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Background: Cefazolin is guideline recommended for perioperative prophylaxis in orthopedic surgery. Despite its unique R1 side chain, cefazolin is often avoided in patients with beta-lactam allergy with concern for cross reactivity. Objectives: The primary outcome was the percentage of patients who received cefazolin perioperatively. Secondary outcomes included the percentage of patients with a beta-lactam allergy clarified following the telephone interview and clinical outcomes including acute kidney injury, surgical site infection, Clostridioides difficile infection, and re-admission at 30 and 90 days. Methods: This single-center, quasi-experimental study evaluated a pilot program in which a pharmacist phoned patients > 18 years of age with a scheduled orthopedic surgery and a documented beta-lactam allergy to assess their allergy preoperatively. Recommendations to use cefazolin were based on an algorithm. Patients were divided into pre- and post-intervention cohorts. Results: A total of 832 patients were screened for inclusion with 135 and 66 patients included in the pre- and post-intervention cohorts. No significant difference was identified in the primary outcome. In the post-intervention cohort, 62% had a beta-lactam reaction updated in the electronic medical record. Those with a beta-lactam allergy delabeled or made less severe were numerically more likely to receive cefazolin than those with an unchanged reaction or a reaction made more severe (95.2% vs 68% vs 65%). There were no differences in clinical outcomes between groups. Conclusion: A pharmacist-conducted preoperative beta-lactam allergy interview in adult patients undergoing elective orthopedic surgery improved beta-lactam allergy documentation but, did not result in increased utilization of cefazolin. [ABSTRACT FROM AUTHOR]

Background: In the United States, less than 5% of all adult cancer patients enroll in clinical trials. Few studies explore participation in cancer clinical trials at safety net hospitals, which disproportionately care for minoritized, low-income, uninsured, and underinsured populations. Our study aims to investigate disparities in clinical trial discussions and enrollment among lung cancer patients at Boston Medical Center, the largest safety net hospital in New England. Methods: We included 1121 patients diagnosed with lung cancer between January 2015 and December 2020. Electronic Medical Records (EMR) were queried, and patients were categorized into three groups: (1) clinical trial discussed and the patient enrolled, (2) clinical trial discussed but the patient not enrolled, and (3) clinical trial not discussed. Sociodemographic variables such as age, gender, race, ethnicity, city, primary language, median household income, medical insurance type, and education level were also collected. Chi-squared, t test, and multivariate regression analysis was done using SPSS version 26.0. Results: Of the 1121 patients, clinical trials were discussed in 141 patients (12.6%), of which 22 (15.6%) were enrolled. Clinical trial discussions were conducted more with younger patients (68.19 vs 71.37, p =.001), but on multivariate analysis there was no significant difference (OR = 1.023; 95% CI 0.998-1.048; p =.068). There was no significant difference in clinical trial discussion or enrollment between the other sociodemographic factors. Conclusion: Additional study of barriers to cancer clinical trial discussion and enrollment at safety net institutions can serve as a prerequisite to ameliorating racial disparities observed on a national scale. [ABSTRACT FROM AUTHOR]

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities. [ABSTRACT FROM AUTHOR]

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P <.001) and more likely to serve both elementary and secondary school settings (P =.002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P <.001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P <.001, for each), and suicide risk assessment and screening (P =.012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity. [ABSTRACT FROM AUTHOR]

This study explores the complex nature of female genital mutilation/cutting (FGM/C) by juxtaposing the mental and sexual health of women who had undergone FGM/C as part of initiation/membership into a traditional women's society (TWS) with those who were also cut but not initiated into a TWS. While considerable differences emerged between TWS members and nonmembers, there was no evidence that TWS membership was protective against the physical and psychological trauma typically ascribed to FGM/C. In fact, the pattern of results would tend to suggest the opposite. Possible explanations for and implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

We examined the prevalence of self-reported motivations and barriers to helping intoxicated peers among emerging adults (N = 377; M age = 18.64; 75% women, 88% White) attending a Southeastern university and whether motivations and barriers differed by age, gender, race, and class standing. Respondents aged 19–24 were more likely to endorse the motivation item "Because it was your "turn" to be the helper/designated driver (DD) that night" than eighteen-year-olds. Race differences were also reported for the motivation item, "Because the person was your friend", where White participants were more likely to endorse this item than non-White participants. Men also reported more Burden/Hassles-related barriers than did women. [ABSTRACT FROM AUTHOR]

Background: Maternal height has been for long a contributory anthropometric factor that can determine the obstetric outcome. There is always a need of a consistent, reliable, and simple risk indicator which is easy to use for preventing unnecessary complications in a country like India where often antenatal care is provided by dais in rural areas. The background of this research aims to ascertain the relationship between maternal height and mode of delivery based on other intrapartum factors which influence labor and consequent maternal and neonatal outcome. Materials and Methods: All primigravidae at term gestation (>37 weeks) with cephalic presentation on admission to labor suite with no other comorbidities were recruited in the study. Their mode of delivery, maternal outcome, along with neonatal outcome was documented. Results: Out of the 680 patients, 104 patients are considered for the short-stature group (15.29%) who were <150 cm in height. Other group comprised patients who were >150 cm in height, a total of 576 (84.71%). There was a higher incidence of induced labor in the study group (66.35%) and emergency lower-segment cesarean section done due to cephalopelvic disproportion (CPD) (60%) was also higher among the short-stature group. The incidence of normal labor (32.99%) was higher in the tall-stature group. Conclusion: Short height (<150 cm) is an independent risk factor for cesarean delivery due to CPD. Statistical correlation was found between mothers of short stature and babies being born with low birth weight. As labor is influenced by multiple factors, it is fair enough to give a trial of labor for short primigravidae except in uncommon circumstances. [ABSTRACT FROM AUTHOR]

Introduction: Non-attendance with scheduled postoperative follow-up visits remains a common issue in orthopaedic clinical research. The objective of this study was to identify the risk factors associated with loss to follow-up among elderly patients with hip-fracture postoperatively. Methods: A retrospective analysis of 1-year post-surgery was performed on patients aged over 60 years who underwent hip-fracture surgery from January 2017 to March 2019. Based on their completion of the appointed follow-up schedule, the patients were classified into 2 groups: the Loss to Follow-up (LTFU) Group and the Follow-up (FU) Group. Clinical outcomes were evaluated by Functional Recovery Score (FRS) questionnaires. Telephone interviews were conducted with patients lost to follow-up to determine the reasons for non-attendance. A comparative analysis of baseline characteristics between the 2 groups was implemented, with further exploration of statistical differences through logistic regression. Results: A total of 992 patients met the inclusion criteria were included in this study, of which 189 patients, accounting for 19.1%, were lost to follow-up 1 year postoperatively. The mean age of the patients in the LTFU Group was 82.0 years, significantly higher than the 76.0 years observed in the FU Group (P < 0.001). The FRS for the LTFU Group was marginally higher than that of the FU group (84.0 vs 81.0), with no significant difference (P = 0.060). Logistic regression analysis identified several significant predictors of noncompliance, including advanced age at surgery, femoral neck fracture, hip arthroplasty, long distance from residence to hospital, and the reliance on urban-rural public transportation for reaching the hospital. Conclusion: Postoperative follow-up loss was prevalent among elderly patients with hip fractures. Our study indicated a constellation of risk factors contributing to noncompliance, including advanced age, transportation difficulties, long travel distance, femoral neck fracture and hip arthroplasty surgery. [ABSTRACT FROM AUTHOR]

Background: Evidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to-noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. Methods: Individuals with PTSD (n = 27), trauma-exposed individuals without PTSD (n = 27), and individuals without trauma exposure (n = 26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. Results: We found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N -acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. Conclusion: In this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo. [ABSTRACT FROM AUTHOR]

Background: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. Methods: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. Results: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (β =.24; 95% CI = 0.14-0.35) and anxiety (β =.31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. Conclusions: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being. [ABSTRACT FROM AUTHOR]

