bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Outcomes of Pedicled Gastrocnemius Flaps in Total Knee Arthroplasty
Authors: Houdek Matthew T. , Wagner Eric R. , Wyles Cody C. , Harmsen William S. , Hanssen Arlen D. , Taunton Michael J. , Moran Steven L. 
Published: May 2018

Background:
Deficient soft tissue following total knee arthroplasty (TKA) can jeopardize outcome. The gastrocnemius flap is an important means of providing coverage of a knee with deficient soft tissue. There is a paucity of long-term studies on the use of the gastrocnemius flap in the setting of TKA. The purpose of this study was to review the outcomes after the use of pedicled gastrocnemius flaps for coverage of a soft-tissue defect at the time of TKA.

Methods:
Eighty-three patients in whom a gastrocnemius flap had been used to cover the site of a primary (n = 18) or revision (n = 65) TKA over a 25-year period were identified. There were 48 women (58%) and 35 men (42%) with a mean age and body mass index (BMI) of 65 years and 32.6 kg/m2. The mean wound size was 49 cm2, and the wound was most commonly located over the anterior aspect of the knee/patellar tendon (n = 33). Patients were followed to the time of implant or flap revision, amputation, or death or for a minimum of 2 years (mean, 8 years). Clinical outcomes were assessed using the Knee Society Score (KSS) for pain and the KSS for function. The Kaplan-Meier method was used to assess revision and amputation-free survival. Risk factors for amputation and revision were identified with Cox regression.

Results:
The 10-year revision and amputation-free survival rates following gastrocnemius flap coverage were 68% and 79%, respectively. The risk of implant failure was increased by morbid obesity (BMI of ≥40 kg/m2) (hazard ratio [HR] = 2.82, 95% confidence interval [CI] = 1.09 to 7.32, p = 0.03) and ≥5 prior surgical procedures on the knee (HR = 2.68, 95% CI = 1.04 to 6.88, p = 0.04). The risk of amputation was increased in patients with ≥5 prior surgical procedures (HR = 10.76, 95% CI = 2.38 to 48.58, p = 0.002), an age of ≥65 years (HR = 4.94, 95% CI = 1.10 to 22.09, p = 0.03), and a wound size of ≥50 cm2 (HR = 3.29, 95% CI = 1.14 to 9.53, p = 0.02). Preoperatively the mean KSSs for pain and function were 46 and 28, and these scores significantly (p < 0.05) improved to 78 and 43, respectively, at the time of follow-up.

Conclusions:
The gastrocnemius flap reliably provides coverage of components used in complex knee reconstruction. A history of multiple surgical procedures on the knee and larger soft-tissue defects increase the risk of revision TKA and of amputation.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Profiles of Practicing Female Orthopaedists Caring for Medicare Patients in the United States
Authors: Chapman Talia R. , Zmistowski Benjamin , Purtill James J. , Chen Antonia F. 
Published: May 2018

Background:
The increase in the percentage of women in orthopaedics in the United States over the last half century has been substantially slower than in every other surgical specialty. While this percentage has improved recently, the current demographic and practice characteristics of female orthopaedic surgeons are not well known. This study defines the landscape of practicing female orthopaedic surgeons caring for Medicare patients.

Methods:
Publicly available Medicare billing data sets from 2012 to 2014 were utilized to identify practicing orthopaedic surgeons. We analyzed demographics, medical training, practice characteristics, case volume, specialization, and procedure profiles of orthopaedic surgeons. Representative Current Procedural Terminology (CPT) codes were utilized for each subspecialty. Multivariate analysis was performed to confirm the independent characteristics that were associated with female orthopaedic surgeons after identification by univariate statistics.

Results:
The percentage of practicing female orthopaedic surgeons caring for Medicare patients increased significantly from 4.7% (1,043 of 22,038) in 2012 to 5.2% (1,179 of 22,510) in 2014. Women had graduated from medical school in more recent years than men (mean, 14.9 versus 22.5 years, respectively; p < 0.001), and were more likely to have attended a top-25 medical school (27.5% versus 24.5%, respectively; p = 0.01). Women were more likely to be part of larger practices (median, 49.5 versus 24 partners, respectively; p < 0.001), and were more likely to leave practice (4.4% versus 3.1% in 2013, respectively; p = 0.02). Women submitted fewer claims for billing per year (median, 528 versus 1,193, respectively; p < 0.001), and performed 6.8% (9,852 of 144,492) of hand procedures compared with 1.5% (10,043 of 651,856) of all other common procedures (p < 0.001). Multivariate analysis demonstrated that despite confounders, gender was an independent predictor of number of claims, the likelihood of leaving clinical practice, and Medicare reimbursement.

