methods

A non-randomised pilot clinical trial was undertaken where eligible patients chose to access treatment either via telerehabilitation or in-person (control group). Outcome measures for pain-related disability, pain severity and health-related quality of life were recorded at baseline, 3-, 6- and 9-months. Secondary outcomes included patient satisfaction and technical disruptions.

Results

Seventy-one patients were recruited (telerehabilitation, n = 51; control group, n = 20). Patient characteristics did not differ at baseline and clinically meaningful improvements for pain-related disability and health-related quality of life were observed in both groups. Non-inferiority of telerehabilitation could not be claimed for any clinical outcome measure. There were no significant group-by-time interactions observed for either pain-related disability ( p = 0.706), pain severity ( p = 0.187) or health-related quality of life ( p = 0.425) measures. The telerehabilitation group reported significantly higher levels of treatment satisfaction (median: 97 vs. 76.5; p = 0.021); 7.9% of telerehabilitation appointments were not completed due to technical disruptions.

Discussion

Findings indicate patients with chronic musculoskeletal spinal conditions can achieve clinically meaningful improvements in their condition when accessing care via telerehabilitation. Telerehabilitation should be considered for individuals unable to access relevant in-person services; however non-inferiority remains inconclusive and requires further exploration.
Is disclosing an autism spectrum disorder in school associated with reduced stigmatization?
Authors: White Rhianna , Barreto Manuela , Harrington Jean , Kapp Steven K , Hayes Jennie , Russell Ginny
Published: November 2019

Evidence suggests disclosing an autism diagnosis is associated with reduced stigmatization for autistic adults. However, it is unknown whether this is true for autistic adolescents. We used a vignette-and-questionnaire design to study stigmatizing attitudes with adolescents (aged 11–12 and 14–16 years, total N = 250) in a UK school. We investigated the effect of disclosing that a fictional adolescent had an autism diagnosis on stigmatizing attitudes of peers by testing the effect of disclosure of diagnosis on the social and emotional distance pupils wanted to maintain from the autistic adolescent. We also tested the effect of disclosure on peers’ assessment of the adolescent’s responsibility for their own behaviour. We checked to see if the effects were moderated by gender and age-group. Disclosing autism did not affect the social and emotional distance peers wanted to maintain from the autistic adolescent, but was associated with significant reduction in personal responsibility attributed to the adolescent’s behaviour. Boys attributed more personal responsibility to the autistic adolescent than girls, but this gender effect was reduced when autism was disclosed. These findings suggest that disclosing autism to other pupils may be of limited use in reducing stigmatization by peers in UK schools.
Prevalence of physical and mental health conditions in Medicare-enrolled, autistic older adults
Authors: Hand Brittany N , Angell Amber M , Harris Lauren , Carpenter Laura Arnstein
Published: November 2019

While there is emerging evidence on the prevalence of physical and mental health conditions among autistic adults, less is known about this population’s needs during older adulthood (aged 65+). We conducted a cross-sectional retrospective cohort study of 2016–2017 Medicare data to compare the prevalence of physical and mental health conditions in a national sample of autistic older adults (N = 4685) to a matched population comparison (N = 46,850) cohort. Autistic older adults had significantly greater odds of nearly all physical health conditions including epilepsy (odds ratio = 18.9; 95% confidence interval = 17.2–20.7), Parkinson’s disease (odds ratio = 6.1; 95% confidence interval = 5.3–7.0), and gastrointestinal conditions (odds ratio = 5.2; 95% confidence interval = 4.9–5.5). Most mental health conditions were more common among autistic older adults, including schizophrenia and psychotic disorders (odds ratio = 25.3; 95% confidence interval = 22.4–28.7), attention deficit disorders (odds ratio = 24.4; 95% confidence interval = 16.2–31.0), personality disorders (odds ratio = 24.1; 95% confidence interval = 17.8–32.5), and suicidality or self-inflicted injury (odds ratio = 11.1; 95% confidence interval = 8.9–13.8). Health conditions commonly associated with advanced age in the general population (e.g. osteoporosis, cognitive disorders, heart disease, cancer, cerebrovascular disease, osteoarthritis) were also significantly more common among autistic older adults. By highlighting the significant physical and mental health needs for which autistic older adults require care, our findings can inform healthcare systems, healthcare providers, and public health initiatives seeking to promote well-being in this growing population.
Work–game balance: Work interference, social capital, and tactical play in a mobile massively multiplayer online real-time strategy game
Authors: Hommadova Lu Anya , Carradini Stephen
Published: November 2019

