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Abstract Background Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. Methods Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44–443) days and 502 (260–1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. Results Ninety patients were included. VAS pain scores were significantly (p

Background: Lipid deposition secondary to dyslipidemia (DLD) is shown to have a significant impact on tendon pathology, including tendon elasticity, fatty infiltration, and healing properties. Rotator cuff repair is a common procedure, susceptible to influence from many tear-related and patient-related characteristics. The purpose of this study was to determine the relationship between DLD and rotator cuff repair outcomes with analysis of retear risk and function. Methods: PubMed, Embase, and SPORTDiscus were searched for all English-language, peer-reviewed studies between 2000 and the present, which analyzed relationships between patient-related factors and outcomes of rotator cuff repair. Studies that explicitly examined the effect of DLD on rotator cuff repair outcomes were chosen for inclusion. Included studies were assessed for methodological quality, and data were extracted for meta-analysis. Results: Of the 3087 titles, 424 were screened by abstract, and 67 were reviewed in full. Inclusion criteria were met by 11 studies. Of these studies, 5 studies assessed retear, 2 studies measured function, 3 studies reported both retear and function, and 1 study evaluated the risk of retear necessitating a revision surgery. The studies report no significant difference in functional outcomes. Meta-analysis revealed that DLD patients had a significantly higher risk of retear after primary rotator cuff repair (odds ratio 1.32, 95% confidence interval 1.06-1.64). Conclusion: DLD leads to an increased risk of retear after rotator cuff repair, although function appears to be unimpaired. DLD should be considered among other risk factors when counseling patients regarding expected rotator cuff repair outcomes.

Purpose: To determine outcomes after adjuvant pelvic local radiation therapy (RT) +/− concurrent chemotherapy for T1 and T2 rectal carcinomas treated with local excision or polypectomy. Methods: We retrospectively identified adult patients with histologically proven T1 and T2 rectal adenocarcinoma, diagnosed incidentally at time of local excision or polypectomy between 01 January 2007 and 31 December 2019, and appropriately staged to confirm N0 M0 status. Patients were excluded if they had recurrent cancer or had received total mesorectal excision (TME): anterior resection (AR) or abdominoperineal resection (APR). Patient, tumour and treatment factors, together with disease and toxicity outcomes were collected from institutional medical records, correspondence and investigation reports. Descriptive statistical analyses were employed. The primary endpoint was loco-regional control and secondary endpoints were treatment-related toxicity, disease free survival, overall survival and rate of surgical salvage for pelvic recurrence. Results: The median age of the 15 eligible patients was 73 (range 49–82 years). There were 9 men (60%) and 6 women (40%). The majority had T1 disease (80%) and most had received endomucosal resection (80%). All patients received 43-52Gy (EQD2) to the primary and 43-48Gy (EQD2) to the pelvis with 46.6% receiving concurrent chemotherapy (infusional 5-FU or oral capecitabine). At median follow up of 51 months, there were no local or regional recurrences. One patient experienced an isolated distant relapse at 48 months without any locoregional recurrence. Conclusion: Our findings demonstrate good locoregional disease control with the use of adjuvant pelvic RT for T1 and T2 rectal adenocarcinoma initially treated with polypectomy or local (non-oncological) excision. These findings indicate that adjuvant pelvic RT may provide an alternative to TME surgery in patients with incidentally detected early rectal cancers.

Abstract Background There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months. Methods In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5LTM. Results Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51–70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p

Objectives Over three decades ago, the Aboriginal Justice Inquiry identified structural racism in Canada’s justice system. Although rates of youth criminal charges and incarcerations have declined substantially since then, it is unclear whether First Nations youth are treated differently than non-First Nations youth for similar offences. Our study addressed this question. Approach This retrospective cohort study of youth born 1991-2001 and living in Manitoba between ages 12-17 used whole-population linked administrative data to identify youth charged with a crime (N=13,543). First Nations youth (n=7,081) were compared with all other Manitoba (AOM) youth (n=6,462) on whether their criminal charge proceeded or was dropped, deferred or diverted. The study applied an intersectionality theoretical framework. Individual (age, type and severity of charge, ever in child protection care, youth and/or mother diagnosed mental disorder, maternal incarceration, number of siblings, urban/rural residence) and social strata (First Nations identity, income, sex) factors were adjusted for using multi-level models. Results After accounting for other factors, First Nations youth had a higher risk of a charge proceeding than AOM (adjusted Relative Risk (aRR) 1.16, 95% CI 1.12-1.20). There was no difference in charges proceeding for male First Nations youth compared with male AOM, whereas among females, the risk was greater for First Nations (aRR 1.31, 95% CI 1.26-1.36). Low income and a history of being in the care of the child protection system increased the risk of charges proceeding for AOM only (aRR 1.16, 95% CI 1.13-1.18; aRR 1.13, 95% CI 1.07-1.20); for First Nations, there was no increased risk of charges proceeding associated with these intersecting factors. Conclusion These findings provide quantitative evidence of the intersecting structural racism in the youth criminal justice system previously identified by First Nations leaders. Future research will follow this cohort to determine whether more judicial sanctions are applied to First Nations youth throughout the justice process, including within criminal courts and corrections.

