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Introduction: Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care.Materials and Methods: MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management.Results: This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report.Conclusions: MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency's Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System. [ABSTRACT FROM AUTHOR]

Field-based, portable motion-capture systems can be used to help identify individuals at greater risk of lower extremity injury. Microsoft Kinect-based markerless motion-capture systems meet these requirements; however, until recently, these systems were generally not automated, required substantial data postprocessing, and were not commercially available. To validate the kinematic measures of a commercially available markerless motion-capture system. Descriptive laboratory study. Laboratory. A total of 20 healthy, physically active university students (10 males, 10 females; age = 20.50 ± 2.78 years, height = 170.36 ± 9.82 cm, mass = 68.38 ± 10.07 kg, body mass index = 23.50 ± 2.40 kg/m2). Participants completed 5 jump-landing trials. Kinematic data were simultaneously recorded using Kinect-based markerless and stereophotogrammetric motion-capture systems. Sagittal- and frontal-plane trunk, hip-joint, and knee-joint angles were identified at initial ground contact of the jump landing (IC), for the maximum joint angle during the landing phase of the initial landing (MAX), and for the joint-angle displacement from IC to MAX (DSP). Outliers were removed, and data were averaged across trials. We used intraclass correlation coefficients (ICCs [2,1]) to assess intersystem reliability and the paired-samples t test to examine mean differences (α ≤.05). Agreement existed between the systems (ICC range = −1.52 to 0.96; ICC average = 0.58), with 75.00% (n = 24/32) of the measures being validated (P ≤.05). Agreement was better for sagittal- (ICC average = 0.84) than frontal- (ICC average = 0.35) plane measures. Agreement was best for MAX (ICC average = 0.77) compared with IC (ICC average = 0.56) and DSP (ICC average = 0.41) measures. Pairwise comparisons identified differences for 18.75% (6/32) of the measures. Fewer differences were observed for sagittal- (0.00%; 0/15) than for frontal- (35.29%; 6/17) plane measures. Between-systems differences were equivalent for MAX (18.18%; 2/11), DSP (18.18%; 2/11), and IC (20.00%; 2/10) measures. The markerless system underestimated sagittal-plane measures (86.67%; 13/15) and overestimated frontal-plane measures (76.47%; 13/17). No trends were observed for overestimating or underestimating IC, MAX, or DSP measures. Moderate agreement existed between markerless and stereophotogrammetric motion-capture systems. Better agreement existed for larger (eg, sagittal-plane, MAX) than for smaller (eg, frontal-plane, IC) joint angles. The DSP angles had the worst agreement. Markerless motion-capture systems may help clinicians identify individuals at greater risk of lower extremity injury. [ABSTRACT FROM AUTHOR]

Context: Military service members commonly sustain lower extremity stress fractures (SFx). How SFx risk factors influence bone metabolism is unknown. Understanding how SFx risk factors influence bone metabolism may help to optimize risk-mitigation strategies. Objective: To determine how SFx risk factors influence bone metabolism. Design: Cross-sectional study. Setting: Military service academy. Patients or other participants: Forty-five men (agepre = 18.56 ± 1.39 years, heightpre = 176.95 ± 7.29 cm, masspre = 77.20 ± 9.40 kg; body mass indexpre = 24.68 ± 2.87) who completed Cadet Basic Training (CBT). Individuals with neurologic or metabolic disorders were excluded. Intervention(s): We assessed SFx risk factors (independent variables) with (1) the Landing Error Scoring System (LESS), (2) self-reported injury and physical activity questionnaires, and (3) physical fitness tests. We assessed bone biomarkers (dependent variables; procollagen type I amino-terminal propeptide [PINP] and cross-linked collagen telopeptide [CTx-1]) via serum. Main outcome measure(s): A markerless motion-capture system was used to analyze trunk and lower extremity biomechanics via the LESS. Serum samples were collected post-CBT; enzyme-linked immunosorbent assays determined PINP and CTx-1 concentrations, and PINP : CTx-1 ratios were calculated. Linear regression models demonstrated associations between SFx risk factors and PINP and CTx-1 concentrations and PINP : CTx-1 ratio. Biomarker concentration mean differences with 95% confidence intervals were calculated. Significance was set a priori using α ≤ .10 for simple and α ≤ .05 for multiple regression analyses. Results: The multiple regression models incorporating LESS and SFx risk factor data predicted the PINP concentration (R2 = 0.47, P = .02) and PINP : CTx-1 ratio (R2 = 0.66, P = .01). The PINP concentration was increased by foot internal rotation, trunk flexion, CBT injury, sit-up score, and pre- to post-CBT mass changes. The CTx-1 concentration was increased by heel-to-toe landing and post-CBT mass. The PINP : CTx-1 ratio was increased by foot internal rotation, lower extremity sagittal-plane displacement (inversely), CBT injury, sit-up score, and pre- to post-CBT mass changes. Conclusions: Stress fracture risk factors accounted for 66% of the PINP : CTx-1 ratio variability, a potential surrogate for bone health. Our findings provide insight into how SFx risk factors influence bone health. This information can help guide SFx risk-mitigation strategies. [ABSTRACT FROM AUTHOR]

Musculoskeletal Injuries (MSKI) are exceedingly common in the US Military, resulting in compromised military medical readiness and a substantial burden on both health care and financial resources. Severe combat-related MSKI sustained during nearly 2 decades of conflict in Iraq and Afghanistan have resulted in frequently devastating injuries that challenge acute care capabilities, require extensive rehabilitation, and often result in long-term disability. Non-combat-related MSKI, while often less severe, are far more common than combat-related MSKI and overall cause a substantially greater number of lost duty days and nondeployable Service Members. Given the strain placed on health care and financial resources by MSKI, further efforts must be directed towards prevention, treatment, and rehabilitative strategies in order to mitigate the burden of MSKI in the US Military. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and strategies for implementing patient-reported outcomes (PROs) within the Military Health System (MHS), with a focus on physical therapy management for low back pain. Topics discussed include the importance of leadership support for PRO collection, the engagement of healthcare providers in utilizing PRO data, and the lessons learned from the RESOLVE clinical trial in improving PRO adoption across MHS facilities.

