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Discoid lateral meniscus (DLM) presents with differing pathoanatomy and may exhibit various types of tears. The treatment strategy is based on the presence and location of instability as a result of deficient capsular attachment. Recently, meniscal stabilization after saucerization has been recommended for DLM to preserve the meniscus shape, prevent extrusion, and mitigate against the progression of osteoarthritis. In addition to stabilization, the resection volume is important to prevent osteoarthritic changes. Although there was no tear and no displacement of the lateral meniscus on magnetic resonance imaging, some DLMs were found to have tears and peripheral instability during arthroscopy. Therefore, the assessment of peripheral instability during surgery is very important to achieve a desirable clinical outcome. This Technical Note describes an arthroscopic technique for anterior peripheral stabilization of the DLM, in which we highlight the surgical procedure for repair of the anterior horn, reassess the instability around the popliteal hiatus after the anterior horn is repaired, and the stabilization of the posterior horn, if necessary.

Preservation of the meniscus has been shown to influence the progression of osteoarthritic changes in the knee. Discoid lateral meniscus (DLM) is classified on the basis of the presence and location of instability resulting from deficient capsular attachments. Recently, meniscal stabilization after saucerization was recommended in cases of DLM to preserve the meniscus shape and avoid the progression of osteoarthritis. However, it is difficult to identify the accurate resection volume and residual meniscal width during surgery, especially when there is an anterocentral shift of the DLM. This Technical Note describes an arthroscopic technique for an anterocentral shift of the DLM in which we highlight the resection point and confirm the methods of retaining an adequate volume of residual meniscus to restore and maintain the shape and function of the meniscus. Level of Evidence Level 1, Knee; Level 2, Meniscus., Technique Video Video 1 We demonstrate a technique for an anterocentral (AC) shift of the discoid lateral meniscus (DLM) in which we show the resection point and preservation methods of the meniscus so as to reshape it to the same size as the normal lateral meniscus. This case is the right knee of 13-year-old boy who had an anterocentral type of DLM. The DLM is confirmed by arthroscopic viewing from the anterolateral portal in the figure-4 position, and meniscal instability was confirmed by pulling the posterolateral corner of the meniscus by using a probe. From the lateral gutter view through the anterolateral portal, absence of the superoposterior fascicle is confirmed in the extension position of the knee. Saucerization is started from the border between the anterior horn and the central area of the DLM with a 45˚ punch from the anteromedial portal parallel to the circumferential fibers of the anterior horn of the DLM as viewed from the anterolateral portal. Measurement of the resection length is performed with a ruler from the anteromedial portal. After 1 cm of resection length is confirmed by viewing from the anterolateral portal, saucerization with removal of the central area is performed with a punch from the anteromedial portal. Resection is performed until it is 10 mm from the hiatus. This type of DLM often has a horizontal tear in the residual meniscus. Meniscal instability is again confirmed by a probe, and the deep flexion position is viewed from the anteromedial portal. An arthroscopic rasp is used to freshen the sites of tears in the meniscus so as to promote healing from the anteromedial portal. The dual meniscal repair needles loaded with 2-0 braided polyester sutures are penetrated to the unstable portion of the meniscus including the horizontal tear through the cannula positioned in the anteromedial portal. The suture needles are retrieved under direct visualization through the previously prepared lateral incision. The sutures are tied over the capsule after every 4 sutures have been passed. Technique with stitches placed at 3 mm intervals: After repairing the posterior portion, the width of the repaired meniscus is confirmed to be 10 mm from the hiatus, and the stability of the meniscus is confirmed by viewing it from the anterolateral portal. Eight mm of residual anterior meniscus is confirmed through the anteromedial portal view. The stability of the meniscus is confirmed by a McMurray test through the anteromedial portal view.

