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This paper addresses the recent body of research in algebra and algebraic thinking from 2018 to 2022. We reviewed 74 journal articles and identified four clusters of content areas: (a) literal symbols and symbolizing, (b) equivalence and the equal sign, (c) equations and systems, and (d) functions and graphing. We present the research on each of these content clusters, and we discuss insights on effective teaching practices and the social processes supporting algebraic reasoning. The research base shows that incorporating algebraic thinking into the elementary grades, emphasizing analytic and structural thinking processes, and emphasizing covariational reasoning supports students' meaningful learning of core algebraic ideas. We close with a discussion of the major theoretical contributions emerging from the past five years, offering suggestions for future research.

In this paper, we explore the role that examples play as mathematicians formulate conjectures, and we describe and exemplify one particular example-related activity that we observed in interviews with thirteen mathematicians. During our interviews, mathematicians productively used examples as they formulated conjectures, particularly by creating systematic lists of examples that they examined for patterns, an activity that we call "Comprehensive Example Generation". We elaborate this construct, and we discuss ways in which it afforded productive conjecturing activity. The results suggest further research and pedagogical implications for explicitly targeting examples in conjecturing, and the study contributes to a body of literature that points to the benefits of exploring, identifying, and leveraging examples in proof-related activity.

Generalizing is a critical aspect of mathematics learning, with researchers and policy documents highlighting generalizing as a core mathematical practice. It can also be challenging to foster in class settings, and teachers need access to better resources to teach generalizing, including an understanding of effective forms of instruction. This article proposes Classroom Supports for Generalizing (CSGs), investigating how multiple elements--such as tasks, teacher moves, student interactions, and representations--interact to meaningfully foster student generalizing. Drawing on class video data from a middle school teacher and two high school teachers, we present the CSG Framework, which identifies three categories of supports: Interactions for Generalizing, Structures for Generalizing, and Routines for Generalizing.

# Background Given rising youth sport participation, 8 to 10-year-olds increasingly display comparable lower-extremity injury incidence to 11 to 17-year-olds and require effective return to sport criteria. One such criterion which quantifies dynamic stability is the Y-Balance Test (YBT), though it has not been validated in children under age 11. # Hypothesis/Purpose The purpose of this study was to examine the performance of 8 to 10-year-old patients on the YBT after lower-extremity injury and determine how these results compare to larger samples of age-grouped athletes within the validated 11 to 17-year-old range. It was hypothesized that 8 to 10-year-olds would display different normalized YBT distances compared to 11 to 17-year-olds. # Study Design Cross-sectional Study. # Methods Patients (N=1093) aged 8 to 17 who presented to a pediatric sports medicine practice with a lower-extremity injury and completed the YBT between December 2015-May 2021 were included. Anterior, posteromedial, and posterolateral YBT scores were collected at return-to-sport for affected and unaffected limbs. Scores were normalized to limb length, and composite scores were created. Between-limb differences were calculated in groups of ages 8-10, 11-12, 13-14, and 15-17. Groups were also evaluated for differences by sex. # Results A rise in performance was observed in unaffected limb anterior reach from ages 8 to 10 years to 11 to 12 years followed by a subsequent significant decrease at older ages (p

Background: Multiple lines of evidence suggest that exposure to per- and polyfluoroalkyl substances (PFAS) may alter glucose homeostasis, particularly during pregnancy, and may affect risk for developing gestational diabetes mellitus (GDM). While previous systematic reviews have been conducted on this topic, they did not assess internal validity of the included studies and their search strategies were narrowly focused. Objective: The objective of this study is to assess the effect of higher PFAS exposure (defined by individual compounds or mixtures measured before or during pregnancy) on GDM and subclinical measures of impaired glucose homeostasis (measured during pregnancy) compared to lower PFAS exposure in pregnant. Methods: We developed our systematic review protocol in accordance with the Navigation Guide. Peer-reviewed journal and grey literature searches were piloted in to identify relevant studies and refine our search terms and strategy. We also piloted the study screening criteria and data extraction form in DistillerSR, and refined our protocol accordingly. The risk of bias assessment protocol was adapted from Navigation Guide guidance and will be piloted and performed in DistillerSR. Pending the identification of comparable studies, quantitative meta-analyses will be performed where possible. Study results that cannot be quantitatively synthesized will be included in a narrative synthesis. The quality and strength of the body of evidence will be evaluated using Navigation Guide methodology, which is informed by guidance from the Cochrane Collaboration and Grading of Recommendations Assessment, Development and Evaluation (GRADE). We also made refinements to the quality of evidence considerations based on guidance from the National Institute of Environmental Health Sciences (NIEHS) Office of Health Assessment and Translation (OHAT). Funding: This work was supported by the Systematizing Data on Per- and Polyfluoroalkyl Substances and Health Northeastern University TIER 1 Award.