Lower extremity injuries have immediate and long-term consequences. Lower extremity movement assessments can assist with identifying individuals at greater injury risk and guide injury prevention interventions. Movement assessments identify similar movement characteristics and evidence suggests large magnitude kinematic relationships exist between movement patterns observed across assessments; however, the magnitude of the relationships for electromyographic (EMG) measures across movement assessments remains largely unknown. This study examined relationships between lower extremity kinematic and EMG measures during jump landings and single leg squats. Lower extremity three-dimensional kinematic and EMG data were sampled from healthy adults (males = 20, females = 20) during the movement assessments. Pearson correlations examined the relationships of the kinematic and EMG measures and paired samples t-tests compared mean kinematic and EMG measures between the assessments. Overall, significant moderate correlations were observed for lower extremity kinematic (ravg = 0.41, rrange = 0.10-0.61) and EMG (ravg = 0.47, rrange = 0.32-0.80) measures across assessments. Kinematic and EMG measures were greater during the jump landings. Jump landings and single leg squats place different demands on the body and necessitate different kinematic and EMG patterns, such that these measures are not highly correlated between assessments. Clinicians should, therefore, use multiple assessments to identify aberrant movement and neuromuscular control patterns so that comprehensive interventions can be implemented. [ABSTRACT FROM AUTHOR]

Context: Although an association between concussion and musculoskeletal injury has been described in collegiate and professional athletes, no researchers have investigated an association in younger athletes. Objective: To determine if concussion in high school athletes increased the risk for lower extremity musculoskeletal injury after return to activity. Design: Observational cohort study. Setting: One hundred ninety-six high schools across 26 states. Patients or Other Participants: We used data from the National Athletic Treatment, Injury and Outcomes Network surveillance system. Athletic trainers provided information about sport-related concussions and musculoskeletal injuries in athletes in 27 sports, along with missed activity time due to these injuries. Main Outcome Measure(s): Three general estimating equations were modeled to predict the odds of sustaining (1) any lower extremity injury, (2) a time-loss lower extremity injury, or (3) a non-time-loss lower extremity injury after concussion. Predictors were the total number of previous injuries, number of previous concussions, number of previous lower extremity injuries, number of previous upper extremity injuries, and sport contact classification. Results: The initial dataset contained data from 18 216 athletes (females = 39%, n = 6887) and 46 217 injuries. Lower extremity injuries accounted for most injuries (56.3%), and concussions for 4.3% of total injuries. For every previous concussion, the odds of sustaining a subsequent time-loss lower extremity injury increased 34% (odds ratio [OR] = 1.34; 95% confidence interval [CI] = 1.13, 1.60). The number of previous concussions had no effect on the odds of sustaining any subsequent lower extremity injury (OR = 0.97; 95% CI = 0.89, 1.05) or a non-time-loss injury (OR=1.01; 95% CI=0.92, 1.10). Conclusions: Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non-time-loss injuries. By definition, time-loss injuries may be considered more severe than non-time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research. [ABSTRACT FROM AUTHOR]

Context: The Landing Error Scoring System (LESS) can be used to identify individuals with an elevated risk of lower extremity injury. The limitation of the LESS is that raters identify movement errors from video replay, which is time-consuming and, therefore, may limit its use by clinicians. A markerless motion-capture system may be capable of automating LESS scoring, thereby removing this obstacle. Objective: To determine the reliability of an automated markerless motion-capture system for scoring the LESS. Design: Cross-sectional study. Setting: United States Military Academy. Patients or Other Participants: A total of 57 healthy, physically active individuals (47 men, 10 women; age = 18.6 ± 0.6 years, height = 174.5 ± 6.7 cm, mass = 75.9 ± 9.2 kg). Main Outcome Measure(s): Participants completed 3 jump-landing trials that were recorded by standard video cameras and a depth camera. Their movement quality was evaluated by expert LESS raters (standard video recording) using the LESS rubric and by software that automates LESS scoring (depth-camera data). We recorded an error for a LESS item if it was present on at least 2 of 3 jump-landing trials. We calculated ĸ statistics, prevalence- and bias-adjusted j (PABAK) statistics, and percentage agreement for each LESS item. Interrater reliability was evaluated between the 2 expert rater scores and between a consensus expert score and the markerless motion-capture system score. Results: We observed reliability between the 2 expert LESS raters (average ĸ=0.45 ± 0.35, average PABAK=0.67 6 0.34; percentage agreement=0.83 6 0.17). The markerless motion-capture system had similar reliability with consensus expert scores (average ĸ = 0.48 6 0.40, average PABAK = 0.71 ± 0.27; percentage agreement = 0.85 ± 0.14). However, reliability was poor for 5 LESS items in both LESS score comparisons. Conclusions: A markerless motion-capture system had the same level of reliability as expert LESS raters, suggesting that an automated system can accurately assess movement. Therefore, clinicians can use the markerless motion-capture system to reliably score the LESS without being limited by the time requirements of manual LESS scoring. [ABSTRACT FROM AUTHOR]

Acute traumatic glenohumeral joint instability is common within the general population and endemic in young athletes and physically active populations. Individuals who experience acute traumatic glenohumeral joint instability events are at high risk of recurrent injury. In addition, glenohumeral joint instability results in substantial short-term and long-term consequences, including significant time loss from activity, degenerative joint changes, and reduced quality of life. This review provides an overview of the epidemiology of glenohumeral joint instability, reviews the modifiable and nonmodifiable risk factors for glenohumeral joint instability identified in the literature, and discusses the need for developing and implementing effective multilevel strategies for the primary, secondary, and tertiary prevention of glenohumeral joint instability and the long-term consequences associated with injury. [ABSTRACT FROM AUTHOR]

The glenohumeral joint is one of the most frequently dislocated joints and occurs with increasing frequency in collision and contact athletes, especially those in sports that repeatedly place the glenohumeral joint in a position of vulnerability. Nonoperative management of shoulder instability especially in young contact athletes results in unacceptably high recurrence rates; thus, early surgical stabilization has become commonplace. Surgical stabilization typically yields acceptable outcomes. However, recurrent anterior instability may occur following a previous stabilization procedure at rates of 7% to 12%. Recurrent glenohumeral instability represents a treatment challenge for orthopedic surgeons as it not only has the potential to result in subsequent surgery, therapy, and missed activity time, but also has been associated with long-term degenerative joint changes. Thus, recurrent instability requires close examination to determine underlying pathology leading to failure. Evaluation of underlying pathology requires consideration of patient activity-related factors, hyperlaxity and multidirectional instability, glenoid bone loss, glenoid track lesions, and other pathologic lesions. Revision surgical stabilization approaches include arthroscopic and open stabilization, as well as glenoid osseous augmentation procedures. Postoperative rehabilitation and release to sports and activity must be tailored to protect the shoulder from continued instability. Understanding that risk of recurrent glenohumeral instability and the risk factors associated with it are essential so that these factors may be mitigated and recurrent instability prevented. [ABSTRACT FROM AUTHOR]