A plasma-sprayed aluminum-silicon (AlSi)/polyester coating is applied in modern gas turbine engines as an abradable sealcoating to maintain tight clearances between the rotating blades and the static casing. While running the engine, the rotating blades “rub” with the abradable coating, which results in extreme strain rate (up to 106) dynamics and a high-temperature environment. Due to the difficulty of collecting direct measurements, predictive computational models are important for analyzing the deformation and failure of the abradable material, to help meet the design target of avoiding damage to the blade tip and maintaining high fuel efficiency. In this research, a microstructure-based finite element (FE) computational model was developed to capture the complex mechanical behavior of the AlSi/polyester microstructure. The model is based on a virtual representative-volume-element (RVE) of a metal-polymer microstructure, reconstructed from x-ray computed tomography. It models the plastic deformation of, and damage to, each AlSi and polyester constituents, as well as the failure at their interface. The model was calibrated and validated with uniaxial tension and compression experiments, conducted at two temperatures (298 K and 533 K) at an applied strain rate of 103-104s-1. The material exhibited strongly asymmetric tension-compression behavior and a sensitivity to temperature, which was well captured by the model. The model was further applied to investigate changes in mechanical behavior due to variations in constituents’ volume fractions, which provides guidance to the microstructural design of AlSi/polyester abradable materials. The model is expected to facilitate the development of improved abradable materials by bypassing the conventional trial-and-error approach and extensive testing requirements.

Introduction Out-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities. Objective We examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes. Methods We linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990$) included children and adolescents who visited BGCW at least once from 2005—2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW. Results Participation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12—17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18—24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13—19) and sexually transmitted infections among adolescents (aged 13—19) also declined as the frequency of participation in BGCW increased. Conclusions The findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.

Background There are limited data on the effect of glenoid retroversion in clinical outcomes following reverse total shoulder arthroplasty (RTSA). The purpose of this study was to evaluate if surgical correction of retroversion affects outcomes following RTSA. Methods An institutional database was utilized to identify 177 patients (mean age: 68.2 ± 10.1 years) with minimum 2-year follow-up after primary RTSA. Glenoid version was measured on preoperative and postoperative radiographs. American Shoulder and Elbow Surgeons (ASES) scores and range of motion were collected before and after RTSA. Change in retroversion was determined by comparing preoperative and postoperative glenoid retroversion on radiographs using paired Wilcoxon signed-rank test. Spearman’s rank correlation was used to investigate relationships between ASES scores and glenoid retroversion. Results The mean postoperative ASES composite score (75.5 ± 22.7) was significantly higher than preoperative (36.8 ± 19.2; P

Hydrologists and water managers increasingly face challenges associated with extreme climatic events. At the same time, historic datasets for modeling contemporary and future hydrologic conditions are increasingly inadequate. Machine learning is one promising technological tool for navigating the challenges of understanding and managing contemporary hydrological systems. However, in addition to the technical challenges associated with effectively leveraging ML for understanding subsurface hydrological processes, practitioner skepticism and hesitancy surrounding ML presents a significant barrier to adoption of ML technologies among practitioners. In this paper, we discuss an educational application we have developed—Sandtank-ML—to be used as a training and educational tool aimed at building user confidence and supporting adoption of ML technologies among water managers. We argue that supporting the adoption of ML methods and technologies for subsurface hydrological investigations and management requires not only the development of robust technologic tools and approaches, but educational strategies and tools capable of building confidence among diverse users.

Bony Bankart lesions are a common finding in patients with anterior glenohumeral dislocation. Although there are no defined guidelines, small bony Bankart fractures are typically treated arthroscopically with suture anchors. The 2 main techniques used are double- and single-row suture anchor stabilization, with debate over superiority. Biomechanical studies have shown improved reduction and stabilization with the double-row over the single-row suture anchor technique; however, this has not been reported for small or comminuted bony fragments. Both techniques have shown promising preliminary clinical outcomes. In this Technical Note, we describe our preferred technique for arthroscopic instability repair using a single-row all-suture anchor method with the incorporation of a comminuted bony Bankart fragment in the lateral decubitus position.

