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OBJECTIVE: To compare injured and uninjured limb knee extensor and flexor peak torque between youth who experienced a sport-related, traumatic knee joint injury and comparable uninjured youth, at baseline (≤4 months of injury) and semiannually for 2 years. Differences by injury type and sex were also explored. DESIGN: Prospective cohort study. METHODS: Bilateral knee extensor and flexor concentric isokinetic peak torque at 90° per second was assessed semiannually in 186 youth (106 injured, 80 controls) for 2 years. Between-group differences in strength over time were estimated with generalized estimating equations (95% confidence interval [CI]). Confounding was controlled using inverse probability weighting. Strength differences between those with anterior cruciate ligament (ACL) tears and those with non-ACL tear injuries as well as between male and female participants were explored. RESULTS: Compared to uninjured controls, injured limb knee extensor strength was lowest at baseline (−37.1 Nm; 95% CI, −45.3 to −28.9) and 6-month follow-up (−13.3 Nm; 95% CI, −20.4 to −6.2), with minimal strength gain beyond the 12-month follow-up (1.7 Nm; 95% CI, −14.3 to 17.6). Knee flexor strength of the injured limb was lowest at baseline (−24.6 Nm; 95% CI, −31.5 to −17.8), and there was minimal strength gain beyond 6 months (2.3 Nm; 95% CI, −7.7 to 12.3). The average residual deficit was similar to the knee extensors (10% to 11%) at 24 months. Exploratory analysis suggested no difference based on injury type or sex. CONCLUSION: Injured limb knee extensor and flexor weakness was present after different youth sport-related knee joint injuries. Strength deficits peaked early after injury, improved over time, and plateaued after 12 months, with lingering deficits at 24 months. Thigh muscle strength trajectory was similar across injury types and sex. J Orthop Sports Phys Ther 2025;55(2):137-147. Epub 20 December 2024. doi:10.2519/jospt.2024.12663 [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Long COVID is an infection-associated chronic condition that can cause a wide variety of symptoms and long-term functional impairments. Although investigation into curative treatment is ongoing, current standard management of long COVID relies heavily on rehabilitative care by physical, occupational, and speech therapists. Unfortunately, many persons with long COVID encounter financial barriers to receiving rehabilitative care, especially because some state Medicaid programs and safety net health insurance plans do not cover one-on-one rehabilitation visits. Shared medical appointments are group visits that can deliver multidisciplinary care, and they are widely reimbursed by health insurance plans. Shared medical appointments also offer the added benefit of peer support and camaraderie, and they are an efficient method for clinicians to deliver care to many patients at once. Shared Medical appointments can serve as an innovative method of delivering rehabilitative care for persons with long COVID who cannot access individual appointments with a physical, occupational, and/or speech therapist. The purpose of this clinical perspective is to present the rationale, development, and organization and content of a six-session curriculum of shared medical appointments, which was created to deliver rehabilitation principles for long COVID management. The curriculum covers physical activity, daily living activities, and thinking and speaking. It includes identification of functional concerns and goals, instruction in rehabilitative strategies and tools, and troubleshooting challenges that are encountered as patients implement strategies. The content in this clinical perspective is intended to be easily adapted and delivered by other clinicians to facilitate more equitable access to long COVID rehabilitative care. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the prevalence of subclinical cardiomyopathy and cardiac mortality in a research colony of non-purebred cats, established as a model of the wider cat population in New Zealand. Methods: All apparently healthy, compliant, non-pregnant, non-neonatal cats in the colony at the Centre for Feline Nutrition (Massey University, Palmerston North, NZ) underwent physical examination and echocardiography using a 4.4–6.2-MHz probe by a board-certified veterinary cardiologist. Cardiac phenotype was classified following current guidelines. Hypertrophic cardiomyopathy (HCM) phenotype was defined as an end-diastolic left ventricular wall thickness ≥ 6 mm. Colony mortality data from February 2012 to February 2022 was reviewed to determine cardiac mortality. Results: Cats (n = 132; 65 females and 67 males) included in the study had a median age of 4.1 (IQR 3.0–8.0) years. Thirty-two (24%) cats had a heart murmur, and three (2%) cats had an arrhythmia. Echocardiography revealed heart disease in 24 (18.2%) cats, including 23 with an HCM phenotype and one with a restrictive cardiomyopathy phenotype. Of the cats with the HCM phenotype, 3/23 had systemic hypertension or hyperthyroidism or both, and these cats were excluded from the final diagnosis of HCM (20/132; 15.2 (95% CI = 9.5–22.4)%). Between 2012 and 2022, 168 colony cats died, with 132 undergoing post-mortem examination. Heart disease was considered the cause of death in 7/132 (5.3%; 95% CI = 2.2–10.6%) cats; five had HCM, one a congenital heart defect, and one myocarditis. The overall prevalence of death related to HCM in the colony during this period was 3.8% (95% CI = 1.2–8.6%). Three cats with HCM and the cat with a congenital heart defect died unexpectedly without prior clinical signs, while congestive heart failure was observed prior to death in two cats with HCM and the cat with myocarditis. Additionally, 30/132 (22.7%) cats had cardiac abnormalities but died for non-cardiac reasons. Conclusions: Subclinical cardiomyopathy, specifically HCM, was common in cats in the colony. Given that the colony originated as a convenience selection of non-purebred cats in New Zealand, the true prevalence of HCM in the wider New Zealand population is likely to fall within the 95% CI (9.5–22%). The proportion of deaths of colony cats due to HCM was lower (3.8%) supporting the conclusion that subclinical cardiomyopathy may not progress to clinical disease causing death. Clinical relevance: Veterinarians should be aware of the high prevalence of subclinical HCM when treating cats. Abbreviations: CAM: Systolic anterior motion of the chordae tendineae; CFN: Centre for Feline Nutrition; HCM: Hypertrophic cardiomyopathy; LA/Ao: Left atrial to aortic ratio; LV FS: Left ventricular fractional shortening; LVIDd: Left ventricular internal diameters in end-diastole; LVIDs: Left ventricular internal diameter in end-systole; LVWT: Max Maximum left ventricular wall thickness; SAM: Systolic anterior motion of the mitral valve; 2D: Two-dimensional [ABSTRACT FROM AUTHOR]

