bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ankle Arthroscopy in Acute Ankle Fractures: Does It Make Sense?
Authors: Carulli Christian , Scalici Gianluca , Lazzarini Francesco , Monteleone Nicola , Macera Armando , Innocenti Massimo 
Published: September 2020

Introduction:
Displaced ankle fractures require surgery, bone healing generally occurs with satisfactory outcomes. In some cases, poor results are recorded related to posttraumatic arthritis or other complications. Occult lesions (osteochondral lesions, loose bodies, impingement syndrome) may be among the common causes of unsatisfactory outcomes. Most of them may be detected by a computed tomography (CT) scan at the emergency room; however, such evaluation is not routinely performed. The aim of this study was to evaluate the clinical results of patients undergoing open reduction and internal fixation (ORIF) and ankle arthroscopy for fractures associated with intra-articular lesions.

Materials and Methods:
Among 397 patients evaluated for displaced ankle fracture, we selected 13 patients who also presented with intra-articular alterations at the CT scan performed in the Emergency room. All subjects underwent ORIF and arthroscopy. Patients were evaluated by NRS and AO-FAS score for at least of 1-year of follow-up.

Results:
The mean follow-up was 2.7 years; all fractures fully healed. The mean age at the time of surgery was 33.5 years. A single complication was recorded (complex regional pain syndrome, healed 6 months after surgery). All subjects reported satisfaction with improvements of the scores and return to their daily life activities.

Discussion:
Occult injuries associated with ankle fractures should be suspected and ruled out by a CT scan at the emergency room. Probably many occult injuries are underestimated because CT scan is not commonly performed, explaining cases of bone healing but poor functional results. In case of confirmation, these alterations should be treated in association with ORIF; arthroscopy may represent a valid and minimally invasive procedure, with low rates of complications.
Consequences and Prognosis of Running-Related Knee Injuries Among Recreational Runners
Authors: Cloosterman Kyra L.A. , Fokkema Tryntsje , de Vos Robert-Jan , Bierma-Zeinstra Sita M.A. , van Middelkoop Marienke 
Published: September 2020

Objective:
To investigate the consequences and prognostic factors of running-related knee injuries (RRKIs) among recreational runners.

Design:
Prospective cohort study.

Setting:
This study is part of a randomized-controlled trial (RCT) on running injury prevention among recreational runners. At baseline during registration for a running event (5-42 km), demographic and training variables were collected. Participants who reported a new RRKI during follow-up were sent a knee-specific questionnaire at 16 months (range 11.7-18.6) after baseline.

Participants:
One hundred thirty-eight runners who reported a new RRKI during the RCT on injury prevention responded to the knee-specific questionnaire.

Assessment of Risk Factors:
To determine the association between potential prognostic factors and time to recovery of an RRKI, a Cox regression analysis was performed.

Main Outcome Measures:
Time to recovery and prognostic factors of RRKIs.

Results:
At 16 months after registration, 71.0% of the participants reported full recovery, with a median time to recovery of 8.0 weeks. Most participants reported iliotibial band syndrome (23.2%) or osteoarthritis (OA)/degenerative meniscopathy (23.2%) as cause of their injury. Male sex was associated with a shorter time to recovery [hazard ratio (HR) 1.84; 95% confidence interval (CI), 1.14-2.97], while suffering knee OA was associated with a longer time to recovery (HR 0.17; 95% CI, 0.06-0.46).

Conclusions:
Nonrecovered participants adjusted running speed more often and had knee imaging more often than recovered participants. At follow-up, one-third of the participants were not recovered. This emphasizes the need for injury prevention programs for runners. More knowledge on the role of running in knee OA seems important, given the high number of participants with knee OA symptoms.
Vestibular/Ocular Motor Screening is Independently Associated With Concussion Symptom Severity in Youths
Authors: Babicz Michelle A. , Woods Steven Paul , Cirino Paul , Presley Chase , Colton Zachary , Podell Kenneth 
Published: September 2020

Objective:
To examine the independent contributions of the Vestibular/Ocular Motor Screening (VOMS) to concussion symptom severity in youths while controlling for computerized neurocognitive screening performance, demographics, and medical history.