PURPOSEWe aimed to evaluate the safety and efficacy of fluoroscopically placed jejunal extension tubes (J-arm) in patients with existing gastrostomy tubes.METHODSWe conducted a retrospective review of 391 J-arm placements performed in 174 patients. Indications for jejunal nutrition were aspiration risk (35%), pancreatitis (17%), gastroparesis (13%), gastric outlet obstruction (12%), and other (23%). Technical success, complications, malfunctions, and patency were assessed. Percutaneous gastrostomy (PEG) tube location, J-arm course, and fluoroscopy time were correlated with success/failure. Failure was defined as inability to exit the stomach. Procedure-related complications were defined as adverse events related to tube placement occurring within seven days. Tube malfunctions and aspiration events were recorded and assessed.RESULTSTechnical success was achieved in 91.9% (95% CI, 86.7%–95.2%) of new tubes versus 94.2% (95% CI, 86.7%–95.2%) of replacements (P = 0.373). Periprocedural complications occurred in three patients (0.8%). Malfunctions occurred in 197 patients (50%). Median tube patency was 103 days (95% CI, 71–134 days). No association was found between successful J-arm placement and gastric PEG tube position (P = 0.677), indication for jejunal nutrition (P = 0.349), J-arm trajectory in the stomach and incidence of malfunction (P = 0.365), risk of tube migration and PEG tube position (P = 0.173), or J-arm length (P = 0.987). A fluoroscopy time of 21.3 min was identified as a threshold for failure. Malfunctions occurred more often in tubes replaced after 90 days than in tubes replaced before 90 days (P < 0.001). A total of 42 aspiration events occurred (OR 6.4, P < 0.001, compared with nonmalfunctioning tubes).CONCLUSIONFluoroscopy-guided J-arm placement is safe for patients requiring jejunal nutrition. Tubes indwelling for longer than 90 days have higher rates of malfunction and aspiration.

Abstract Radiation treatment to the left breast is associated with increased cardiac morbidity and mortality. The deep inspiration breath‐hold technique (DIBH) can decrease radiation dose delivered to the heart and this may facilitate the treatment of the internal mammary chain nodes. The aim of this review is to critically analyse the literature available in relation to breath‐hold methods, implementation, utilisation, patient compliance, planning methods and treatment verification of the DIBH technique. Despite variation in the literature regarding the DIBH delivery method, patient coaching, visual feedback mechanisms and treatment verification, all methods of DIBH delivery reduce radiation dose to the heart. Further research is required to determine optimum protocols for patient training and treatment verification to ensure the technique is delivered successfully.

The field of neuroimaging has embraced the need for sharing and collaboration. Data sharing mandates from public funding agencies and major journal publishers have spurred the development of data repositories and neuroinformatics consortia. However, efficient and effective data sharing still faces several hurdles. For example, open data sharing is on the rise but is not suitable for sensitive data that are not easily shared, such as genetics. Current approaches can be cumbersome (such as negotiating multiple data sharing agreements). There are also significant data transfer, organization and computational challenges. Centralized repositories only partially address the issues. We propose a dynamic, decentralized platform for large scale analyses called the Collaborative Informatics and Neuroimaging Suite Toolkit for Anonymous Computation (COINSTAC). The COINSTAC solution can include data missing from central repositories, allows pooling of both open and ``closed'' repositories by developing privacy-preserving versions of widely-used algorithms, and incorporates the tools within an easy-to-use platform enabling distributed computation. We present an initial prototype system which we demonstrate on two multi-site data sets, without aggregating the data. In addition, by iterating across sites, the COINSTAC model enables meta-analytic solutions to converge to ``pooled-data'' solutions (i.e. as if the entire data were in hand). More advanced approaches such as feature generation, matrix factorization models, and preprocessing can be incorporated into such a model. In sum, COINSTAC enables access to the many currently unavailable data sets, a user friendly privacy enabled interface for decentralized analysis, and a powerful solution that complements existing data sharing solutions.

As the population ages, more older adults will undergo surgical procedures, and common physiologic changes can raise the risk for surgical complications while increasing morbidity and mortality. In conjunction with the National Surgical Quality Improvement Program, we piloted a comprehensive and interdisciplinary assessment and intervention protocol for perioperative care for patients aged ≥75 years undergoing elective general, gynecology-oncologic, and orthopedic surgery. The intervention included screening tools for cognitive, functional, and nutritional deficits, a Geriatric Nurse Champion on each inpatient surgical unit, and an interdisciplinary Geriatric Surgery Quality Committee. Our intervention group was compared to surgical patients during the same time period 1 year prior to the intervention, and the groups were well matched in demographics and comorbidities. The intervention group had significantly higher rates of advance care plan documentation in analysis of all patients (P < .001) and in subgroup analysis of those 85 and older (P = .006). The preintervention group had less postoperative delirium compared to the postintervention group but it was not significant and there was no difference in length of stay between groups. Various explanations for the minimal impact of the protocol exist: small sample size, presence of other hospital initiatives to reduce pressure ulcer and delirium, and clinician's awareness of project planning that led to incorporating ideas prior to official implementation. Future research implementing this protocol in naïve and/or underperforming institutions may demonstrate a greater effect. Larger sample size as well as implementation in other surgical fields may reveal a significant impact. However, if additional study does not reveal a meaningful impact of a comprehensive geriatric assessment for surgical patients, then consideration must be made regarding unrecognized factors in surgical care for older adults or perhaps that factors cannot be mitigated in older adults because they are intrinsically a higher surgical risk., (Copyright © 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction., Objective: To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial., Design: Randomized trial. (ClinicalTrials.gov: NCT00023595)., Setting: 99 clinical sites in 22 countries., Patients: 1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease., Intervention: Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients)., Measurements: A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients' symptoms, physical function, social limitations, and QOL., Results: The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings., Limitation: Therapy was not masked., Conclusion: In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in quality of life compared with medical therapy alone over 36 months., Primary Funding Source: National Heart, Lung, and Blood Institute.