Mobile gaming has experienced rapid growth with the development of mobile technology. A mechanic of constant risk in the mobile massively multiplayer online real-time strategy game Lords Mobile prompted us to investigate the effects of the game on players’ work activities. Through a 19-month virtual ethnography of Lords Mobile, we found that game and work activities affected each other. Study participants played the game at work due to the constant risk mechanic, resulting in time-based and strain-based work interference. Players also reported receiving some social support for work stress, but development and use of social capital around work topics was unexpectedly limited. Resisting the “work” and “non-work” binary, some players avoided some areas of interference by playing tactically throughout the day. In the context of work–game relationship, players reported interference more often than use of social capital or tactical play. We suggest that the constant risk mechanic needs more research and that players structuring their play and work activities so that the relationships between them are positive instead of negative could be called work–game balance.
The East Lancashire Clinic Model: Supporting care homes to understand reactive behaviours (Innovative Practice)
Authors: Smith Michael , Sayer Kelly
Published: November 2019

The East Lancashire Clinic model is a consultancy-based approach to supporting care home staff to assess and respond to reactive behaviours of people with dementia and reduce the need to refer into secondary mental health services. The clinics are person centred and solution focused, aiming to promote recognition of unmet needs and early interventions implemented by staff. The pilot was able to resolve most cases and reduce referral rates into secondary care services. Through working collaboratively, it empowers staff to improve the care of all their residents, improves relationship with secondary care services and has potential to offer efficiency savings.
Brief Intimate Partner Violence Perpetration Screening Tools: A Scoping Review
Authors: Davis Maxine , Padilla-Medina Diana M.
Published: November 2019

Recent research findings indicate that patients are willing to disclose their use of violence to health-care providers if asked. Health-care providers have a unique opportunity to screen their patients for intimate partner violence (IPV) perpetration; however, given the time constraints and limited personnel within medical offices and emergency-care facilities, instrument brevity is critically important. The development and evaluation of tools to screen for IPV perpetration in health-care settings, particularly brief instruments, is limited by the lack of adequate guidelines, clear institutional policies for screening, and reviews of the available literature. Given the need for validated measurement tools, we assessed the psychometric properties of measurement tools designed to quickly detect IPV perpetration by conducting a scoping review. Our search identified five measures meeting eligibility requirements. Inclusion criteria required that study information be published in a peer-reviewed journal, be published in English or Spanish languages, contain 10 or less items, report psychometric testing results, require no additional information, and be designed to detect IPV perpetration. We searched subject-specific databases and the bibliographies of relevant publications to identify studies. As part of appraising and synthesizing the evidence, we found most measures to have good reliability and validity. Most measures contained 2–5 items. Most studies were conducted in the United States and utilized an adequate sample size. There were considerable differences in how each of the measures determined a positive or negative screening. Gaps in the literature and areas for future research pertained to sample diversity, invariance testing, and practice guidelines for implementation.
State Coalitions, Informational Signals, and Success as Amicus Curiae at the U.S. Supreme Court
Authors: Canelo Kayla S.
Published: November 2019

States are uniquely situated as both individual governments in the federal system and entities that represent the interests of their citizens. So, what makes groups of states successful when they lobby the Supreme Court as amicus curiae filers? I argue that it is not just the number of states included in a coalition that matters, but ratherwhichstates are included. In this article, I offer a theory that implies certain types of coalitions will be more influential than others, as these coalitions can vary in how representative they are of public preferences. I use a dataset on state amicus curiae filings from 1960 to 2013 to test the implications of my theory. I find that the regional diversity of coalitions increases the odds of state amicus curiae filers obtaining their preferred outcome, but the ideological heterogeneity of the group of states does not. This latter result is interesting given that it is contrary to the theoretical expectations of the existing scholarship on state amicus filings.
Youth Pathways: Evaluating the Influence of Gender, Involvement With the Public Mental Health System, Perceived Mental Health Need, and Traumatic Experiences on Juvenile Justice System Processing
Authors: Espinosa Erin M. , Sorensen Jonathan R. , Walfield Scott
Published: November 2019