Background: Ankle sprains are among the most common injuries experienced by collegiate athletes. The type of ankle sprain is rarely differentiated in epidemiological studies. This differentiation is necessary, as each ankle sprain type has a unique injury mechanism and recovery period. High ankle sprains commonly result in long recovery periods. Thus, a further examination of the epidemiology of high ankle sprains is warranted. Purpose: To describe the epidemiology of high ankle sprains in National Collegiate Athletic Association (NCAA) sports during the 2009/2010-2014/2015 academic years. Study Design: Descriptive epidemiology study. Methods: NCAA Injury Surveillance Program high ankle sprain data and athlete-exposures (AEs) from 25 sports were evaluated. Certified athletic trainers recorded sport-related injury, event, and AE data during team-sanctioned events. High ankle sprain injury rates per 10,000 AEs were calculated. Percentage distributions were calculated for the amount of time lost from sport and percentage of recurrent injuries. Injury rate ratios (RRs) and 95% CIs compared injury rates by event type, participation restriction time, and sex. 95% CIs not containing 1.00 were considered statistically significant. Results: The overall high ankle sprain injury rate was 1.00 per 10,000 AEs. Overall, 56.7% of high ankle sprain injuries occurred during competitions, and 9.8% of high ankle sprain injuries were recurrent. Men’s football (2.42/10,000 AEs), wrestling (2.11/10,000 AEs), and ice hockey (1.19/10,000 AEs) had the highest high ankle sprain injury rates. In sex-comparable sports, men had higher injury rates (RR, 1.77; 95% CI, 1.28-2.44). Player contact was the most common injury mechanism (60.4%), and 69.0% of injuries resulted in ≥1 day of participation restriction, with 47.1% resulting in ≥7 days of participation restriction and 15.8% resulting in >21 days of participation restriction. Conclusion: High ankle sprains resulted in significant participation restriction time from sport participation. The majority of high ankle sprain injuries resulted from player contact and were observed in contact/collision sports. The large proportion of high ankle sprains resulting from player contact, specifically in male contact sports, is worthy of further investigation. Clinical Relevance: The enhanced understanding of the epidemiology of high ankle sprains provided in our study will aid clinicians in developing targeted injury prevention strategies to mitigate the negative consequences of these injuries. [ABSTRACT FROM AUTHOR]

Dynamic postural control deficits and disrupted cortical pathways have been reported to persist beyond an athlete's return to activity after concussion, potentially increasing the risk of acute lower extremity musculoskeletal injury. Purpose: This study aimed to investigate acute lower extremity musculoskeletal injury rates before and after concussion in athletes with concussion and their matched control. Methods: College athletes with concussion (n = 44; age, 20.0 T 1.2 yr) were physician-diagnosed. Nonconcussed college athletes (n = 58; age, 20.5 T1.3 yr) were matched to individuals with concussion. Acute lower extremity musculoskeletal injury data were collected for 2 yr (T1 yr of the diagnosed concussion) using electronic medical records. Control participants_ 2-yr window for exposure and musculoskeletal injury data were anchored to their match's concussion injury date. Pre- and postconcussion musculoskeletal injury rates were calculated for 90-, 180-, and 365-d periods for both study cohorts. Risk ratios were calculated to determine differences within and between groups for all periods. Results: Within 1 yr after concussion, the group with concussion was 1.97 (95% confidence interval (CI), 1.19-3.28; P = 0.01) times more likely to have experienced an acute lower extremity musculoskeletal injury after concussion than before concussion and 1.64 times (95% CI, 1.07-- 2.51; P = 0.02) more likely to have experienced an acute lower extremity musculoskeletal injury after concussion than their matched nonconcussed cohort over the same period. Up to 180 d after concussion, the group with concussion was 2.02 (95% CI, 1.08-3.78; P = 0.02) times more likely to have experienced an acute lower extremity musculoskeletal injury after concussion than before concussion. Conclusions: Previous literature has identified dynamic postural control deficits along with increased motor evoked potential latency and decreased amplitude after concussion, suggesting that the brain may be unable to effectively coordinate movement. Our findings underscore the need to explore functional movement and dynamic postural control assessments in postconcussion injury assessment protocols. [ABSTRACT FROM AUTHOR]

The article discusses a study which was aimed to compare lower extremity (LE) muscle activation and passive range of motion (PROM) between subjects who display visual medial knee displacement (MKD) during a single leg squat (SLS) and those who do not. The study included 40 physically active adults. The study findings indicate that MKD during a SLS seems to be influenced by decreased coactivation of the gluteal to the hip adductor muscles and restricted dorsiflexion.

Researchers have examined the role of cognitive apprenticeship in relation to individual performance in the classroom, but there has been limited quantitative research directly linking cognitive behaviors to mentoring relationships and workplace performance. This study investigates the characteristics of mentoring behavior that influence group performance using data from 52 different organizations. A mediation model was tested and the results indicate that the group-level construct protégé cognitive behavior plays a central role in the mentor-protégé-performance relationship. The findings indicate that the protégés collective articulation of problem solving processes fully mediate unit performance, while exploration partially mediates the relationship. The theoretical and practical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

The article presents information about a history conference held on May 6-8, 2010 in Magdeburg, Germany. Topics under discussion at the conference included the history of imperial reign during the first millennium after Jesus Christ, comparisons between kingdoms and empires, and succession rules for emperors. Presentations were given by international historians Josef Wiesehöfer, Michael Grünbart, and Bernd Schneidmüller.

The article presents information about a conference held in Paris, France on October 19, 2009. Topics under discussion at the conference included political boundaries in medieval Europe, the importance of strategic royal marriages for medieval political relations, and the symbolism of neutrality in medieval perspectives on bridges and rivers. Presentations were given by international historians Martin Kintzinger, Laurence Moal, and Robert Gramsch.

Recently, there has been much debate about how and when to balance the federal budget. Economists have examined how to safely raise taxes without stifling crucial growth in a fragile economic climate. This Note argues that a method already exists for tapping additional, secure sources of funding, namely the taxation of repatriated earnings from foreign subsidiaries. The Note explores the advantages and disadvantages of reenacting a tax break on foreign profits returning to the U.S. and concludes that the reenactment of this tax break coupled with major revision of the tax code will improve the taxation of U.S. businesses with subsidiaries abroad. These two acts are keys to a more honest and more effectual international tax system. [ABSTRACT FROM AUTHOR]