Background: Surgical ventricular reconstruction (SVR) is used in conjunction with coronary artery bypass graft surgery (CABG) to improve left ventricular function and clinical outcomes in selected patients with ischemic heart failure. The impact of SVR on quality of life (QOL) and medical costs is unknown., Methods: We compared CABG plus SVR with CABG alone in 1,000 patients with ischemic heart failure, an anterior wall scar, and a left ventricular ejection fraction or=92% complete. Cost data were collected on 196 (98%) of 200 patients enrolled in the United States., Results: Heart-failure-related QOL outcomes did not differ between the 2 treatment strategies out to 3 years (median Kansas City Cardiomyopathy Questionnaire scores for CABG alone and CABG plus SVR, respectively: baseline 53 versus 54, P = .53; 3 years 85 versus 84, P = .89). There were no treatment-related differences in other QOL measures. In the US patients, total index hospitalization costs averaged over $14,500 higher for CABG plus SVR (P = .004) due primarily to 4.2 extra postoperative, high-intensity care days in the hospital., Conclusions: Addition of SVR to CABG in patients with ischemic heart failure did not improve QOL but significantly increased health care costs.

Background: Although Staphylococcus aureus bacteremia is a common, serious infection, accurately identifying febrile patients with this diagnosis at the time of initial evaluation is difficult. The purpose of this investigation was to define clinical characteristics present at the time of the initial recognition of fever that were associated with the presence of any bloodstream infection and, in particular, with S. aureus bacteremia., Methods: All patients > or =18 years of age with a new episode of health care-associated fever (temperature > or =38 degrees C) and at least one blood culture drawn were eligible for enrollment into this prospective multicenter cohort study. Multivariable analyses were conducted and internally validated scoring systems were developed to categorize the risk of bacteremia., Results: Of 1015 patients enrolled, 181 patients (17.8%) had clinically significant bacteremia, including 77 patients (7.6%) with S. aureus bacteremia. Clinical characteristics associated with S. aureus bacteremia were the presence of a hemodialysis graft or shunt (odds ratio [OR] 3.22; 95% confidence interval [CI], 1.85-5.61), chills (OR 2.38; 95% CI, 1.43-3.98), and a history of S. aureus infection (OR 2.68; 95% CI, 1.38-5.20). Peripheral vascular catheters were inversely associated with S. aureus bacteremia (OR 0.42; 95% CI, 0.26-0.69). Clinical characteristics associated with any bloodstream infection were central venous access, chills, history of S. aureus infection, and hemodialysis access., Conclusions: Among patients with health care-associated fever, the presence of easily recognizable clinical characteristics at the time of obtaining the initial blood cultures can help to identify patients at increased risk for any bloodstream infection, in particular for S. aureus bacteremia.

Eighty-six members of the Grandparents' Federation in Britain returned questionnaires about changes in contact with their grandchildren following parental divorce; ten grandparents were also interviewed to obtain more contextual information and measures of health and coping strategies. Three questionnaire measures of the grandparent-grandchild relationship, proximity, contact frequency, and emotional involvement, were interrelated and a significant decrease was reported after parental divorce. There were no significant differences on these measures between grandparents all of whose grandchildren were affected by parental divorce, and grandparents for whom only some grandchildren were so affected; but the latter group did show a greater decline in emotional involvement and also had less recourse to legal action to sustain contact. With grandchildren affected by parental divorce, proximity to grandparents was not significantly less than for grandchildren not so affected, but contact and emotional involvement were significantly less. Many grandparents reported emotional and physical health problems related to the loss of contact. Results are discussed in terms of the extent to which grandparents are victims of the divorce situation, or agents involved in cross-generational family dysfunction; the victim model appears to get more support from our data. Recommendations are made for further research, as well as counseling to help move grandparents through the grief process and to a better quality of life.