Conclusions:
There are significant differences between female and male orthopaedic surgeons caring for Medicare patients in terms of subspecialty choices, education, billing practices, and attrition rates. Despite the recent increase in the number of female orthopaedic surgeons, there are significant gender differences within the specialty.
Short-Term Effect of Low-Dose, Electromyography-Guided Botulinum Toxin A Injection in the Treatment of Chronic Lateral Epicondylar Tendinopathy
Authors: Creuzé Alexandre , Petit Hervé , de Sèze Mathieu 
Published: May 2018

Background:Botulinum toxin A (BoNT-A) is a novel treatment for chronic lateral epicondylar tendinopathy. Preliminary studies have demonstrated promising results; however, confirmation of the effectiveness of BoNT-A treatment and further assessment of its side effects are required. This study investigated the analgesic effects of BoNT-A in the treatment of chronic lateral epicondylar tendinopathy.Methods:This was a phase-III, single-center, randomized, double-blinded, placebo-controlled study including 60 patients with chronic lateral epicondylar tendinopathy that had been resistant to treatment for >6 months. Patients received either a 40-IU injection of BoNT-A or saline solution placebo into the extensor carpi radialis brevis (ECRB) muscle, aided by electromyographic (EMG) stimulation. Follow-up was 3 months. The primary assessment criterion was the percentage of patients whose pain was reduced by >50% at 90 days after injection. Secondary outcomes, including pain intensity, pain frequency, interference with quality of life, sick leave taken, maximum grip strength, and side effects, were assessed at days 30 and 90, and the number of participants per group requesting additional therapies at day 90 was recorded.Results:Twenty-nine patients in the BoNT-A group and 28 patients in the placebo group were included in the day-90 analysis. Fifteen (51.7%) of the patients who were administered BoNT-A and 7 (25%) of the patients who received placebo reported a >50% reduction in initial pain intensity at day 90 (p = 0.005). Pain intensity and the effect on quality of life, measured using visual analog scales, were both significantly lower in the group treated with BoNT-A compared with placebo at day 90 (p < 0.05). The rate of clinically detected transitory paresis of the third finger on extension was 17.2% in the BoNT-A group, with no associated functional impairment.Conclusions:BoNT-A at 40 IU injected into the ECRB is an effective treatment for chronic lateral epicondylar tendinopathy that has been otherwise resistant to medical treatment. The rate of paresis of the third finger was low, with no associated functional impairment.Level of Evidence:TherapeuticLevel I. See Instructions for Authors for a complete description of levels of evidence.
Health-Related Quality of Life in Adulthood in Untreated and Treated Individuals with Adolescent or Juvenile Idiopathic Scoliosis
Authors: Diarbakerli Elias , Grauers Anna , Danielsson Aina , Gerdhem Paul 
Published: May 2018

Background:
Health-related quality of life in adults with idiopathic scoliosis diagnosed before maturity has been reported to be similar between brace-treated and surgically treated individuals. The aim of this study was to compare health-related quality of life in untreated, brace-treated, and surgically treated adults with idiopathic scoliosis diagnosed before skeletal maturity. Subgroup analyses were performed on the basis of age at the time of the study, age of onset, surgical characteristics, and curve magnitude.

Methods:
We included 1,187 adults with juvenile or adolescent idiopathic scoliosis with a mean age (and standard deviation) of 38.8 ±12.7 years. Of these, 347 were untreated, 459 had been brace-treated, and 381 had been surgically treated. The Scoliosis Research Society-22r (SRS-22r) and EuroQol 5-Dimensions (EQ-5D) were used. Statistical analyses were performed using analysis of covariance.