Study Design:
Cross-sectional.

Setting:
Concussion specialty clinic.

Participants:
A retrospective review of 278 concussed youths clinical charts resulted in a total of 158 participants (16.5 ± 2.8 years, 46.8% women, 4.3 ± 3.3 days post-injury) when exclusionary criteria (ie, neurological or substance use disorders, age >21, >14 days since injury, and missing/incomplete data) were applied.

Independent Variables:
Vestibular/Ocular Motor Screening items and computerized neurocognitive test scores.

Main Outcome Measures:
Standardized postconcussion symptom scale scores.

Results:
At the univariate level, all VOMS items were positively associated with concussion symptom severity at small to medium effect sizes (r range 0.26-0.42). Women and individuals with a concussion history and/or Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder diagnosis reported higher VOMS item scores (Ps < 0.10). In a multiple hierarchical regression, the contribution of VOMS item scores was significant and explained 9.6% of the variance in concussion symptom severity after adjustment for sex, baseline VOMS symptom ratings, and ImPACT scores [F(6, 141) = 3.90, P = 0.001]. Vertical saccades (b = 2.22, P = 0.003) and vertical vestibulo-ocular reflex (VOR; b = −1.46, P = 0.004) VOMS items significantly contributed to concussion symptom severity in the multivariable model.

Conclusions:
Findings from this study provide support for the independent contributions of the VOMS items, particularly vertical saccades and vertical VOR, to acute concussion symptom severity in youths. Further work is warranted for a comparison of the VOMS to the full gold standard of concussion testing (ie, clinical interview, physical examination, balance testing, and neurocognitive assessment).
Age-Group Differences and Annual Variation in Return-To-Play Practices After Sport-Related Concussion
Authors: Kerschner Anna E. , Huber Daniel L. , Brett Benjamin L. , Meier Timothy B. , Nelson Lindsay D. , McCrea Michael A. 
Published: September 2020

Objective:
To examine return-to-play (RTP) practice differences between high school and collegiate athletes, as well as the stability (ie, year-by-year) in these practices over a 5-year period. We hypothesized that similar protocols for treatment will be comparable across competition levels and that these practices will vary year-to-year.

Design:
Prospective cohort study.

Setting:
Nine high schools and 4 National Collegiate Athletic Association Division III colleges in Southeastern Wisconsin.

Participants and Independent Variables:
Two-hundred seventy-three (N = 273) athletes with sport-related concussions (SRCs). Independent predictors included competition level (high school, n = 88 vs collegiate, n = 185) and year-of-injury.

Outcome Measures:
Athletes were evaluated prospectively for differences in symptom duration, symptom free waiting period (SFWP), and time to RTP, as well as longitudinal changes in management.

Results:
High school and collegiate athletes experienced comparable median symptom duration (high school, 6.0 days, interquartile range (IQR) = 3.5-11.0; college, 6.0 days, IQR = 4.0-9.0, P = 0.95), SFWP (high school, 5.0 days, IQR = 3.0-8.0; college, 5.0 days, IQR = 3.0-7.0, P = 0.12), and total time to RTP (high school, 10.5 days, IQR = 7.0-16.0; college, 11.0 days, IQR = 8.0-14.0 days, P = 0.94). A Cox regression analysis revealed a nonsignificant trend toward longer SFWPs in high school athletes (P = 0.055; hazard ratio = 1.347, confidence interval = 0.99-1.83). Among football players, SFWPs in 2017 (Median = 3.5 days, IQR = 1.5-5.0 days) were significantly longer than those in 2014 (Median = 5.0 days, IQR = 4.0-8.5 days, P = 0.029) after correction for multiple comparisons.