Pain during movement screens is a risk factor for musculoskeletal injury (MSKI). Movement screens often require specialized or clinical expertise and large amounts of time to administer. Evaluate if self-reported pain (1) with movement clearing screens is a risk factor for any MSKI, (2) with movement clearing screens is a risk factor for body region–specific MSKIs, and (3) with a greater number of movement clearing screens progressively increases MSKI risk. Retrospective cohort study. Field-based. Military service members (n = 4222). Active-duty service members self-reported pain during movement clearing screens (Shoulder Clearing, Spinal Extension, Squat-Jump-Land). Musculoskeletal injury data were abstracted up to 180 days post-screening. A traffic light model grouped service members if they self-reported pain during 0 (Green), 1 (Amber), 2 (Red), or 3 (Black) movement clearing screens. Cox proportional hazards models adjusted for age, gender, body mass index, and prior MSKI determined the relationships between pain during movement clearing screens with any and body region–specific MSKIs. Service members self-reporting pain during the Shoulder Clearing (adjusted hazard ratio and 95% confidence interval [HRadj (95% CI)] = 1.58 [1.37, 1.82]), Spinal Extension (HRadj = 1.48 [1.28, 1.87]), or Squat-Jump-Land (HRadj = 2.04 [1.79, 2.32]) tests were more likely to experience any MSKI than service members reporting no pain. Service members with pain during the Shoulder Clearing (HRadj = 3.28 [2.57, 4.19]), Spinal Extension (HRadj = 2.80 [2.26, 3.49]), or Squat-Jump-Land (HRadj = 2.07 [1.76, 2.43]) tests were more likely to experience an upper extremity, spine, back, and torso, or lower extremity MSKI, respectively, than service members reporting no pain. The Amber (HRadj = 1.69 [1.48, 1.93]), Red (HRadj = 2.07 [1.73, 2.48]), and Black (HRadj = 2.31 [1.81, 2.95]) cohorts were more likely to experience an MSKI than the Green cohort. Self-report movement clearing screens in combination with a traffic light model provide clinician- and nonclinician-friendly expedient means to identify service members at MSKI risk. [ABSTRACT FROM AUTHOR]

Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. Purpose: To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non–time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. Results: A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. Conclusion: First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football. [ABSTRACT FROM AUTHOR]

Context: Verbal and tactile feedback (VTF) during rehabilitation exercises can increase muscle activation, thus improving the therapeutic benefits. However, it is unclear which feedback method elicits the greatest electromyographic (EMG) amplitude. Objective: To determine if the addition of tactile to verbal feedback (VF) increases EMG amplitude of selected shoulder musculature during scapular plane elevation (Ys), shoulder horizontal abduction with external rotation (Ts), and scapular retraction with external rotation (Ws). Design: Repeated-measures cross-over design. Setting: Biomechanics laboratory. Participants: A total of 30 physically active adults volunteered for this study—age = 20.23 (1.25) years; height = 1.71 (0.073) m; and mass = 70.11 (15.14) kg. Interventions: Electromyography of the serratus anterior; upper, middle, and lower trapezii; and anterior and posterior deltoids was recorded during Ys, Ts, and Ws with VTF and VF alone during separate testing sessions. Participants completed baseline trials without feedback, then received VTF and VF across 2 counterbalanced sessions. Main Outcome Measures: Difference scores were calculated between prefeedback and postfeedback interventions, and the difference score between baseline measurements was used as a control. One-way analysis of variance of the difference scores was used to evaluate the influence of VTF and VF on EMG amplitude during Ys, Ts, and Ws. Results: There was a significant difference between conditions for EMG amplitude of the middle trapezius (F2,28 = 4.09, P =.02) and serratus anterior (F2,28 = 3.91, P =.03) during Ys, the middle trapezius (F2,28 = 7.82, P =.001) during Ws, and the upper (F2,28 = 3.61, P =.03) and middle trapezii (F2,28 = 5.81, P =.01) during Ts. Post hoc testing revealed that both feedback conditions elicited greater EMG amplitude compared with no feedback, but there were no significant differences between the feedback conditions. Conclusions: The addition of tactile feedback to VF does not increase EMG amplitude compared with VF alone. This study indicates that feedback, regardless of type, is more beneficial than providing no feedback, for increasing EMG amplitude. [ABSTRACT FROM AUTHOR]

Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. Purpose: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative variables. Patients in MOTION research who underwent shoulder surgery and completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points were included in the present analysis. Nonlinear multivariable predictive models were created to establish an ASES index score and then validated using "leave 1 out" techniques and minimal clinically important difference /substantial clinical benefit (MCID/SCB) analysis. Results: A total of 909 patients completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at presurgery, 6 weeks, 6 months, and 1 year after surgery, providing 1502 complete observations. The PROMIS CAT predictive model was strongly validated to predict the ASES (Pearson coefficient = 0.76-0.78; R 2 = 0.57-0.62; root mean square error = 13.3-14.1). The MCID/SCB for the ASES was 21.7, and the best ASES index MCID/SCB was 19.4, suggesting that the derived ASES index is effective and can reliably re-create ASES scores. Conclusion: The PROMIS CAT predictive models are able to approximate the ASES score within 13 to 14 points, which is 7 points more accurate than the ASES MCID/SCB derived from the sample. Our ASES index algorithm, which is freely available online (https://osf.io/ctmnd/), has a lower MCID/SCB than the ASES itself. This algorithm can be used to decrease patient survey burden by 11 questions and provide a reliable ASES analog to clinicians. [ABSTRACT FROM AUTHOR]

Researchers have suggested that balance deficiencies may linger during functional activities after concussion recovery. To determine whether participants with a history of concussion demonstrated dynamic balance deficits as compared with control participants during single-legged hops and single-legged squats. Cross-sectional study. Laboratory. A total of 15 previously concussed participants (6 men, 9 women; age = 19.7 ± 0.9 years, height = 169.2 ± 9.4 cm, mass = 66.0 ± 12.8 kg, median time since concussion = 126 days [range = 28–432 days]) were matched with 15 control participants (6 men, 9 women; age = 19.7 ± 1.6 years, height = 172.3 ± 10.8 cm, mass = 71.0 ± 10.4 kg). During single-legged hops, participants jumped off a 30-cm box placed at 50% of their height behind a force plate, landed on a single limb, and attempted to achieve a stable position as quickly as possible. Participants performed single-legged squats while standing on a force plate. Time to stabilization (TTS; time for the normalized ground reaction force to stabilize after landing) was calculated during the single-legged hop, and center-of-pressure path and speed were calculated during single-legged squats. Groups were compared using analysis of covariance, controlling for average days since concussion. The concussion group demonstrated a longer TTS than the control group during the single-legged hop on the nondominant leg (mean difference = 0.35 seconds [95% confidence interval = 0.04, 0.64]; F2,27 = 5.69, P =.02). No TTS differences were observed for the dominant leg (F2,27 = 0.64, P =.43). No group differences were present for the single-legged squat on either leg (P ≥.11). Dynamic balance-control deficits after concussion may contribute to an increased musculoskeletal injury risk. Given our findings, we suggest that neuromuscular deficits currently not assessed after concussion may linger. Time to stabilization is a clinically applicable measure that has been used to distinguish patients with various pathologic conditions, such as chronic ankle instability and anterior cruciate ligament reconstruction, from healthy control participants. Whereas the single-legged squat may not sufficiently challenge balance control, future study of the more dynamic single-legged hop is needed to determine its potential diagnostic and prognostic value after concussion. [ABSTRACT FROM AUTHOR]