Introduction: Increasing incidence of fragility fractures has spurred development of protocols, largely focused on peri-operative care, with numerous proven benefits. The purpose of this investigation was to evaluate outcomes of our hip fracture treatment program regarding successful protocol implementation, compliance, effect on subsequent fracture rates, and mortality during the first decade of adoption. Methods: A retrospective review identified patients >65 years old with fragility hip fractures between 2010 and 2022. The HiROC (+) cohort consisted of patients who received a "High-Risk Osteoporosis Clinic" (HiROC) referral for bone health evaluation and bisphosphonate initiation as indicated. Additional fracture rates and mortality at 3 years were calculated. Protocol implementation and compliance over the first 10 years was analyzed in the four identified cohorts. Results: A total of 1671 fragility hip fractures were identified, with 386 excluded due to insufficient follow-up, with an average age of 81.6 years and a median follow-up of 36.4 months. Of the 1280 included cases, 56% (n = 717) had a HiROC referral placed. HiROC(+) groups had lower subsequent fracture rates at two years, compared to those without referral (28% vs 13%, P < 0.0001) and those completing more steps of the protocol had lower subsequent fracture rates (28% vs 15% vs 13% vs 5%, P < 0.0001). No statistically significant difference was observed between the cohorts for anatomic site of subsequent fractures. Discussion: Greater than half of all eligible patients were successfully captured by the protocol. Patients completing more steps of the protocol had lower subsequent fracture rates. Captured patients demonstrated reduced mortality rates when compared to current literature. Conclusion: Successful implementation of this geriatric hip fracture protocol was associated with reduced additional fractures and mortality rates. Identifying steps of process failures in the protocol can provide opportunities for increased compliance and reduction in future fracture occurrences. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the impacts of different middle-ear mucosal conditions on the outcomes of type I tympanoplasty. Methods: A retrospective analysis of 164 patients with chronic otitis media was carried out. The patients were divided into 4 groups according to their mucosal condition. Preoperative hearing levels and air-bone gap (ABG) before and after surgery were compared via the Kruskal‒Wallis H test. The chi-squared test and Fisher's exact test were used to assess the postoperative complications and impact factors of functional success. Results: Preoperatively, neither the air conduction nor bone conduction values differed significantly among groups with different mucosal conditions. All of the ABG closed dramatically after type I tympanoplasty (P <.05) regardless of the mucosal conditions. The functional success rates were lower when the intratympanic mucosa was moderately or severely edematous compared with mildly edematous or normal (P <.05). The disease course, perforation site, and perforation size, as well as the status of the opposite ear, were not related to the auditory functional outcome. The differences in postoperative reotorrhea and reperforation among the 4 groups were not statistically significant. Conclusion: Preoperative hearing levels were not affected by middle-ear mucosal conditions. The functional success rate was influenced by mucosal conditions, but hearing levels were significantly enhanced after surgical intervention regardless of the mucosal status. Postoperative complications were not related to the mucosal conditions. Thus, type I tympanoplasty is adoptable for mucosal abnormalities when pharmacotherapy cannot result in a healthy tympanum. [ABSTRACT FROM AUTHOR]

This study investigated the use of smartphones by family caregivers for hospitalized patients with chronic heart failure (CHF). In total, 120 patients and their unpaid family caregivers participated in this study. The caregivers were divided into two groups based on the perceived importance of smartphones in patient care. Both groups completed the General Demographic Information Survey, Problematic Mobile Phone Use Questionnaire, Barthel Index Scale, Modified Early Warning Score (MEWS), Johns Hopkins Fall Risk Assessment Tool (JH-FRAT), and Family Burden Scale of Diseases Survey. Moreover, left ventricular ejection fraction (LVEF) and stroke volume (SV) were measured in all participants. The age of hospitalized patients with CHF was correlated with the Barthel Index Scale, MEWS, and JH-FRAT, whereas LVEF and SV were correlated with MEWS. The important group had a much higher financial burden than the nonimportant group. Linear regression analysis revealed that financial burden and mental health had a remarkable impact on the content of mobile calls about treatment. Furthermore, the economic status of family caregivers determined the importance of smartphone calls in the care of patients with CHF during hospitalization. [ABSTRACT FROM AUTHOR]

Evaluating stroke campaigns and associated behavioural changes is crucial to assess intervention effectiveness and inform future strategies. We aimed to evaluate patient's and bystanders' foreknowledge of stroke signs and symptoms and their response at stroke onset. We interviewed stroke patients using a validated questionnaire or their bystanders if the stroke patient had disabling stroke. The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients and 23 (13.9%) bystanders. The mean age was 52.6 (SD = 11.7), and male–female ratio was 7:1. Among the participants, 33 (20.1%) had foreknowledge of stroke signs, and of these, 27 (16.5%) were aware of the stroke campaign in Qatar. The behavioural responses at stroke onset included; activating Emergency Medical Services (EMS) (n = 55, 33.3%), calling friends/relatives (n = 69, 41.8%), driving to hospital (n = 33, 20%), waiting for improvement in condition (n = 21, 12.7%). There was no association of ethnicity, marital status, or campaign awareness with EMS activation. Despite limited community awareness of stroke signs and campaign, help-seeking behaviour through EMS activation was generally high, underscoring the need for focused educational efforts and public health interventions. [ABSTRACT FROM AUTHOR]

This study aimed to assess differences in emotion and elaboration quality between clinical and community child cohorts in both past reminiscing and future worry conversations. We analyzed 54 Australian parents (46 mothers, 8 fathers) and their 8- to 12-year-old children (M = 9.63, SD = 1.29; 28 boys, 26 girls) in reminiscing interactions. Dyads were recruited from local schools (community cohort, n = 26) or a children's psychology clinic waitlist (clinical cohort, n = 28). Clinical cohort children engaged in less emotion exploration in both past and future conversations, as did parents for future conversations. Elaboration quality did not differ. Parent-son dyads differed in the clinical cohort, exhibiting significantly lower emotion resolution than the community cohort, or parent-daughter dyads when discussing past events. These findings suggest that discussing anticipated negative events may be a relevant point of family-based intervention for anxious children. Additionally, this study highlights the importance of parent-son emotional discussion. [ABSTRACT FROM AUTHOR]

Objective: This study compared the utilization and outcomes of face-to-face (F2F) vestibular support groups and online support communities (OSC) for individuals with vestibular disorders. Methods: We distributed a 31-question anonymous electronic survey through the Vestibular Disorders Association (VeDA) to F2F participants, categorizing user involvement in F2F, OSCs, or both and assessed impact on medical decision-making, psychosocial benefits, and goals achieved. Results: The F2F cohort consisted of 97 individuals comprising primarily of non-Hispanic White women (mean age = 57 years, SD ± 14 years) with diagnoses including persistent postural-perceptual dizziness (19%), Meniere's disease (15%), and vestibular neuritis (13%). Most participants were diagnosed by an otolaryngologist (65%) and attended F2F meetings monthly or less frequently (78%). The OSC group comprised of 551 individuals, primarily of non-Hispanic White women, but was younger in age (mean age = 50 years, SD ± 13 years). OSC participants notably engaged more, with 36% participating on a daily basis and 32% multiple times a week. F2F participants were older (mean age 57 years vs 50 years, P <.001) and more commonly referred by medical professionals (22% F2F vs 6% OSC, P <.001). Both groups had similar achieved goals, including hearing from others with the same diagnosis (84% vs 89%, P >.05) and similar impact on medical decision-making (75% vs 78%, P >.05). More F2F participants reported increased development of coping skills (79% F2F vs 69% OSC, P =.037). OSC participants typically found the group via an online search (75%), compared to 51% for F2F. OSC participants had higher daily engagement (36%) compared to F2F (1%). Conclusion: F2F users are older and more commonly referred by medical professionals. Despite less frequent engagement, F2F participants reported similar influences on achieved goals, medical decision-making, and impact on psychosocial benefits. These findings highlight the importance of both F2F and OSC support groups for individuals with vestibular disorders. [ABSTRACT FROM AUTHOR]

The objectives of the present analyses are to examine the frequency, nature, and correlates of nonfatal gun use in incidents of conflict between adult children and their parents, to which police were summoned. A cross-sectional study design was used with all cases of domestic violence to which police were called between adult children and their parents, in Philadelphia, PA, in 2013 (N = 6,248). Data were drawn from forms required to be completed by police when responding to domestic violence calls for assistance. A series of multivariate logistic regression models were estimated. Of the 6,248 incidents, 5,486 involved no weapon, 522 involved a bodily weapon, 190 involved a non-gun external weapon, and 50 involved a gun. Guns were most often used to threaten victims (66%), with guns less often fired (6%) or used to pistol whip victims (4%). Compared to incidents involving a bodily weapon, when guns were involved, offenders were less likely to have pushed, grabbed, or punched the victim and victims were less likely to have visible injuries; however, offenders were more likely to have threatened victims and victims were more likely to be observed as frightened. Police officers intervened similarly to incidents involving guns vs. bodily weapons. This is the first study we are aware of to focus on nonfatal gun use between family members who are not intimate partners, with the results extending much of what is known regarding nonfatal gun use among intimate partners to nonfatal gun use among adult children and parents. [ABSTRACT FROM AUTHOR]