Purpose The purpose was to assess the incidence of postoperative osteochondritis dissecans (OCD) and the related epidemiologic factors following meniscal surgery for juvenile discoid lateral meniscus (DLM). Methods The study was a retrospective review of 103 knees in 89 patients with a mean age of 12.1 years who underwent arthroscopic meniscal surgery for DLM. Mean follow-up was 4.2 years. The surgical procedures were either saucerization, saucerization with repair or subtotal meniscectomy, depending on the type of DLM tear. Postoperative OCD lesions were identified radiographically. Age, sex, weight, Lysholm score, Tegner activity scale, exercise frequency, and surgical procedure were compared between the postoperative OCD diagnosis group and non-OCD control group. Results Postoperative OCD was diagnosed in 8/103 (7.8%) knees following DLM surgery. The incidence of postoperative OCD was significantly greater for patients age less than 10 years old, and male sex, low weight, Lysholm score, Tegner activity scale preinjury and after returning to sports, and exercise frequency per week on univariate analyses. On multivariate analyses, postoperative OCD occurred more commonly with subtotal meniscectomy than with saucerization or saucerization with repair, and in patients less than 11 years of age. Receiver operating characteristic curve analysis revealed a cutoff value of age at surgery of 10 years. Conclusions Subtotal meniscectomy and patients younger than 10 years at the time of surgery are at greater risk for postoperative OCD. To decrease this risk, if possible, we recommend performing saucerization or saucerization with repair in patients undergoing surgery for DLM. Level of evidence Level III-retrospective comparative study.

Arthrofibrosis, as a result of osteoarthritis, after trauma, or after knee surgery, can have significant implications for patient function, satisfaction, and outcomes. When extensive conservative management fails to achieve satisfactory results, surgical intervention may be necessary. Arthroscopic techniques to release anterior adhesions are often viewed as easier and safer than posterior releases required for flexion contractures. We present our technique of a safe, effective, and reproducible arthroscopic complete posterior capsulotomy.

Arthroscopic rotator cuff repairs (ARCRs) are common procedures that have been increasing in incidence. When performing ARCR, the surgeon often identifies an undesirable flap or fold, referred to as a “dog-ear” deformity, between sutures or knots. The height and/or thickness of a dog-ear deformity may decrease the rotator cuff–to–acromion distance, resulting in possible impingement and repair compromise. Furthermore, the goal of ARCR is to achieve complete restoration of the tendon-to-footprint relation. To restore the entire footprint, this lesion must be reduced and stabilized. We present a technique using looped sutures to augment the rotator cuff repair and prevent dog-ear formation.

Purpose To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy. Methods After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction. Results We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability. Conclusions With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable. Level of Evidence Level III, systematic review of Level III evidence.

Medical and psychological sciences historically have been dominated by research on males. This gender disparity in research focus has been especially notable when considering children and adolescen...

This report is one of a series of outcome evaluation studies for parent-training procedures tailored specifically to families of preadolescent antisocial children. Referred families were screened to identify 19 problem children who were observed in their homes to be high-rate social aggressors. Cases were randomly assigned to the parent-training procedures or to a waiting-list comparison group. All but one of the latter accepted a referral for treatment elsewhere in the community. After an average of 17hours of therapy time, the cases in the experimental group were terminated. Posttreatment observation data were collected in the homes of both the experimental and the comparison groups. The results indicated that, relative to the changes in the comparison sample, the parent-training sample showed a significantly greater reduction in the observed rates of deviant child behavior.

Since the year 2000 the Waikato Institute of Technology has been reviewing the list of “Notable and Historic” trees of New Zealand first published by the Forest Service in 1974. Since that time 29.7% of those trees have been lost – 53% of those losses due to development, 29% to natural causes such as storms and disease, and a further 18% that could not be located. Despite this tree loss New Zealand has an impressive list of trees of international significance, many of which are regarded as the largest of their species in the world.