Purpose: To define the surgical anatomy of the meniscotibial ligament complex of the pediatric medial and lateral menisci and their relation to the proximal tibial physis and posterior joint capsule. Methods: Fourteen pediatric cadaveric knee specimens (aged 3 months to 11 years) were dissected to clarify the relation of the posterior knee capsule, the meniscus, and the meniscotibial ligament complex. Metallic markers were placed marking the meniscotibial ligament capsular attachment on the proximal tibia. Specimens underwent computed tomography scanning to evaluate pin placement and relation to the physis. A digital measurement tool was used to measure the distances between the proximal tibial physis and the pins (placed at 5 points on both the lateral and medial menisci). Results: In each specimen, clear separation was noted between the posterior joint capsule from the meniscus and meniscotibial ligament complex in the medial and lateral compartments. There was an increase in the distance between the proximal tibial physis and the insertion points of the meniscotibial ligament complex with increasing specimen age. For both the medical and lateral menisci in group 1, the median meniscotibial ligament insertion points were often less than 7 mm (interquartile range, 0.00-7.8 mm) away from the physis. The median meniscotibial ligament insertion points in group 2 tended to be farther from the physis but always less than 20 mm (interquartile range, 2.5-17.5 mm)—and as close as less than 5 mm (lateral posterior root). Conclusions: In this anatomic study of pediatric knees, we observed a distinct recess/cul-de-sac space between the posterior knee capsule and meniscal attachments in all specimens. This defines a distinct plane between the posterior knee capsule and the meniscotibial ligament complex, with a distance between the physis and meniscotibial ligament capsular attachments that increases with age. Clinical Relevance: The anatomic parameters evaluated in our study should be considered as future meniscal repair and transplantation techniques aim to restore the meniscal anatomy, stability, and mobility provided by the meniscotibial ligament complex and capsule structures.

Substantial research exists on predation and its ecology. Most research has focused on durophagous fishes, brachyuran crabs, and lobsters. Data are lacking, however, on soft-bodied predators like anemones, and their contribution to overall levels of predation remains largely unevaluated. Here, we compared predation rates of the durophagous predator, the crab C. maenas and the soft-bodied predator, the anemone Actinia equina on 15 intertidal shores around Anglesey, north Wales, UK. We employed a novel approach to assess predation based on measuring faecal output from recently collected individuals and converting it to food consumed using absorption efficiencies (AEs) measured using potential prey species inhabiting the same shores. Anemone mean abundance was 8.21 (± 0.27, s.e.) individuals.m−2, whereas for C. maenas it was 0.23 (± 0.02, s.e.) individuals.m−2. AEs when fed mussel tissue, a polychaete worm, or a shrimp were 92.8–94.0% in C. maenas and 40.5–95.8% in A. equina. This difference in values reflected the different feeding modes of the two predators. Unexpectedly, A. equina consumed 3.5–7 times more prey than C. maenas. The consumption of larger amounts of prey by an anemone than the dominant durophagous predator has important consequences for calculating energy flows in food webs, understanding predation controls in assemblages, and potentially for wider predation trends.

The history and physical exam are crucial components of the initial assessment of hip pain in adolescents and young adults to identify the cause of the pain, distinguish between common causes of early degeneration such as femoroacetabular impingement (FAI) and acetabular dysplasia (instability), and guide further workup and management. Different aspects of the history and exam are specific to various common causes of hip pain in this patient population. The purpose of this review is to synthesize these components to provide a comprehensive approach to the history and physical exam for adolescents and young adults presenting with hip pain. Key Concepts: (1) Common signs that suggest a mechanical hip problem, but are not specific for the etiology, include symptoms that worsen with activity, discomfort in a seated position, pain on rising from a seated position, or difficulty with ascending or descending stairs. (2) A Trendelenburg gait is caused by insufficient abductors that are unable to maintain a level pelvis and is commonly associated with hip instability due to the biomechanical disadvantage of the dysplastic hip joint. (3) Obligate external rotation of the hip during hip flexion is concerning for slipped capital femoral epiphysis (SCFE) and warrants an AP pelvis and frog leg lateral view for evaluation. (4) The Prone Apprehension Relocation Test (PART) assesses for anterior undercoverage of the acetabulum, and a positive test has been found to be correlated with radiographic markers of instability.