Objective: To document the impact of early follow-up by specialized cleft nurses (SCNs) to families of infants with cleft lip and/or cleft palate (CL/P). Design: Prospective inclusion of a control group, which received standard care alone, followed by an intervention group, which in addition received early SCN follow-up. Setting: The cleft lip and palate team at a University hospital. Participants: 70 families (69 mothers and 57 fathers); control group (n = 38); intervention group (n = 32). Intervention: SCNs offered a consultation at the maternity ward and follow-ups by phone or face-to-face at one, three, eight weeks and six months after birth. Outcome measures: Use of Internet-Questionnaire, Quality of discharge teaching scale (QDTS), Post discharge coping difficulty scale (PDCDS), Response on follow-up by health professionals. Results: Infants in the intervention group were admitted less frequently to a Neonatal Intensive Care unit (NICU); 21.9% vs 51.4%, P =.012. Parents in the intervention group used internet for cleft-related reasons less frequently (74.6% vs 85.9%), P =.112 and the mothers benefitted less from cleft-related activity on the internet (P =.013). The intervention group reported higher mean score for satisfaction with total cleft care (P =.001). There were no significant group differences regarding mean total score for discharge teaching (P =.315) and coping difficulties (P =.919). Conclusion: Early follow-up by a SCN with expertise in cleft care is highly valued by parents. Closer cooperation between the cleft team and health professionals at birth hospitals and Child health centers is necessary for optimal follow-up. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is a promising treatment for common symptoms after traumatic brain injury (TBI). Our objectives were to explore knowledge, attitudes and beliefs about acupuncture, identify health service needs and assess the perceived feasibility of weekly acupuncture visits among individuals with TBI. Methods: We surveyed adults 18 years of age and older with TBI who received care at the University of Washington. Respondents were asked to complete 143 questions regarding acupuncture knowledge, attitudes and beliefs, injury-related symptoms and comorbidities, and to describe their interest in weekly acupuncture. Results: Respondents (n = 136) reported a high degree of knowledge about acupuncture as a component of Traditional Chinese Medicine, needle use and safety, but were less knowledgeable regarding that the fact that most conditions require multiple acupuncture treatments to achieve optimal therapeutic benefit. Respondents were comfortable talking with healthcare providers about acupuncture (63.4%), open to acupuncture concurrent with conventional treatments (80.6%) and identified lack of insurance coverage as a barrier (50.8%). Beliefs varied, but respondents were generally receptive to using acupuncture as therapy. Unsurprisingly, respondents with a history of acupuncture (n = 60) had more acupuncture knowledge than those without such a history (n = 66) and were more likely to pursue acupuncture without insurance (60%), for serious health conditions (63.3%) or alongside conventional medical therapy (85.0%). Half of all respondents expressed interest in participating in weekly acupuncture for up to 12 months and would expect almost a 50% improvement in symptoms by participating. Conclusion: Adults with TBI were receptive and interested in participating in weekly acupuncture to address health concerns. These results provide support for exploring the integration of acupuncture into the care of individuals with TBI. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with hospitalization among Mexican Americans aged 75 years and older with diabetes (with and without complications) and without diabetes over 12 years of follow up. Methods: Participants (N = 1454) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005-2016) residing in Arizona, California, Colorado, New Mexico, and Texas. Measures included socio-demographics, medical conditions, falls, depressive symptoms, cognitive function, disability, physician visits, and hospitalizations. Participants were categorized as no diabetes (N = 1028), diabetes without complications (N = 180), and diabetes with complications (N = 246). Results: Participants with diabetes and complications had greater odds ratio (1.56, 95% Confidence Interval = 1.23-1.98) over time of being admitted to the hospital in the prior year versus those without diabetes. Participants with diabetes had greater odds of hospitalization if they had heart failure, falls, amputation, and insulin treatment. Conclusions: In Mexican American older adults, diabetes and diabetes-related complications increased the risk of hospitalization. [ABSTRACT FROM AUTHOR]

Background: The maternal mortality rate in the United States is high and disparities among non-Hispanic White and non-Hispanic Black women remain. In the State of Georgia, the pregnancy-related death rate is among the worst in the nation. Objective: To examine current pregnancy-related deaths in the State of Georgia using measures of timing and cause-specific mortality across maternal sociodemographic characteristics. Design: This cross-sectional study of pregnancy-related deaths in Georgia was based on 2016–2019 maternal mortality data obtained from the Georgia Department of Public Health. Methods: Our study analysis involved complete-case data of maternal deaths identified as pregnancy-related deaths (n = 129). Statistical analyses included two distinct population-level measures: (a) timing (i.e. during pregnancy, 0 to 60 days, 61 to 180 days, and 181 to 365 days postpartum) and (b) cause-specific deaths patterned by sociodemographic groups of women and by rural and urban county of residence. Categorical variables were compared using the Chi square or Fisher's exact test and presented as numbers and percentages. A post hoc power analysis was conducted to inform whether there was sufficient power to detect statistically significant effects given available sample sizes. Results: Among a total of 129 pregnancy-related deaths, 30 (23.3%) deaths occurred during pregnancy and 63 (48.8%) deaths occurred within the first 60 days postpartum. Pregnancy-related deaths were disproportionally common among non-Hispanic Black, 25 to 34 years old, and poorly educated women. Three leading underlying causes, cardiomyopathy (22.7%), hemorrhage (21.6%), and cardiovascular or coronary disease (20.4%), accounted for about 65% of all pregnancy-related deaths. Mental health conditions were common causes of death among non-Hispanic White women during pregnancy and in late postpartum. Conclusion: Continued monitoring, collecting and analyzing reliable data will help identify root causes and find ways to eliminate the disproportionate burden of pregnancy-related deaths in the State of Georgia. [ABSTRACT FROM AUTHOR]

Background: A few studies have documented the long-term results of chondrocyte-based procedures for the treatment of patellofemoral cartilage lesions, but specific results are lacking after matrix-assisted autologous chondrocyte transplantation (MACT) for patellar and trochlear lesions. Purpose: To document the clinical results of MACT for the treatment of patellar and trochlear chondral defects at long-term follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients were prospectively evaluated after MACT for patellofemoral lesions. There were 24 patients affected by patellar lesions, 16 by trochlear lesions, and 4 with both patellar and trochlear defects. Clinical outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective form, EuroQol visual analog scale, and Tegner score for sport activity level before surgery and at follow-up time points of 5, 10, and a minimum of 15 years (mean final follow-up, 17.6 ± 1.6 years). A Kaplan-Meier survival analysis was performed to examine the survival to failure. Failure was defined as the need for a second surgery because of the persistence of symptoms related to the primary defect. Results: An overall significant improvement was documented from baseline to the last follow-up. The IKDC subjective score improved in the trochlear group from 41.0 ± 13.3 at baseline to 83.9 ± 21.6 at 5 years (P <.005), remaining stable up to the final follow-up (81.3 ± 20.5). In the patellar group, the IKDC subjective score improved from 36.1 ± 14.4 at baseline to 72.3 ± 17.5 at 5 years (P <.005), remaining stable up to the final follow-up (62.0 ± 20.3). Patients with trochlear lesions presented higher IKDC subjective scores compared with those with patellar lesions at 5 (P =.029), 10 (P =.023), and ≥15 years (P =.006) of follow-up. Similar trends were documented for the Tegner score, while no differences were documented for the EuroQol visual analog scale score between patellar and trochlear lesions. There were 4 failures (9.1%) during the follow-up period. The Kaplan-Meier survival analysis did not show statistically significant differences between trochlear and patellar lesions. Conclusion: This hyaluronic acid–based MACT technique offered positive and durable clinical outcomes with a low failure rate at long-term follow-up in patients affected by patellofemoral cartilage lesions. However, trochlear and patellar lesions demonstrated a notable difference in terms of clinical findings and sport activity level, with significantly higher results for patients with trochlear lesions but less satisfactory outcomes for patients with patellar lesions. [ABSTRACT FROM AUTHOR]

Background: Return to sport (RTS) after treatment of an anterior cruciate ligament (ACL) tear is a critical parameter to assess the outcome of a surgical procedure. However, few studies have investigated RTS after ACL repair. Purpose: To evaluate RTS of a group of amateur soccer players at a minimum follow-up of 2 years after ACL repair. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all patients treated with acute ACL repair was conducted. A total of 50 amateur soccer players were included in the study. Patients were examined clinically or contacted to complete postoperative patient-reported outcome measures, namely the Knee injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee questionnaire, the ACL–Return to Sport After Injury scale, and the Forgotten Joint Score–12. Results: The patients' mean age was 25.8 ± 7.7 years (range, 14-47 years), and the mean follow-up was 34.3 ± 10.7 months (range, 24-51.3 months). The median Tegner Activity Scale score was 9. The ACL repair failure rate was 16% (8/50). The mean time from repair to failure was 23.1 ± 12.7 months (range, 6-44 months), and the mean age of patients who sustained ACL repair failure was 19.9 ± 3.3 years (range, 14-24 years), significantly lower compared with patients who did not experience ACL repair failure (26.9 ± 7.9 years; range, 16-47 years; P =.017). Multivariate analysis showed that age ≤21 years was the only significant risk factor for ACL repair failure (odds ratio, 5.45; confidence interval, 1.24-27.91; P =.041). Excluding the 8 patients who experienced repair failure, 31 of 42 patients (73.8%) returned to soccer after ACL repair, with 29 of the 31 (93.5%) returning at their preinjury level of play. Moreover, patients who played competitive soccer and returned to their preinjury level of play were significantly younger than those who did not return to their preinjury level of play (mean, 21.1 ± 3.4 vs 29.2 ± 9.5 years, respectively; P =.002) and had significantly better ACL-Return to Sport After Injury scores (mean, 96.6 ± 4 vs 87.8 ± 11, respectively; P =.044). Conclusion: In this study, 73.8% (n = 31) of patients returned to playing soccer, of whom 93.5% (n = 29) returned to their preinjury level after ACL repair. The failure rate was 16% (n = 8) and mainly involved patients ≤21 years old. [ABSTRACT FROM AUTHOR]

