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The Open Access movement has gathered significant momentum over the last couple of years. This has been instigated largely by cOAlition S and those funders which support its aims. Is 'Read and Publish' the way forward? Will it work for all publishers? All authors? All subscribers? All readers? This article looks at the history of OA and updates a similar piece from 2013. A detailed glossary of terms is given at the end of the article. [ABSTRACT FROM AUTHOR]

Introduction: We assess the ability of low-dose hybrid iterative reconstruction (IR) and 'pure' model-based IR (MBIR) images to maintain accurate Hounsfield unit (HU)-determined tissue characterization.Methods: Standard-protocol (SP) and low-dose modified-protocol (MP) CTs were contemporaneously acquired in 34 Crohn's disease patients referred for CT. SP image reconstruction was via the manufacturer's recommendations (60% FBP, filtered back projection; 40% ASiR, Adaptive Statistical iterative Reconstruction; SP-ASiR40). MP data sets underwent four reconstructions (100% FBP; 40% ASiR; 70% ASiR; MBIR). Three observers measured tissue volumes using HU thresholds for fat, soft tissue and bone/contrast on each data set. Analysis was via SPSS.Results: Inter-observer agreement was strong for 1530 datapoints (rs > 0.9). MP-MBIR tissue volume measurement was superior to other MP reconstructions and closely correlated with the reference SP-ASiR40 images for all tissue types. MP-MBIR superiority was most marked for fat volume calculation - close SP-ASiR40 and MP-MBIR Bland-Altman plot correlation was seen with the lowest average difference (336 cm3 ) when compared with other MP reconstructions.Conclusions: Hounsfield unit-determined tissue volume calculations from MP-MBIR images resulted in values comparable to SP-ASiR40 calculations and values that are superior to MP-ASiR images. Accuracy of estimation of volume of tissues (e.g. fat) using segmentation software on low-dose CT images appears optimal when reconstructed with pure IR. [ABSTRACT FROM AUTHOR]

This essay asks whether queer oral history is different in light of recent interventions in queer theory, LGBTQ history, and oral history. It explores the intellectual genealogy of queer oral history in the research projects of some of its early practitioners. It also provides a close reading of Alessandro Portelli's classic essay and considers its implications for a queer methodology, drawing from the work of recent scholarship in queer studies as well as our collaborative research in the Twin Cities Gay, Lesbian, Bisexual, and Transgender Oral History Project. Finally, it gestures towards some of the unique dimensions of a queer methodology and its rich potential for research in LGBTQ oral history. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the incorporation of LGBT knowledge in the archives, the Lesbian Herstory Archives (LHA), and LGBT archival practice.

An introduction is presented which discusses various reports within the issue on topics including queer archives, feminist author Gabriela Mistral, and undocumented immigrants.

Background: Pubic symphysiotomy is a rarely performed procedure in which the pubic symphysis is divided to facilitate vaginal delivery in cases of obstructed labor. Recently, many obstetricians have shown renewed interest in this procedure. The purpose of this paper is to report the long-term radiographic findings for patients who had undergone pubic symphysiotomy compared with the radiographic appearance of a group of age-matched and parity-matched controls. Methods: This was a retrospective case-control study. Twenty-five women who had previously undergone pubic symphysiotomy for childbirth were compared with twenty-five age-matched and parity-matched controls. The radiographic parameters recorded included pubic symphysis width, pubic symphysis translation, grade of sacroiliac joint osteoarthritis, and presence of parasymphyseal degeneration. Results: The mean time to follow-up after symphysiotomy was 41.6 years (range, twenty-two to fifty-five years). The symphysiotomy group had a significantly higher proportion of patients (80%) with high-grade sacroiliac joint osteoarthritis (Grade 3 or 4 according to the Kellgren and Lawrence osteoarthritis scoring system) than the control group (16%) (p < 0.001). Within the symphysiotomy group, patients with high-grade sacroiliac joint osteoarthritis tended to be older, have a longer time to follow-up, and have a larger pubic symphysis width. The control group had a higher prevalence of parasymphyseal degeneration than did the symphysiotomy group (p = 0.011). Conclusions: Late-onset sacroiliac joint osteoarthritis secondary to pelvic instability was a major finding in this study and, to our knowledge, has not been discussed previously in the literature regarding pubic symphysiotomy. [ABSTRACT FROM AUTHOR]

