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Background: Patellofemoral instability (PFI) occurs most commonly in pediatric and adolescent patients, with evolving indications for surgery and changes in surgical techniques over the past decade. Purpose: To characterize the demographic, clinical, and radiologic characteristics of a large cohort of patients undergoing PFI surgery and investigate longitudinal trends in techniques utilized over a 10-year period at a tertiary-care academic center. Study Design: Case series; Level of evidence, 4. Methods: Electronic medical records of patients younger than 25 years of age who underwent primary surgery for lateral PFI from 2008 to 2017 at a single center by 1 of 5 different sports medicine surgeons were retrospectively reviewed. Demographic, clinical, and radiographic parameters of instability were analyzed. Routine surgical techniques included medial retinacular plication/reefing/repair (MRP), medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy (TTO), or a combination thereof, with or without lateral retinacular release (LR) or lateral retinacular lengthening (LRL). Exclusion criteria, selected for potentially altering routine surgical indications or techniques, included fixed/syndromic PFI, a formally diagnosed collagen disorder, cases in which a chondral/osteochondral shear fragment underwent fixation or was >1 cm in diameter, and body mass index >30 kg/m2. Results: Of the 492 study patients (556 knees; 71% female; median age, 15.2 years; 38% open physes), 88% were athletes, with the most common sports participated in being soccer, basketball, dance, football, gymnastics, and baseball/softball. While 91% of the cohort had recurrent dislocations, the 9% with primary dislocations were more likely to have small osteochondral fractures/loose bodies (P <.001). Female patients were younger (P =.002), with greater patellar tilt (P =.005) than male patients. Utilization of MPFLR and TTO increased significantly over the study period, while use of MRP+LR decreased. Conclusion: Most patients younger than 25 years of age who underwent PFI surgery were skeletally immature, female, and athletes and had recurrent dislocations. The <10% who had primary dislocations and underwent surgery were likely to have osteochondral fractures. Surgical techniques have changed significantly over time, with increasing use of TTO and MPFLR, while the use of MRP+LR/LRL has significantly decreased. [ABSTRACT FROM AUTHOR]

Purpose: Patellofemoral instability is a common cause of knee pain and dysfunction in paediatric and adolescent patients. The purpose of the study was to evaluate the frequency of patellar dislocations seen in emergency departments (EDs) and the rates of surgical procedures for patellar instability at paediatric hospitals in the United States between 2004 and 2014. Methods: The Pediatric Health Information System database was queried for all paediatric patients who underwent surgery for patellar instability or were seen in the ED for acute patellar dislocation between 2004 and 2014. This was compared with the annual numbers of overall orthopaedic surgical procedures. Results: Between 2004 and 2014, there were 3481 patellar instability procedures and 447 285 overall orthopaedic surgical procedures performed at the included institutions, suggesting a rate of 7.8 per 1000 orthopaedic surgeries. An additional 5244 patellar dislocations treated in EDs were identified. Between 2004 and 2014, the number of patellar instability procedures increased 2.1-fold (95% confidence interval (CI) 1.4 to 3.0), while orthopaedic surgical procedures increased 1.7-fold (95% CI 1.3 to 2.0), suggesting a 1.2-fold relative increase in patellar instability procedures, compared with total paediatric orthopaedic surgeries. Conclusion: This study shows a significant rise in the rate of acute patellar instability treatment events in paediatric and adolescent patients across the country. Surgery for patellar instability also increased over the study period, though only slightly more than the rate of all paediatric orthopaedic surgical procedures. This may suggest that increasing youth sports participation may be leading to a spectrum of increasing injuries and associated surgeries in children. [ABSTRACT FROM AUTHOR]

Responsibility center management (RCM) budgeting systems devolve budget responsibility while creating funding formulas that provide incentives for academic units to generate revenues and decrease costs. A growing number of public universities have adopted RCM. The desire to grow tuition revenue has often been cited as a rationale for adoption. Previous research has not assessed the effect of RCM on institution-level tuition revenue. Traditional regression methods that calculate “average treatment effects” are inappropriate because RCM policies differ across universities. This study employed a synthetic control method (SCM) approach. The SCM approximates the counterfactual for an RCM adopter by creating a synthetic control institution composed of a weighted average of nonadopters. The SCM estimates the effect of RCM separately for each adopter rather than estimating the average effect across multiple adopters. We used SCM to analyze the effect of RCM adoption on tuition revenue at 4 public research universities that adopted RCM during 2008 to 2010. We found a positive relationship between RCM and tuition revenue at Iowa State University, Kent State University, and the University of Cincinnati. The magnitude of this relationship was moderately large relative to placebo adopters. We found no relationship between RCM and tuition revenue at the University of Florida. [ABSTRACT FROM AUTHOR]

The study examines the direct and indirect costs of enrolling initially at a community college before transferring to a 4-year institution for baccalaureate-degree-seeking students in the USA. Using nationally generalizable data, this study employs propensity score weighting to identify the influence of initial community college enrollment on baccalaureate degree attainment, cumulative student loan debt, and time-to-degree. Our findings show that students who enrolled initially at a community college before transferring to a 4-year institution were less likely to obtain their baccalaureate degree, accrued $2221 less in cumulative student loan debt, and took about three months longer to graduate than their peers who began at 4-year colleges and universities. We provide empirical evidence of the potential trade-off associated with direct savings in cumulative loan debt and indirect costs of community college enrollment related to decreases in the likelihood of baccalaureate degree attainment and increases in time-to-degree. Given these findings, we suggest that 4-year institutions should alter their institutional policies to better accommodate vertical transfer students and ensure that these historically underrepresented students are able to succeed academically. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the relationship between school climate and ADHD medication treatment among adolescents in Medicaid in Georgia., Method: School climate and Medicaid claims data were aggregated for 159 GA counties. County-level school climate percentile and medicated ADHD prevalence were calculated. The t tests and regression models evaluated the relationship between school climate, medicated ADHD, and demographics, weighted by county population. Poorer 2008 school climate (<25th percentile) was regressed on 2011 medicated ADHD prevalence, controlling for potential confounders., Results: The prevalence of medicated ADHD was 7.8% among Medicaid-enrolled GA adolescents. The average county-level prevalence of medicated ADHD was 10.0% ( SD = 2.9%). Poorer school climate was associated with lower rates of medicated ADHD ( p < .0001); along with demographics, these factors accounted for 50% of the county variation in medicated ADHD., Conclusion: School climate is associated with medicated ADHD among adolescents in Medicaid. Additional research may reveal whether high medicated ADHD may reflect a lack of access to non-pharmacological therapies in some communities.