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Objective: To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design: Systematic review and meta-analysis. Data sources: Four bibliographic databases (from inception until November 2021): Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL. Eligibility criteria: Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results: Eleven studies were included in this systematic review. When wearing foot orthoses, the risk ratio of developing a BSI on any lower extremity bone is 0.47 (95% CI 0.26 to 0.87; p = 0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p = 0.79). No meta-analyses could be performed for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion: This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Decision rules (eg, Canadian computed tomography head rule [CCHR] for adults and Pediatric Emergency Care Applied Research Network [PECARN] rule for children/adolescents) are used in emergency settings (emergency room [ER] rules) to assess traumatic brain injuries (TBIs). The rules have a high-sensitivity and nearperfect negative predictive value that help to rule out more severe TBI. * CLINICAL QUESTION: Which criteria should be added to the Sport Concussion Assessment Tool 5 (SCAT5) to reach the sensitivity of the ER rules and improve the utility of the SCAT5 for screening for higher-severity head and brain injuries? * KEY RESULTS: We performed a comparative analysis of the SCAT5 with the CCHR and PECARN rules. We compared the presence (yes or no) and comparative "face value" sensitivity (lower, identical, or higher) of the SCAT5 criteria to the ER rules criteria. Loss of consciousness, vomiting, severe/ increasing headache, and seizure are SCAT "red flags" with similar or higher sensitivity compared to ER rules criteria. Five criteria had lower sensitivity or were absent from the SCAT. Emergency room rules include any abnormality on the Glasgow Coma Scale (GCS<15), but only a "deterioration of the state of consciousness" is considered a "red flag" in the SCAT5. Persistent retrograde amnesia for more than 30 minutes, age >65, severity of the mechanism of injury, and signs of skull fractures are not mentioned in the SCAT5. * CLINICAL APPLICATION: We identified 5 criteria that could inform the evolution the SCAT5 to improve its ability to rule out more severe TBI in a sideline assessment context. [ABSTRACT FROM AUTHOR]

To describe ocular anomalies (OAs) in children and fetuses in a French general population, to estimate their prevalence, and to investigate a possible association between prenatal medication exposure and the occurrence of OA in utero or in early childhood. We conducted a case-control study using the EFEMERIS cohort, a database containing pregnancies registered in Haute-Garonne and their outcomes. We collected OA descriptions of fetuses at the time of pregnancy termination or of children at birth and the results of eye examinations of children at 9 months and 2 years of age. The prevalence of overall OAs was 2.13%, of which 0.04% were congenital ocular malformations (COMs). A total of 2,968 cases and 136,619 controls were selected for analysis. There was a significant difference between the two groups with regard to prenatal exposure to medications for the digestive tract and metabolism, the cardiovascular system, and the respiratory system. Multivariable analysis revealed an increased risk of OA in children of mothers exposed to magnesium during and 1 month before pregnancy (OR = 1.24; 95% CI, 1.11-1.38). This first pharmaco-epidemiological study on OA in France suggests that OA may be associated with exposure to commonly used medications. Given the rarity of COM, larger, international studies are warranted. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decision-making for diagnosis and treatment, and planning for successful return to work. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To present the methods used to develop a clinical practice guideline (CPG) with recommendations endorsed by key stakeholders for assessing, managing, and supporting return to work for adults with rotator cuff disorders. DESIGN: Clinical practice guideline development. METHODS: A steering committee composed of the research team of this project led the development of this CPG in 5 phases, which followed the standards of the NICE and AGREE II collaborations. During the preparation phase (I), a multidisciplinary working committee of experts in managing rotator cuff disorders (n = 20) determined the scope and objectives of the CPG. The recommendations development phase (II) included initial knowledge synthesis, development of preliminary recommendations, systematic consultations with a multidisciplinary panel of key stakeholders (n = 51) using a modified three-round Delphi approach and drafting of the original CPG. In the external evaluation phase (III), an external committee of experts evaluated the original CPG using the AGREE II tool. In the dissemination phase (IV), the strategy for disseminating the CPG was developed and implemented. During the update phase (V), the CPG was revised based on an update of the initial knowledge synthesis. RESULTS: Seventy-three preliminary recommendations were developed from the initial knowledge synthesis. During the Delphi consultation, all of these recommendations were endorsed, and one new recommendation was proposed by panelists. The original CPG received an overall AGREE II score of 83% from the external evaluators. In 2021, an update of the initial 2017 knowledge synthesis was conducted and 13 recommendations were revised. CONCLUSION: The 5-phase consensus methods approach guided the development of a high-quality CPG on assessing, managing, and supporting return to work for adults with rotator cuff disorders. [ABSTRACT FROM AUTHOR]