Using a longitudinal, prospective adoption design, the authors of this study examined the effects of the environment (adoptive parents' depressive symptoms and responsiveness) and genetic liability of maternal depression (inferred by birth mothers' major depressive disorder [MDD]) on the development of fussiness in adopted children between 9 and 18 months old. The sample included 281 families linked through adoption, with each family including 4 individuals (i.e., adopted child, birth mother, adoptive father and mother). Results showed that adoptive mothers' depressive symptoms when their child was 9 months old were positively associated with child fussiness at 18 months. A significant interaction between birth mothers' MDD and adoptive mothers' responsiveness indicated that children of birth mothers with MDD showed higher levels of fussiness at 18 months when adoptive mothers had been less responsive to the children at 9 months. However, in the context of high levels of adoptive mothers' responsiveness, children of birth mothers with MDD did not show elevated fussiness at 18 months. Findings are discussed in terms of gene-environment interactions in the intergenerational risk transmission of depression.

To further the understanding of the effects of early experience on the pathways to externalizing behavior, 9-month-old infants were observed during a frustration task. The analytical sample was composed of 348 linked triads of participants (adoptive parents, adopted child, and birth parent[s]) from a prospective adoption study, thereby permitting an examination of the interplay between genetic characteristics and early environmental experiences. It was hypothesized that genetic risk for externalizing problems (indexed by birth parents’ externalizing behavior) and affect dysregulation in the home (indexed by adoptive parents’ anxious/depressive symptoms) would independently and interactively predict a known precursor to externalizing problems: heightened infant attention to frustrating events. The results from the SEM analyses supported the moderation hypotheses involving adoptive mother affect dysregulation but did not support those involving adoptive father affect dysregulation: infants at genetic risk showed heightened attention to frustrating events only when the adoptive mother had higher levels of anxious/depressive symptoms. The Genotype x Environment interaction pattern held when substance use during pregnancy was considered. Sex-specific patterns of effects and future directions are discussed.

In this paper, we describe the development and history of the Keeping Foster Parents Trained and Supported (KEEP) foster-parent training intervention. KEEP intervention represents a modified version of the Multidimensional Treatment Foster Care intervention developed by interventionists at the Oregon Social Learning Center and is designed to provide training and support for children ages 5–11 in regular foster care. We also report on the initial findings from a programme of research focused on determining the effectiveness of the intervention. Thus far, the results indicate that the intervention is effective in reducing child behaviour problems and that the effects of the intervention are mediated through changes in parenting behaviour. There is also evidence that the KEEP foster-parent training intervention increases the chances of a positive change of placement (e.g. child reunited with biological parents) and mitigates the negative risk-enhancing effect of a history of multiple placements. We conclude with a discussion of unanswered questions and directions for future research.

Substance use outcomes were examined for 351 youth participating in a randomized controlled trial designed to assess the efficacy of a school-based multimodal universal preventive intervention, Linking the Interests of Families and Teachers (LIFT). Frequency of any use of tobacco, alcohol, and other drugs was assessed via self-report from grades 5 through 12. Latent variable growth models specified average level, linear growth and accelerated growth. The LIFT intervention had a significant effect on reducing the rate of growth in use of tobacco and illicit drugs, particularly for girls, and had an overall impact on average levels of use of tobacco, alcohol, and illicit drugs. Average tobacco use reductions were mediated by increases in family problem solving. The intervention had significant indirect effects on growth in substance use through intervention effects on reduced playground aggression and increased family problem solving. The intervention was also associated with roughly a 10% reduced risk in initiating tobacco and alcohol use. Implications for future studies of multimodal preventive interventions are discussed.

Nearly every state in the nation requires training for foster parents and treatment foster parents. However, very little is known about the effectiveness of this required training. The current paper provides a comprehensive research synthesis on training of caregivers for youth in these out-of-home settings. The review shows potentially promising directions; however, there is little empirical support for the most widely-used curricula of foster parent training. Scattered research on a wide variety of training protocols and approaches provides little empirical evidence for any specific program. Additionally, research on treatment foster care shows promising and positive results, but has paid little attention to requirements or variations in training for treatment foster parents. Evidence-based programs from other areas (e.g., treatment foster care, parent training) have begun to be tested with foster parents with positive results. The article includes highlights of promising current directions and a discussion of challenges and possibilities for advancing the evidence base on this key topic.