This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose. [ABSTRACT FROM AUTHOR]

Introduction. Poor distention decreases the sensitivity and specificity of CTC. The total volume of gas administered will vary according tomany factors.We aim to determine the relationship between the volume of retained gas at the time of image acquisition and colonic distention and specifically the presence of collapsed bowel segments at CTC. Materials and Methods. All patients who underwent CTC over a 12-month period at a single institution were included in the study. Colonic luminal distention was objectively scored by 2 radiologists using an established 4-point scale. Quantitative analysis of the volume of retained gas at the time of image acquisition was conducted using the threshold 3D region growing function of OsiriX. Results. 108 patients were included for volumetric analysis. Mean retained gas volume was 3.3 L. 35% (38/108) of patients had at least one collapsed colonic segment. Significantly lower gas volumes were observed in the patients with collapsed colonic segments when compared with those with fully distended colons 2.6 L versus 3.5 L (p = 0.031). Retained volumes were significantly higher for the 78% of patients with ileocecal reflux at 3.4 L versus 2.6 L without ileocecal reflux (p = 0.014). Conclusion. Estimation of intraluminal gas volume at CTC is feasible using image segmentation and thresholding tools. An average of 3.5 L of retained gas was found in diagnostically adequate CTC studies with significantly lower mean gas volume observed in patients with collapsed colonic segments. [ABSTRACT FROM AUTHOR]

Aim To determine the prevalence of symptomatic neurogenic bladder (SNB) and social and functional variables in a large sample of people with cerebral palsy (CP). Method The medical records of 214 individuals (96 females, 118 males) with CP between the years 1990 and 2000 were retrospectively reviewed. Individuals with frequency, urgency, or incontinence were assigned Gross Motor Function Classification System levels and underwent cystometrogram/electromyelogram studies. Neurogenic bladders were classified according to the nomenclature of the International Continence Society. Results Fifty-two patients had hemiplegia, 42 diplegia, 117 quadriplegia, and three dyskinesia. Educational levels ranged from full special education to those with graduate degrees. Thirty-five individuals in our group aged 5 to 66 years had SNB with a prevalence of 16.4%. The median age for the entire population was 9 years 7 months and for those with SNB 12 years 4 months (range 5-57y). Over 80% of individuals who underwent investigation were found to have spastic hyper-reflexic type bladders. Ninety-one percent obtained total continence or major improvement with conservative care. SNB was documented across the lifespan, educational spectrum, and functional level. Upper urinary tract pathology was infrequent. Interpretation SNB is a common finding in individuals with CP. In most patients it is readily diagnosed and treated with conservative interventions. [ABSTRACT FROM AUTHOR]

The article discusses various published reports within the issue, including one by Pete Sigal that examines the feminine and masculine attributes of the Nahua deity Cihuacoatl, one by Marisa Fuentes that explores the life of former slave Rachel Pringle Polgreen and one by Leon Rocha that discusses the globalization of sexual knowledge.

Cerebral palsy (CP) has always been considered a static condition in the neurological sense. Secondary and associated conditions that occur in the patient with CPcan progress over time and cause unwanted sequelae. This paper discusses four musculoskeletal conditions that present across the lifetime and can lead to progressive loss of function in the patient with CP. Patella alta can be particularly painful in the early adult years, limiting mobility particularly when associated with crouch gait. Adults with lower-extremity weight-bearing status having hip dysplasia, progressive over time, often develop pain and severe degenerative arthritis, with or without arthrodesis. Spondylolysis, particularly at the L5 S1 level, is fairly common in the ambulatory adult with diplegia and may, if not diagnosed early, progress to spondylolisthesis. Cervical stenosis appears to be more prevalent in adults with spastic quadriparesis and dystonia and is often associated with myelomalacia and/or radiculopathy. All four of these conditions may be lessened, or even prevented, with intervention and diagnosis in the younger years. Possible interventions and outcomes over time are discussed in the context of multidisciplinary team management of the individual with CP. [ABSTRACT FROM AUTHOR]

The author discusses advances in airborne light detection and ranging (LiDAR) technology. This technology allows rapid and inexpensive generation of digital surface models (DSMs), three-dimensional point clouds of buildings, vegetations, cars, and natural terrain features over big regions. Also provided is an introduction to a machine learning approach to automatically extract digital terrain models (DTMs) from their corresponding DSMs.

