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Background: The use of artificial turf in American football continues to grow in popularity, and the effect of these playing surfaces on athletic injuries remains controversial. Knee injuries account for a significant portion of injuries in the National Collegiate Athletic Association (NCAA) football league; however, the effect of artificial surfaces on knee injuries remains ill-defined. Hypothesis: There is no difference in the rate or mechanism of knee ligament and meniscal injuries during NCAA football events on natural grass and artificial turf playing surfaces. Study Design: Descriptive epidemiology study. Methods: The NCAA Injury Surveillance System Men's Football Injury and Exposure Data Sets for the 2004-2005 through 2013-2014 seasons were analyzed to determine the incidence of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), medial meniscus, and lateral meniscal tear injuries. Injury rates were calculated per 10,000 athlete exposures, and rate ratios (RRs) were used to compare injury rates during practices and competitions on natural grass and artificial turf in NCAA football as a whole and by competition level (Divisions I, Divisions II and III). Mechanisms of injury were calculated for each injury on natural grass and artificial turf surfaces. Results: A total of 3,009,205 athlete exposures and 2460 knee injuries were reported from 2004 to 2014: 1389 MCL, 522 ACL, 269 lateral meniscal, 164 medial meniscal, and 116 PCL. Athletes experienced all knee injuries at a significantly higher rate when participating in competitions as compared with practices. Athletes participating in competitions on artificial turf experienced PCL injuries at 2.94 times the rate as those playing on grass (RR = 2.94; 95% CI, 1.61-5.68). When stratified by competition level, Division I athletes participating in competitions on artificial turf experienced PCL injuries at 2.99 times the rate as those playing on grass (RR = 2.99; 95% CI, 1.39-6.99), and athletes in lower NCAA divisions (II and III) experienced ACL injuries at 1.63 times the rate (RR = 1.63; 95% CI, 1.10-2.45) and PCL injuries at 3.13 times the rate (RR = 3.13; 95% CI, 1.14-10.69) on artificial turf as compared with grass. There was no statistically significant difference in the rate of MCL, medial meniscal, or lateral meniscal injuries on artificial turf versus grass when stratified by event type or level of NCAA competition. No difference was found in the mechanisms of knee injuries on natural grass and artificial turf. Conclusion: Artificial turf is an important risk factor for specific knee ligament injuries in NCAA football. Injury rates for PCL tears were significantly increased during competitions played on artificial turf as compared with natural grass. Lower NCAA divisions (II and III) also showed higher rates of ACL injuries during competitions on artificial turf versus natural grass. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the 2010 round table discussion titled "Workable Health Systems: Potential Implementation Strategies." Background on the signing of the health care reform law by U.S. President Barack Obama on March 23 is offered. Topics discussed include medical care costs, quality of health care, social determinants of health and systems integration, among others. Also tackled is the health care spending of the U.S. government.

Purpose: To review the published literature on the use of levodopa/carbidopa to augment the treatment of amblyopia., Methods: Literature searches for English language studies were last conducted in October 2022 in the PubMed database with no date restrictions. The combined searches yielded 55 articles, of which 23 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Nine studies were rated level I, and 3 studies were rated level II; there were no level III studies., Results: The duration of treatment was limited to 3 to 16 weeks because of concern about long-term adverse effects such as tardive dyskinesia. This complication was not reported in any of the study participants. The dose of levodopa ranged from 1.5 to 8.3 mg/kg/day, generally divided into 3 daily doses. The carbidopa dose was approximately 25% of the levodopa dose in all treatments. Evidence from these studies indicates that augmenting traditional patch occlusion therapy with the oral administration of levodopa/carbidopa can improve the vision of amblyopic children, but the effect was small (0.17-0.3 logarithm of the minimum angle of resolution [logMAR] units) and only statistically significant when compared with patching alone in 2 of the 12 studies cited. Regression of vision was reported in the majority of studies (9 of 12 reported; range, 0-0.17 logMAR unit regression) after discontinuation of therapy. Short-term side effects of the medications were not consistently reported but were most frequently mild and included headache and nausea., Conclusions: The best available evidence is currently insufficient to show that augmenting amblyopia therapy using up to 16 weeks of levodopa/carbidopa will result in meaningful improvement in visual acuity. Given the potential for significant side effects such as tardive dyskinesia with long-term therapy, levodopa/carbidopa does not appear to be a viable option for amblyopia therapy FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