Researchers have examined the role of cognitive apprenticeship in relation to individual performance in the classroom, but there has been limited quantitative research directly linking cognitive behaviors to mentoring relationships and workplace performance. This study investigates the characteristics of mentoring behavior that influence group performance using data from 52 different organizations. A mediation model was tested and the results indicate that the group-level construct protégé cognitive behavior plays a central role in the mentor-protégé-performance relationship. The findings indicate that the protégés collective articulation of problem solving processes fully mediate unit performance, while exploration partially mediates the relationship. The theoretical and practical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder instability is one of the most common pathologies seen by the orthopedic sports medicine surgeon. With a uniquely young, high-demand patient population in the U.S. Military, the incidence of shoulder instability is remarkably more common than the civilian population. As such, military orthopedic surgeons and sports medicine and shoulder specialists have developed a unique understanding and experience of shoulder instability. The historical advances of shoulder instability in the military have been instrumental in understanding the epidemiology, evaluation, pathology, treatment of first-time shoulder subluxations and dislocations, operative and non-operative treatment options, arthroscopic and open stabilization methods, management of the in-season athlete, treatment of combined and circumferential labral pathology, and associated pathology.Methods: The purpose of this article is to chronicle the experience of military orthopedic surgeons in treating shoulder instability. We discuss how this unique experience has led to a better understanding of the epidemiology and pathology of this condition and how we have adapted our clinical practice to improve patient outcomes.Results: The historical contribution of U.S. Military orthopedics to the understanding of shoulder instability has been monumental. This article reviews the evolution of shoulder instability treatment and the understanding as it has evolved in the U.S. Military. It further elaborates on our understanding of the epidemiology of shoulder instability in the U.S. Military, with attention given to our incidence of 1.69 per 1000 person-years, approximately 20 times higher incidence than the general population. We discuss known risk factors for dislocation that contribute to this incidence, which are specific to military service. We address pathologic changes seen following a first-time instability event, including an analysis of labral injury and the role of these pathologic changes in recurrent instability. We also review our results from arthroscopic evaluation of first-time dislocations and compare the pathologic changes with those following a first-time subluxation. Evaluation of treatment outcomes is discussed, comparing operative and non-operative results as well as open and arthroscopic stabilization in the U.S. Military population and contact/collision athletes. Finally, we address how these results drive our current treatment algorithm.Discussion and Conclusion: The physical demands of military service result in a high rate of shoulder instability relative to the general population. For years military orthopedic surgeons have sought to better understand this pathology and learn how to optimally manage it so as to reduce this heavy burden of disease. This article discusses our experience with treating shoulder instability, provides an overview of the lessons learned, and provides a historical perspective for the evolution of shoulder instability understanding in the U.S. Military. [ABSTRACT FROM AUTHOR]

This article reports on the 1994 Children's Assistance and Resource Event in Tucson, Arizona. The fair offers a broad variety of services that prepare children for school and improve family health and welfare. Some government agencies join in presenting the event. They responsible for providing the resources needed to deliver their services at the fair. Some typical services are: food stamp enrollment; health screenings; immunizations; reduced-cost bus passes; utility assistance; and social security inscription.

The article describes updates on drone technology as of February 2018 and discusses regulatory considerations for pharmacy and related stakeholders. Topics mentioned include limitations of current drone models, the Prime Air delivery system from electronic commerce company Amazon in 2013, and the Small UAS Rule released by the U.S. Federal Aviation Administration in June 2016.

Ultrasound tissue characterization (UTC) is an imaging tool used to quantify tendon structural integrity. UTC has quantified Achilles tendon (AT) acute response to load in athletes; however, AT response to cumulative load over a season is unknown. The purpose of this study was to evaluate AT response across a four‐month competitive season in collegiate cross‐country (XC) runners. Participants (n=21; male=9, female=12; age=19.8±1.2 years; height=171.9±8.9 cm; weight=60.2±8.5 kg) were imaged using the UTC device with a 10‐MHz linear‐array transducer mounted in a tracking device. The device captures images at 0.2 mm intervals along the AT. UTC algorithms quantified the stability of pixel brightness over every 17 contiguous transverse images into four echo types (I‐IV). A total of 168 scans (n=21, bilateral limbs) were performed monthly across the four‐month season (Aug=M1, Sep=M2, Oct=M3, Nov=M4). Echo‐type percentages (%) were calculated from each scan. Generalized estimating equations (GEE) linear regression models evaluated echo‐type % change (β) over the season (M1=reference). Type I increased from M1 to M4 (β=9.10, P<.01; 95%CI: 7.01, 11.21) and Type II decreased from M1 to M3 (β=−2.71, P=.018; 95%CI: −4.96, −0.47) and M1 to M4 (β=−10.19, P<.01; 95%CI: −12.22, −8.17). Type III increased from M1 to M3 (β=0.42, P=.003; 95%CI: 0.19, 0.65) and M1 to M4 (β=0.49, P=.002; 95%CI: 0.18, 0.81), Type IV increased from M1 to M4 (β=0.57, P<.01; 95%CI: 0.29, 0.84). A positive adaptation in AT structural integrity was observed over the XC season, with a ~10% shift from Type II to Type I UTC echo types, suggesting AT resilience to a competitive season of repetitive loading in highly trained runners. [ABSTRACT FROM AUTHOR]

Combining dynamic postural control assessments and cognitive tasks may give clinicians a more accurate indication of postural control under sport-like conditions compared to single-task assessments. We examined postural control, cognitive and squatting performance of healthy individuals during static and dynamic postural control assessments in single- and dual-task paradigms. Thirty participants (female = 22, male = 8; age = 20.8 ± 1.6 years, height = 157.9 ± 13.0 cm, mass = 67.8 ± 20.6 kg) completed single-leg stance and single-leg squat assessments on a force plate individually (single-task) and concurrently (dual-task) with two cognitive assessments, a modified Stroop test and the Brooks Spatial Memory Test. Outcomes included centre of pressure speed, 95% confidence ellipse, squat depth and speed and cognitive test measures (percentage of correct answers and reaction time). Postural control performance varied between postural control assessments and testing paradigms. Participants did not squat as deep and squatted slower (P < 0.001) during dual-task paradigms (≤12.69 ± 3.4 cm squat depth, ≤16.20 ± 4.6 cm · s−1squat speed) compared to single-task paradigms (14.57 ± 3.6 cm squat depth, 19.65 ± 5.5 cm · s−1squat speed). The percentage of correct answers did not change across testing conditions, but Stroop reaction time (725.81 ± 59.2 ms;F2,58 = 7.725,P = 0.001) was slowest during single-leg squats compared to baseline (691.64 ± 80.1 ms;P = 0.038) and single-task paradigms (681.33 ± 51.5 ms;P < 0.001). Dynamic dual-task assessments may be more challenging to the postural control system and may better represent postural control performance during dynamic activities. [ABSTRACT FROM PUBLISHER]