Background: The clinical implications of structural integrity have been a subject of long debate. The oversimplified binary categorization of structural integrity into either healing or retear, along with faulty preoperative baselines for comparison, may contribute to the controversy. Purpose: To determine how the quality of structural integrity in a repaired cuff tendon affects both clinical and structural outcomes by dividing the patients into groups based on integrity and using the immediate postoperative baseline (time zero). Study design: Cohort study; Level of evidence, 3. Methods: A total of 504 patients with a full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The quality of structural integrity was graded using the Sugaya classification. To evaluate clinical outcomes, pain, range of motion, strength, functional scores, and overall satisfaction and function were used for within- and between-group analyses at the last follow-up. For the assessment of structural outcomes, the Goutallier classification for fatty infiltration (FI) and the tangent sign, occupation ratio, and normalized cross-sectional area for muscle atrophy (MA) were used. The baselines for these structural measurements were both the preoperative and the time-zero MRI scans. Results: The mean clinical follow-up period was 31.8 ± 27.5 months, and the MRI follow-up period was 10.9 ± 5.3 months. There were 178 (35.3%), 228 (45.2%), 58 (11.5%), 14 (2.8%), and 26 (5.2%) shoulders with Sugaya grades 1, 2, 3, 4, and 5, respectively. Regardless of structural integrity, all clinical outcomes at a mean follow-up of 31.8 months after repair significantly improved compared with those before repair. Only in shoulders with Sugaya grade 1 did the FI of the supraspinatus muscle improve significantly from baseline. FI of the infraspinatus muscle did not change significantly in those with grades 1 and 2 but worsened in those with grades 3 and 5. MA measured using the occupation ratio improved significantly in shoulders with Sugaya grades 1 and 2 but declined in those with grade 5. Conclusion: This study established a correlation between improved structural integrity of the repaired cuff tendon and enhanced structural outcomes in rotator cuff muscles. Furthermore, the findings revealed that both FI and MA could be reversed in patients exhibiting high-quality structural integrity. However, these structural improvements were not mirrored in the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Short- and midterm evaluations of arthroscopic meniscal surgery have shown little or no effect in favor of surgery, although long-term effects, including radiographic changes, are unknown. Purpose: To compare the 10-year outcomes in middle-aged patients with meniscal symptoms between a group that received an exercise program alone and a group that received knee arthroscopy in addition to the exercise program with respect to the prevalence of radiographic and symptomatic osteoarthritis (OA), patient-reported outcomes, and clinical status. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to undergo either 3 months of exercise therapy (nonsurgery group) or knee arthroscopy in addition to the exercise therapy (surgery group). Surgery usually consisted of partial meniscectomy (n = 56) or diagnostic arthroscopy (n = 8). Radiographs were assessed according to the Kellgren-Lawrence score at the baseline and 5- and 10-year follow-ups. Patient-reported outcome measures were reported at the baseline and 1-, 3-, 5-, and 10-year follow-ups. Clinical status was assessed at a 10-year follow-up. The primary outcomes were radiographic OA and changes in the Knee injury and Osteoarthritis Outcome Score Pain subscale (KOOSPAIN) from the baseline to the 10-year follow-up. The primary analysis was performed using the intention-to-treat approach. Results: At the time of the 10-year follow-up, eight patients had died, leaving 142 eligible patients. Radiographic OA was assessed for 95 patients (67%), questionnaires were answered by 110 (77%), and the clinical status was evaluated for 95 (67%). Radiographic OA was present in 67% of the patients in each group (P ≥.999); symptomatic OA was present in 47% of the nonsurgery group and 57% of the surgery group (P =.301). There were no differences between groups regarding changes from baseline to 10 years in any of the KOOS subscales. Conclusion: Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. Considering the short-term benefit and no long-term harm from knee arthroscopic surgery, the treatment may be recommended when first-line treatment—including exercise therapy for ≥3 months—does not relieve patient's symptoms. Registration: Clinical Trials NCT01288768 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Use of a rapid rehabilitation protocol for postoperative recovery after recurrent patellar dislocation (RPD) has gradually gained attention; nonetheless, evidence of its safety and effectiveness is lacking. Purpose: To compare the short-term postoperative outcomes of early rapid rehabilitation with those of conservative rehabilitation in patients with RPD. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 50 patients with RPD who underwent tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction were enrolled between January 2018 and February 2019. Postoperatively, the patients were randomly assigned to either the early rapid group (rapid group; n = 25 patients) or the conservative group (control group; n = 25 patients) for rehabilitation training. The rapid group underwent faster progression in weightbearing and range of motion (ROM) training. Knee joint functional scores, ROM, bilateral thigh circumference differences, and imaging data were recorded preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively for comparison. Postoperative complications were recorded over the 24-month follow-up period. Results: The baseline data did not significantly differ between the 2 groups. Postoperatively, compared with the control group, the rapid group had higher Tegner scores at 6 weeks and 3 months; higher Lysholm scores at 3 and 6 months; higher International Knee Documentation Committee scores at 6 weeks, 3 months, and 12 months; better ROM; and smaller bilateral thigh circumference differences at 24 months (P <.05 for all). However, no differences were observed in the Tegner, Lysholm, and International Knee Documentation Committee scores at 24 months postoperatively. At the 6-week and subsequent follow-up visits, the Caton and Insall indices were lower in the control group than in the rapid group (P <.01 for all). Moreover, compared with the control group, the rapid group had a lower incidence of patella baja at 24 months (0% vs 17%) and fewer complications during the whole follow-up period (P <.01). Conclusion: Early rapid postoperative rehabilitation appears to be safe and effective for patients who undergo tibial tubercle osteotomy combined with medial patellofemoral ligament reconstruction to treat RPD. In the short term, this approach was shown to be more advantageous than conservative rehabilitation in improving functional scores, allowing an earlier return to daily activities, although the lack of difference at 24 months implies no long-term benefits. In addition, it potentially helped to prevent the occurrence of complications, including patella baja. Registration: ChiCTR1800014648 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that short-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) predict midterm outcomes, but a limited number of studies have evaluated whether short-term outcomes predict long-term outcomes and survivorship. Purpose: To evaluate whether achieving clinically significant outcomes at 2 years after hip arthroscopy for FAIS can predict patient-reported outcomes (PROs) and survivorship at 10 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between June 2012 and December 2012 with a minimum 10-year follow-up were identified. Using previously established thresholds, we classified patients who achieved the 2-year Patient Acceptable Symptom State (PASS) for the visual analog scale (VAS) for satisfaction as the high satisfaction group and patients who did not as the low satisfaction group. Minimum 10-year PROs were then compared between the groups, including scores for the Hip Outcome Score (HOS)–Activities of Daily Living and –Sports Specific, the modified Harris Hip Score, the VAS for pain, and the VAS for satisfaction. Reoperation-free survivorship was compared. Results: Of 120 eligible consecutive patients, 85 patients were included (70.8% follow-up rate), of whom 61.2% were female. The mean age was 34.0 ± 12.8 years, and the mean body mass index was 25.4 ± 4.6. Of the 85 patients, 29 (34.1%) did not achieve PASS for the VAS for satisfaction at 2 years postoperatively compared with 56 (65.9%) who did. The low satisfaction group had significantly worse acetabular chondral grades at the time of surgery (P =.008). At minimum 10-year follow-up, the high satisfaction group showed significantly better HOS-Activities of Daily Living, HOS-Sports Specific, modified Harris Hip Score, VAS pain, and VAS satisfaction scores (P ≤.031). Compared with the low satisfaction group, the high satisfaction group had a significantly lower rate of secondary surgery (1.8% vs 24.1%, respectively; P =.002). Conclusion: Patients who achieved PASS for the VAS for satisfaction at 2 years after hip arthroscopy demonstrated superior minimum 10-year outcomes compared with patients who did not, including greater PRO scores and a higher survivorship rate. The high satisfaction group had lower grade acetabular cartilage damage at the time of surgery compared with those who did not achieve PASS for the VAS for satisfaction at 2 years. [ABSTRACT FROM AUTHOR]

Background: Osteochondritis dissecans (OCD) is a condition characterized by abnormal subchondral bone with disturbance of overlying articular cartilage. The role of weightbearing alignment in the pathophysiology of OCD lesion development is not fully understood. Hypothesis: Lower extremity mechanical axis would be concordant with femoral condylar OCD lesion location. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Cases were identified from a single, large academic institutional database using International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes associated with OCD. Patients were included if they had a magnetic resonance imaging scan demonstrating the OCD lesion and lower extremity alignment radiographs. OCD lesion location was identified using Cahill and Berg zones. The primary outcome was the association of OCD lesion location with weightbearing mechanical axis. Secondary outcomes included the association of mechanical axis with skeletal maturity, OCD lesion stability, and treatment. For unilateral OCD lesions, mechanical axis was compared between affected and unaffected lower extremities. Results: A total of 86 patients (95 knees) with an OCD lesion of the femoral condyle were identified. The population was 74% male, and the mean age was 21 years. In total, 65% of knees had closed physes, 82% of lesions were unstable, and 85% underwent a surgical procedure. Mechanical axis was located in the same zone as the OCD lesion in 48% of cases and within the same compartment in 56% of cases. Spearman correlation coefficient demonstrated a moderate positive correlation (rs = 0.59). No significant differences were found in the association of mechanical axis and OCD lesion location in subgroup analysis of medial versus lateral femoral condylar OCD lesions, skeletal maturity, stability of the lesion, or treatment group. For patients with varus alignment and medial femoral condylar OCD lesions, the mean lateral distal femoral angle was 89.9°, and medial proximal tibial angle was 85.4°; for valgus alignment and lateral femoral condylar lesions, the lateral distal femoral angle was 84.8°, and medial proximal tibial angle was 88.8°. Patients with unilateral medial femoral condylar OCD lesions were more likely to have varus alignment of the affected extremity compared with the contralateral extremity (59% vs 36%; P =.01). Conclusion: This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condylar OCD location. Patients with unilateral medial femoral condylar OCD lesions frequently had asymmetric varus alignment in the affected extremity. [ABSTRACT FROM AUTHOR]