Case history: Over a period of 2 months in the spring and early summer of 2021, 13 cases of sudden death in cull ewes due to aortic rupture were diagnosed at a small number of New Zealand abattoirs. Clinical findings: In 12/13 (92%) cases, a large blood clot was present in the thorax, and in one case the blood clot was seen in the tissues dorsal to the heart. There were no obvious signs of external trauma. The pluck (heart and lungs) or fixed aorta was submitted for histological examination in seven cases and in all of these, a tear in the aorta was found. Comparing the microscopic appearance of the proximal aorta in these seven cases to three clinically normal ewes from unaffected farms, the aortic wall thickness appeared thinner in the case ewes than the unaffected ewes. Subjectively, there was increased collagen in the tunica media in 3/7 and decreased elastin fibres in 5/7 case ewes compared to the control ewes. Further investigations on the index farm (where the first cases originated), found that the mean liver and serum Cu concentrations in 10 similarly aged, clinically normal ewes were within the normal reference range for New Zealand sheep. Similarly, the liver Cu concentrations of the seven case ewes were within the normal reference range. Diagnosis: Aortic rupture due to an unknown aetiology. Clinical relevance: Clinicians should be aware of this condition as a differential diagnosis for sudden death in older sheep and to assist the Ministry for Primary Industries in establishing the extent of this problem in New Zealand. [ABSTRACT FROM AUTHOR]

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Background: Three-dimensional weightbearing CT (WBCT) has been widely used to assess foot and ankle alignment. However, most current measurement methods are based on 2-dimensional concepts—distance, long axis, angulation, etc—and are sensitive to changes in orientation of the WBCT images. This study demonstrated how changes in positioning of the image can significantly influence the evaluation of hindfoot alignment. Methods: WBCT scans of 10 feet without deformities were used. In the horizontal view, the long axis of the foot image was aligned to a neutral position and then rotated 5, 10, 15, and 20 degrees both internally and externally to simulate malposition. The Calcaneal Moment Arm (CMA) was measured by 2 investigators independently in the above positions. An intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliabilities. The correlation between the CMA and the rotation angle of the foot images was analyzed using linear regression. Results: The CMA measurements demonstrated that internal rotation of the image changed the neutral hindfoot into valgus, whereas external rotation led to varus. A 1-degree internal or external rotation of the image correlated with 0.48 (±0.03) mm increase or decrease in the modified WBCT-CMA value (P <.0001, R 2 = 0.6406). Conclusion: This study demonstrated that although 3D WBCT provides the ability to observe the foot from different perspectives, current alignment evaluation tools are limited to 2 dimensions. Therefore, positioning the WBCT images in a consistent orientation is important to generate correct data. [ABSTRACT FROM AUTHOR]

The authors describe a case study of a quality improvement initiative to implement the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain 2 2 The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain ("2022 Clinical Practice Guideline") updates and replaces the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm. ("2016 CDC Guideline") into nurse-led primary care practices in central Appalachia. In this controlled pre–post quality improvement study, a policy change, an electronic health record form, and supporting education were implemented. Knowledge change and quality improvement metrics were measured before and after implementation. The data comprised pre- and post-knowledge survey and quality improvement metrics from the electronic health record. After the implementation of the chronic pain intake form and supporting training and education, marked improvements in documentation and completion of the 2016 CDC Guideline and Tennessee Clinical Practice Guideline-concordant activities were observed, suggesting an increase in compliance with guidelines. Quality improvement efforts that focus on opioid management best practices may be effective at enhancing 2016 CDC Guideline-concordant care in clinics, including nurse-led ones. Similar strategies could be trialed to ensure the 2022 CDC Clinical Practice Guideline recommendations for opioid and pain management are adopted effectively. Interventions to improve opioid and pain management through quality improvement efforts require policy changes, clinician and patient education, and electronic record tools. [ABSTRACT FROM AUTHOR]