Purpose: Anterior cruciate ligament tears and anterior cruciate ligament reconstruction (ACLR) are common in young athletes. The modifiable and non-modifiable factors contributing to ACLR failure and reoperation are incompletely understood. The purpose of this study was to determine ACLR failure rates in a physically high-demand population and identify the patient-specific risk factors, including prolonged time between diagnosis and surgical correction, that portend failure. Methods: A consecutive series of military service members with ACLR with and without concomitant procedures (meniscus [M] and/or cartilage [C]) done at military facilities between 2008 and 2011 was completed via the Military Health System Data Repository. This was a consecutive series of patients without a history of knee surgery for two years prior to the primary ACLR. Kaplan–Meier survival curves were estimated and evaluated with Wilcoxon test. Cox proportional hazard models calculated hazard ratios (HR) with 95% confidence intervals (95% CI) to identify demographic and surgical factors that influenced ACLR failure. Results: Of the 2735 primary ACLRs included in the study, 484/2,735 (18%) experienced ACLR failure within four years, including (261/2,735) (10%) undergoing revision ACLR and (224/2,735) (8%) due to medical separation. The factors that increased failure include Army Service (HR 2.19, 95% CI 1.67, 2.87), > 180 days from injury to ACLR (HR 1.550, 95% CI 1.157, 2.076), tobacco use (HR 1.429 95% CI 1.174, 1.738), and younger patient age (HR 1.024, 95% CI 1.004, 1.044). Conclusion: The overall clinical failure rate of service members with ACLR is 17.7% with minimum four-year follow-up, where more patients are likely to fail due to revision surgery than medical separation. The cumulative probability of survival at 4 years was 78.5%. Smoking cessation and treating ACLR patients promptly are modifiable risk factors impacting either graft failure or medical separation. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Study Design.: Controlled laboratory study. Objective.: The aim was to compare motions at the upper instrumented vertebra (UIV) and supra-adjacent level (UIV+1) between two fixation techniques in thoracic posterior spinal fusion constructs. We hypothesized there would be greater motion at UIV+1 after cyclic loading across all constructs and bilateral pedicle screws (BPSs) with posterior ligamentous compromise would demonstrate the greatest UIV+1 range of motion. Summary of Background Data.: Proximal junctional kyphosis is a well-recognized complication following long thoracolumbar posterior spinal fusion, however, its mechanism is poorly understood. Materials and Methods.: Twenty-seven thoracic functional spine units were randomly divided into three UIV fixation groups (n=9): (1) BPS, (2) bilateral transverse process hooks (TPHs), and (3) BPS with compromise of the posterior elements between UIV and UIV+1 (BPS-C). Specimens were tested on a servohydraulic materials testing system in native state, following instrumentation, and after cyclic loading. functional spine units were loaded in flexion-extension (FE), lateral bending, and axial rotation. Results.: After cyclic testing, the TPH group had a mean 29.4% increase in FE range of motion at UIV+1 versus 76.6% in the BPS group (P <0.05). The BPS-C group showed an increased FE of 49.9% and 62.19% with sectioning of the facet joints and interspinous ligament respectively prior to cyclic testing. Conclusion.: BPSs at the UIV led to greater motion at UIV+1 compared to bilateral TPH after cyclic loading. This is likely due to the increased rigidity of BPS compared to TPH leading to a "softer" transition between the TPH construct and native anatomy at the supra-adjacent level. Facet capsule compromise led to a 49.9% increase in UIV+1 motion, underscoring the importance of preserving the posterior ligamentous complex. Clinical studies that account for fusion rates are warranted to determine if constructs with a "soft transition" result in less proximal junctional kyphosis in vivo. [ABSTRACT FROM AUTHOR]

Background: Ankle sprains are a common injury in collegiate sports. Few studies have examined the epidemiology of individual ligament injuries, specifically the lateral ligament complex (LLC) of the ankle. Purpose: To describe the epidemiology, including the estimated yearly national incidence, of LLC sprains among National Collegiate Athletic Association (NCAA) athletes. Study Design: Descriptive epidemiology study. Methods: Injury surveillance data for 25 sports from the NCAA Injury Surveillance Program (NCAA-ISP) for the academic years 2009-2010 to 2014-2015 were used for analysis. All injuries included for analysis had a diagnosis of an LLC sprain. LLC sprain rates and rate ratios (RRs) with 95% CIs were calculated. From the sample, national estimates of the annual incidence of LLC sprains across the entire student-athlete body from these 25 sports were also calculated. Results: During the 2009-2010 to 2014-2015 academic years, 2429 LLC sprains were reported, for a rate of 4.95 per 10,000 athlete-exposures (AEs). LLC sprains comprised 7.3% of all reported collegiate sports injuries in the NCAA-ISP. Also, an estimated 16,022 LLC sprains occurred annually among the 25 sports. The sports with the highest LLC sprain rates were men's basketball (11.96/10,000 AEs) and women's basketball (9.50/10,000 AEs). Most LLC sprains occurred during practices (57.3%); however, the LLC sprain rate was higher in competitions than in practices (RR, 3.29; 95% CI, 3.03-3.56). Also, 11.9% of LLC sprains were identified as recurrent injuries, with the largest proportions of recurrent LLC sprains being found within women's basketball (21.1%), women's outdoor track (21.1%), women's field hockey (20.0%), and men's basketball (19.1%). In 44.4% of LLC sprains, the athlete returned to play in less than 24 hours; in 3.6%, the athlete required more than 21 days before returning to play (including those who did not return to play at all). Conclusion: LLC sprains were the most commonly reported injury diagnosis among United States collegiate student-athletes. Continued examination of interventions that aim to reduce the incidence, severity, and recurrence of LLC sprains, specifically in women, is warranted. [ABSTRACT FROM AUTHOR]