The development of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) results in impaired physical function and quality of life. However, limited data exist regarding the employment and financial impact on patients and caregivers. The objective of this study was to examine the impact of chronic GVHD on patient employment, disability leave, income, reliance on caregivers, and effects on caregiver employment. The Living With Chronic GVHD Patient Survey was a cross-sectional online survey administered from May to August 2020 in the United States to adult HSCT survivors diagnosed with chronic GVHD within the past 5 years. Data on respondent demographics and disease characteristics and the effects of chronic GVHD on employment, income, and need for caregiver assistance were collected. Respondents also were asked to report on the impact of their chronic GVHD on their caregivers' employment. All data were summarized using descriptive statistics; no formal statistical comparisons were conducted. A total of 165 respondents completed the survey (median age, 57.0 years; 63.6% women; 83.0% white). The respondents had been experiencing chronic GVHD for a median of 4.5 years (range, .1 to 36.7 years), with a median of .5 years (range, 0 to 3.6 years) from the most recent transplantation to chronic GVHD diagnosis. Among those employed full- or part-time at the time of their most recent transplantation (n = 80), 61.3% reported taking disability leave, 58.8% worked reduced hours, 27.5% took a less demanding job, and 33.8% left a job because of chronic GVHD. Additionally, 71.3% believed they had lost income due to chronic GVHD. Among all respondents, 72.1% reported receiving regular caregiver assistance. Respondents commonly reported employment changes among unpaid caregivers; 34.5% reduced their working hours, and 16.6% left a job). HSCT survivors who develop chronic GVHD are vulnerable to employment changes and financial hardship. This analysis highlights the need for effective therapies and improved symptom management to reduce the multifaceted burden of chronic GVHD on patients and their caregivers and ultimately improve long-term HSCT outcomes., (Copyright © 2023. Published by Elsevier Inc.)

Objectives: The aim of this study was to investigate the safety and in-hospital outcomes of transcutaneous lead extraction (TLE) associated with device-related infection (DRI) in the United States from 2003 to 2015., Background: DRI remains the most serious complication and the most common indication for lead extraction in patients with cardiac implantable electronic devices. The rates of DRI and associated lead extraction have been growing in line with the increasing number of cardiac implantable electronic device implantations worldwide., Methods: Data for this study were drawn from the National (Nationwide) Inpatient Sample. The International Classification of Diseases-9th Revision-Clinical Modification coding system was used to identify hospitalizations with TLE for DRI and to investigate the rates of major adverse events., Results: From a total of approximately 100 million unweighted hospitalizations over the 13-year study period, 12,257 unweighted observations were identified. This represents 59,082 (95% confidence interval [CI]: 58,982 to 59,182) patients who underwent TLE for DRI during the study period. A large majority of patients (75%) were older than 60 years. Patients were predominantly male (70%) and Caucasian (76%), and 80% had at least 1 comorbidity. The median length of stay was 8 days (interquartile range 5 to 14 days). At least 1 major adverse event occurred in 10.42% of procedures. The all-cause in-hospital mortality rate was 4.11%. Independent predictors of mortality were weight loss (adjusted odds ratio [aOR]: 4.02; 95% CI: 3.13 to 5.17), congestive heart failure (aOR: 3.28; 95% CI: 2.48 to 4.34), chronic kidney disease (aOR: 2.09; 95% CI: 1.70 to 2.56), pericardial complications (aOR: 2.87; 95% CI: 1.79 to 4.61), and procedure-related pulmonary injury (aOR: 2.06; 95% CI: 1.25 to 3.40)., Conclusions: These results reflect the high rate of complications and mortality for TLE due to DRI in real-world experience, highlighting the importance of comorbidities, especially congestive heart failure and chronic kidney disease, as significant predictors of mortality in these patients., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Cancer treatment evolves through oncology clinical trials. Cancer trials are multimodal and complex. Assuring high-quality data are available to answer not only study objectives but also questions not anticipated at study initiation is the role of quality assurance. The National Cancer Institute reorganized its cancer clinical trials program in 2014. The National Clinical Trials Network (NCTN) was formed and within it was established a Diagnostic Imaging and Radiation Therapy Quality Assurance Organization. This organization is Imaging and Radiation Oncology Core, the Imaging and Radiation Oncology Core Group, consisting of 6 quality assurance centers that provide imaging and radiation therapy quality assurance for the NCTN. Sophisticated imaging is used for cancer diagnosis, treatment, and management as well as for image-driven technologies to plan and execute radiation treatment. Integration of imaging and radiation oncology data acquisition, review, management, and archive strategies are essential for trial compliance and future research. Lessons learned from previous trials are and provide evidence to support diagnostic imaging and radiation therapy data acquisition in NCTN trials., (Copyright © 2016 Elsevier Inc. All rights reserved.)