ABSTRACT: Radiographic evaluation of hip pain in adolescents and young adults is an important component of the assessment to aid in the identification of the cause of pain, distinguish between etiologies of early hip degeneration such as acetabular dysplasia (instability) and femoroacetabular impingement, and guide further workup and management. Recent advances in radiographic assessment include the importance of obtaining a standing anterior-posterior radiograph to illustrate the functional position of the pelvis, the use of anterior and posterior wall indices to illustrate anterior and posterior wall coverage and the importance of interpreting radiographic measures in the context of a patient’s sagittal balance. Advances in magnetic resonance imaging, computed tomography, and ultrasound have also occurred and can provide further diagnostic clarity. The purpose of this work is to review the literature to provide a systematic approach to the radiographic evaluation of hip pain in skeletally mature adolescents and young adults. Key Concepts: (1) The standing AP pelvis, 45° Dunn, and false-profile views provide a preliminary comprehensive radiographic assessment of the symptomatic hip in the skeletally mature adolescent and young adult and help to distinguish between instability and impingement. (2) The Lateral Center Edge Angle (LCEA) should be augmented by the anterior center edge angle (ACEA), anterior wall index (AWI), and posterior wall index (PWI) to obtain a more complete understanding of 3-dimensional femoral head coverage from plain radiographs. (3) While the crossover and posterior wall signs on radiographs can be helpful in screening for acetabular retroversion and anteversion, CT should be used to confirm if considering reorientation or resection. (4) Cam morphology should be quantitatively assessed using the alpha angle and head-neck offset on the 45° Dunn view. (5) Dynamic ultrasound may be useful in illustrating the motion associated with impingement and instability in real-time but may be limited by the technician-dependent nature of this modality.

Abstract Behaviour change through voluntary action can be an important approach to reducing human impacts on biodiversity. One example is self‐regulation in hunting, potentially a vital contributory factor in improving the sustainability of wild bird harvest. There has been a growing realisation among woodcock Scolopax rusticola hunters, reinforced by advice from sector organisations, that components of the UK woodcock populations are declining and that some aspects of woodcock hunting, specifically timing of harvest, may contribute to these. This study utilised five qualitative and quantitative data sets, collected for different purposes, to assess the behaviour and attitudes of woodcock hunters, both currently and over the past century. In the UK, relatively few woodcock are harvested and few hunters or species‐specific shoots target them. An estimated 26%–29% of lowland shoots advertise or harvest woodcock, with fewer than 5% of shoots or hunters participating in ‘woodcock specific’ shoot days. The number of birds harvested has fallen in recent years and is estimated to be between 62,000 and 140,000. Qualitative data suggests that over 90% of hunters now report shooting woodcock only after the recommended date of 1st December, or not at all. This is reflected in bag data which shows that, since 2018, fewer than 3%–13% of woodcock shot were harvested prior to 1st December. Around a third of hunters have reported stopping shooting woodcock and it is likely the harvest will decline in coming years due to voluntary restraint. This work demonstrates both through self‐report data and independent harvest data that behaviour change among hunters can be effected. This provides a working example where self‐regulation in response to a collective sector‐led effort has the potential to conserve wild quarry.