This study examined the influence of gender, participation in public mental health services, perceived mental health need, and traumatic experiences on juvenile justice system processing. Data were collected on youth formally processed for delinquency or status offenses by a large statewide juvenile justice system and youth served by the state’s public mental health system during a 7-year period ( n = 271,427). The results indicated that accessing mental health services in the community or being viewed as having a mental health need by a juvenile probation officer increased the likelihood of youth being removed from their home by the juvenile justice system, especially for girls. While girls generally had decreased odds of out-of-home placement compared to boys, their odds significantly increased when combined with involvement in public mental health services and/or receiving a violation of probation. Once placed out of the home, boys discharged much more quickly than girls, with the rate of discharge being related primarily to the severity of their offenses. When controlling for relevant variables using propensity score matching, girls who experienced trauma or involvement with the public mental health system had a significantly lower rate of discharge from out-of-home placement than similarly matched boys.
Examining What Variables Lead to Improved Outcomes for Club Sports Participants
Authors: Lifschutz Leon
Published: November 2019

Student affairs and campus recreation practitioners trumpet the values of cocurricular experiences and believe that they can have a deep impact on key learning outcomes for participants. This study surveys club sports participants at the University of Vermont to assess club sports participant satisfaction, belonging, and participations impact on key outcomes. The study affirms the reliability and validity of the survey instrument through strong internal consistency scores and factor analysis. It also positively affirms a positive relationship between key variables such as satisfaction and belonging to key outcomes. A final key finding of this study is the statistically significant effect of belonging scores on key outcomes.
Towards a parrhesiastic engagement with graduate employability
Authors: Hall Michael
Published: November 2019

Graduate employability has become a central part of the policy debate on the relevance and value of higher education in Europe, often associated with meeting the economic demands of society. This has led to a sense of institutional vulnerability to the vagaries of market forces and public opinion, leading some higher education institutions to adopt narrow and reductive approaches to engaging with graduate employability in response. Yet such responses are not inevitable. This article deploys Foucault’s notion of parrhesia to argue that the vulnerability experienced by institutions represents an opportunity to engage with the truth of graduate employability. By conceiving of employability as the pursuit of self-transformation, institutions are able to induce students to problematise their own employability. In doing so, the possibility exists of disrupting narrow conceptions of employability and of opening up myriad possibilities of being.
The emerging role of CDK4/6i in HER2-positive breast cancer
Authors: O’Sullivan Ciara C. , Suman Vera J. , Goetz Matthew P.
Published: November 2019

Prior to the advent of the monoclonal antibody trastuzumab, human epidermal growth-factor receptor 2 (HER2)-positive (HER2+) breast cancer (BC) was associated with an aggressive clinical course and poor survival outcomes. In the era of effective HER2-directed therapies, median survival rates for patients with metastatic HER2+ BC now approach 5 years. Despite these improvements, the majority of affected patients unfortunately die from disease. Therapies to overcome treatment resistance are being actively pursued. One strategy has been to target the cyclin-dependent kinases 4/6 (CDK4/6), as they are downstream of HER2 and many of the cellular pathways driving resistance to HER2-targeted therapies, and play a key role in proliferation by controlling transition through the G1 restriction point to the S phase of the cell cycle. In this article, we review the published literature with regard to the rationale for CDK4/6-directed therapies in HER2+ BC and discuss ongoing clinical research and new challenges in the field.
Improving communication on climate policies: A young person’s view
Authors: Pereira Lidia
Published: November 2019

This article discusses why climate change is a major concern for European citizens and how centre–right political parties must address and re-evaluate this topic. Along with developing a new approach to effectively communicating issues regarding climate change, it gives an overview of the communication challenges, the growing awareness of climate change and the importance of meeting citizens’ expectations, as well as the risks and consequences of not acting. This article suggests tangible solutions for how political agents can communicate effectively with their audiences.
Do-It-Yourself (DIY) Closed Loop Systems: Perspectives of an Endocrinologist
Authors: Hng Tien-Ming
Published: November 2019

Do-It-Yourself closed loop systems are becoming increasingly popular as an alternative choice for managing type 1 diabetes. In this commentary, the issues that are faced by both the clinician and the person with diabetes are discussed from my perspective.
CircHECTD1 mediates pulmonary fibroblast activation via HECTD1
Authors: Chu Han , Wang Wei , Luo Wei , Zhang Wei , Cheng Yusi , Huang Jie , Wang Jing , Dai Xiaoniu , Fang Shencun , Chao Jie
Published: November 2019

Background:

Circular RNA (circRNA), a new class of noncoding RNA, has been shown to be important in silicosis due to its unique role as a transcription regulator or as a sponge of small RNA regulators. Here, the mechanisms underlying circHECTD1/HECTD1 in fibroblast activation and subsequent fibrosis induced by SiO2 were investigated.