This report describes the current state of flattening filter-free (FFF) radiotherapy beams implemented on conventional linear accelerators, and is aimed primarily at practicing medical physicists. The Therapy Emerging Technology Assessment Work Group of the American Association of Physicists in Medicine (AAPM) formed a writing group to assess FFF technology. The published literature on FFF technology was reviewed, along with technical specifications provided by vendors. Based on this information, supplemented by the clinical experience of the group members, consensus guidelines and recommendations for implementation of FFF technology were developed. Areas in need of further investigation were identified. Removing the flattening filter increases beam intensity, especially near the central axis. Increased intensity reduces treatment time, especially for high-dose stereotactic radiotherapy/radiosurgery (SRT/SRS). Furthermore, removing the flattening filter reduces out-of-field dose and improves beam modeling accuracy. FFF beams are advantageous for small field (e.g., SRS) treatments and are appropriate for intensity-modulated radiotherapy (IMRT). For conventional 3D radiotherapy of large targets, FFF beams may be disadvantageous compared to flattened beams because of the heterogeneity of FFF beam across the target (unless modulation is employed). For any application, the nonflat beam characteristics and substantially higher dose rates require consideration during the commissioning and quality assurance processes relative to flattened beams, and the appropriate clinical use of the technology needs to be identified. Consideration also needs to be given to these unique characteristics when undertaking facility planning. Several areas still warrant further research and development. Recommendations pertinent to FFF technology, including acceptance testing, commissioning, quality assurance, radiation safety, and facility planning, are presented. Examples of clinical applications are provided. Several of the areas in which future research and development are needed are also indicated.

Introduction: The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients., Materials and Methods: Patients were retrospectively categorized as stable or borderline unstable depending on the presence of at least one of the following: ISS >40, ISS >20 and chest injury, exploratory laparotomy or thoracotomy, lactate >2.5 mEq/L, platelet <110,000/mm(3), or >10 U PRBCs transfused pre-operatively. Surgical morbidity, complications, and neurologic improvement between the two groups were compared retrospectively., Results: 30 casualties underwent 31 spine surgeries during a 12-month period. 16 of 30 patients met criteria indicating a borderline unstable patient. Although there were no significant differences in the procedures performed for stable and borderline unstable patients as measured by the Surgical Invasiveness Index (7.5 vs. 6.9, p = 0.8), borderline unstable patients had significantly higher operative time (4.3 vs. 3.0 h, p = 0.01), blood loss (1,372 vs. 366 mL, p = 0.001), PRBCs transfused intra-op (3.88 vs. 0.14 U, p < 0.001), and total PRBCs transfused in theater (10.18 vs. 0.31 U, p < 0.001)., Conclusions: The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.