The timing of trauma exposure is a risk factor for the development of psychopathology in adulthood. We aim to assess the presence of adverse life events (ALEs) before age 13 in patients with eating disorders (ED). Specifically, we examined the relationship between exposure to interpersonal trauma before the age of 13 and body image distortion (BID), impulsivity, and perfectionism. We conducted a cross-sectional, retrospective study in which 79 outpatients with ED were consecutively enrolled. Assessment was performed using the Traumatic Life Event Questionnaire, Contour Drawing Rating Scale, and Eating Disorder Inventory. Linear regression models were used to analyze the predictive role of interpersonal trauma before age 13 on BID perfectionism and impulsivity. Seventy-two patients (91.1%) reported ALEs throughout their lives. Patients with trauma before age 13 (55.6%) overestimated their shape. Patients with ED and bulimic symptoms had significantly higher BID levels. Interpersonal trauma predicted higher levels of impulsivity and perfectionism. Experiencing interpersonal ALEs before age 13 may be a risk factor for the development of BID, impulsivity, and perfectionism in adulthood. Body image can be modified during childhood through interventions focused on identifying stressful relationships. Plain language summary: Childhood is important for the construction of self-image. When people feel threatened in relationships they trust, they feel ashamed and guilty. These emotions could lead to ED and BID. To explore this, we conducted a study on how ALEs during childhood influence the way we perceive our bodies. We asked participants with ED to close their eyes and sense their bodies. We then invited them to choose a shape from a list of nine figures with different shapes. Participants who experienced childhood trauma chose a shape that was distorted with respect to their actual figure. We believe that closing the eyes connects people to their inner emotions and influences their body appreciation. This will help patients identify and treat negative emotions so that they feel more comfortable with their bodies. [ABSTRACT FROM AUTHOR]

Background: Physical therapy is frequently utilized in the postoperative care of femoroacetabular impingement syndrome (FAIS). There has been limited research into the efficacy of a structured home exercise program (HEP) compared with formal physical therapy (FPT) in this patient population. Purpose/Hypothesis: The purpose was to evaluate the short-term outcomes of patients utilizing FPT versus an HEP after hip arthroscopic surgery for FAIS. It was hypothesized that both groups would show similar improvements regarding outcome scores, which would improve significantly compared with their preoperative scores. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing hip arthroscopic surgery for FAIS at a single center between October 2020 and October 2021 were prospectively enrolled. Patients were allowed to self-select FPT or an HEP and were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. The survey included the Single Assessment Numeric Evaluation, visual analog scale for pain, 12-item International Hip Outcome Tool, Patient-Reported Outcomes Measurement Information System Physical Function, and patient satisfaction with physical therapy and overall care. Statistical analysis was conducted between the 2 groups and within groups to compare preoperative and postoperative scores. Results: The patients' mean age was 32.6 ± 10.4 years, with 47.2% being female and 57.4% choosing the HEP. At 12 months postoperatively, no significant differences were reported between the FPT and HEP groups regarding the Single Assessment Numeric Evaluation score (P =.795), visual analog scale for pain score (P >.05), Patient-Reported Outcomes Measurement Information System Physical Function T-score (P =.699), 12-item International Hip Outcome Tool score (P =.582), and patient satisfaction (P >.05). Outcome scores at 12 months postoperatively were significantly improved from the preoperative scores across all measures in both groups (P <.001). Conclusion: There were no significant differences regarding patient outcomes between FPT and the HEP at 1-year follow-up after hip arthroscopic surgery for FAIS when patients selected their own treatment, with both groups demonstrating significant improvements in their outcome scores from their preoperative values. These findings suggest that a structured HEP may be a viable alternative to FPT after hip arthroscopic surgery in patients who prefer a self-directed rehabilitation program. [ABSTRACT FROM AUTHOR]

Background: Although pediatric medial epicondylar fractures and apophysitis are well studied, patterns of subapophyseal avulsion and ligamentous injuries of the medial elbow in this population merit investigation to inform optimal treatment strategies. Purpose: To describe the occurrence and demographic correlates of ulnar collateral ligament (UCL) avulsion and soft tissue injuries of the pediatric and adolescent elbow. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An institutional review board–approved review was conducted to identify consecutive patients with medial elbow injuries treated in a tertiary pediatric sports medicine practice between 2016 and 2021. Radiographs were obtained during injury evaluation, and patients with nondisplaced medial epicondylar apophysitis and complete epicondylar fracture were excluded, resulting in 150 patients with soft tissue injuries occurring distal to the medial epicondyle apophysis (subapophyseal) for study. Radiographs were evaluated for bony avulsion of the UCL from either the medial epicondyle proximally or the ulnar sublime tubercle distally. Injuries without radiographic evidence of bony avulsion, but with clinical examination findings consistent with ligamentous injury, were classified as radiographically negative UCL injuries, and magnetic resonance imaging (MRI) was performed to further evaluate these injuries if moderate to severe medial swelling of the elbow or significant concern for medial structural injury was present on examination. These MRI scans were evaluated to classify the UCL injury and assess for periosteal or cartilaginous avulsions. Results: A total of 150 patients (mean age, 12.5 ± 3.4 years; 70 female), 55% (150/274) of the entire medial elbow injury population, had a subapophyseal injury. Of these patients, 62 had a bony avulsion detected on radiograph, and 88 had a radiographically negative injury. In addition to the 62 radiographic avulsions, the 61 MRI scans obtained on those radiographically negative injuries revealed 33 complete UCL disruptions, resulting in 63.3% (95/150) of patients sustaining a complete ligamentous disruption. With the MRI scans, 37 (61%) cases of cartilaginous or periosteal avulsion of the UCL were diagnosed. Overall, 66% of all 150 subapophyseal injuries had a bony, cartilaginous, or periosteal UCL avulsion. Patients with cartilaginous (mean age, 10.3 years) and bony (mean age, 10.6 years) avulsions were younger than those with central ligament injury (mean age, 14.2 years) or periosteal (mean age, 14.2 years) avulsions (P =.005). There was a significant association between the mechanism of injury and the location of UCL tear identified on MRI scans: traumatic falls were associated with distal tears, and throwing injuries were associated with proximal tears (P <.001). Conclusion: UCL central ligament and avulsion lesions may be frequently diagnosed after injury to the pediatric medial elbow, the majority of which are complete injuries, and may require MRI for diagnosis. The mechanism of injury may predict the location of ligamentous injury, and osteocartilaginous avulsions are more likely to present at younger ages than injuries to the soft tissue of the UCL or periosteum. The prevalence of these injuries merits further investigation into best protocols of nonoperative treatment or surgical repair techniques and outcomes. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of literature evaluating long-term outcomes and survivorship of patients undergoing primary hip arthroscopy with capsular repair for femoroacetabular impingement syndrome (FAIS). Purpose: To report 10-year survivorship and patient-reported outcomes (PROs) after primary hip arthroscopy with capsular repair for FAIS and evaluate the effect of capsular repair in patients at the highest risk for conversion to arthroplasty. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed on all patients undergoing primary hip arthroscopy with capsular repair between October 2008 and February 2011. Patients with a minimum 10-year follow-up on the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale for pain (VAS) scores were selected. The preoperative and minimum 10-year follow-up Hip Outcome Score—Sports Specific Subscale (HOS-SSS) scores were also reported, if available. Patients with ipsilateral hip surgery, worker's compensation, Tönnis osteoarthritis grade >1, and hip dysplasia (lateral center-edge angle <25°) were excluded. Survivorship, PROS, and clinical benefit—minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS)—were reported. An additional propensity-matched subanalysis was performed on patients at the highest risk for conversion to arthroplasty, comparing patients undergoing capsular repair to patients with unrepaired capsules. Results: A total of 145 (n = 130 patients) out of 180 eligible hips (n = 165 patients) had a minimum 10-year follow-up (80.6%). Also, 126 hips (86.9%) belonged to women, and 19 hips (13.1%) belonged to men. The mean patient age was 30.3 ± 12.9 years. The survivorship rate was 91% at the 10-year follow-up. The cohort experienced significant improvements (P <.001) in the mHHS, NAHS, HOS-SSS, and VAS for pain scores. Moreover, the cohort achieved high rates of the PASS for the mHHS (89.8%), high rates of the MCID for the mHHS (82.4%), and high rates of the MCID for VAS for pain (80.6%) scores. In the propensity-matched subanalysis performed on patients with the highest risk for arthroplasty, 29 hips with capsular repair were matched to 81 hips with unrepaired capsules. While both groups experienced significant improvements in all PROs (P <.05), the group without capsule repair trended toward a higher conversion to arthroplasty rate when compared with the repair group. In addition, an odds ratio was calculated for the likelihood of converting to arthroplasty after having an unrepaired capsule compared with capsular repair (2.54 [95% CI, 0.873-7.37]; P =.087). Conclusion: Patients undergoing primary hip arthroscopy with capsular repair experienced a high survivorship rate of 91% at a minimum 10-year follow-up. Patients who did not convert to arthroplasty saw favorable improvements in PROs and achieved high clinical benefit rates. In addition, among those patients at the highest risk for conversion to arthroplasty, a trend toward greater survivorship was observed with capsular repair. [ABSTRACT FROM AUTHOR]