Abstract Open‐conduit conditions characterize several of the most hazardous and active volcanic systems of basaltic composition worldwide, persistently refilled by magmatic inputs. Eruptive products with similar bulk compositions, chemically buffered by continual mafic inputs, nevertheless exhibit heterogeneous glass compositions in response to variable magma mixing, crystallization, and differentiation processes within different parts of the plumbing system. Here, we document how multivariate statistics and magma differentiation modeling based on a large data set of glass compositions can be combined to constrain magma differentiation and plumbing system dynamics. Major and trace elements of matrix glasses erupted at Stromboli volcano (Italy) over the last 20 years provide a benchmark against which to test our integrated petrological approach. Principal component analysis, K‐means cluster analysis, and kernel density estimation reveal that trace elements define a multivariate space whose eigenvectors are more readily interpretable in terms of petrological processes than major elements, leading to improved clustering solutions. Comparison between open‐ and closed‐system differentiation models outlines that steady state magma compositions at constantly replenished and erupting magmatic systems approximate simple fractional crystallization trends, due to short magma residence times. Open‐system magma evolution is associated with magma storage crystallinities that are lower than those associated with closed‐system scenarios. Accordingly, open‐system dynamics determine the efficient crystal‐melt separation toward the top of the reservoir, where eruptible melts continuously supply the ordinary activity. Conversely, a mush‐like environment constitutes the bottom of the reservoir, where poorly evolved magmas result from mixing events between mush residual melts and primitive magmas injected from deeper crustal levels.

IntroductionWhile youth sports benefits the developing athlete, athletes may also be subject to injury and subsequent return-to-sport protocols. The current return-to-sport criteria emphasize physical measures; however, psychological measures may also be valuable to inform providers of an athlete’s readiness. One such measure is athletic identity defined as the degree to which an individual identifies with the athlete role. To better understand athletic identity in return-to-sport, this study aimed to identify relationships and trends between the Athletic Identity Measurement Scale (AIMS), demographic variables, sport participation measures, and the Athletic Coping Skills Inventory-28 (ACSI-28) in youth athletes during rehabilitation following anterior cruciate ligament reconstruction (ACLR).MethodsA retrospective review was completed of patients who underwent ACLR at a sports medicine clinic between October 2019 and May 2021. Patients responded to a series of patient reported outcomes (PROs) regarding physical and psychological function at a pre-surgical baseline and after 1 year of rehabilitation. Patients were then divided into groups of high/low AIMS and an increased/decreased AIMS between 1 year and baseline for comparison. Independent samples t-tests and ANOVAs were performed as appropriate with a 95% confidence interval.ResultsIn the final sample, 87 patients (15.3 ± 1.8 years) were included, with 51.7% being females. Total AIMS scores decreased from 50.3 to 47.5 over rehabilitation (p = 0.019). Furthermore, results indicated that nearly all AIMS scores decreased during rehabilitation, with none showing an increase; however, not all domains were significant. Conversely, all sport participation and coping ability PROs increased over time points except for ACSI-Confidence and Achievement Motivation. Generally, those in the groups with high AIMS and an increase in AIMS also had higher scores in physical function and coping ability PROs, with the groups separated by high/low AIMS exhibiting more frequent statistical significance.DiscussionGiven these results, it appears that athletes may lose identification with the athlete role after ACLR and struggle even 1 year for rehabilitation, but those who recover athletic identity the best may also be those able to cope most effectively with the stressors induced by injury.

The response of the hydrological cycle to anthropogenic climate change, especially across the tropical oceans, remains poorly understood due to the scarcity of long instrumental temperature and hydrological records. Massive shallow-water corals are ideally suited to reconstructing past oceanic variability as they are widely distributed across the tropics, rapidly deposit calcium carbonate skeletons that continuously record ambient environmental conditions, and can be sampled at monthly to annual resolution. Climate reconstructions based on corals primarily use the stable oxygen isotope composition (δ18O), which acts as a proxy for sea surface temperature (SST), and the oxygen isotope composition of seawater (δ18Osw), a measure of hydrological variability. Increasingly, coral δ18O time series are paired with time series of strontium-to-calcium ratios (Sr/Ca), a proxy for SST, from the same coral to quantify temperature and δ18Osw variability through time. To increase the utility of such reconstructions, we present the CoralHydro2k database, a compilation of published, peer-reviewed coral Sr/Ca and δ18O records from the Common Era (CE). The database contains 54 paired Sr/Ca–δ18O records and 125 unpaired Sr/Ca or δ18O records, with 88 % of these records providing data coverage from 1800 CE to the present. A quality-controlled set of metadata with standardized vocabulary and units accompanies each record, informing the use of the database. The CoralHydro2k database tracks large-scale temperature and hydrological variability. As such, it is well-suited for investigations of past climate variability, comparisons with climate model simulations including isotope-enabled models, and application in paleodata-assimilation projects. The CoralHydro2k database is available in Linked Paleo Data (LiPD) format with serializations in MATLAB, R, and Python and can be downloaded from the NOAA National Center for Environmental Information's Paleoclimate Data Archive at https://doi.org/10.25921/yp94-v135 (Walter et al., 2022).