Methods:

Primary human pulmonary fibroblasts (HPF-a) were utilized, combined with quantitative real-time PCR (qRT-PCR) and fluorescence in situ hybridization (FISH) assays. LC3B-LV-RFP lentivirus was used to evaluate the role of autophagy. The CRISPR/Cas9 system was applied to specifically knock down HECTD1, combined with MTT, BrdU, and migration assays, to explore the functional changes induced by SiO2.

Results:

After exposure to SiO2, the circHECTD1 level was decreased, which was associated with an increase in HECTD1 in HPF-a cells. SiO2-induced autophagy was reversed by either circHECTD1 overexpression or HECTD1 knockdown in HPF-a cells, with restored SiO2-induced fibroblast activation, proliferation, and migration via downstream autophagy. The lungs of mice exposed to SiO2 confirmed the upregulation of HECTD1 in pulmonary fibroblasts.

Conclusions:

Our data suggested a link between circHECTD1/HECTD1 and fibroblast activation with subsequent fibrosis induced by SiO2, providing novel insight into the potential of circHECTD1/HECTD1 to be a therapeutic target for silicosis.
Varieties of urban entrepreneurialism
Authors: Phelps Nicholas A , Miao Julie T
Published: November 2019

We revisit the concept of urban entrepreneurialism to highlight some of its variety. In particular, the present article refocuses discussion on: processes of innovation, bringing geography into dialogue with the literature on innovation in public services; normative questions surrounding the ends to which urban entrepreneurship is turned; and the need for analysis to go beyond the territorial traps of the nation and the city to consider how urban entrepreneurialism articulates with the national state and is projected internationally. We distinguish urban managerialism from the new urban managerialism, urban diplomacy, urban intrapreneurialism and urban speculation, drawing on international examples to highlight the mixed qualities and effects of these varieties of urban entrepreneurialism. In conclusion, we note the limitations of our framework and its relationship to the related ideas of neoliberalization, financialization and accumulation by dispossession.
Interrelations between pain, stress and executive functioning
Authors: Feller Liviu , Feller Gal , Ballyram Theona , Chandran Rakesh , Lemmer Johan , Khammissa Razia Abdool Gafaar
Published: November 2019

Aim:

The purpose of this narrative review is to discuss the interrelations between pain, stress and executive functions.

Implications for practice:

Self-regulation, through executive functioning, exerts control over cognition, emotion and behaviour. The reciprocal neural functional connectivity between the prefrontal cortex and the limbic system allows for the integration of cognitive and emotional neural pathways and then for higher-order psychological processes (reasoning, judgement etc.) to generate goal-directed adaptive behaviours and to regulate responses to psychosocial stressors and pain signals. Impairment in cognitive executive functioning may result in poor regulation of stress-, pain- and emotion-related processing of information. Conversely, adverse emotion, pain and stress impair executive functioning. The characteristic of the feedback and feedforward neural connections (quantity and quality) between the prefrontal cortex and the limbic system determine adaptive behaviour, stress response and pain experience.
Pharmacist-Driven Spirometry Screening to Target High-Risk Patients in a Primary Care Setting
Authors: Whitner Jangus B. , Mueller Lisa A. , Valentino Alexa Sevin
Published: November 2019

Objectives: The primary objective of this study is to determine the effect of proactive pharmacist identification of high-risk patients eligible for diagnostic spirometry testing on the percentage of appropriate spirometry referrals ordered and the percentage of spirometry tests completed in those that qualify. Methods: This prospective study compares spirometry referrals ordered and tests completed between an intervention site and control site within a federally qualified health center (FQHC) where pharmacists provide spirometry services. At both sites, all patients who had a primary care provider (PCP) appointment and qualified for spirometry screening on the designated intervention dates during a 12-week period were included in this study. At the intervention site, the pharmacist recommended a spirometry screening to the PCP prior to identified high-risk patients’ appointments. At both sites, a chart review was completed to determine if referrals were ordered and tests were completed for patients who qualified. Results: The number of patients eligible for diagnostic spirometry testing at the intervention and control sites was 190 (n = 125 vs n = 65, respectively). Among eligible patients, the percentage of referrals ordered was significantly higher at the intervention site (47.2% vs 7.7%, P < .001). Among patients who qualified, completion of spirometry testing was significantly higher in the intervention site (23.2% vs 3.1%, P < .001). Conclusion: Results of this study suggest that pharmacists proactively identifying high-risk patients for spirometry screenings within an FQHC increases appropriate referrals ordered by PCPs and tests completed by high-risk patients. Pharmacists in the primary care setting can aid the PCP in the management of chronic obstructive pulmonary disease through significantly increased spirometry referrals and therapeutic clinical assessments and recommendations. They also can provide face-to-face motivational counseling for smoking cessation, inhaler education, and vaccine recommendations. This population health approach to spirometry testing represents an emerging role for pharmacists and could be adopted in other primary care settings.
Anything Can Happen in Women’s Tennis, or Can It? An Empirical Investigation Into Bias in Sports Journalism
Authors: Tejkalova Alice N. , Kristoufek Ladislav
Published: November 2019