Background: Non-battle related musculoskeletal injuries (MSKI) are one of the primary medical issues diminishing Service member medical readiness. The MSKI problem is challenging because it is difficult to assess all of the factors that increase MSKI risk and influence post-MSKI outcomes. Currently, there are no high-throughput, clinically-feasible, and comprehensive assessments to generate patient-centric data for informing pre- and post-MSKI risk assessment and mitigation strategies. The objective of the "Pre-neuromusculoskeletal injury Risk factor Evaluation and Post-neuromusculoskeletal injury Assessment for Return-to-duty/activity Enhancement (PREPARE)" study is to develop a comprehensive suite of clinical assessments to identify the patient-specific factors contributing to MSKI risks and undesired post-MSKI outcomes. Methods: This is a phased approach, multi-center prospective, observational study (ClinicalTrials.gov number: NCT05111925) to identify physical and psychosocial factors contributing to greater MSKI risk and undesired post-MSKI outcomes, and to identify and validate a minimal set of assessments to personalize risk mitigation and rehabilitation strategies. In Phase I, one cohort (n = 560) will identify the physical and psychosocial factors contributing to greater MSKI risks (single assessment), while a second cohort (n = 780) will identify the post-MSKI physical and psychosocial factors contributing to undesired post-MSKI outcomes (serial assessments at enrollment, 4 weeks post-enrollment, 12 weeks post-enrollment). All participants will complete comprehensive movement assessments captured via a semi-automated markerless motion capture system and instrumented walkway, joint range of motion assessments, psychosocial measures, and self-reported physical fitness performance and MSKI history. We will follow participants for 6 months. We will identify the minimum set of clinical assessments that provide requisite data to personalize MSKI risk mitigation and rehabilitation strategies, and in Phase II validate our optimized assessments in new cohorts. Discussion: The results of this investigation will provide clinically relevant data to efficiently inform MSKI risk mitigation and rehabilitation programs, thereby helping to advance medical care and retain Service members on active duty status. Trial Registration: PREPARE was prospectively registered on ClinicalTrials.gov (NCT05111925) on 5 NOV 2021, prior to study commencement. [ABSTRACT FROM AUTHOR]

Background: Non-battle related musculoskeletal injuries (MSKI) are one of the primary medical issues diminishing Service member medical readiness. The MSKI problem is challenging because it is difficult to assess all of the factors that increase MSKI risk and influence post-MSKI outcomes. Currently, there are no high-throughput, clinically-feasible, and comprehensive assessments to generate patient-centric data for informing pre- and post-MSKI risk assessment and mitigation strategies. The objective of the "Pre-neuromusculoskeletal injury Risk factor Evaluation and Post-neuromusculoskeletal injury Assessment for Return-to-duty/activity Enhancement (PREPARE)" study is to develop a comprehensive suite of clinical assessments to identify the patient-specific factors contributing to MSKI risks and undesired post-MSKI outcomes. Methods: This is a phased approach, multi-center prospective, observational study (ClinicalTrials.gov number: NCT05111925) to identify physical and psychosocial factors contributing to greater MSKI risk and undesired post-MSKI outcomes, and to identify and validate a minimal set of assessments to personalize risk mitigation and rehabilitation strategies. In Phase I, one cohort (n = 560) will identify the physical and psychosocial factors contributing to greater MSKI risks (single assessment), while a second cohort (n = 780) will identify the post-MSKI physical and psychosocial factors contributing to undesired post-MSKI outcomes (serial assessments at enrollment, 4 weeks post-enrollment, 12 weeks post-enrollment). All participants will complete comprehensive movement assessments captured via a semi-automated markerless motion capture system and instrumented walkway, joint range of motion assessments, psychosocial measures, and self-reported physical fitness performance and MSKI history. We will follow participants for 6 months. We will identify the minimum set of clinical assessments that provide requisite data to personalize MSKI risk mitigation and rehabilitation strategies, and in Phase II validate our optimized assessments in new cohorts. Discussion: The results of this investigation will provide clinically relevant data to efficiently inform MSKI risk mitigation and rehabilitation programs, thereby helping to advance medical care and retain Service members on active duty status. Trial Registration: PREPARE was prospectively registered on ClinicalTrials.gov (NCT05111925) on 5 NOV 2021, prior to study commencement. [ABSTRACT FROM AUTHOR]

Context: Reported injury rates and services in sports injury surveillance may be influenced by the employment setting of the certified athletic trainers (ATs) reporting these data. Objective: To determine whether injury rates and the average number of AT services per injury in high school football varied by AT employment status. Design: Cross-sectional study. Setting: We used data from the National Athletic Treatment, Injury and Outcomes Network and surveyed ATs about their employment setting. Patients or Other Participants: Forty-four responding ATs (37.9% of all National Athletic Treatment, Injury and Outcomes Network participants) worked at high schools with football programs and were included in this study. Fourteen ATs were full-time employees of the high school, and 30 ATs were employed as outreach ATs (ie, full-time and part-time ATs from nearby clinics, hospitals, and graduate school programs). Main Outcome Measure(s): We calculated injury rates per 1000 athlete-exposures and average number of AT services per injury. Results: Reported injury rates and services per injury were greater among full-time school employees compared with outreach ATs. However, injury rates did not differ when restricted to time-loss injuries only. Conclusions: Our findings suggest that ATs who are fulltime school employees may be able to identify and care for more patients with injuries. [ABSTRACT FROM AUTHOR]

There exist limited data to guide the development of methodologies for evaluating impact resilience of prosthetic ankle–foot systems, particularly regarding human-device interaction in ecologically valid scenarios. The purpose of this study was to biomechanically characterize foot–ground interactions during drop-landings among Service members with and without unilateral transtibial limb loss. Seven males with, and seven males without, unilateral transtibial limb loss completed six drop-landing conditions consisting of all combinations of three heights (20 cm, 40 cm, 60 cm) and two loads (with and without a 22.2 kg weighted vest). Peak ground reaction forces (GRF), vertical GRF loading rate and impulse, as well as ankle–foot, knee, and hip joint negative (absorption) powers and work were compared across groups (i.e., contralateral side and prosthetic side vs. uninjured controls) by height and load conditions. Loading occurred primarily in the vertical direction, and increased with increasing drop height and/or with added load. Vertical GRFs were overall ~ 15% smaller on the prosthetic side (vs. controls) with similar loading rates across limbs/groups. From the most challenging condition (i.e., 60 cm with 22 kg load), ankle–foot absorption energies on the prosthetic side were 64.6 (7.2) J; corresponding values were 187.4 (8.9) J for the contralateral limb and 161.2 (6.7) J among uninjured controls. Better understanding biomechanical responses to drop-landings in ecological scenarios will help inform future iterations of mechanical testing methodologies for evaluating impact resilience of prosthetic ankle–foot systems (enhancing prescription criteria and return-to-activity considerations) as well as identifying and mitigating risk factors for long-term secondary complications within the contralateral limb (e.g., joint degeneration). [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcomes (PROs) measure progression and quality of care. While legacy PROs such as the International Knee Documentation Committee (IKDC) survey are well-validated, a lengthy PRO creates a time burden on patients, decreasing adherence. In recent years, PROs such as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference surveys were developed as computer adaptive tests, reducing time to completion. Previous studies have examined correlation between legacy PROs and PROMIS; however, no studies have developed effective prediction models utilizing PROMIS to create an IKDC index. While the IKDC is the standard knee PRO, computer adaptive PROs offer numerous practical advantages. Purpose: To develop a nonlinear predictive model utilizing PROMIS Physical Function and Pain Interference to estimate IKDC survey scores and examine algorithm sensitivity and validity. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The MOTION (Military Orthopaedics Tracking Injuries and Outcomes Network) database is a prospectively collected repository of PROs and intraoperative variables. Patients undergoing knee surgery completed the IKDC and PROMIS surveys at varying time points. Nonlinear multivariable predictive models using Gaussian and beta distributions were created to establish an IKDC index score, which was then validated using leave-one-out techniques and minimal clinically important difference analysis. Results: A total of 1011 patients completed the IKDC and PROMIS Physical Function and Pain Interference, providing 1618 complete observations. The algorithms for the Gaussian and beta distribution were validated to predict the IKDC (Pearson = 0.84-0.86; R 2 = 0.71-0.74; root mean square error = 9.3-10.0). Conclusion: The publicly available predictive models can approximate the IKDC score. The results can be used to compare PROMIS Physical Function and Pain Interference against historical IKDC scores by creating an IKDC index score. Serial use of the IKDC index allows for a lower minimal clinically important difference than the conventional IKDC. PROMIS can be substituted to reduce patient burden, increase completion rates, and produce orthopaedic-specific survey analogs. [ABSTRACT FROM AUTHOR]