CFTR modulators are approved for approximately 90% of people with cystic fibrosis in the USA and provide substantial clinical benefit. N1303K (Asn1303Lys), one of the most common class 2 CFTR defects, has not been approved for these therapies by any regulatory agency. Preclinical investigation by our laboratories showed N1303K CFTR activation with elexacaftor–tezacaftor–ivacaftor (ETI). In this trial, we evaluate whether ETI improves CFTR function, measured by sweat chloride and other clinical outcomes, in people with cystic fibrosis and CFTR N1303K. In this prospective, open-label, single-arm trial, participants aged 12 years or older with cystic fibrosis encoding at least one N1303K variant and at least one CFTR N1303K allele who were ineligible for modulator therapy by US Food and Drug Administration labelling were given ETI for 28 days followed by a 28-day washout period at two cystic fibrosis centres in the USA. Participants received two orally administered pills of 100 mg elexacaftor, 50 mg tezacaftor, and 75 mg ivacaftor once daily in the morning, and 150 mg ivacaftor once daily in the evening. The primary endpoint was mean change in sweat chloride from baseline up to day 28 compared with mixed-effects models. Secondary endpoints were changes in percentage of predicted FEV 1 (ppFEV 1), Cystic Fibrosis Questionnaire-Revised (CFQ-R) respiratory domain, BMI, and weight after ETI therapy. Safety was assessed in all participants who received at least one dose of the study drug and primary and secondary analyses were performed in all participants who took the study drug per protocol. The trial was registered at ClinicalTrials.gov (NCT03506061) and remains open for reporting purposes. Between June 7, 2022, and Oct 20, 2023, 20 participants (ten male and ten female) were enrolled and received ETI treatment. One participant was lost to follow-up but was included in intention-to-treat analyses. At 28 days, the mean sweat chloride reduction was –1·1 mmol/L (95% CI –5·3 to 3·1; p=0·61) with only one participant showing a sweat chloride decrease greater than 15 mmol/L. There was a mean increase in ppFEV 1 from baseline at day 28 of 9·5 percentage points (6·7–12·3; p<0·0001) with 15 (75%) participants showing at least a 5% increase in ppFEV 1. Improvements were also identified in mean CFQ-R respiratory domain score (20·8 increase [95% CI 11·9–29·8]; p<0·0001), BMI (0·4 kg/m2 increase [0·2–0·7]; p=0·0017), and weight (1·0 kg increase [0·4–1·7]; p=0·0020) after 28 days of ETI treatment. 14 (70%) of 20 participants had adverse events (12 [60%] mild, one [5%] moderate), with one (5%) serious adverse event of hospitalisation attributed to pneumonia. No deaths were recorded in the study. Individuals with CFTR N1303K showed no change in sweat chloride after 28 days of treatment with ETI. However, there were improvements in secondary clinical endpoints, which suggest clinical efficacy. Our approach provides support for the use of in vitro model systems to inform clinical trials for rare CFTR variants. The Cystic Fibrosis Foundation and the US National Institutes of Health. [ABSTRACT FROM AUTHOR]

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Recent ICE3 trial of breast cryoablation for breast cancer demonstrated 98% success rate, similar to breast-conserving surgery. However, ICE3 and other published studies did not differentiate curative from palliative treatment nor define patient-specific treatment objectives. We sought to define treatment success of curative and palliative breast cryoablation for breast cancer in meeting procedure objectives and patient-specific treatment objectives. We conducted a retrospective analysis of breast cancer patients who underwent breast cryoablation during 2021–2024. Breast radiologists performed outpatient cryoablation using local anesthesia and argon gas cryoprobes under ultrasound or MRI guidance. Patient demographics, referral indications, tumor characteristics, procedure details, and imaging follow-up findings were analyzed. Cryoablation was categorized as curative or palliative. Treatment success was defined as achievement of both procedure and patient-specific treatment objectives. Breast cryoablation was performed for 34 lesions in 29 patients with N0M0 (n = 25), N1M0 (n = 2), N2M0 (n = 1), and N0M1 (n = 1) disease. Most tumors were invasive ductal carcinoma (IDC), low to intermediate grade, estrogen receptor (ER) and progesterone receptor (PR) positive and HER2 negative (23 tumors, 68%). Tumor size ranged from 0.4–1.9 (median 0.8) cm for curative cryoablation and 0.6–6.0 (median 1.3) cm for palliative cryoablation. For 27 patients with follow-up imaging, ablation was curative in 14 patients, 14 tumors and palliative in 13 patients, 18 lesions. Imaging follow-up time ranged from 3 to 26 (median 16) months, > 12 months in 22 of 27 patients and 25 of 32 tumors. Complications were limited to 2 cases of skin frost injury, 1 mild and 1 moderate. Treatment success was achieved in 13 of 14 patients with curative and all 13 patients with palliative cryoablation. Our study defines treatment success for curative and palliative breast cryoablation, demonstrates breast cryoablation achieves not only procedure (technical) but also patient-specific treatment objectives without significant complications, and may serve as guide for integrating breast cryoablation in the treatment of breast cancer patients. [ABSTRACT FROM AUTHOR]