Results:
The mean SRS-22r subscore was 4.15 ± 0.59 points for the untreated group, 4.10 ± 0.57 points for the previously braced group, and 4.01 ± 0.64 points for the surgically treated group (p = 0.007 adjusted for age and sex). The EQ-5D index was 0.82 ± 0.20 for the untreated group, 0.82 ± 0.20 for the previously brace-treated group, and 0.79 ± 0.24 for the surgically treated group (p = 0.026, adjusted for age and sex). Brace cessation was at the mean age of 16.2 ± 1.5 years, and the surgical procedure had been performed at the mean age of 15.3 ± 2.1 years. A more caudal fusion was associated with a lower SRS-22r subscore and EQ-5D index. No differences were observed when comparing individuals with juvenile or adolescent onset scoliosis (all p > 0.05).

Conclusions:
Untreated adults with idiopathic scoliosis had similar health-related quality of life to previously brace-treated individuals, and they had marginally higher health-related quality of life compared with surgically treated individuals. Therefore, both surgical and brace treatments for idiopathic scoliosis could be considered successful from a health-related quality-of-life point of view in adulthood. The age of onset of idiopathic scoliosis does not seem to influence quality of life in adulthood.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Impact of Clinical Practice Guidelines on Use of Intra-Articular Hyaluronic Acid and Corticosteroid Injections for Knee Osteoarthritis
Authors: Bedard Nicholas A. , DeMik David E. , Glass Natalie A. , Burnett Robert A. , Bozic Kevin J. , Callaghan John J. 
Published: May 2018

Background:
The efficacy of corticosteroid and hyaluronic acid injections for knee osteoarthritis has been questioned. The purpose of this study was to determine the impact of the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines on the use of these injections in the United States and determine if utilization differed by provider specialty.

Methods:
Patients with knee osteoarthritis were identified within the Humana database from 2007 to 2015, and the percentage of patients receiving a knee injection relative to the number of patients having an encounter for knee osteoarthritis was calculated and was trended for the study period. The impact of each edition of the AAOS clinical practice guidelines on injection use was evaluated with segmented regression analysis. Injection trends were also analyzed relative to the specialty of the provider performing the injection.

Results:
Of 1,065,175 patients with knee osteoarthritis, 405,101 (38.0%) received a corticosteroid injection and 137,005 (12.9%) received a hyaluronic acid injection. The rate of increase in hyaluronic acid use, per 100 patients with knee osteoarthritis, decreased from 0.15 to 0.07 injection per quarter year (p = 0.02) after the first clinical practice guideline, and the increase changed to a decrease at a rate of −0.12 injection per quarter (p < 0.001) after the second clinical practice guideline. After the first clinical practice guideline, the rate of increase in utilization of corticosteroids, per 100 patients with knee osteoarthritis, significantly lessened to 0.12 injection per quarter (p < 0.001), and after the second clinical practice guideline, corticosteroid injection use plateaued (p = 0.72). The trend in use of hyaluronic acid injections by orthopaedic surgeons and pain specialists decreased with time following the second-edition clinical practice guideline but did not change for primary care physicians or nonoperative musculoskeletal providers.

Conclusions:
Subtle but significant changes in hyaluronic acid and corticosteroid injections occurred following the publication of both clinical practice guidelines. Although the clinical practice guidelines did impact injection use, given the high costs of these injections and their questionable clinical efficacy, further interventions beyond publishing clinical practice guidelines are needed to encourage higher-value care for patients with knee osteoarthritis.
A 20-Year Prospective Longitudinal Study of Degeneration of the Cervical Spine in a Volunteer Cohort Assessed Using MRI
Authors: Daimon Kenshi , Fujiwara Hirokazu , Nishiwaki Yuji , Okada Eijiro , Nojiri Kenya , Watanabe Masahiko , Katoh Hiroyuki , Shimizu Kentaro , Ishihama Hiroko , Fujita Nobuyuki , Tsuji Takashi , Nakamura Masaya , Matsumoto Morio , Watanabe Kota 
Published: May 2018

Background:
Few studies have addressed in detail long-term degenerative changes in the cervical spine. In this study, we evaluated the progression of degenerative changes of the cervical spine that occurred over a 20-year period in an originally healthy cohort. We also sought to clarify the relationship between the progression of cervical degenerative changes and the development of clinical symptoms.