Background/Objective: To share technical pearls of a basic knee arthroscopy in a pediatric patient by presenting tips and tricks used by experienced pediatric arthroscopists. Indications: Knee arthroscopy is a common procedure performed by most orthopedic surgeons. However, technical considerations and equipment should be considered before performing this procedure in a pediatric patient. This video provides information on indications, equipment, and patient positioning, as well as outlining a systematic approach to diagnostic arthroscopy and pertinent pediatric anatomy. Discussion/Conclusion: This video provides an excellent overview as well as specific pathology-dependent considerations for the inexperienced orthopedic surgeon, or the orthopedic surgeon who rarely performs knee arthroscopy. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Abstract Mourning doves are the most hunted game species in the United States. Mourning dove populations are declining, and the continued use of lead shot has been cited as one contributory factor. We examined the relationship between support for a ban on lead shot when dove hunting and 3 sets of variables: (1) beliefs about lead and steel shot, (2) prior dove hunting experiences, and (3) hunter demographics. Data were obtained from a mailed survey of 4,330 dove hunters in Illinois (response rate = 59%). Our results indicated that 81% of respondents were opposed to restrictions on the use of lead shot and these individuals believed that lead ammunition did not pose a risk to wildlife and that steel shot was less effective than lead shot. Supporters of banning lead shot were almost twice as likely to use steel shot, reported 2 fewer years hunting doves, went dove hunting 75% as much, and harvested 2/3 as many doves as those who opposed a ban. Consistent with social‐psychological theory, beliefs were the best predictors of whether an individual supported or opposed a ban, followed by dove hunting experiences and demographic variables.

Abstract The human health impacts of lead have been known for millennia but the environmental impacts of lead ammunition have only received attention during the past 100 years. To a large extent the United States provided leadership in identifying and researching these effects and then spearheading campaigns to transition away from lead shotgun ammunition for waterfowl hunting. However, the appetite for further federal transition has largely stalled in the U.S. except for apparently limited action linked to individual states, charismatic species, and specific sites. Europe, on the other hand, though generally rather late to the table with regard to lead shotgun ammunition and waterfowl hunting, is now pushing ahead with several initiatives that are likely to see substantial partial, if not total, restrictions on the use of all lead ammunition (for shotguns and rifles) within 5 to 10 years. We discuss the policy drivers behind these moves, summarize the key attitudes and perceived constraints to transition, and provide (cautious) timetables and limited recommendations for future changes. Our discussion will include comparisons between efforts in the U.S. and those in Europe.

ObjectiveDiverticular disease (DD) is one of the most prevalent conditions encountered by gastroenterologists, affecting ~50% of Americans before the age of 60. Our aim was to identify genetic risk variants and clinical phenotypes associated with DD, leveraging multiple electronic health record (EHR) data sources of 91,166 multi-ancestry participants with a Natural Language Processing (NLP) technique.Materials and methodsWe developed a NLP-enriched phenotyping algorithm that incorporated colonoscopy or abdominal imaging reports to identify patients with diverticulosis and diverticulitis from multicenter EHRs. We performed genome-wide association studies (GWAS) of DD in European, African and multi-ancestry participants, followed by phenome-wide association studies (PheWAS) of the risk variants to identify their potential comorbid/pleiotropic effects in clinical phenotypes.ResultsOur developed algorithm showed a significant improvement in patient classification performance for DD analysis (algorithm PPVs ≥ 0.94), with up to a 3.5 fold increase in terms of the number of identified patients than the traditional method. Ancestry-stratified analyses of diverticulosis and diverticulitis of the identified subjects replicated the well-established associations between ARHGAP15 loci with DD, showing overall intensified GWAS signals in diverticulitis patients compared to diverticulosis patients. Our PheWAS analyses identified significant associations between the DD GWAS variants and circulatory system, genitourinary, and neoplastic EHR phenotypes.DiscussionAs the first multi-ancestry GWAS-PheWAS study, we showcased that heterogenous EHR data can be mapped through an integrative analytical pipeline and reveal significant genotype-phenotype associations with clinical interpretation.ConclusionA systematic framework to process unstructured EHR data with NLP could advance a deep and scalable phenotyping for better patient identification and facilitate etiological investigation of a disease with multilayered data.