Abstract: Two patients are presented who underwent successful combined L1 and L2 paravertebral blocks as part of an anesthetic technique for hip arthroscopy. [Copyright &y& Elsevier]

The article discusses various reports published within the issue, including one by Susan Stryker which challenges queer studies to acknowledge the central roles that transgender communities played in countering heteronormativity, and Christina Hanhardt's history of so-called safe street patrols in Greenwich Village in New York City and Castro Neighborhood in San Francisco, California.

We consider the problem of detecting a large number of different classes of objects in cluttered scenes. Traditional approaches require applying a battery of different classifiers to the image, at multiple locations and scales. This can be slow and can require a lot of training data since each classifier requires the computation of many different image features. In particular, for independently trained detectors, the (runtime) computational complexity and the (training-time) sample complexity scale linearly with the number of classes to be detected. We present a multitask learning procedure, based on boosted decision stumps, that reduces the computational and sample complexity by finding common features that can be shared across the classes (and/or views). The detectors for each class are trained jointly, rather than independently. For a given performance level, the total number of features required and, therefore, the runtime cost of the classifier, is observed to scale approximately logarithmically with the number of classes. The features selected by joint training are generic edge-like features, whereas the features chosen by training each class separately tend to be more object-specific. The generic features generalize better and considerably reduce the computational cost of multiclass object detection. [ABSTRACT FROM AUTHOR]

Early surgical treatment of injuries to the posterolateral corner of the knee is recommended to promote rehabilitation for normal function of the knee. To optimize the chance at primary repair, surgery should be performed within 2 weeks; otherwise, reconstruction is the most viable option. During operative treatment, each component of the posterolateral corner is assessed individually, with primary repair performed if amenable to repair. Additional techniques, such as augmentation, advancement, or reconstruction may be needed if the primary repair is tenuous or the tissues damaged. [ABSTRACT FROM AUTHOR]

Introduces a series of articles about social policy and poverty and the role of culture in the reproduction of economic inequality.

Focuses on the accuracy of clinical knee examinations among patients with arthroscopically documented knee injuries. Patient characteristics; Experimental procedure; Missed observance for chondromalacia and loose bodies; Study limitations.

The article offers information on a study which discusses association between cerebral palsy (CP), non-communicable diseases, and lifespan care. Topics discussed include impact of environmental factors on CP; higher risk of non-communicable diseases such as stroke, chronic obstructive pulmonary disease, and cancer associated with CP; and information on improvement in specialty healthcare for adults with CP.

This commentary is on the original article by Verhoef et al. on pages 722–728 of this issue. [ABSTRACT FROM AUTHOR]

The article presents a case study of 79-years old woman having a background history of several diseases including type II diabetes mellitus, hypertension and hypercholesterolemia. An Esophago-gastro-duodenoscopy was performed on to diagnose the disorder fistula. The computer topography (CT) of the abdomen was performed which indicated the small bowel obstruction. She was further diagnosed with gallstone ileus and was referred to the gastro-intestinal surgeons.

This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose. [ABSTRACT FROM AUTHOR]