This study provides critical evidence of the diversity of college students' experiences with intimate partner violence (IPV) and their informal and formal help-seeking behaviors at a historically Black college and university (HBCU). The study collected data on college students (N = 266) in fall 2021 using a one-site cross-sectional survey data. Findings revealed that many students at the HBCU reported IPV victimization (68.4%), IPV perpetration (68.0%), and coexperience of IPV victimization and perpetration (61.3%) in the past 12 months, but a few student survivors of IPV sought help from formal or informal support systems. Further, we found that IPV victimization types (e.g., physical, psychological, sexual abuse, and injury) with different severity levels (e.g., less severe or more severe) were differently related to the student survivor's help-seeking behaviors from formal and informal support systems. The findings of this study highlight the importance of supporting students attending HBCUs by addressing their perceptions of IPV help-seeking and coping with different types of IPV victimization via culturally tailored IPV prevention programs. HBCU campuses should promote physical health and mental health services for Black/African American survivors in HBCUs. [ABSTRACT FROM AUTHOR]

Background: Influenza (flu) and COVID-19 vaccination rates are subpar across the US, especially in racial and/or socioeconomic minority groups who are understudied in public health literature. Objective: The objective of this mixed-methods study was to elucidate attitudes of patients at the Turtle Creek Primary Care Center, a clinic that cares for ∼70% non-white patients, towards flu and COVID-19 vaccines, with the goal of establishing vaccine education gaps and increasing vaccine uptake in minority communities. Design/Patients: This study was conducted as a cross-sectional analysis. Authors completed 123 patient phone surveys of patients cared for at the Turtle Creek clinic inquiring about flu and COVID-19 infection status and vaccination uptake (August 26–October 10, 2021). Approach/Key Results: We found that rates of vaccination were subpar in the Turtle Creek community, with only 54% having received the COVID-19 vaccine and only 44% receiving the flu vaccine regularly. There was a strong association between COVID-19 and flu vaccine acceptance and a notable correlation between vaccine acceptance and age. When assessing how vaccine acceptance was influenced by trusted sources of information, those who cited trusting "medical professionals" and "word of mouth" had higher odds of COVID-19 vaccine acceptance but those who cited trusting "social media" had decreased odds of acceptance. Finally, we uncovered 14 common factors for either vaccine acceptance or refusal that clustered into four overarching themes of trust, need, safety, and availability. Conclusion: These data highlight the necessity of improved vaccine education and reveal targetable populations and approaches for disseminating vaccine information. [ABSTRACT FROM AUTHOR]

Background: The consumer availability and automated response functions of chat generator pretrained transformer (ChatGPT-4), a large language model, poise this application to be utilized for patient health queries and may have a role in serving as an adjunct to minimize administrative and clinical burden. Purpose: To evaluate the ability of ChatGPT-4 to respond to patient inquiries concerning ulnar collateral ligament (UCL) injuries and compare these results with the performance of Google. Study Design: Cross-sectional study. Methods: Google Web Search was used as a benchmark, as it is the most widely used search engine worldwide and the only search engine that generates frequently asked questions (FAQs) when prompted with a query, allowing comparisons through a systematic approach. The query "ulnar collateral ligament reconstruction" was entered into Google, and the top 10 FAQs, answers, and their sources were recorded. ChatGPT-4 was prompted to perform a Google search of FAQs with the same query and to record the sources of answers for comparison. This process was again replicated to obtain 10 new questions requiring numeric instead of open-ended responses. Finally, responses were graded independently for clinical accuracy (grade 0 = inaccurate, grade 1 = somewhat accurate, grade 2 = accurate) by 2 fellowship-trained sports medicine surgeons (D.W.A, J.S.D.) blinded to the search engine and answer source. Results: ChatGPT-4 used a greater proportion of academic sources than Google to provide answers to the top 10 FAQs, although this was not statistically significant (90% vs 50%; P =.14). In terms of question overlap, 40% of the most common questions on Google and ChatGPT-4 were the same. When comparing FAQs with numeric responses, 20% of answers were completely overlapping, 30% demonstrated partial overlap, and the remaining 50% did not demonstrate any overlap. All sources used by ChatGPT-4 to answer these FAQs were academic, while only 20% of sources used by Google were academic (P =.0007). The remaining Google sources included social media (40%), medical practices (20%), single-surgeon websites (10%), and commercial websites (10%). The mean (± standard deviation) accuracy for answers given by ChatGPT-4 was significantly greater compared with Google for the top 10 FAQs (1.9 ± 0.2 vs 1.2 ± 0.6; P =.001) and top 10 questions with numeric answers (1.8 ± 0.4 vs 1 ± 0.8; P =.013). Conclusion: ChatGPT-4 is capable of providing responses with clinically relevant content concerning UCL injuries and reconstruction. ChatGPT-4 utilized a greater proportion of academic websites to provide responses to FAQs representative of patient inquiries compared with Google Web Search and provided significantly more accurate answers. Moving forward, ChatGPT has the potential to be used as a clinical adjunct when answering queries about UCL injuries and reconstruction, but further validation is warranted before integrated or autonomous use in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Disruption of the medial patellofemoral ligament (MPFL) may lead to recurrent lateral patellar dislocation and patellofemoral chondral injury. Despite significant previous work investigating numerous performance parameters, the optimal graft choice for MPFL reconstruction for patellar instability remains unclear. Purpose: To compare functional outcomes scores, subjective recurrent instability, and revision rates between autograft and allograft in MPFL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent MPFL reconstruction with autograft between 2013 and 2018 were identified. A 2:1 comparison group of patients who underwent MPFL reconstruction with allograft was matched by sex, age (±3 years), and body mass index (BMI) (±3 kg/m2). Patient characteristics, preoperative radiograph measurements, and intraoperative data were compared between the groups, as were patient-reported outcome measures, including International Knee Documentation Committee (IKDC) score, Lysholm score, Single Assessment Numerical Evaluation (SANE), and visual analog scale (VAS) for pain. Subjective recurrent instability and revision rate were also compared between groups. Results: The autograft group was composed of 30 patients (13 male, 17 female) with a mean age of 24.4 years and mean BMI of 25.0 kg/m2, and the allograft group was composed of 60 matched patients (25 male, 35 female) with a mean age of 24.1 years and mean BMI of 25.1 kg/m2. The autograft and allograft groups reported similar IKDC scores (73.0 vs 73.7; P =.678), Lysholm scores (77.5 vs 80.7; P =.514), SANE (72.0 vs 75.8; P =.236), and VAS pain (30.7 vs 26.6; P =.482), as well as similar rates of postoperative patellar subluxations (20.0% vs 19.3%; P =.867) and dislocations (10.0% vs 15.0%; P =.805). Conclusion: Both allograft and autograft were found to be viable options for MPFL reconstruction. There were no significant group differences in failure rates, patient-reported outcomes, pain, or complications between autograft and allograft MPFL reconstruction in this series. [ABSTRACT FROM AUTHOR]

Background: Head-down tackling has been associated with higher rates of head and neck injuries and less successful tackles compared with head-up tackling in American football. In rugby, head and neck injuries have been associated with tackling, with the tackler's head positioned in front of the ball carrier. Purpose: To assess the success and risks of tackling techniques used in the English Rugby Premiership matches. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three reviewers analyzed 1000 consecutive solo defensive tackling attempts during the 2022 to 2023 season in 6 English Rugby Premiership matches. Slow-motion replays were used to analyze the success of the tackling attempt in terms of head angulation (head up vs head down), head position relative to the offensive player's waist at point of contact, and tackling method (inside shoulder, arm, head across the bow, and head-to-head). The chi-square test or Fisher exact test was used to analyze categorical data, and the 2-tailed Student t test or the Mann-Whitney U test was used to analyze continuous data. Results: The mean interrater reliabilities for analyzing the tackles were good across all groups (κ = 0.715). Head-up and head-down tackling occurred in 848 tackle attempts (84.8%) and 152 tackle attempts (15.2%), respectively. Head-up tackles were successful in 80.7% of the tackle attempts compared with 71.1% of the head-down tackle attempts (P =.0072). Tackles made at or above the waist were successful in 80.7% of the tackle attempts compared with 73.1% of tackles below the waist (P =.0193). The inside-shoulder technique had the highest successful tackle rate at 90.8%, compared with 44.2% with the arm technique (P <.0001) and 72.4% with the head-across-the-bow technique (P <.0001). The inside-shoulder technique resulted in head-up tackling in 84.8% of players compared with 59.8% with the head-across-the-bow technique (P <.0001) and 94.9% with arm tackling (P =.0001). There were 4 recorded injuries to the tackler: 2 neck injuries, 1 shoulder injury, and 1 wrist/hand injury. Conclusion: Head-up tackling, tackles made at or above the level of the offensive player's waist, and inside-shoulder tackling were found to be more efficient in producing successful tackles. The head-down, tackling below the waist, and head-across-the-bow techniques were associated with poor tackling and lower success rates. [ABSTRACT FROM AUTHOR]

Body mass index (BMI) is routinely used to ascertain health status, including activities of daily living (ADLs); however, the associations of ADLs with height and weight in older adults have not been elucidated. Therefore, we cross-sectionally investigated the correlations between ADLs and height, weight, and BMI in 155 participants aged 82 to 103 years and characterized the naïve Bayesian prediction for ADLs. Activities of daily living showed a significant negative correlation with height and weight and a positive correlation with age. In males, a shorter height was associated with an increased risk of falling and disability in phone calling independently, and losing weight was associated with an increased risk of disability in going out. Combining age, weight, and height improved the area under the receiver operating characteristic curve in the prediction of disability in going out and phone calling independently in males. Therefore, height and weight, not BMI, are potential predictors of ADL decline. [ABSTRACT FROM AUTHOR]