Asbestosis is defined as diffuse pulmonary fibrosis caused by the inhalation of excessive amounts of asbestos fibers. Pathologically, both pulmonary fibrosis of a particular pattern and evidence of excess asbestos in the lungs must be present. Clinically, the disease usually progresses slowly, with a typical latent period of more than 20 years from first exposure to onset of symptoms., Differential Diagnosis: IDIOPATHIC PULMONARY FIBROSIS: The pulmonary fibrosis of asbestosis is interstitial and has a basal subpleural distribution, similar to that seen in idiopathic pulmonary fibrosis, which is the principal differential diagnosis. However, there are differences between the 2 diseases apart from the presence or absence of asbestos. First, the interstitial fibrosis of asbestosis is accompanied by very little inflammation, which, although not marked, is better developed in idiopathic pulmonary fibrosis. Second, in keeping with the slow tempo of the disease, the fibroblastic foci that characterize idiopathic pulmonary fibrosis are infrequent in asbestosis. Third, asbestosis is almost always accompanied by mild fibrosis of the visceral pleura, a feature that is rare in idiopathic pulmonary fibrosis., Differential Diagnosis: RESPIRATORY BRONCHIOLITIS: Asbestosis is believed to start in the region of the respiratory bronchiole and gradually extends outward to involve more and more of the lung acinus, until the separate foci of fibrosis link, resulting in the characteristically diffuse pattern of the disease. These early stages of the disease are diagnostically problematic because similar centriacinar fibrosis is often seen in cigarette smokers and is characteristic of mixed-dust pneumoconiosis. Fibrosis limited to the walls of the bronchioles does not represent asbestosis., Role of Asbestos Bodies: Histologic evidence of asbestos inhalation is provided by the identification of asbestos bodies either lying freely in the air spaces or embedded in the interstitial fibrosis. Asbestos bodies are distinguished from other ferruginous bodies by their thin, transparent core. Two or more asbestos bodies per square centimeter of a 5- mu m-thick lung section, in combination with interstitial fibrosis of the appropriate pattern, are indicative of asbestosis. Fewer asbestos bodies do not necessarily exclude a diagnosis of asbestosis, but evidence of excess asbestos would then require quantitative studies performed on lung digests., Role of Fiber Analysis: Quantification of asbestos load may be performed on lung digests or bronchoalveolar lavage material, employing either light microscopy, scanning electron microscopy, or transmission electron microscopy. Whichever technique is employed, the results are only dependable if the laboratory is well practiced in the method chosen, frequently performs such analyses, and the results are compared with those obtained by the same laboratory applying the same technique to a control population.

Objective: To assess what effect organizational, funding, and system changes in the health care environment may have on rehabilitation research., Design: National survey., Setting: Academic and clinical research programs., Participants: A total of 138 physicians participated in the survey., Intervention: Mailed instrument requesting information on demographics, research activities, and indicators of change., Main Outcome Measures: Percentage of respondents reporting specific perceptions on (1) how academic and research programs are affected by organizational changes, (2) availability of research funds, and (3) the overall impact that health care changes have on research; between-group comparisons on survey responses., Results: Usable responses were obtained from 138 physicians (response rate, 42.5%). Responding physicians reported workplace changes that included organizational restructuring (32.6%), affiliation with managed care plans (24%), and staff decreases (45.9%). Over half (54.8%) indicated that facility changes had detracted from their abilities to conduct research. A third (34.8%) reported declines in numbers of inpatient beds, and 89.6% reported decreased length of stay (LOS). Decreased LOS was cited as detracting from ongoing research by 36.6% and as discouraging new research by 33.3% of respondents. Although not reflected in measures of scholarly productivity, 53.6% reported having less time to devote to scholarship and 48.5% reported decreased professional activities. Over two thirds (67.4%) of responding physicians indicated that health care system changes had a negative impact on current research, and 54.5% indicated that such changes made it less likely that they would pursue new research., Conclusion: Changes in the health care system have had a dampening effect on rehabilitation physicians' research pursuits., (Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

During the creation of a university digital library and press intended to serve as a medical reference and education tool for health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving. The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing lessons learned and outline the challenges facing university digital libraries and presses.

As the federal administration advances the idea of the "information superhighway," many disciplines are being challenged to find ways to use advanced telecommunications to improve access to information, enhance learning opportunities, and achieve higher levels of international competitiveness. Telemedicine, the use of communications technology in the practice of medicine, may change the way rural health care is provided by improving access to medical information, diagnostic tools, and consultations. The information and health care services required by health care professionals are rapidly changing, and dissemination of this information to isolated practitioners has proven to be difficult. By providing support electronically from a central site, the most current information is more readily available. Using test-bed hospitals in rural and urban settings, the National Library of Medicine-funded National Laboratory for the Study of Rural Telemedicine at the University of Iowa is currently developing the necessary infrastructure to support targeted projects studying how telemedicine applications can be made more effective and readily available.

Board members charged with a facility's stewardship should include executives among the key assets involved, and the way to assure executive compensation committee, says Jos. Michael Galvin.

The evaluation of chest pain in the postoperative coronary artery bypass graft patient is an important part of the cardiologist's and cardiothoracic surgeon's practice. Ultrafast computed tomography, by virtue of its speed and 0.75- to 1.5-mm spatial resolution, can detect graft patency with sensitivities of 93% to 96% and specificities of 86% to 100% in 94.2% of patients studied. Although image resolution is insufficient to demonstrate graft stenosis or sequential anastomoses, ultrafast computed tomography is becoming an increasingly important, minimally invasive imaging modality for the evaluation of coronary artery bypass graft patency.