Conclusion:
Similar postinjury and RTP management practices were observed at the high school and collegiate levels after SRCs. Symptom duration and time from injury to unrestricted RTP were comparable, although high school athletes may have longer SFWPs.
Fair Play as an Injury Prevention Intervention: Do Yellow Card Accumulation Policies Reduce High School Soccer Injuries?
Authors: Kriz Peter K. , Yang Jingzhen , Arakkal Alan , Keeley Timothy , Comstock R. Dawn 
Published: September 2020

Objectives:
Evaluate yellow card policies' (YCPs) effectiveness in reducing competition contact injuries (CCIs).

Design:
Retrospective cohort.

Setting:
High schools.

Participants:
Soccer players from High School (HS) Reporting Information Online participating schools, 2005/06 to 2017/18.

Independent Variables:
Athlete exposure (AE), CCIs from HS competitions collected from states with/without YCPs.

Main Outcome Measures:
Rate and rate ratio (RR) of athlete–athlete CCIs recorded by athletic trainers were compared between states with/without YCPs and pre-YCPs/post-YCPs among the states with YCPs using Poisson regressions. Proportions of severe athlete–athlete CCIs were also described in states with/without YCPs.

Results:
Fifteen states implemented YCPs between 2005/06 and 2017/18; 901 athlete–athlete CCIs occurred during 352 775 competition AEs in states with YCPs, and 3525 injuries during 1 459 708 competition AEs in states without YCPs. There was no significant difference in injury rates between schools in states with/without YCPs (RR 1.07; 95% confidence interval [CI]: 0.97-1.17). Among state with YCPs, injury rates were not significantly different between pre-YCP and post-YCP implementation (RR 1.15; 95% CI: 0.98-1.34). Although a significantly lower proportion of injuries resulting in >3 weeks' time loss (TL) occurred in states with YCPs (injury proportion ratio 0.81; 95% CI: 0.66-0.997), no significant differences were observed in proportions of other severe athlete–athlete CCIs between states with/without YCPs.

Conclusions:
Yellow card policies were ineffective in lowering HS soccer athlete–athlete CCI rates, although injuries resulting in >3 weeks' TL were less prevalent in states with YCPs. Implementation of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy.
Case Report: What Are We Doing for Our “20/20 Unhappy” Scleral Lens Patients?
Authors: Nguyen Lan Chi , Kauffman Matthew J. , Hastings Gareth D. , Applegate Raymond A. , Marsack Jason D. 
Published: September 2020

SIGNIFICANCE
Scleral lenses (SLs) partially mask higher-order aberrations (HOAs) in highly aberrated eyes. Although visual acuity (VA) may show satisfactory quantitative clinical outcomes during SL wear, residual (uncorrected) HOAs can leave subjective visual quality goals unmet.

PURPOSE
The purpose of this study was to report a case where a “20/20 unhappy” patient with SLs was able to meet visual goals with wavefront-guided SLs.

CASE REPORT
A 40-year-old male with bilateral keratoconus, whose Snellen VA with SLs was 20/20+2 right eye (OD) 20/16+2 left eye (OS), reported halos and glare at night and perceptual smearing. When viewing a point of light, a “Ferris wheel” shadowing was observed OD and a U-shaped shadowing OS. Residual higher-order root mean square wavefront error was 0.49 μm OD and 0.39 μm OS; visual image quality measured by visual Strehl ratio was 0.067 OD and 0.092 OS (pupil size, 4.00 mm). Wavefront-guided SLs reduced residual higher-order root mean square to 0.19 μm OD and 0.25 μm OS, VA improved to 20/10 OD and 20/13 OS, and visual Strehl improved to 0.150 OD and 0.121 OS. The patient reported reduced smearing, shadowing, and night vision concerns, meeting his visual expectations and goals.