Using 323 matched parties of birth mothers and adoptive parents, this study examined the association between the degree of adoption openness (e.g., contact and knowledge between parties) and birth and adoptive parents’ post-adoption adjustment shortly after the adoption placement (6 to 9 months). Data from birth fathers (N=112), an understudied sample, also were explored. Openness was assessed by multiple informants. Results indicated that openness was significantly related to satisfaction with adoption process among adoptive parents and birth mothers. Increased openness was positively associated with birth mothers’ post-placement adjustment as indexed by birth mothers’ self reports and the interviewers’ impression of birth mothers’ adjustment. Birth fathers’ report of openness was associated with their greater satisfaction with the adoption process and better post-adoption adjustment.

There is a growing consensus that implementation of evidence-based intervention and treatment models holds promise to improve the quality of services in child public service systems such as mental health, juvenile justice, and child welfare. Recent policy initiatives to integrate such research-based services into public service systems have created pressure to expand knowledge about implementation methods. Experimental strategies are needed to test multi-level models of implementation in real world contexts. In this article, the initial phase of a randomized trial that tests two methods of implementing Multidimensional Treatment Foster Care (an evidence-based intervention that crosses child public service systems) in 40 non-early adopting California counties is described. Results are presented that support the feasibility of using a randomized design to rigorously test contrasting implementation models and engaging system leaders to participate in the trial.

A careful history and physical examination are the cornerstones of orthopaedic sports medicine. When evaluating a patient for ligamentous instability of the knee joint, an understanding of the contribution of anatomic structures to stability enhances a practitioner's ability to achieve an accurate clinical diagnosis. This article reviews the various types of knee instability and the associated anatomic structures. Ultimately, information must be obtained from multiple tests to reach the final diagnosis. We describe in detail the pathologic and biomechanical basis of the tests for both tibiofemoral and patellofemoral instability of the knee joint and provide recommendations for performance and interpretation of these physical examinations.

Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Grimm, Youth Law News, April-June:3-29, 2003). On the other hand, numerous theoretically based, developmentally sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin and Wassell, Journal of the American Academy of Child and Adolescent Psychiatry, 39:414-420, 2000; McMahon and Forehand, Helping the noncompliant child, Guilford Press, New York, USA, 2003; Patterson and Forgatch, Parents and adolescents: I. Living together, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al., Journal of Clinical Child Pyschology Psychiatry, 42:943-952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain, Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents' skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children in foster families reporting more than six behavior problems per day at baseline.

Background Autologous chondrocyte implantation (ACI) is an expensive treatment option for focal cartilage defects, and commercial funding of research is associated with a study reaching a positive conclusion. The purpose of this analysis is to compare outcomes (and levels of evidence) between published ACI outcome studies that were commercially funded and studies that were not commercially funded. Hypothesis Commercially funded ACI literature could be commercially biased. Study Design Comparative meta-analysis. Methods MEDLINE was searched for human, knee, ACI, nonmembrane, English language, and clinical outcome studies. Studies were evaluated with regard to funding status (commercially funded or not commercially funded), outcomes, and levels of evidence. Outcomes and levels of evidence were evaluated and compared for commercially funded studies versus those that were not commercially funded. Results Twenty-three studies were included; 16 (70%) were commercially funded. Pooled clinical outcome measures data were not significantly different (Lysholm, Modified Cincinnati, patient-reported Cincinnati, Tegner, pain Visual Analog Scale) when comparing commercially funded studies with those that were not commercially funded. However, distribution of levels of evidence was significantly lower (P = .045) for commercially funded studies. Conclusion Reassuringly, commercial funding of ACI studies did not result in a difference in published clinical outcomes versus those that were not commercially funded. However, the lower levels of evidence of commercially funded studies suggests that commercially funded ACI studies may be of less value to surgeons desiring to practice evidence-based medicine, and, in the future, commercial entities funding medical research could selectively fund studies of the highest levels of evidence.