Approximately 30% of patients with typical gastroesophageal reflux disease (GERD) symptoms have endoscopic evidence of erosive esophagitis (EE).1 The severity of EE is commonly graded using the Los Angeles (LA) classification system as grade A (minimal) to D (very severe), depending on the extent of endoscopically visible mucosal breaks (Supplementary Figure 1).2 Accurate grading of EE severity is crucial in clinical trials of medical EE treatments, as EE severity strongly influences both initial rates of healing and the likelihood of recurrence during maintenance treatment.3,4 Almost all EE treatment studies have relied exclusively on local investigators' grading of EE severity to determine study eligibility and response to treatment. Those few studies that included central adjudication did not assess the reliability of grading by local investigators.5 Unlike typical studies of EE treatment, the phase III clinical trial of vonoprazan versus lansoprazole for the treatment of EE (NCT04124926) mandated central adjudication of endoscopic grading for study participation.6 The aim of the present investigation was to evaluate the rate of agreement between local investigators and central adjudicators for EE grading during screening for entrance into that clinical trial. [ABSTRACT FROM AUTHOR]

Background: Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries. Purpose: To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury. Study Design: Cross-sectional Methods: Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital. Results: One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older. Conclusion: The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics. Level of Evidence: 2b [ABSTRACT FROM AUTHOR]

Growing awareness of social inequities and injustices in education highlights the urgent need to address harmful mechanisms, policies, and norms within health education curricula and systems. This study examines inclusivity and exclusivity content in four fundamental nursing textbooks and contributes to the broader discourse on fostering equitable health education. A Directed Qualitative Content Analysis on 32 chapters from four fundamental nursing textbooks was systematically conducted. Seven codes within inclusivity and exclusivity themes were deductively developed from the literature. Inclusivity codes included equity language and contextualized race-based prevalence. Exclusivity codes included normalizing Whiteness in assessment, stigmatizing and negative descriptors, race-based prevalence without context, cisgenderism, and othering. Two trained analysts independently reviewed the chapters, assigning texts to these codes. Discrepancies were resolved by team consensus. A total of 118 inclusivity instances: equity language (n = 109) and race-based prevalence with context (n = 9). Exclusivity codes were more prevalent (n = 642), including normalizing Whiteness (n = 398), stigmatizing descriptors (n = 106), cisgenderism (n = 59), and othering (n = 32). The study highlights inclusive language in fundamental nursing textbooks but reveals significant exclusive language perpetuating negative generalizations, including marginalized identities and race prevalence without context. This content undermines person-centered care and hinders understanding the complex interplay between intersectionality, social justice, and social determinants of health. • Textbooks should incorporate information that highlights socio-historical-political context as critical drivers of health risks and inequities in healthcare. • Exclusivity persists in nursing textbooks, often normalizing Whiteness and excluding diverse realities. • Revisions in nursing educational materials are essential to address health equity and improve culturally informed care. • Significant disparities in how nursing textbooks address race, gender, and social determinants of health may hinder nursing students' ability to deliver equitable and inclusive care. [ABSTRACT FROM AUTHOR]

Background: Technology is pivotal in nursing education, with methods such as the flipped classroom, active learning, and patient simulation becoming integral. Despite this, persistent barriers hinder technology's full integration. Methods: An online survey collected data from nursing faculty members (n = 1761) in prelicensure nursing programs. The survey assessed their views on technology, barriers, training needs, and importance in classroom and simulation settings. Results: Participants highlighted financial support, commitment, and administrative support as critical for technology adoption. Statistical analysis of the results revealed differences in the rankings of the importance of technology, emphasizing the significance of these factors. Additionally, time in the classroom was noted as a significant barrier. Conclusions: Technology's role in nursing education continues to expand. Overcoming financial constraints and enhancing faculty buy-in are essential for successful technology integration, ultimately, improving informatics competencies and advancing technological nursing education. [ABSTRACT FROM AUTHOR]