Objective: To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI). Participants: Canadian healthcare professionals caring for patients with mTBI. Design: Online Delphi process. Main Measures: A first Delphi round documented important dimensions or criteria to consider when defining persistent symptoms. Expert opinions were then resubmitted in 4 subsequent Delphi rounds and their relevance was rated using a 9-point Likert scale. An item with a median rating of 7 or more and a sufficient level of agreement were considered consensual. Results: After 5 rounds, consensus was reached on a set of criteria that can be summarized as follows: presence of any symptom that cannot be attributed to a preexisting condition and that appeared within hours of an mTBI, that is still present every day 3 months after the trauma, and that has an impact on at least one sphere of a person's life. Conclusion: This Delphi consensus proposes a set of criteria that support a more uniform definition of persistent symptoms in mild TBI among clinicians and researchers. This definition may help clinicians better identify persistent postconcussion symptoms and improve patient management. [ABSTRACT FROM AUTHOR]

To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults. A systematic bibliographic search was conducted up until May 2018 in Medline, Embase, and Physiotherapy Evidence Database, or PEDro, databases, in addition to 12 clinical guidelines search engines listed on the Appraisal of Guidelines for Research and Evaluation (AGREE) website. Nine CPGs on the management of rotator cuff disorders in adults or workers, available in English or French, and published from January 2008 onward, were included and screened by 2 independent reviewers. CPG methodology was assessed with the AGREE II checklist. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following 4 levels: "essential," "recommended," "may be recommended," and "not recommended." Methodological quality was considered high for 3 CPGs and low for 6. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen or nonsteroidal anti-inflammatory drug prescriptions and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return-to-work strategies included intervening early, use of a multidisciplinary approach, and adaptation of work organization. Only 3 CPGs were of high quality. The development of more rigorous CPGs is warranted. [ABSTRACT FROM AUTHOR]

Background: The current approach to the clinical diagnosis of traumatic and degenerative symptomatic meniscal tears (SMTs) proposes combining history elements and physical examination tests without systematic prescription of imaging investigations, yet the evidence to support this diagnostic approach is scarce.Objective: To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude traumatic and degenerative SMT compared with other knee disorders.Design: Prospective diagnostic accuracy study.Settings: Patients were recruited from 2 orthopedic clinics, 2 family medicine clinics, and from a university community.Patients: A total of 279 consecutive patients who underwent consultation for a new knee complaint.Methods: Each patient was assessed independently by 2 evaluators. History elements and standardized physical examination tests performed by a physiotherapist were compared with the reference standard: an expert physicians' composite diagnosis including a clinical examination and confirmatory magnetic resonance imaging. Participating expert physicians were orthopedic surgeons (n = 3) or sport medicine physicians (n = 2). Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of SMT and recursive partitioning was used to develop diagnostic clusters.Main Outcome Measures: Diagnostic accuracy measures were calculated including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (LR+/-) with associated 95% confidence intervals (CIs).Results: Eighty patients had a diagnosis of SMT (28.7%), including 35 traumatic tears and 45 degenerative tears. The combination a history of trauma during a pivot, medial knee pain location, and a positive medial joint line tenderness test was able to diagnose (LR+ = 8.9; 95% CI 6.1-13.1) or exclude (LR- = 0.10; 95% CI 0.03-0.28) a traumatic SMT. Combining a history of progressive onset of pain, medial knee pain location, pain while pivoting, absence of valgus or varus knee misalignment, or full passive knee flexion was able to moderately diagnose (LR+ = 6.4; 95% CI 4.0-10.4) or exclude (LR- = 0.10; 95% CI 0.03-0.31) a degenerative SMT. Internal validation estimates were slightly lower for all clusters but demonstrated positive LR superior to 5 and negative LR inferior to 0.2 indicating moderate shift in posttest probability.Conclusion: Diagnostic clusters combining history elements and physical examination tests can support the differential diagnosis of SMT. These results represent the initial derivation of the clusters and external validation is mandatory.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Background Multiple factors have been associated with the presence of a subacromial pain syndrome (SPS), including deficits in performance of scapular and glenohumeral muscles. Such deficits can lead to inadequate kinematics and decreased acromiohumeral distance (AHD). Exercises that aim at correcting these deficits, such as movement training, were suggested to improve symptoms and functional limitations. To date, few studies have assessed outcomes following an intervention focused on movement training. Objectives Evaluate the effects of a rehabilitation program based on movement training on symptoms, functional limitations and AHD in individuals with SPS. Design Prospective single group pre-post design. Methods Twenty-five participants with SPS (SPS group) participated in a 6-week program. Twenty asymptomatic volunteers were recruited for normative AHD values (control group). Outcomes of both groups were evaluated at baseline and 6 weeks, i.e. immediately following intervention for the SPS group. Changes in symptoms and functional limitations for SPS group were assessed using the Western Ontario Rotator Cuff (WORC) index and Disability of the Arm Shoulder and Hand (DASH) questionnaire. Changes in AHD for both groups were assessed using ultrasonographic measures. Results Following the rehabilitation program, the scores on WORC and DASH were significantly improved (p < 0.001). AHD increased significantly in the SPS group (p = 0.019), especially in a subgroup with initial deficits (p < 0.001). Conclusion The rehabilitation program yielded improvements in symptoms and functional limitations in participants with SPS. Moreover, it led to an increase of the AHD – thus potentially decreasing subacromial compression, particularly in participants with an initially smaller AHD. The trial was registered at ClinicalTrials.gov: identifier – NCT02395770 . [ABSTRACT FROM AUTHOR]