Purpose: The superior-medial (SM) shoulder arthroscopic portal (Neviaser portal) is the portal anatomically closest to the suprascapular nerve, and any potential benefits of this portal would be mitigated if risk of suprascapular nerve injury were significant. The purpose of this study is to determine the safety of the SM arthroscopic shoulder portal. We hypothesize that the SM shoulder arthroscopic portal is safe. Methods: Twelve fresh cadaveric shoulders were securely positioned to simulate shoulder arthroscopy in the beach-chair position with the arm at the patient's side in neutral rotation. An SM portal was established 1 cm medial to the acromion and 1 cm posterior to the clavicle, and a 5.5-mm burr sheath was oriented toward the acromioclavicular joint. The skin and trapezius were resected, the supraspinatus was retracted, and the suprascapular nerve was identified. The distance between the sheath and the nerve was measured by 2 independent observers with calipers. A safe distance was defined as 10 mm. Results: The measured distances between the nerve and burr ranged from 18.5 to 35.7 mm, with a mean of 24.2 ± 5 mm. The distance is significantly greater than the safe distance of 10 mm ( P Conclusions: This study shows that the SM portal is safe. The distance between an instrument oriented toward the acromioclavicular joint via the SM portal and the suprascapular nerve was 18.5 mm or greater in all specimens. Clinical Relevance: Our study has clinical relevance because the SM portal is useful for arthroscopic rotator cuff repair, arthroscopic superior labrum repair, and arthroscopic distal clavicle excision.

The Early Growth and Development Study is a prospective adoption study of birth parents, adoptive parents, and adopted children (N = 359 triads) that was initiated in 2003. The primary study aims are to examine how family processes mediate or moderate the expression of genetic influences in order to aid in the identification of specific family processes that could serve as malleable targets for intervention. Participants in the study are recruited through adoption agencies located throughout the United States, following the birth of a child. Assessments occur at 6-month intervals until the child reaches 3 years of age. Data collection includes the following primary constructs: infant and toddler temperament, social behavior, and health; birth and adoptive parent personality characteristics, psychopathology, competence, stress, and substance use; adoptive parenting and marital relations; and prenatal exposure to drugs and maternal stress. Preliminary analyses suggest the representativeness of the sample and minimal confounding effects of current trends in adoption practices, including openness and selective placement. Future plans are described.

The role of behavior observation in theory-driven prevention intervention trials is examined. A model is presented to guide choice of strategies for the measurement of five core elements in theoretically informed, randomized prevention trials: (1) training intervention agents, (2) delivery of key intervention conditions by intervention agents, (3) responses of clients to intervention conditions, (4) short-term risk reduction in targeted client behaviors, and (5) long-term change in client adjustment. It is argued that the social processes typically thought to mediate interventionist training (Element 1) and the efficacy of psychosocial interventions (Elements 2 and 3) may be powerfully captured by behavior observation. It is also argued that behavior observation has advantages in the measurement of short-term change (Element 4) engendered by intervention, including sensitivity to behavior change and blinding to intervention status.

Child welfare service agencies provide parent training as part of their legally mandated responsibility to provide services to assist families to keep their children at home or to achieve reunification. The use of parent-training programs for families in the child welfare system has undergone relatively little examination. Mental health, special education, and juvenile justice have been identifying evidence-based approaches that have demonstrated effectiveness with children and families with conduct disorders and other behavioral problems, although few of these interventions have been tested with child welfare services clientele. This article brings together evidence about the most promising programs from other child service sectors with information about the current parent training approaches in child welfare and generates a range of proposals about next steps to enhance the capacity of parent training and fulfill the high expectations set in law and practice.

Because the dental hard tissues commence development in the 13th week in utero and once formed are essentially inert, they may provide unique windows onto environmental and physiological changes du...