Abstract Background The Massachusetts General Hospital is a large, quaternary care institution with 58 operating rooms, 164 anesthesiologists, 76 certified nurse anesthetists (CRNAs), an anesthesiology residency program that admits 25 residents annually, and 35 surgeons who perform laparoscopic, vaginal, and open hysterectomies. In March of 2018, our institution launched an Enhanced Recovery After Surgery (ERAS) pathway for patients undergoing hysterectomy. To implement the anesthesia bundle of this pathway, an intensive 14-month educational endeavor was created and put into effect. There were no subsequent additional educational interventions. Methods We retrospectively reviewed records of 2570 patients who underwent hysterectomy between October 2016 and March 2020 to determine adherence to the anesthesia bundle of the ERAS Hysterectomy pathway. RESULTS: Increased adherence to the four elements of the anesthesia bundle (p

Athletic identity, or the degree with which individuals identify with the athlete role, is an important rehabilitation factor for sports care providers to consider; however, it lacks extensive study in youth. The purpose of this study was to identify demographic, sport participation, and psychosocial measures which correlate with youth athletic identity after anterior cruciate ligament injury. Participants completed standardized sports medicine intake and patient-reported outcome measures, including the Athletic Identity Measurement Scale (AIMS). A total of 226 participants were included, and two groups were created based on high or low total AIMS score. Results indicated that sex (p = 0.002), years active in sport (p = 0.049), activity level (p = 0.038), and ACSI-Coachability (p = 0.027) differed by AIMS score. While youth athletes appear resilient, these results emphasize that they identify strongly with the athlete role and may suffer psychosocial consequences after injury. Future work should evaluate similar factors over course of recovery in a larger, diversified population.

In-person sport participation was suspended across the United States in the spring of 2020 to slow the spread of the novel coronavirus (COVID-19). The purpose of this study was to survey the impact of COVID-19 on young athletes during a period of social and organized sports restrictions. An anonymous cross-sectional survey study was conducted of youth athletes in the midst of social distancing mandates and consisted of six components: demographics, sport participation, changes in sport-related goals/aspirations, sleep habits, and measures of anxiety and depression. 711 individuals who accessed the survey link yielded 575 (81%) participants with responses available for analysis. All respondents (aged 13.0 years) played organized sports, 62% were single-sport athletes, and 74% considered high-level. Participants were training ∼3.3 h less per week, spending more time outside, and 86% of participants continued to train while social distancing. Sleep duration increased (∼1.2 h/night) and sleep quality improved in 29% of young athletes. Additionally, 22% and 28% reported PROMIS® anxiety and depression scores characterized as ‘mild’, ‘moderate’, or ‘severe’. Older single-sport participants reported higher depression scores, while higher anxiety scores were seen in female participants with fewer years played. 10% of young athletes and 20% of teenagers changed their sports-related goals. Training style modifications, decreased training, and increased sleep quantity and quality were positive effects of COVID-19 restrictions, while athletic aspirational changes were undesirable effects. Single-sport athletes may be at greater risk for psychological symptoms when their routine is altered.

# Background Three-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good–to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST. # Study Design Repeated Measures # Methods Ten videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of “1”, or not present, which were given a score of “0”. Video sequence was randomized in each rating session, and a two-week wash out period was given. # Results The cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively). # Conclusion These findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers. # Level of Evidence Level 2 Diagnosis

Surgical management of septic arthritis in young children is traditionally performed with open techniques, although arthroscopic approaches are commonly used in the knee and shoulder. Hip arthroscopy is technically demanding in small children and requires modification from traditional hip arthroscopy. The purpose of this study is to describe a safe technique to perform hip arthroscopy without traction in the pediatric hip and, secondarily, to report short-term results of a case series. Pediatric hip arthroscopy can be safely performed without traction on a radiolucent table and allows joint irrigation and debridement including drain placement through the use of 1 or 2 portals. Hip arthroscopy is a safe, valuable, minimally invasive technique in the treatment of children with septic arthritis of the hip.