CONCLUSIONS
Wavefront sensing quantifies both lower and HOAs, which can cause visual dissatisfaction in individuals with highly aberrated eyes, despite sometimes reaching typical levels of VA. As wavefront-guided SLs targeting these residual aberrations to improve visual image quality become more available, they should be considered for 20/20 unhappy patients when conventional clinical options are unsatisfactory.
Manipulation of Front-Surface Profile of Scleral Contact Lenses to Alter Peripheral Refraction
Authors: Peguda Rajini , Kang Pauline , Swarbrick Helen A. 
Published: September 2020

SIGNIFICANCEThe front optic zone diameter of scleral contact lenses was manipulated to mimic the central treatment zone induced by orthokeratology contact lens wear, to explore potential effects on the peripheral refraction profile.PURPOSEThe purpose of this study was to investigate effects on the peripheral refraction profile of changing front optic zone diameters of scleral contact lenses.METHODSTwelve young adults were fitted with scleral contact lenses (diameter, 16.5 mm) with two front optic zone diameters (6 and 4 mm) on one eye only on 2 separate days. Both lenses were fabricated with front optic zone power of −3.00 D and plano power outside the optic zone to mimic the orthokeratology treatment effect. All lenses had the same spherical back-surface design with a toric lens periphery. Peripheral refraction was measured at 10° increments along horizontal (±35°) and vertical (±30°) meridians before lens insertion and after 10 minutes of lens wear. Mixed-model analysis and post hocttests with Bonferroni correction were performed.RESULTSCompared with baseline, no significant change in relative spherical equivalent refractionMwas observed with 6-mm optic zone lenses along the horizontal meridian. However, a significant difference in relativeMprofile was found with 4-mm optic zone lenses (P= .009).Mbecame myopic at all locations in the nasal visual field (P< .05) except at 35°. In contrast, compared with baseline, no significant changes in relativeMwere found with either 6- or 4-mm optic zone lenses along the vertical meridian.CONCLUSIONSThe greater myopic shift in relative peripheral refraction with 4-mm compared with 6-mm front optic zone lenses suggests that a reduced treatment zone diameter in orthokeratology may induce more myopic peripheral refraction changes. This may guide us toward novel orthokeratology lens designs for more effective myopia control.
Underemployment of Female Surgeons?
Authors: Chen Ya-Wen , Westfal Maggie L. , Chang David C. , Kelleher Cassandra M. 
Published: September 2020

Objective:
To compare the complexity of operations performed by female versus male surgeons.

Background:
Prior literature has suggested that female surgeons are relatively underemployed when compared to male surgeons, with regards to operative case volume and specialization.

Methods:
Operative case records from a large academic medical center from 1997 to 2018 were evaluated. The primary end point was work relative value unit (wRVU) for each case with a secondary end point of total wRVU per month for each surgeon. Multivariate linear analysis was performed, adjusting for surgeon race, calendar year, seniority, and clinical subspecialty.

Results:
A total of 551,047 records were analyzed, from 131 surgeons and 13,666 surgeon-months. Among them, 104,424 (19.0%) of cases were performed by female surgeons, who make up 20.6% (n = 27) of the surgeon population, and 2879 (21.1%) of the surgeon months. On adjusted analysis, male surgeons earned an additional 1.65 wRVU per case, compared to female surgeons (95% confidence interval 1.57–1.74). Subset analyses found that sex disparity increased with surgeon seniority, and did not improve over the 20-year study period.

Conclusions:
Female surgeons perform less complex cases than their male peers, even after accounting for subspecialty and seniority. These sex differences are not due to availability from competing professional or familial obligations. Future work should focus on determining the cause and mitigating this underemployment of female surgeons.
High-resolution Crystal Structures of Transient Intermediates in the Phytochrome Photocycle
Authors: Carrillo Melissa , Pandey Suraj , Sanchez Juan , Noda Moraima , Poudyal Ishwor , Aldama Luis , Malla Tek Narsingh , Claesson Elin , Wahlgren Weixiao Yuan , Feliz Denisse , Šrajer Vukica , Maj Michal , Castillon Leticia , Iwata So , Nango Eriko , Tanaka Rie , Tanaka Tomoyuki , Fangjia Luo , Tono Kensuke , Owada Shigeki , Westenhoff Sebastian , Stojković Emina A. , Schmidt Marius 
Published: September 2020