A systematic review and meta-analysis on the efficacy of therapeutic ultrasound (US) in adults suffering from rotator cuff tendinopathy. A literature search was conducted in four databases for randomized controlled trials (RCT) published until 12/2013, comparing the efficacy of US to any other interventions in adults suffering from rotator cuff tendinopathy. The Cochrane Risk of Bias tool was used to evaluate the risk of bias of included studies. Data were summarized qualitatively or quantitatively. Eleven RCTs with a low mean methodological score (50.0% ± 15.6%) were included. Therapeutic US did not provide greater benefits than a placebo intervention or advice in terms of pain reduction and functional improvement. When provided in conjunction with exercise, US therapy is not superior to exercise alone in terms of pain reduction and functional improvement (pooled mean difference of the Constant-Murley score: -0.26 with 95% confidence interval of -3.84 to 3.32). Laser therapy was found superior to therapeutic US in terms of pain reduction. Based on low to moderate level evidence, therapeutic US does not provide any benefit compared to a placebo or advice, to laser therapy or when combined to exercise. More methodologically sound studies on the efficacy of therapeutic US are warranted. [ABSTRACT FROM AUTHOR]

* STUDY DESIGN: Systematic review and meta-analysis. * OBJECTIVES: To evaluate the efficacy of manual therapy (MT) for patients with rotator cuff (RC) tendinopathy. * BACKGROUND: Rotator cuff tendinopathy is a highly prevalent musculoskeletal disorder, for which MT is a common intervention used by physical therapists. However, evidence regarding the efficacy of MT is inconclusive. * METHODS: A literature search using terms related to shoulder, RC tendinopathy, and MT was conducted in 4 databases to identify randomized controlled trials that compared MT to any other type of intervention to treat RC tendinopathy. Randomized controlled trials were assessed with the Cochrane risk-of-bias tool. Meta-analyses or qualitative syntheses of evidence were performed. * RESULTS: Twenty-one studies were included. The majority had a high risk of bias. Only 5 studies had a score of 69% or greater, indicating a moderate to low risk of bias. A small but statistically significant overall effect for pain reduction of MT compared with a placebo or in addition to another intervention was observed (n = 406), which may or may not be clinically important, given a mean difference of 1.1 (95% confidence interval: 0.6,1.6) on a 10-cm visual analog scale. Adding MT to an exercise program (n = 226) significantly decreased pain (mean difference, 1.0; 95% confidence interval: 0.7,1.4), as reported on a 10-cm visual analog scale, which may or may not be clinically important. Based on qualitative analyses, it is unclear whether MT used alone or added to an exercise program improves function. * CONCLUSION: For patients with RC tendinopathy, based on low- to moderate-quality evidence, MT may decrease pain; however, it is unclear whether it can improve function. More methodologically sound studies are needed to make definitive conclusions. * LEVEL OF EVIDENCE: Therapy, level 1a -. [ABSTRACT FROM AUTHOR]