Little is known about service utilization among female entertainment workers (FEWs) after experiencing gender-based violence (GBV). This study explored factors associated with post-GBV service utilization among FEWs in Cambodia. We included 299 FEWs, who experienced any forms of GBV in the past 12 months. This study highlights low access (14.05%) to post-GBV services among FEWs. Factors associated with post-GBV services utilization were marital status, living conditions, mental health, and types of entertainment venues. To improve post-GBV services utilization, ensuring quality, and availability of services are required. Further research is needed to develop pathways toward a supportive environment for FEWs to access these services. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the impact of sarcopenia on clinical outcomes after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). Methods: We retrospectively analyzed the medical records of patients with single-segment OVCF who underwent percutaneous kyphoplasty (PKP) between September 2021 and August 2022. Patients were categorized into a sarcopenia group (43 patients) and a non-sarcopenia group (125 patients) based on their Advanced Skeletal Muscle Index (ASMI). Clinical and radiological data were collected and analyzed. Results: There were no significant differences between the sarcopenia and non-sarcopenia groups in age, sex, bone mineral density (BMD), body mass index (BMI), fractured segment, fracture type, surgical approach, bone cement volume, bone cement distribution, comorbidities, preoperative and immediate postoperative VAS and ODI scores (P >.05). However, the time to ambulation, hospital stays, VAS and ODI scores at follow-up, excellent/good rate, and the incidence of residual pain and re-fractures in the non-sarcopenia group were significantly better than those in the sarcopenia group (P <.05). Meanwhile, radiological outcomes, including regional kyphosis and vertebral height loss rate, were significantly better in the non-sarcopenia group than in the sarcopenia group at 6 and 12 month follow-ups (P <.05). Conclusion: Clinical outcomes after PKP in patients with OVCF could be negatively affected by sarcopenia. Therefore, prevention and treatment of sarcopenia should be actively considered in the management of patients with OVCF. [ABSTRACT FROM AUTHOR]

Aims: To assess the prevalence and risk factors for chronic kidney disease (CKD) among adults with type 2 diabetes within primary care. Methods: This cross-sectional study evaluated 1319 individuals receiving standard care across 26 primary units from July 2017 to January 2023. The estimated glomerular filtration rate (eGFR) and albuminuria were used for the diagnosis of CKD. CKD was defined by eGFR values of <60 mL/min/1.73 m2 and/or albumin-to-creatine ratio ≥30 mg/g. Logistic regression was applied to identify factors associated with CKD and study variables. Results: The median age of participants (60.6% females) was 55 years and the median diabetes duration was 10 years. The overall CKD prevalence in the study population was 39.2%. Within the CKD group, the prevalence rates of albuminuria, albuminuria coupled with low eGFR and isolated low eGFR were 72.1%, 19%, and 8.9%, respectively. The prevalence of CKD was 30.6% among participants under 40 years old and a higher value was observed in middle-aged adults with early-onset diabetes (at age <40 years) compared with the later-onset group. Multivariable analyses identified associations between CKD and factors such as age, the male sex, diabetes duration, hypertension, retinopathy, and metformin use. Conclusion: A relatively high prevalence of CKD, especially in non-elderly adults, was revealed in this primary care study. Early recognition strategies for CKD are crucial for timely prevention within primary care. [ABSTRACT FROM AUTHOR]

Background: Pediatricians' offices are primary locations for pediatric influenza vaccination; however, pharmacists are also well-positioned as immunizers. Considering the current COVID-19 pandemic and Public Readiness and Emergency Preparedness (PREP) Act, pharmacists' authority to vaccinate children has been recently expanded. Methods: We used the de-identified Optum ClinformaticsTM Data Mart database to identify demographic and clinical predictors of pharmacist-administered pediatric influenza vaccination compared with influenza vaccination in pediatricians' offices. Procedures codes for influenza vaccinations among children were captured for the 2016-2017 influenza season. Logistic regression was used to identify significant predictors. Results: We included 336 841 children receiving influenza vaccines by a pharmacist (5.2%) or in pediatricians' offices (94.8%). The following significant predictors were identified: older pediatric age groups (13-17 years odds ratio [OR] 91.51, 5-12 years OR 35.41), states allowing pharmacist-administered influenza vaccination at younger ages (no age restrictions OR, 26.68, minimum age 2-4 years old OR, 33.76), influenza vaccination outside of pediatricians' offices in the previous year (pharmacist-administered OR, 22.18, convenience care OR 4.15, emergency care OR 1.69), geographic region (South OR, 2.02, Midwest OR 1.60, and West OR 1.38), and routine health exam or follow-up in the prior 6-months (OR, 1.59). Conclusions: The strongest drivers of pharmacist-administered pediatric influenza vaccination were older pediatric age, more lenient minimum age restrictions, and previous influenza vaccination in a pharmacy. Due to the COVID-19 pandemic, the PREP Act, and forthcoming pediatric COVID-19 vaccines for children, pharmacists may play a greater role in pediatric vaccination resulting in sustained changes in pediatric vaccination practices. [ABSTRACT FROM AUTHOR]

Background: Patients with borderline hip dysplasia (BHD) and concomitant femoroacetabular impingement syndrome (FAIS) have demonstrated similar outcomes at short- and midterm follow-up compared with equivalent patients without dysplasia. However, comparisons between these groups at long-term follow-up have yet to be investigated. Purpose: To compare long-term clinical outcomes between patients with BHD undergoing primary hip arthroscopy for FAIS versus matched control patients without BHD. Study Design: Cohort study; Level of evidence, 2. Methods: A retrospective cohort study was conducted on patients with BHD (lateral center-edge angle, 18°-25°) who underwent hip arthroscopy for FAIS between January 2012 and February 2013. Patients were propensity matched in a 1:3 ratio by age, sex, and body mass index to control patients without BHD who underwent primary hip arthroscopy. Groups were compared in terms of patient-reported outcomes (PROs) preoperatively and at 10 years postoperatively, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score, 12-item International Hip Outcome Tool, visual analog scale (VAS) for pain and satisfaction. Achievement rates for minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were compared between groups. Kaplan-Meier survivorship curves were assessed between groups. Results: At a mean follow-up of 10.3 ± 0.3 years, 28 patients with BHD (20 women; age, 30.8 ± 10.8 years) were matched to 84 controls who underwent primary hip arthroscopy. Both groups significantly improved from preoperative assessment in all PRO measures at 10 years (P <.001 for all). PRO scores were similar between groups, aside from HOS-SS (BHD, 62.9 ± 31.9 vs controls, 80.1 ± 26.0; P =.030). Rates of MCID achievement were similar between groups for all PROs (HOS-ADL: BHD, 76.2% vs controls, 67.9%, P =.580; HOS-SS: BHD, 63.2% vs controls, 69.4%, P =.773; modified Harris Hip Score: BHD, 76.5% vs controls, 67.9%, P =.561; VAS pain: BHD, 75.0% vs controls, 91.7%, P =.110). Rates of PASS achievement were significantly lower in the BHD group for HOS-ADL (BHD, 39.1% vs controls, 77.4%; P =.002), HOS-SS (BHD, 45.5% vs controls, 84.7%; P =.001), and VAS pain (BHD, 50.0% vs controls, 78.5%; P =.015). No significant difference was found in the rate of subsequent reoperation on the index hip between groups. Kaplan-Meier survival analysis demonstrated comparable survivorship at long-term follow-up (P =.645). Conclusion: After primary hip arthroscopy, patients with BHD in the setting of FAIS had significantly improved PRO scores at 10-year follow-up, comparable with propensity-matched controls without BHD. Rates of MCID achievement were similar between groups, although patients with BHD had lower rates of PASS achievement. Patients with BHD had similar long-term hip arthroscopy survivorship compared with controls, with no significant difference in rates of revision hip arthroscopy or conversion to total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: The incremental biological changes in the synovial microenvironment of the shoulder in acute and chronic instability that may contribute to joint degeneration are poorly understood. Proteomic analysis of synovial fluid in patients with shoulder instability may improve our understanding of proteins that are shed into shoulder synovial fluid after an injury. Hypothesis: Injury-specific factors such as the direction of instability and the severity of glenoid and humeral bone loss are associated with the proteome of synovial fluid in patients with shoulder instability. Study Design: Descriptive laboratory study. Methods: Synovial fluid lavage samples were compared between patients with anterior (n = 12) and posterior (n = 8) instability and those without instability (n = 5). Synovial proteins were identified with liquid chromatography–tandem mass spectrometry. Orthogonal validation of protein targets found to be significant on tandem mass spectrometry was performed in a separate set of prospective patients with Western blotting. Data were processed and analyzed, and P values were adjusted with the Benjamini-Hochberg method for multiple comparisons. Results: A total of 25 patients were included. Tandem mass spectrometry identified 720 protein groups in synovial fluid of patients with shoulder instability. There were 4 synovial proteins that were significantly expressed in patients with anterior instability relative to posterior instability: periostin (POSTN) (adjusted P value =.03; log fold change [logFc] = 4.7), transforming growth factor beta–induced protein ig-h3 (adjusted P value =.05; logFc = 1.7), collagen type VI alpha-3 chain (adjusted P value =.04; logFc = 2.6), and coagulation factor V (adjusted P value =.04; logFc = −3.3). Among these targets, POSTN showed a moderate correlation with the Hill-Sachs lesion size (r = 0.7). Prospective validation with Western blotting confirmed a significantly higher level of POSTN in synovial fluid of patients with anterior instability (P =.00025; logFc = 5.1). Conclusion: Proteomic analysis enriched our understanding of proteins that were secreted into shoulder synovial fluid of patients with shoulder instability. The identification of POSTN, a proinflammatory catabolic protein involved with tissue remodeling and repair, as a significant target in anterior shoulder instability is a novel finding. Therefore, further study is warranted to determine the role that POSTN may play in the progression of bone loss and posttraumatic osteoarthritis. Clinical Relevance: Proteomic analysis of synovial fluid in patients with shoulder instability improved our understanding of this abnormality after an injury. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is a successful procedure in treatment of degenerative disease of the knee, and optimal component placement is essential for long-term implant survival. The purpose of this study was to compare the accuracy of the accelerometer-based KneeAlign 2 (KA2) navigation system against conventional methods for accurate positioning of the femoral and tibial components in TKA in a Chinese population. Methods: A total of 123 (37 conventional and 86 KA2) cases of elective primary TKA were reviewed. Hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), and anatomical lateral distal femoral angle (aLDFA) were measured from hip-to-ankle EOS radiographs. Accuracy of conventional alignment and KA2 navigation system was assessed by measuring the difference between intraoperative goal and postoperative radiographic measurements of the components for each respective case. Results: There was no significant difference between conventional alignment methods and KA2 navigation in achieving a neutral mechanical alignment of the lower limb. KA2 navigation was significantly more accurate than conventional alignment methods for optimal positioning of the tibial component in both the coronal and sagittal plane, while no significant difference between the two groups was appreciated in the positioning of the femoral component in the coronal plane. Conclusions: TKA using the accelerometer-based KA2 system was found to offer a high degree of accuracy in component alignment, and in particular, significantly improved tibial component alignment in comparison with conventional alignment methods in a Chinese population. However, no significant improvements were observed in neutral mechanical axis of the lower limb alignment and femoral component placement in the coronal plane. [ABSTRACT FROM AUTHOR]