Methods:
For this prospective follow-up investigation, we recruited 193 subjects from an original cohort of 497 participants who had undergone magnetic resonance imaging (MRI) of the cervical spine between 1993 and 1996. The subjects were asked about the presence or absence of cervical spine-related symptoms. Degenerative changes of the cervical spine were assessed on MRI using an original numerical grading system. The relationship between the progression of degenerative changes and the onset of clinical symptoms was evaluated by logistic regression analysis.

Results:
Degeneration in the cervical spine was found to have progressed in 95% of the subjects during the 20-year period. The finding of a decrease in signal intensity of the intervertebral disc progressed in a relatively high proportion of the subjects in all age groups and occurred with similar frequency (around 60%) at all intervertebral disc levels. The rate of progression of other structural failures on MRI increased with age and was highest at C5-C6. The progression of foraminal stenosis was associated with the onset of upper-limb pain (odds ratio, 4.71 [95% confidence interval, 1.02 to 21.7]).

Conclusions:
A progression of degenerative changes in the cervical spine on MRI over the 20-year period was detected in nearly all subjects. There was no relationship between the progression of degeneration on MRI and the development of clinical symptoms, with the exception of an association found between foraminal stenosis and upper-limb pain.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Dedicated Satellite Trauma Orthopaedic Program Operating Room Safely Increases Capacity
Authors: Waters Peter M. , Yang Brian W. , White Doreen , Barth Ellen , Chiang Vincent , Mizrahi-Arnaud Arielle , Sparks William 
Published: May 2018

Background:
Providing high-value care for urgent orthopaedic trauma patients requires effective and timely treatment. Herein, we describe the implementation of an innovative program utilizing the operating room (OR) capacity of a satellite campus to decrease stress on a pediatric tertiary care center without jeopardizing patient safety.

Methods:
In addition to the daily emergency surgical room on the main campus, a dedicated orthopaedic trauma surgery OR was established in a satellite hospital location for 3 days per week in the summer and for 2 days per week for the rest of the year. Nonemergency, non-multitrauma operative fracture cases presenting to our tertiary care facility emergency department or orthopaedic clinic were considered for satellite referral. Eligible patients required clearance for transfer via orthopaedic, emergency department, and anesthesia checklists. An opt-out policy was established for provider judgment or patient family concern to overrule transfer decisions. Selected patients were discharged home with satellite OR scheduling or approved for same-day satellite location admission. Short elective cases were performed when openings existed in the schedule.

Results:
From June 1, 2016, through June 30, 2017, 480 cases (372 trauma, 108 elective) were completed in our satellite OR. The most common trauma cases that were treated in the satellite OR were type-II supracondylar humeral fractures (n = 76). Summer months averaged 41.75 trauma cases and 11.25 elective cases per month, with 3.15 trauma cases and 0.85 elective cases per day. Nonsummer months averaged 22.78 trauma cases and 7.00 elective cases per month, with 2.93 trauma and 0.90 elective cases per day. Of the 17 postoperative issues, the greatest number (n = 7 [41%]) involved symptomatic hardware. The remaining complications were not surgeon or geographic-site-specific. There were no intraoperative complications, compartment syndrome episodes, or patients who required transfer back to our tertiary care facility for unexpected or serious medical issues.

Conclusions:
With the proper screening protocols in place for appropriate patient selection, the use of a dedicated satellite orthopaedic trauma OR can increase capacity without compromising patient safety.
Using the Mistake Buster Technique to Improve the English Grammar Mastery
Authors: Syam Andi Tenrisanna 
Published: May 2018

This research aims at finding out whether or not the use of mistake buster technique is able to improve the English grammar mastery and finding out the students’ interest toward the use of mistake buster technique. The research employs a quasi-experimental research method. The population and sample consist of 66 students which belong to two groups; 33 students in experimental group and 33 students in control group. The research data are collected using grammar test and questionnaire which are analyzed by inferential and descriptive statistics through SPSS 17.0 and Likert Scale. The research result indicates that the use of mistake buster technique is more effective than non-mistake buster technique in improving English grammar mastery of the ten grade students of SMA Negeri 3 Makassar in academic year 2014/2015. The students’ result of posttest for experimental group is higher than the students’ result of posttest for control group. It is proven by the mean score of posttest of experimental group is higher than the control group in grammar test (63.87 > 40.00). The difference of those mean score is statistically significant; it is based on t-test value at significant level 0.05, the probability value is lower than significant level (0.00 < 0.05). Then, analysis using Likert Scale shows that the students’ interested to learn grammar by using mistake buster technique. It is proved by 60.6% students were in very interested category.
A Study of e-Learning, Blended learning, and Traditional Teaching Methods to Motivate Autonomous Learning in English Reading Comprehension of Thais Learners
Authors: Saeheng Pornpimon 
Published: May 2018