The claim that “anything is possible in women’s sports” frequently employed by both sports journalists and general audiences highlights the widespread perception of a seemingly uncontested truth about female athletes and their (in)ability to perform consistently at peak levels in comparison to male athletes. We focus on this treatment of female athletes in the world of women’s tennis and contest the “common sense” and “experience” justifications of the unpredictability in women’s sports with actual data to reveal clear media bias. Utilising a database of the Association of Tennis Professionals and Women’s Tennis Association tournaments dating back to the late 1960s and covering approximately 225,000 fully described matches, we examine the “anything can happen in women’s tennis” assumption through logistic regression, focusing on the effect of rank differential on the winning probability in the match while controlling for other factors (tournament type and stage, court surface, age differential, and elite players). The results are rather shocking. The women’s matches do not show higher instability or lower predictability at all, but rather the contrary—the men’s matches show lower dependence on the rank difference. The results are robust as checked for data sets of the year 2000 onwards and those including only special events such as Grand Slams.
Variation in ACL and MCL Strain Before Initial Contact Is Dependent on Injury Risk Level During Simulated Landings
Authors: Bates Nathaniel A. , Schilaty Nathan D. , Krych Aaron J. , Hewett Timothy E.
Published: November 2019

Background:

The existent literature has well explored knee ligament kinetics and strain at and after initial contact (IC) during landing tasks. However, little is known about knee ligament biomechanics in flight before IC.

Purpose:

To quantify and compare change in anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strain before IC relative to after IC.

Study Design:

Descriptive laboratory study.

Methods:

A total of 40 cadaveric specimens were analyzed after being subjected to simulated landings in a mechanical impact simulator. External joint loads of varying magnitudes were applied to mimic relative injury risk load levels from an in vivo cohort and were coupled with an impulse force to represent initial ground contact. Implanted strain gauges continually recorded ligament strain. Kruskal-Wallis tests evaluated the significance of risk level and pre- and post-IC factors, while Wilcoxon each-pair tests evaluated differences within both factors.

Results:

Strain responses during simulated landing tasks for the ACL ( P ≥ .545) and MCL ( P ≥ .489) were consistent after IC regardless of the level of relative injury risk simulated in each trial. Before IC, the level of injury risk kinetics applied to a specimen differentiated strain response in the ACL ( P < .001) and MCL ( P < .001), as higher risk profiles produced greater changes in ligament strain. Mean baseline strain was 4.0% in the ACL and 1.0% in the MCL. Mean change in strain from the ACL ranged from 0.1% to 3.9% pre-IC and from 2.9% to 5.7% post-IC, while the MCL ranged from 0.0% to 3.0% pre-IC and from 0.9% to 1.3% post-IC.

Conclusion:

Within each ligament, post-IC strain response lacked statistical differences among simulated risk profiles, while pre-IC response was dependent on the risk profile simulated. Individually, neither pre- nor poststrain changes were enough to induce ACL failure, but when combined over the course of a full landing task, they could lead to rupture.

Clinical Relevance:

Prevention and rehabilitation techniques should aim to limit the presence of increased risk biomechanics in flight before landing, as impulse delivery at IC is inevitable.
Primary ACL Repair Revisited: Back to the Future?
Authors: Reider Bruce
Published: November 2019