Context: Type I superior labrum anterior-posterior (SLAP) lesions involve degenerative fraying and probably are not the cause of shoulder pain. Type II to IV SLAP lesions are tears of the labrum. Objective: To determine the diagnostic accuracy of patient history and the active compression, anterior slide, and crank tests for type I and type II to IV SLAP lesions. Design: Cohort study. Setting: Clinic. Patients or Other Participants: Fifty-five patients (47 men, 8 women; age = 40.6±15.1 years) presenting with shoulder pain. Intervention^): For each patient, an orthopaedic surgeon conducted a clinical examination of history of trauma; sudden onset of symptoms; history of popping, clicking, or catching; age; and active compression, crank, and anterior slide tests. The reference standard was the intraoperative diagnosis. The operating surgeon was blinded to the results of the clinical examination. Main Outcome Measure(s): Diagnostic utility was calculated using the receiver operating characteristic curve and area under the curve (AUC), sensitivity, specificity, positive likelihood ratio (+LR), and negative likelihood ratio (-LR). Forward step- wise binary regression was used to determine a combination of tests for diagnosis. Results: No history item or physical examination test had diagnostic accuracy for type I SLAP lesions (n = 13). The anterior slide test had utility (AUC = 0.70, +I_R = 2.25, -LR = 0.44) to confirm and exclude type II to IV SLAP lesions (n = 10). The combination of a history of popping, clicking, or catching and the anterior slide test demonstrated diagnostic utility for confirming type II to IV SLAP lesions (+LR = 6.00). Conclusions: The anterior slide test had limited diagnostic utility for confirming and excluding type II to IV SLAP lesions; diagnostic values indicated only small shifts in probability. However, the combination of the anterior slide test with a history of popping, clicking, or catching had moderate diagnostic utility for confirming type II to IV SLAP lesions. No single item or combination of history items and physical examination tests had diagnostic utility for type I SLAP lesions. [ABSTRACT FROM AUTHOR]

Background: Glenoid labral tears provide a diagnostic challenge. Hypothesis: Combinations of items in the patient history and physical examination will provide stronger diagnostic accuracy to suggest the presence or absence of glenoid labral tear than will individual items. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: History and examination findings in patients with shoulder pain (N = 55) were compared with arthroscopic findings to determine diagnostic accuracy and intertester reliability. Results: The intertester reliability of the crank, anterior slide, and active compression tests was 0.20 to 0.24. A combined history of popping or catching and positive crank or anterior slide results yielded specificities of 0.91 and 1.00 and positive likelihood ratios of 3.0 and infinity, respectively. A positive anterior slide result combined with either a positive active compression or crank result yielded specificities of 0.91 and positive likelihood ratio of 2.75 and 3.75, respectively. Requiring only a single positive finding in the combination of popping or catching and the anterior slide or crank yielded sensitivities o 0.82 and 0.89 and negative likelihood ratios of 0.31 and 0.33, respectively. Conclusion: The diagnostic accuracy of individual tests in previous studies is quite variable, which may be explained in part by the modest reliability of these tests. The combination of popping or catching with a positive crank or anterior slide result or a positive anterior slide result with a positive active compression or crank test result suggests the presence of a labral tear. The combined absence of popping or catching and a negative anterior slide or crank result suggests the absence of a labral tear. [ABSTRACT FROM AUTHOR]

Shoulder pain is a common musculoskeletal complaint. Patients with shoulder pain who are seeking care in a military tertiary setting in the United States have not been previously described. This study describes the clinical features of 55 patients (47 men, 8 women) undergoing shoulder surgery at a tertiary care military medical center. Patients presenting to a military medical center are different than other previously described samples in the literature. Specifically. the patients in this study had a known mechanism of injury (n = 42; 76%). multiple structures involved (n = 46; 84%) and a high prevalence of glenoid labral involvement (n = 44; 80%). Further research is needed to determine if these patient characteristics identified in this study warrant different management strategies and resource utilization in both the tertiary care center, and in the primary care center where these patients are typically seen before referral to a tertiary care center. [ABSTRACT FROM AUTHOR]

Orthopedic injuries comprise a majority of combat injuries seen in recent U.S. military conflicts. Interventions in the forward deployed area have played an important role in improving mortality rates of soldiers as well as outcome at a medical center level. A retrospective review was conducted on orthopedic injuries from Operation Enduring Freedom evaluated at Walter Reed Army Medical Center (WRAMC). Patients were grouped into one of five injury categories (open fracture, amputation, arterial injuries, neurological injuries, and soft tissue injury) with evacuation time (days from time of injury to arrival at WRAMC) and procedures performed before arrival at WRAMC evaluated. The average evacuation time for all orthopedic casualties was 7.9 days. There was an average of 2.6 procedures performed per patient before arrival at WRAMC. There was no difference in evacuation time among the injury groups. Those with only soft tissue injuries underwent fewer procedures than the other injury groups; however, there was no difference among the injury groups in terms of procedures performed. The number of procedures performed did not affect the evacuation time. Fifty-six percent of casualties required operative intervention after arrival at WRAMC. With the unavoidable evacuation time that all casualties must endure regardless of severity of the injury, early operative intervention in forward deployed medical assets, such as the forward surgical team and combat support hospital, remains a necessity for rehabilitative and reconstructive efforts of the soldiers at the medical center level. [ABSTRACT FROM AUTHOR]