Context: Dynamic balance deficits have been described postconcussion, even after athletes return to play. Lower extremity (LE) musculoskeletal injury rates increase for up to 1 year after concussion, but the long-term musculoskeletal implications of concussion are unclear. Objective: To (1) examine the association of concussion and LE injury histories with osteoarthritis (OA) prevalence in retired National Football League players and (2) examine the association of concussion and LE injury histories with OA prevalence in those <55 years of age. Design: Case-control study. Setting: Survey. Patients or Other Participants: We administered the Health Survey of Retired National Football League Players, which collects information about demographics, OA, LE injury, and concussion history. Main Outcome Measure(s): Twelve discrete categories were created based on concussion and LE injury history, ranging from 0 concussions and 0 LE injuries (referent group) to 3+ concussions and 2+ LE injuries. Binomial regression analysis modeled lifetime OA prevalence. Covariates were body mass index, age at the time of the survey, and total years playing professional football. Participants. Lifetime OA prevalence was smallest in the referent group (21.1%) and largest in the 3+ concussion and 2+ LE group (50.6%; 2.5 times the referent; 95% confidence interval [CI] = 2.1, 3.1). Participants in all concussion groups (1, 2, 3+) who reported a history of 0 LE injuries had a greater OA prevalence than the referent group. When participants were stratified by age, the ≤55 years of age, 3+ concussions, and 2+ LE injuries group prevalence ratio (3.6; 95% CI = 2.7, 5.2) was larger than that of the >55 years of age, 3+ concussions, and 2+ LE injuries group (1.8; 95% CI = 1.3, 2.4) compared with the respective referent groups. Conclusions: Concussion with or without a history of LE injury may be an important moderator of OA. Future researchers should seek to better understand the mechanisms that influence the association among concussion, LE injury, and OA. [ABSTRACT FROM AUTHOR]

Introduction: Triceps tendon ruptures are uncommon injuries primarily occurring in young, active males or elderly individuals with various systemic diseases. Relatively little is known about the epidemiology of this injury, or the results of surgical management in high-demand populations. The purpose of this study was to define the incidence and outcomes of surgical treatment in active duty American military personnel.Patients and Methods: The Military Data Repository (MDR) was queried for all active duty military personnel undergoing surgical repair or reconstruction of a triceps tendon rupture between January 2012 and December 2014. The electronic health records of all patients with at least 12 months clinical follow-up were searched for demographic information, injury details, preoperative imaging findings, post-operative complications, and ability to return to duty following surgical repair. Incidence was calculated based on total active duty population in the MDR over the study period. Risk factors for postoperative complication and inability to return to duty following surgical repair were assessed using univariate analyses.Results: A total of 54 acute triceps tendon ruptures were identified in the search, of which 48 had at least 12 months follow-up and complete post-operative records. The incidence of acute triceps tendon rupture was 1.1 per 100,000 person-years. Twelve patients experienced post-operative complications, six of which were traumatic re-ruptures within four months of the index surgery. No patient had a post-operative infection or atraumatic repair failure. 94% of patients were able to return to active military service following surgical repair. Enlisted rank was a significant risk factor for a post-operative complication, but no factor predicted inability to return to active duty service.Conclusions: Surgical repair of acute triceps tendon ruptures reliably restores strength and function even in high-demand individuals. In our population, traumatic rerupture was the most common complication. [ABSTRACT FROM AUTHOR]

Inactivation of phosphatase and tensin homology deleted on chromosome 10 (PTEN) is linked to increased PI3K-AKT signaling, enhanced organismal growth, and cancer development. Here we generated and analyzed Pten knock-in mice harboring a C2 domain missense mutation at phenylalanine 341 (PtenFV), found in human cancer. Despite having reduced levels of PTEN protein, homozygous PtenFV/FV embryos have intact AKT signaling, develop normally, and are carried to term. Heterozygous PtenFV/+ mice develop carcinoma in the thymus, stomach, adrenal medulla, and mammary gland but not in other organs typically sensitive to Pten deficiency, including the thyroid, prostate, and uterus. Progression to carcinoma in sensitive organs ensues in the absence of overt AKT activation. Carcinoma in the uterus, a cancer-resistant organ, requires a second clonal event associated with the spontaneous activation of AKT and downstream signaling. In summary, this PTEN noncatalytic missense mutation exposes a core tumor suppressor function distinct from inhibition of canonical AKT signaling that predisposes to organ-selective cancer development in vivo. [ABSTRACT FROM AUTHOR]

To assess whether sport involvement, particularly as a fan, is central enough to one's self-concept to be mentioned in obituary content, it was hypothesized that a greater proportion of men's obituaries than women's would mention the deceased individual's sport fan identification. Obituaries were randomly selected from 19 newspapers and coded for specific affiliations (e.g., military) and involvement in leisure activities (e.g., sport participation). Consistent with the hypothesis, a chi-squared analysis indicated the men's obituaries (15.2%) were significantly more likely than the women's (5.2%) to mention sport fan identification. A higher proportion of the men's obituaries (24.4%) mentioned sport participation than the women's obituaries (7.4%). [ABSTRACT FROM AUTHOR]