Introduction: In India, the incidence of coronary artery disease (CAD) has doubled, and the association between diabetes mellitus, peripheral arterial disease, and CAD remains unclear. This study aimed to explore the relationship between ankle-brachial index (ABI) and CAD in diabetic patients, using the ABI as a diagnostic tool for peripheral arterial disease. Materials and Methods: A cross-sectional study at a tertiary care center analyzed 100 diabetes cases for CAD using angina history, past treatment, electrocardiography, and two-dimensional echocardiography. Blood pressure was measured in all limbs, and ABI was calculated by dividing ankle pressure by brachial pressure, selecting the lower ratio. Results: Out of 100 patients, 28 had ABI <0.9 and 72 had ABI ≥0.9. The majority of both groups were male. The highest percentage in both groups was aged 51–60. The ABI +VE group had higher proportions of hypertension, smokers, and dyslipidemia. The majority in the ABI −VE group were nonsmokers and without dyslipidemia. Both groups had a majority with body mass index ≥25 kg/m2. Mean diabetes duration was higher in the ABI +VE group, while mean glycated hemoglobin levels were higher in the ABI −VE group. Conclusion: In our study, the prevalence of ABI +VE patients was 28% and prevalence of CAD in this group was 42.85%, which is statistically significant. Hypertension, smoking, dyslipidemia, diabetes duration, and glycemic control were significantly associated with low ABI index (ABI <0.9). [ABSTRACT FROM AUTHOR]

Objective: To examine the current trends and practices across disciplines for feeding infants with cleft palate with or without cleft lip and to describe provider training within this area Design: Prospective survey Setting: ACPA approved cleft palate teams and healthcare providers in the United States and Canada Participants: Interdisciplinary providers that regularly provide feeding services to infants with cleft palate Intervention: 50-item survey designed and distributed electronically via the ACPA Main Outcome Measures: Information on provider demographics and practice patterns Results: 76 respondents included providers in North America that have either currently or previously served on a cleft palate team. The majority of respondents were in speech-language pathology (49%) or nursing (38%) disciplines, worked in an outpatient setting (70%), and received no information (68%) regarding cleft palate feeding in their academic training. While specific practice patterns were relatively consistent across the respondent cohort, provider characteristics were significantly associated with squeezing the Haberman (p =.013) and likelihood of collaboration with other providers when counseling parents/caregivers (p =.039). Conclusions: While provider characteristics varied, there were similar practice patterns observed across disciplines. Future research is needed explore training related to feeding knowledge as well as practice patterns in locations with a lower patient volume. [ABSTRACT FROM AUTHOR]

Background: Pickleball is one of the fastest-growing sports in the United States, with more than an 11-fold increase in injuries from 2010 to 2019. Purpose: To (1) determine the prevalence and demographic variables associated with pickleball-related fractures among patients evaluated at emergency departments in the United States between 2002 and 2022 and (2) identify variables influencing patient disposition status. Study Design: Descriptive epidemiology study. Methods: The US Consumer Product Safety and Commission's publicly available database, the National Electronic Injury Surveillance System (NEISS), was used in this study. Analyses consisted of descriptive statistics for fracture prevalence and demographic variables as well as univariate analysis for disposition status (discharged home vs hospital admission). Results: A total of 397 pickleball-related fractures were recorded between 2002 and 2022, which indicated a 90-fold increase in our study period. Based on weighted national average of NEISS sampling, this equated to approximately 5400 fractures annually. Players who sustained pickleball fractures were primarily aged >60 years (n = 344 [87%]; P <.001) and female (n = 273 [69%]; P <.001). Most fractures involved the upper extremity (n = 262 [66%]; P <.001), with the most common ones involving the radius (n = 79 [30%]), humerus (n = 22 [8%]), and ulna (n = 8 [3%]). Fractures were due most commonly to falls (n = 365 [92%]; P <.001) and occurred in the winter months (n = 142 [36%]; P <.001). There was a significant difference in disposition status, with most patients discharged (n = 320 [81%] vs n = 77 [19%] for hospital admission; P <.001). Univariate analysis revealed that age >60 years, male sex, and fractures to the trunk and lower extremity all led to significantly increased odds of being admitted (odds ratios: 2.27, 2.31, 2.89, and 13.8, respectively). Conclusion: Between 2002 and 2022, there was a 90-fold increase in pickleball-related fractures. Most fractures were of the upper extremity after a fall in women aged >60 years. Despite female fracture predominance, men were 2.3 times more likely to be admitted after sustaining a fracture. [ABSTRACT FROM AUTHOR]

Background: The effect of local corticosteroid (CS) injections on rotator cuff muscles remains poorly defined, despite the significance of muscle quality as a crucial prognostic factor for patients with rotator cuff tears (RCTs). Purpose: To compare alterations in gene and protein expression patterns in the rotator cuff muscles of patients with RCTs who received frequent joint CS injections with alterations in those without a history of CS injections. Study Design: Controlled laboratory study. Methods: A total of 24 rotator cuff muscle samples with medium-sized tears from 12 patients with a frequent joint CS injection history (steroid group; 7 men and 5 women who had received ≥5 injections with at least 1 within the previous 3 months; mean age, 63.0 ± 7.2 years) and 12 age- and sex-matched control patients without a history of CS injections (no-steroid group) were acquired. Alterations in the expression of genes and proteins associated with adipogenesis, myogenesis, inflammation, and muscle fibrosis were compared between the groups using quantitative reverse transcription–polymerase chain reaction, Western blotting, and immunohistochemistry. Statistical analysis included comparison of group means using the Mann-Whitney U test, chi-square test, or Fisher exact test and logistic regression for multivariate analysis. Results: In the steroid group, the mRNA expression levels of adipogenic CCAAT/enhancer-binding protein alpha (C/EBPα; P =.008) and muscle atrophy–related genes (atrogin; P =.019) were significantly higher, and those of myogenic differentiation 1 (MyoD; P =.035), inflammatory interleukin 6 (IL-6; P =.035), and high mobility group box 1 (P =.003) were significantly lower compared with the no-steroid group. In addition, MyoD (P =.041) and IL-6 (P =.026) expression were decreased in the steroid versus no-steroid group. Immunohistochemistry revealed increased expression of C/EBPα and atrogin and decreased expression of MyoD and IL-6 in the steroid versus no-steroid group. Conclusion: Patients with RCTs and a history of frequent CS injections exhibited an upregulation of adipogenic and muscle atrophy–related genes and proteins within the rotator cuff muscles and a downregulation in the expression of myogenic and inflammatory genes and proteins in the same muscles. Clinical Relevance: These altered gene and protein expressions by frequent local CS injections may cause poor outcomes in patients with RCTs. [ABSTRACT FROM AUTHOR]

Background: While vaccines have reduced the incidence of vaccine-preventable diseases, vaccine hesitancy threatens the re-emergence of childhood infectious diseases. Purpose: This randomized controlled study evaluated an online vaccine education program to advance vaccine acceptance among middle-school students. Methodology: Study participants were randomly assigned to an intervention group who viewed the VEP videos or to a comparison group who viewed a science-based video unrelated to vaccines. Results: Knowledge scores improved in both groups and more favorable shifts in vaccine-related beliefs and attitudes occurred in the intervention than in the comparison group. Conclusions: This program can be feasibly delivered via an online platform to middle school students, resulting in shifts in vaccine-related knowledge, beliefs and attitudes. Implications: Delivering evidence-based content to instruct about vaccine effectiveness and safety is an area in which school nurses have demonstrated an important role as a resource for patient education to promote vaccine advocacy. [ABSTRACT FROM AUTHOR]