Cadaveric material has long been used to teach anatomy and more recently to train students in clinical skills. The aim of this study was to develop a systematic approach to compare the impact of four embalming solutions on the tissues of human cadavers. To this end, a formalin‐based solution, Thiel, Genelyn and Imperial College London soft‐preservation (ICL‐SP) solution were compared. The effect of these chemicals on the properties of the tissue was assessed by measuring the range of motion (ROM) of joints and measuring the dimensions of different structures on computed tomography (CT) images before and after embalming. The mean changes in the ratio (angle to ROM) differed statistically between embalming methods (Welch Statistic 3,1.672 = 67.213, p = 0.026). Thiel embalmed cadavers showed an increase in range of motion while ICL‐SP cadavers remained relatively the same. Genelyn and formalin embalmed cadavers registered a notable decrease in range of motion. Furthermore, investigation into the impact of the embalming chemicals on the dimensions of internal organs and vessels revealed that Thiel embalming technique leads to a decrease in the dimension of the cardiovascular system alone while formalin‐based solutions maintain the shape of the organs and vessels investigated. Our findings suggest that the joints of cadavers' embalmed using ICL‐SP technique may faithfully mimic that of unembalmed cadavers and that formalin is necessary to retain shape and size of the organs and vessels investigated in this study. Despite this, a study with larger numbers of cadavers is required to confirm these findings. [ABSTRACT FROM AUTHOR]

Objectives We designed a prospective study to investigate the in-vivo relationship between abdominal body composition and radiation exposure to determine the strongest body composition predictor of dose length product (DLP) at CT. Methods Following institutional review board approval, quantitative analysis was performed prospectively on 239 consecutive patients who underwent abdominopelvic CT. DLP, BMI, volumes of abdominal adipose tissue, muscle, bone and solid organs were recorded. Results All measured body composition parameters correlated positively with DLP. Linear regression (R2 = 0.77) revealed that total adipose volume was the strongest predictor of radiation exposure [B (95% CI) = 0.027(0.024-0.030), t=23.068, p < 0.001]. Stepwise linear regression using DLP as the dependent and BMI and total adipose tissue as independent variables demonstrated that total adipose tissue is more predictive of DLP than BMI [B (95% CI) = 16.045 (11.337- 20.752), t=6.681, p < 0.001]. Conclusions The volume of adipose tissue was the strongest predictor of radiation exposure in our cohort. [ABSTRACT FROM AUTHOR]

Since their introduction into the structural health monitoring field, time-domain statistical models have been applied with considerable success. Current approaches still have several flaws, however, as they typically ignore the structure of the system, using individual sensor data for modeling and diagnosis. This paper introduces a Bayesian framework containing much of the previous work with autoregressive models as a special case. In addition, the framework allows for natural inclusion of structural knowledge through the form of prior distributions on the model parameters. Acknowledging the need for computational efficiency, we extend the framework through the use of decomposable graphical models, exploiting sparsity in the system to give models that are simple to fit and understand. This sparsity can be specified from knowledge of the system, from the data itself, or through a combination of the two. Using both simulated and real data, we demonstrate the capability of the model to capture the dynamics of the system and to provide clear indications of structural change and damage. We also demonstrate how learning the sparsity in the system gives insight into the structure׳s physical properties. [ABSTRACT FROM AUTHOR]

Tracking and identifying players in sports videos filmed with a single pan-tilt-zoom camera has many applications, but it is also a challenging problem. This paper introduces a system that tackles this difficult task. The system possesses the ability to detect and track multiple players, estimates the homography between video frames and the court, and identifies the players. The identification system combines three weak visual cues, and exploits both temporal and mutual exclusion constraints in a Conditional Random Field (CRF). In addition, we propose a novel Linear Programming (LP) Relaxation algorithm for predicting the best player identification in a video clip. In order to reduce the number of labeled training data required to learn the identification system, we make use of weakly supervised learning with the assistance of play-by-play texts. Experiments show promising results in tracking, homography estimation, and identification. Moreover, weakly supervised learning with play-by-play texts greatly reduces the number of labeled training examples required. The identification system can achieve similar accuracies by using merely 200 labels in weakly supervised learning, while a strongly supervised approach needs a least 20,000 labels. [ABSTRACT FROM AUTHOR]