Primary repair of the Anterior Cruciate Ligament (ACL) had some popularity among a select group of surgeons in the mid 20th century. Techniques described by Ivar Palmer of Sweden were adopted in the United States by surgeons such as O’Donoghue, Marshall, and Feagin. However, promising early results were followed by disappointing failure rates at 5-year follow-up, and ACL reconstruction became the norm. Recently there has been a renewed interest in ACL repair. One use has been in conjunction with ACL reconstruction as remnant preservation. Isolated repair has been reported using a variety of techniques, including bridge-enhanced repair (BEAR) with a sheath, meticulous suturing with or without suture tape reinforcement, and repair to a dynamic intraligamentary stabilization (DIS) device. Early reports have been encouraging. However, in the case of the BEAR, the series is so far small and short-term; the two other techniques have more results reported but they include some studies with a concerning level of failure, especially in younger or more active patients. My current recommendation is to await more clinical documentation before adopting these technique in lieu of ACL reconstruction.
Tendon of Achilles (TA) Repair: “This is How I Do It”
Authors: Eufemio Edgar Michael T.
Published: November 2019

A torn TA is a devastating injury and majority of the cases are sports-related. Several procedures have been developed over the years and these have continued to evolve.

The keys to a successful outcome are still the same: A Thorough Physical Examination A Sound Surgical Technique Strong Suture Material A Good Physical Therapy Program

I would like to present a method I have been using for the past twenty years. Only the post-op rehabilitation course has changed.

In 2008, I drastically changed my system after surgery. The highlights are the following: Full Weight Bearing Started Immediately with a Cast Boot Active Range of Motion Allowed as Tolerated Stretching Exercises Started After 4 Weeks Strengthening Program Started After 6 Weeks Running, Trampoline Exercises and Sports-Specific Drills After 3 Months Back to Sports After 4 Months
Arthroscopic Lateral Ligament Repair
Authors: Lee Jin Woo
Published: November 2019

Ankle sprain is one of the most common sports-related injuries and involves the three ligaments of the lateral ligament complex of the ankle. Approximately 80% of patients tear the anterior talo-fibular ligament (ATFL), while the other 20% of patients tear the ATFL and calcaneo-fibular ligament (CFL). Rarely, the posterior talo-fibular ligament (PTFL) is involved. Non-surgical management of ankle sprains leads to excellent results in most cases for the initial phase. An incidence of 10 – 30% of patients would fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical intervention. And the CLAI is commonly associated with other lesions, such as osteochondral lesion, soft tissue impingement syndrome, loose body, and peroneal tendon disorder so that diagnostic arthroscopy is mandatory with stabilizing lateral ankle.

Although more than 50 surgical procedures have been described for stabilizing the lateral ankle ligaments complex. The original technique of Broström, modified by Gould, has become the gold standard procedure with infrequent exception in the literatures. However, the open technique requires at least a 4-cm-long incision with significant dissection and soft tissue debridement. Recently, there has been a recent advent of published descriptions on arthroscopic procedures for CLAI with advanced anatomic and bio-mechanic researches of lateral ankle ligaments complex. As in other minimal invasive surgical techniques in the foot and ankle, arthroscopic lateral ligament repair has advantages of less pain, addressing intra-articular pathologies, less injury to surrounding tissue, faster recovery, shorter hospital stay, and better cosmetic result. However, there are concerns about this new emerging technique with a technically demanding and lack of long-term clinical results.

The purpose of this presentation is to review what has been established for the CLAI and discuss the arthroscopic lateral ligament repair technique.
ACL reconstruction: Which grafts can be used if hamstring is too small?
Authors: Lubis Andri
Published: November 2019

Hamstring grafts are the most often grafts used for ACL reconstruction procedures. Especially in Asia, hamstrings are preferable since small incision for taking the graft, and not produce anterior knee pain during kneeling, since there is no bony part taken. However, sometimes hamstring is too small for the graft. Many literatures mention that at least 7-8 mm needed for the best result of ACL reconstruction using hamstring tendon. It is not easy to predict the size of the hamstring tendon before surgery. Quadriceps tendons are good alternative as the grafts for ACL reconstruction. However, sometimes surgeons realize that hamstring is too small after they took the hamstring. The peroneus longus tendon can be added to the small hamstring. Even though peroneus longus tendon should not be used routinely, it could be considered if the hamstring that has been taken is too small.
Remnant Preserving or Augmentation SB PCL Reconstruction: Tips and Tricks
Authors: Nelwan Bobby Natanel
Published: November 2019

Injury to the Posterior Cruciate Ligament (PCL) is thought to account for 3% to 20% of all knee ligament injuries. Accurate diagnosis of the PCL injury is the first step in determining appropriate management. Approximately 60% of PCL injuries are associated with tearing of the Posterolateral Corner (PLC) structures.