Background:. Graft choice for pediatric anterior cruciate ligament reconstruction (ACLR) is determined by several factors. There is limited information on the use and outcomes of allograft ACLR in pediatric patients. The purpose of this systematic review and meta-analysis was to quantify reported failure rates of allograft versus autograft ACLR in patients ≤19 years of age with ≥2 years of follow-up. We hypothesized that there would be higher rates of failure for allograft compared with autograft ACLR in this population. Methods:. PubMed/MEDLINE and Embase databases were systematically searched for literature regarding allograft and autograft ACLR in pediatric/adolescent patients. Articles were included if they described a cohort of patients with average age of ≤19 years, had a minimum of 2 years of follow-up, described graft failure as an outcome, and had a Level of Evidence grade of I to III. Qualitative review and quantitative meta-analysis were performed to compare graft failure rates. A random-effects model was created to compare failure events in patients receiving allograft versus autograft in a pairwise fashion. Data analysis was completed using RevMan 5.3 software (The Cochrane Collaboration). Results:. The database search identified 1,604 studies; 203 full-text articles were assessed for eligibility. Fourteen studies met the inclusion criteria for qualitative review; 5 studies were included for quantitative meta-analysis. Bone-patellar tendon-bone (BTB) represented 58.2% (n = 1,012) of the autografts, and hamstring grafts represented 41.8% (n = 727). Hybrid allografts (autograft + supplemental allograft) represented 12.8% (n = 18) of all allograft ACLRs (n = 141). The unweighted, pooled failure rate for each graft type was 8.5% for BTB, 16.6% for hamstring, and 25.5% for allograft. Allografts were significantly more likely than autografts to result in graft failure (odds ratio, 3.87; 95% confidence interval, 2.24 to 6.69). Conclusions:. Allograft ACLR in pediatric and adolescent patients should be used judiciously, as existing studies revealed a significantly higher failure rate for allograft compared with autograft ACLR in this patient population. Additional studies are needed to improve the understanding of variables associated with the high ACLR failure rate among pediatric and adolescent patients. Level of Evidence:. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Abstract Purpose Meniscal repair has become increasingly common in a pediatric and adolescent population. All-inside repair techniques are utilized more often given their ease of insertion and decreased operative time required. However, there are possible risks including damage to adjacent neurovascular structures. The purpose of this study to was examine the proximity of the neurovascular structures during lateral meniscus repairs in pediatric specimens simulating a worst-case scenario. Methods Ten pediatric cadaveric knees (age 4–11) were utilized and simulated lateral meniscal repair through the posterior horn of the lateral meniscus and both medial and lateral to the popliteal hiatus through the body of the lateral meniscus was performed with an all-inside meniscal repair device. The distance to the popliteal artery or peroneal nerve was measured. Results During posterior horn repair, the average distance from the all-inside device to the popliteal artery was 1.9 mm ± 1.1 mm. There was penetration of the artery in one specimen. During repair on the medial side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 3.2 mm ± 2.0 mm. During repair on the lateral side of popliteal hiatus, the average distance from the all-inside device to the peroneal nerve was 12.4 mm ± 3.7 mm. Conclusions This study demonstrates that the proximity of the neurovascular structures to the lateral meniscus in children is extremely close and at high risk during meniscal repair with all-inside devices. This study gives important data for the proximity of these structures during these repair techniques. Level of evidence Level 5 Cadaveric Study.

The overwhelming majority of efforts to cultivate early mathematical thinking rely primarily on counting and associated natural number concepts. Unfortunately, natural numbers and discretized thinking do not align well with a large swath of the mathematical concepts we wish for children to learn. This misalignment presents an important impediment to teaching and learning. We suggest that one way to circumvent these pitfalls is to leverage students’ non-numerical experiences that can provide intuitive access to foundational mathematical concepts. Specifically, we advocate for explicitly leveraging a) students’ perceptually based intuitions about quantity and b) students’ reasoning about change and variation, and we address the affordances offered by this approach. We argue that it can support ways of thinking that may at times align better with to-be-learned mathematical ideas, and thus may serve as a productive alternative for particular mathematical concepts when compared to number. We illustrate this argument using the domain of ratio, and we do so from the distinct disciplinary lenses we employ respectively as a cognitive psychologist and as a mathematics education researcher. Finally, we discuss the potential for productive synthesis given the substantial differences in our preferred methods and general epistemologies.