Motivation: Next-generation sequencing (NGS) has enabled whole genome and transcriptome single nucleotide variant (SNV) discovery in cancer. NGS produces millions of short sequence reads that, once aligned to a reference genome sequence, can be interpreted for the presence of SNVs. Although tools exist for SNV discovery from NGS data, none are specifically suited to work with data from tumors, where altered ploidy and tumor cellularity impact the statistical expectations of SNV discovery. [ABSTRACT FROM PUBLISHER]

Purpose: To evaluate variables unique to our military population to determine whether we can be better predict functional outcome and return to duty of active duty military soldiers with multiligament knee disruption following arthroscopically assisted reconstruction.Materials and Methods: Twenty-four active duty Army personnel who underwent arthroscopically assisted reconstruction of multiple ligament disruption by the same surgeon were enrolled in this study. Postoperatively, a standardized knee joint questionnaire was administered and current vocational and recreational status was evaluated. Demographic data as well as military-specific factors to include rank, military occupation specialty, associated injuries, and retention on active duty were reviewed for these patients to determine their correlation with outcome.Results: Overall, 13 (54%) remained on active duty following surgical reconstruction of their knee. There was a positive correlation between military rank and return to military duty. We were unable to correlate physical job demand to postinjury duty status. The Cincinnati Knee Ligament Rating Scale indicated that most soldiers were able to perform sports at "half speed", with "some limits" in daily living function scores.Conclusion: Arthroscopically assisted multiligament knee reconstruction enabled only a slight majority of active duty soldiers to return to duty following reconstruction and rehabilitation of this devastating injury. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate variables unique to our military population to determine whether we can be better predict functional outcome and return to duty of active duty military soldiers with multiligament knee disruption following arthroscopically assisted reconstruction. Materials and Methods: Twenty-four active duty Army personnel who underwent arthroscopically assisted reconstruction of multiple ligament disruption by the same surgeon were enrolled in this study. Postoperatively, a standardized knee joint questionnaire was administered and current vocational and recreational status was evaluated. Demographic data as well as military-specific factors to include rank, military occupation specialty, associated injuries, and retention on active duty were reviewed for these patients to determine their correlation with outcome. Results: Overall, 13 (54%) remained on active duty following surgical reconstruction of their knee. There was a positive correlation between military rank and return to military duty. We were unable to correlate physical job demand to postinjury duty status. The Cincinnati Knee Ligament Rating Scale indicated that most soldiers were able to perform sports at "half speed," with "some limits" in daily living function scores. Conclusion: Arthroscopically assisted multiligament knee reconstruction enabled only a slight majority of active duty soldiers to return to duty following reconstruction and rehabilitation of this devastating injury. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. Hypothesis: Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores. Study Design: Case series; Level of evidence, 4. Methods: The records of active-duty soldiers who underwent hip arthroscopy at the authors' institution were retrospectively reviewed. Forty consecutive patients who underwent hip arthroscopy for the primary indication of labral tear formed the basis of the study group. Patients completed the modified Harris hip score, the Short Form-36 general health survey, and a subjec- tive overall satisfaction questionnaire. Results: Thirty-three patients, with a mean age of 34.6 years, were available for follow-up at a mean of 25.7 months postoper- atively. Fourteen (43%) patients were undergoing medical evaluation boards (military equivalent of workers' compensation or disability claim). Pearson correlation coefficients for comparing the Short Form-36 Bodily Pain, Physical Function, and Physical Component subscale scores to the modified Harris hip score were 0.73, 0.71, and 0.85, respectively (P < .001). The mean mod- ified Harris hip score was significantly lower in patients on disability status than in those who were not (92.4 vs 61.1; P < .0001). The Short Form-36 subscale scores were significantly lower in disability patients (P < .02). Patient-reported satisfaction rates (70% overall) were 50% for those undergoing disability evaluations and 84% for those who were not (P c .04). There was no sig- nificant difference in outcomes based on patient age, surgically proven chondromalacia, or gender for military evaluation board status. Conclusion: The Short Form-36 demonstrated good correlation with the modified Harris hip score for measuring outcomes after arthroscopic partial limbectomy. Arthroscopic debridement yielded a high percentage of good results when patients undergoing disability evaluations were excluded. Disability status may be a negative predictor of success after hip arthroscopy. [ABSTRACT FROM AUTHOR]