When the surgery, arthroscopy PCL reconstruction, is decided then we have to think how and what the best technique will be used to reconstruct. Various techniques of PCL Reconstruction Arthroscopy are known that based on research. According the position of PCL, the procedure of reconstruction is more difficult than ACL one. If combined with PLC rupture, all the structures will be reconstructed in one step.

Will be proposed the tips and tricks how to do arthroscopy remnant preserving or augmentation single bundle PCL reconstruction, such as: how to preserve the remnant, how to find the position of tibial attachment and what the landmark, how to deliver the graft into the tunnels so preventing “killer turn” on the posterior part of joint, and how to do the proper rehabilitation.

By using the Posterior Medial Portal, working with Remnant Preserved of PCL Reconstruction will be made easier. Joint line of medial tibial plateau as a landmark to find the tibial tunnel. About 1.5 cm below the joint line, the point of tibial tunnel is made or directly finding the edge of the ‘shelf’ where the tunnel is made on there. The remnant will be split and the graft will be laid in between.

A strong suture material is used to pull the graft with all in side technique. The tibial part of the graft goes in first through the anterolateral portal following the suture material, go into between the remnant and go into the tibial tunnel from posterior to anterior (inside out). The femoral part of the graft will go into the joint together with the wire that carrying the distal end of the graft go into the femoral tunnel. After that we make the finalization of procedure.

Finally, a special rehab program is needed to get the good result of PCL reconstruction as a whole.
Which Stretching Method is Superior in Plantar Fasciosis?
Authors: Butarbutar John
Published: November 2019

Plantar fasciosis is prevalent in orthopedic clinic particularly foot and ankle sections. First-line treatment includes rest, non-steroidal anti-inflammatory drugs, orthotics, and stretching. However, approximately 10-40% of patients will have persistent symptoms after 2 years.

Several stretching methods have been proposed, targeting plantar fascia and calf muscle. Plantar fascia specific stretching alone showed superior result in short-term follow up only, compare to calf muscle stretching, but combine stretching effectiveness is still inconclusive.

The practical conclusion is difficult to draw because foot arch type and leg flexibility are not included in those stretching studies. We believe that the possible benefit of combined stretching benefits should not be overlooked, especially in patients with a high arch or tight calf muscles.

In our opinion, future studies of plantar fasciosis and stretching should include foot type and lower extremity flexibility.
Clinical Outcomes of Revision Meniscal Repair
Authors: Sakti Muhammad
Published: November 2019

Background:

The failure rate after arthroscopic primary meniscal repair ranges from 5% to 43.5% (mean 15%). Patients requiring revision surgery may benefit from revision meniscal repair, however, the results of this procedure remain underreported.

Objective:

This was a retrospective study aim to evaluate the outcome of revision meniscal repair in patients with re-tears in Makassar’s hospitals from 2010 – 2017.

Methods:

A medical record review was performed to identify all patients undergoing revision meniscal repair between 2010 and 2017 in Makassar’s hospitals. Only patients with re-tears of the primary repaired meniscus were included. Surgical technique of primary and revision meniscus repair was detailed. The records of all patients were reviewed to collect patient demographics, affected side of the re-teared meniscus, reasons for failed primary repair, combined disorder, location of the tear, and duration between the primary and revision surgery. Follow-up evaluation included clinical outcome scores (Lysholm Score).

Results:

A total 9 of 15 patients (5 male and 4 female) with a mean age of 25.3 years (range, 19 to 44) and a mean BMI of 24.48 kg/m2 (range, 19.6 to 32.9) were included. Three lateral menisci and six medial meniscal repairs were revised at mean 23.3 months (range, 19 to 32) after primary repair. Reasons for failed primary repairs were traumatic re-tears in 4 patients (44%) and non-traumatic re-tears in 5 patients (56%). Patients undergoing isolated meniscal repair were found in 6 patients, 2 patients with ACL concomitant disorder, and 1 patient with osteoarthritis. Two tears occurred in the red-red zone and 7 in the red-white zone. At final follow-up, the mean Lysholm score significantly improved from 79.8 points (range, 75-84 points) at pre-revision to 88.1 (range, 80 to 97).