AbstractPhytochromes are red/far-red light photoreceptors in bacteria to plants, which elicit a variety of important physiological responses. They display a reversible photocycle between the resting (dark) Pr state and the light activated Pfr state, in which light signals are received and transduced as structural change through the entire protein to modulate the activity of the protein. It is unknown how the Pr-to-Pfr interconversion occurs as the structure of intermediates remain notoriously elusive. Here, we present short-lived crystal structures of the classical phytochrome from myxobacteriumStigmatella aurantiacacaptured by an X-ray Free Electron Laser 5 ns and 33ms after light illumination of the Pr state. We observe large structural displacements of the covalently bound bilin chromophore, which trigger a bifurcated signaling pathway. The snapshots show with atomic precision how the signal progresses from the chromophore towards the output domains, explaining how plants, bacteria and fungi sense red light.
The impact of land renting-in on farm productivity: evidence from maize production in China
Authors: Qiu Tongwei , He Qinying , Choy S.T. Boris , Li Yifei , Luo Biliang 
Published: September 2020

PurposeThis study investigates the effect of renting in land on farm productivity, and the impacts of rented-in land size and transaction partner type on farm productivity.Design/methodology/approachData from the 2015 China Household Finance Survey are analyzed using an extended regression model and the two-stage least squares method.FindingsFarm households that rent in land are likely to achieve higher farm productivity, and ignoring endogeneity underestimates the positive effect of land renting-in. Further evidence indicates that rented-in land size has an insignificant impact on farm productivity, and that there is no difference in farm productivity between lessees renting-in land from acquaintances and those renting-in land from non-acquaintances. These results may be caused by the higher degree of marketization of land rentals between acquaintances in China. With increasing competition in agricultural factor markets, in theory, rented-in land size should not affect farm productivity.Practical implicationsOverall, the analysis suggests that renting in land improves farm productivity, which supports the land transfer policies that have been rolled out in recent decades in China. However, our finding that rented land size does not affect farm productivity, consistent with the results in the literature, implies that the Chinese government should no longer subsidize or prefer large farms with low productivity. More attention should be paid to small lessees and market-oriented land rentals between acquaintances. Promoting the marketization of land transfers inside acquaintance networks could realize the potential of the land market, especially if land transfers decrease.Originality/valueThis study identifies the effects of renting in land, rented-in land size and type of rental transaction partner on farm productivity using nationally representative data. The findings imply that the government should pay more attention to the marketization of land rentals between acquaintances. Although existing studies regard land rental between acquaintances as informal and of low efficiency, the recent evidence shows that China's land markets are changing, and policy makers should adjust their policies accordingly.
Theorizing the virus: abjection and the COVID-19 pandemic
Authors: Pfaller Larissa 
Published: September 2020

PurposeUsing Kristeva's theory of abjection, this article analyzes the psychosocial reality of the coronavirus disease 2019 (COVID-19) pandemic, advancing the understanding of exclusion and stigmatization as forms of social abjection.Design/methodology/approachThe article applies abjection to understand how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is both a medical emergency but also a cultural challenge. The analysis is structured in three dimensions: (1) the transgressive potential of the virus, (2) forms of cultural coping with its threat and (3) the moral order of abjection.FindingsThe virus is an existential challenge to cultural boundaries and subjectivity. Strategies to prevent its further spread (e.g. handwashing, “social distancing” and closing national borders) are thus culturally significant. The virus triggers the processes of abjection, (re-)establishing challenged boundaries and exclusionary social hierarchies. Collateral consequences of protective measures vary across regions and social groups, creating and exacerbating social inequalities.Research limitations/implicationsPractices of abjecting the virus go far beyond handwashing, masking, etc. The virus, an invisible enemy to be expunged, is also a hybrid of threatening pathogen and human body; it is not the virus but people who experience exclusion, discrimination and disrespect. Thus, cultural sociology must address the moral economy of abjection.Social implicationsAs Kristeva insists, the abject threatens both the subject and the symbolic order. Overcoming social abjection means recognizing and strengthening individual and community agency and requires understanding vulnerability as an anthropological condition, enacting caring relationships and acting in solidarity.Originality/valueThis article demonstrates that abjection is a suitable theoretical tool for analyzing the social dynamics of the COVID-19 crisis.