Abstract: α-Fetoprotein (AFP) is a 68kDa glycoprotein expressed at high levels by the fetal liver and yolk with transcription repressed to very low levels after birth. Transfer of fetal AFP through the placenta into the circulation of the mother is correlated with remission of rheumatoid arthritis, multiple sclerosis, and other autoimmune disorders. AFP is therefore under development as a biopharmaceutical for the treatment of autoimmune diseases. The clinical evaluation of AFP requires the production of hundreds of grams of highly purified and biologically active protein. We have produced goats that express a form of the human AFP transgene under the control of the β-casein promoter. In this form of rhAFP, the single N-linked glycosylation site was removed by mutagenesis (N233Q). Here, we describe a purification protocol for this recombinant human (rh)AFP from the milk of these transgenic goats. A three-column procedure was developed to produce gram quantities of highly purified rhAFP. Near- and far-UV circular dichroism spectra of human umbilical cord blood AFP and rhAFP were essentially identical, suggesting that the structure is not affected by removal of the glycosylation site. Furthermore, the cell binding and pharmacokinetics of purified rhAFP were similar to human AFP isolated from cord blood. Our results demonstrate that an active form of rhAFP can be produced on industrial scale by expression in transgenic goat milk. [Copyright &y& Elsevier]

Presents a study which determined whether braiding hamstring tendons favorably increases graft strength and stiffness compared with unbraided four-strand hamstring tendon and bone-patellar tendon-bone grafts. Review of related studies; Materials and methods; Results and discussion.

Shoulder pain is a common musculoskeletal complaint. Patients with shoulder pain who are seeking care in a military tertiary setting in the United States have not been previously described. This study describes the clinical features of 55 patients (47 men, 8 women) undergoing shoulder surgery at a tertiary care military medical center. Patients presenting to a military medical center are different than other previously described samples in the literature. Specifically, the patients in this study had a known mechanism of injury (n = 42; 76%), multiple structures involved (n = 46; 84%) and a high prevalence of glenoid labral involvement (n = 44; 80%). Further research is needed to determine if these patient characteristics identified in this study warrant different management strategies and resource utilization in both the tertiary care center, and in the primary care center where these patients are typically seen before referral to a tertiary care center. [ABSTRACT FROM AUTHOR]

Orthopedic injuries comprise a majority of combat injuries seen in recent U.S. military conflicts. Interventions in the forward deployed area have played an important role in improving mortality rates of soldiers as well as outcome at a medical center level. A retrospective review was conducted on orthopedic injuries from Operation Enduring Freedom evaluated at Walter Reed Army Medical Center (WRAMC). Patients were grouped into one of five injury categories (open fracture, amputation, arterial injuries, neurological injuries, and soft tissue injury) with evacuation time (days from time of injury to arrival at WRAMC) and procedures performed before arrival at WRAMC evaluated. The average evacuation time for all orthopedic casualties was 7.9 days. There was an average of 2.6 procedures performed per patient before arrival at WRAMC. There was no difference in evacuation time among the injury groups. Those with only soft tissue injuries underwent fewer procedures than the other injury groups; however, there was no difference among the injury groups in terms of procedures performed. The number of procedures performed did not affect the evacuation time. Fifty-six percent of casualties required operative intervention after arrival at WRAMC. With the unavoidable evacuation time that all casualties must endure regardless of severity of the injury, early operative intervention in forward deployed medical assets, such as the forward surgical team and combat support hospital, remains a necessity for rehabilitative and reconstructive efforts of the soldiers at the medical center level. [ABSTRACT FROM AUTHOR]