Conclusion:

Meniscal repair should always be considered when the anatomic conditions are favorable (location, type of tear, ACL status).
Meniscal Root Tear: A Missed Epidemic?
Authors: Ifran Nadia Nastassia
Published: November 2019

Meniscal root tears often go unnoticed and represent unique injury patterns with unique biomechanical consequences. Meniscal root tear occurs about 10-21% of all meniscal tears. Almost 10% of ACL tears involving posterior lateral meniscus tears. Meniscal root tears interrupt the continuity of the circumferential fibers, hence meniscus will fail to function as a shock absorber and load distributor. The biomechanical implication is the accelerated degeneration of the joint comparable to total meniscectomy. Repair of meniscal root tear will reduce contact pressure and increase contact area biomechanically similar to the uninjured meniscus. However, the repair must be done as anatomic as possible. Otherwise, the goal of restoring the meniscus function may not be achieved. Sign and symptoms, physical examination and radiological findings that may suggest a meniscal root tear will be discussed in this paper. Moreover, an overview of the management will also be described.
Comparison Effect of Corticosteroid Injection with Low Level Laser Therapy in Plantar Fasciitis Patients in Dr. Bratanata Hospital, Jambi
Authors: Simanjuntak Charles A , Gading Patrick W
Published: November 2019

Objectives:

Plantar fasciitis is a common pain disorder that affects the heel and soles of the feet. These are abnormalities at the location of tendon insertions in the bone and are characterized by scarring, inflammation, or damage to the plantar fascia. Treatment options for patients with plantar fasciitis vary with little consensus on the clinical approach. Physical therapy procedures including LLLT (Low-Level Laser Therapy) are most often applied in conservative treatment of plantar fasciitis. While steroid injection is a treatment that has been proven effective in the management of short-term symptoms. The aim of this study was to compare the effects of LLLT and steroid injection on pain and functional conditions in patients with plantar fasciitis.

Methods:

This is a prospective study conducted in 30 patients. 15 patients were treated with local injection steroids (single Group A) and 15 patients were treated with LLLT (Group B), 8 J / cm2 per day, 3 days per week for 2 weeks. VAS scores and FFI (Foot Function Index) are measured.

Results:

Pain intensity was reduced in both groups after 2 weeks. VAS scores decreased to 3.47 in Group A and 3.82 in Group B in 2 weeks (p <0.05). In Group A, FFI decreased to 22.03 ± 4.45 while in Group B it decreased to 26.40 ± 2.52 in the same interval. But generally, patients who suffer from plantar fasciitis prefer LLLT compared to more invasive steroid injection therapy.

Conclusion:

LLLT therapy and steroid injection are effective methods for reducing pain and improving foot function in plantar fasciitis. It appears that steroid injection is superior to LLLT therapy. But fear of invasive action, patients have LLLT.
Extensive Lateral Release and Medial Patello-femoral Ligament Reconstruction in 25 years of Chronic Fixed Lateral Patellar Dislocation: A 5 year follow up Case Report
Authors: Lubis Andri , Aprianto Petrus , Siregar Yudistira P.
Published: November 2019

Objectives:

Chronically fixed lateral patellar dislocation is uncommon and mostly associated with disruption of the medial patellofemoral ligament (MPFL) which is a major risk factor for this condition, as it functions as the main patella medial stabilizer. This paper focuses on the reconstruction of the MPFL after an extensive lateral release in a fixed lateral patellar dislocation. We aim to explain the technique that was used to reduce and maintain the position of the patella and prevent it from re-dislocation. Extensive lateral release and modified MPFL reconstruction for a chronically fixed patellar lateral dislocation provide a satisfactory result. We aim to explain a modified technique to treat a chronically fixed patellar lateral dislocation

Case presentation:

We present a case report of a 49-year-old Caucasian male with a history of falling on his right knee 25 years before. He complained of pain on his knee for 8 months before. Physical examination showed chronically fixed lateral patellar dislocation with a normal range of motion. The diagnosis of patellar dislocation was confirmed with a conventional radiograph. The patient underwent extensive lateral release of the knee followed by a modified technique for MPFL reconstruction. Semitendinosus tendon was used as the graft because of the chronic nature of this condition. The graft was inserted into the patellar tunnel and fixed using endobutton®. The graft was inserted into the femoral tunnel that was made at Schottle point from the medial through the lateral side. After that, the cortical screw with the washer was inserted on the lateral femoral side just above the femoral tunnel as an anchor to make sure the tendon is secured. We follow-up the patient for 5 years.

Results and Conclusion:

On a 5 year follow-up, there was no complaint of recurrent patellar dislocation. The result of this extensive lateral release followed by modified MPFL reconstruction for a chronically fixed lateral patellar dislocation is satisfactory. The extensive release was needed to reduce the fixed dislocated patella and this modified technique of MPFL reconstruction by using screw and washer as an anchor on lateral sides of the femur could be an alternative to prevent re-dislocation.