Résumé La présente étude porte sur l’épuisement professionnel des cadres et teste les liens entre, d’une part, la charge psychologique, la latitude décisionnelle, la justice organisationnelle et l’estime de soi et, d’autre part, l’épuisement professionnel en mesurant l’effet médiateur du soutien. Les données issues d’un questionnaire soumis auprès de 122 cadres ont permis d’établir une matrice des corrélations, des régressions linéaires sur l’épuisement professionnel et des analyses de médiation. Les résultats indiquent que les variables prépondérantes de notre étude seraient la justice organisationnelle, le soutien des collègues, l’estime de soi et l’affectivité. L’effet médiateur du soutien sur le lien entre les différents types de justice et l’épuisement professionnel a été partiellement validé. This study focuses on the burnout framework and aims at examining the links between, on the one hand, the psychological burden, decision latitude, organizational justice and self-esteem and, on the other hand, the burnout. We measure the mediator effect of the social support. The data derived from a questionnaire submitted to 122 managers allowed us to establish a correlation matrix, linear regressions on the burnout and mediation analyzes. The results indicate that the predominant variables would be the organizational justice, support from colleagues, self-esteem and affects. The mediator effect of the social support between the different types of justice and the burnout was partially validated. [ABSTRACT FROM AUTHOR]

Infection of mice with Citrobacter rodentium serves as a model to study human intestinal infections. C. rodentium infection leads to increased production of inflammatory cytokines, immune cell infiltration and damage to the gut barrier. We used this model of colitis to evaluate the therapeutic properties of OM-X®, an extract prepared by fermentation of vegetables, seaweeds, fruits and mushrooms. Administration of OM-X® to C. rodentium -infected mice reduced damage to the intestinal epithelium, lowered inflammation scores, increased IL-10 expression and maintained FoxP3 gene expression. OM-X® also partially prevented bacterial translocation, increased expression of tight junction genes and increased proliferation of epithelial cells. PCR analysis of stool samples showed that OM-X® significantly reduced the populations of bacteria harboring buk gene (mostly Clostridium species). It is suggested that alterations of microbiota composition, following OM-X® consumption, contribute to protection against infection and epithelial damage, and lead to an increased expression of anti-inflammatory cytokines. [ABSTRACT FROM AUTHOR]

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Local interactions and communication are key features in swarm robotics, but they are most often fixed at design time, limiting flexibility and causing a stiff and inefficient response to changing environments. Motivated by the need for higher adaptation abilities, we propose that information about emergent collective structures should percolate onto the individual behavior, modifying it in a way that determines suitable responses in the face of new working conditions and organizational challenges. Indeed, complex societies are driven by an evolving set of individual and social norms subject to cultural propagation, which contribute to determining the individual behaviors. We leverage ideas from the evolution of natural language – an undoubtedly efficient cultural trait – and exploit the resulting social dynamics to select and propagate microscopic behavioral parameters that adapt continuously to macroscopic conditions, which in turn affect the agents' communication topography, and, therefore, feed back onto the social dynamics. This concept is demonstrated on a self-organized aggregation behavior, which is a building block for most swarm robotics behaviors and a striking example of how collective dynamics are sensitive to experimental parameters. By means of experiments with simulated and real robots, we show that the cultural evolution of aggregation rules outperforms conventional approaches in terms of adaptivity to multiple experimental settings. [Display omitted] • Cultural evolution provides feedback from the social environment into individual micro-controllers. • Scalable model of self-organized aggregation, both in simulation and on real robots. • Heterogeneous and dynamic controllers in the swarm outperform optimized, but static and homogeneous, controllers. [ABSTRACT FROM AUTHOR]