The purposes of this study were to examine the differences in learners’ satisfaction of using e-Learning, blended learning, and traditional teaching methods for TR and HI students and to study learners’ autonomy after receiving three different kinds of teaching methods. The informants were 90, second year students majoring in Tourism and Hospitality Industry which were divided by purposive sampling method into three groups of 30 learners, Group A received e-Learning method, Group B received Blended Learning method, and Group C received Traditional teaching style. The research instruments used for data collection were lesson plans, e-Learning program, learners’ perception questionnaires, interview questions, and English Reading Comprehension test (Pretest and Posttest). Quantitative data were collected and analyzed by mean, standard deviation. The interview data was read, reread, and then coded. Coding organized the raw data into meaningful categories. The results of this study indicated that the overall of students’ satisfaction and autonomous learning rate after receiving their teaching delivery methods were at “good.” Additionally, the interview results showed that the students were positively satisfied with e-Learning and blended learning. The students have become autonomous learning. Recommendations were made and presented in two categories: benefits of future practice and further research.
The Effect of Self Regulated Strategy Development on Students’ Skill to Write Persuasive Text
Authors: Sartika Dewi , Rachmanita Rachmanita 
Published: May 2018

Writing is one of the four skills taught in the school which is used as communication in daily life. It is considered as a difficult subject by the eleventh grade of the senior high school students because of the limitation of the time provided and some aspects of language to be considered. Therefore, the purpose of this study was to find out whether or not there was a significant difference in students’ writing achievement of persuasive text between the students who were taught by using Self-Regulated Strategy Development and that of those who were not. By conducting a quasi-experimental investigation at senior high school level in South Sumatera, Indonesia, two classes consisting of thirty students in each class at SMA Negeri 1 Kandis were chosen as the samples by using purposive sampling method. To analyze the data, the t-test was used. The result findings showed that t-obtained (3.29) was higher than t-table (2.0017) at the significance level of p-value was lower than 0.05. It indicated that there was a significant difference in students’ writing achievement of writing persuasive text between the students who were taught by using Self-Regulated Strategy Development and that of those who were not. The students who were taught by using Self-Regulated Strategy Development had better improvement in their writing persuasive text because the students could write the persuasive text well based on the Self-Regulated Strategy Development which applied POW (pick, organize, write) and TREE (topic, reasons, explanation, ending).
China y la construcción de un régimen internacional de Cooperación Sur-Sur
Authors: Domínguez Rafael 
Published: May 2018

El artículo analiza en perspectiva histórica el reciente proceso de construcción de un régimen internacional de Cooperación Sur-Sur (CSS). La hipótesis predictiva principal es que China está construyendo un régimen internacional de cooperación alternativo al del Comité de Ayudaal Desarrollo (CAD) de la OCDE, que, de acuerdo a una lógica de isomorfismo institucional, se sustenta en tres pilares: organizaciones internacionales de carácter financiero y político, instrumentos financieros de carácter concesional, y un sistema de monitoreo y evaluación. Como hipótesis subordinada se mantiene que, tras la experiencia fracasada de la década de 1970, el intento de construcción de un régimen internacional alternativo al del CAD, y, por tanto, un cambio de régimen, tendrá éxito esta vez por la creciente fortaleza de China como potencia ascendente en términos económicos, militares y culturales y de liderazgo político. Este nuevo régimen estará integrado por el primer pilar de las organizaciones internacionales financieras (el Banco Asiático de Inversión en Infraestructura) y políticas (la recién creada Agencia Estatal de Cooperación Internacional para el Desarrollo); el segundo pilar de la financiación ampliada del desarrollo; y el tercer pilar del sistema de monitoreo y evaluación.