Middle school outcomes for a population-based, randomized preventive intervention trial for conduct problems are reported. Students ( n = 361), and their parents, from six elementary schools participated in the trial. Randomization into control and preventive intervention conditions occurred at the school level. Schools were located in neighborhoods characterized by high rates of juvenile delinquency. The Linking the Interest of Families and Teachers (LIFT) multimodal preventive intervention, which included behavioral parent management training, child social and problem-solving skills training, a recess behavior management program, and a classroom dedicated phone line and answering machine, was offered to students and parents from all fifth and combined fourth-fifth classrooms within preventive intervention schools. Survival analyses were conducted using logistic regression for substance use outcomes and Cox regression for police arrest. The onset of polic arrest and patterned alcohol use during the middle school years was less likely for participants in the preventive intervention condition than for participants in the control condition, but no differences were found in terms of onset of tobacco use or marijuana use.

Purpose Controversy exists regarding the best method for creating the knee anterior cruciate ligament (ACL) femoral tunnel or socket. The purpose of this study was to systematically review the risks, benefits, advantages, and disadvantages of the endoscopic transtibial (TT) technique, anteromedial portal technique, outside-in technique, and outside-in retrograde drilling technique for creating the ACL femoral tunnel. Methods A PubMed search of English-language studies published between January 1, 2000, and February 17, 2014, was performed using the following keywords: "anterior cruciate ligament" AND "femoral tunnel." Included were studies reporting risks, benefits, advantages, and/or disadvantages of any ACL femoral technique. In addition, references of included articles were reviewed to identify potential studies missed in the original search. Results A total of 27 articles were identified through the search. TT technique advantages include familiarity and proven long-term outcomes; disadvantages include the risk of nonanatomic placement because of constrained (TT) drilling. Anteromedial portal technique advantages include unconstrained anatomic placement; disadvantages include technical challenges, short tunnels or sockets, and posterior-wall blowout. Outside-in technique advantages include unconstrained anatomic placement; disadvantages include the need for 2 incisions. Retrograde drilling technique advantages include unconstrained anatomic placement, as well as all-epiphyseal drilling in skeletally immature patients; disadvantages include the need for fluoroscopy for all-epiphyseal drilling. Conclusions There is no one, single, established "gold-standard" technique for creation of the ACL femoral socket. Four accepted techniques show diverse and subjective advantages, disadvantages, risks, and benefits. Level of Evidence Level V, systematic review of Level II through V evidence.

Purpose: The purpose of this study was to compare arthroscopic versus open examination of the proximal long head of the biceps tendon (LHB) in patients undergoing open, subpectoral tenodesis. Methods: Eighty consecutive patients were prospectively enrolled, of whom 62 were included in the study. During arthroscopy, the most distal extent of the LHB visualized was marked with a Bovie device. The tendon was pulled into the joint with an arthroscopic grasper, showing additional LHB and was again marked with the device. LHB fraying, flattening, redness, and degeneration were graded as absent, mild, moderate, or severe. During open subpectoral tenodesis, the grossly visualized LHB was graded in the same manner and the locations of both marks plus the total length of the LHB observed during open visualization were measured and recorded. After subpectoral tenodesis, the excised portion of the LHB was histologically graded as normal, fibrosis/ tendinosis, or inflamed. Results: On average, during open tenodesis, 95 mm (range, 75 to 130 mm) of LHB was visualized. This was greater than the length visualized during diagnostic arthroscopy of 16 mm (range, 5 to 28 mm), or 17%, and the lengthvisualizedwhilepullingthetendonintothejointwithanarthroscopicgrasperof30mm(range,15to45mm),or32%. The difference in LHB length observed during open versus arthroscopic examination with a grasper was statistically significant (P < .0001). In addition, when compared with LHB pathology observed in an open manner, arthroscopic visualization showed only 67% of pathology, underestimated noted pathology in 56% of patients, and overestimated noted pathology in 11% of patients. Histologic evaluation showed fibrosis/tendinosis in 100% of cases but inflammation in only 5%. Conclusions: When compared with open inspection during subpectoral tenodesis, arthroscopic examination of the LHB visualizes only 32% of the tendon and may underestimate pathology. Level of Evidence: Level II, diagnostic studyddevelopment of diagnostic criteria based on consecutive patients with universally applied gold standard.

Objective. Identification and quantification of strain in shoulder capsular-ligamentous structures during clinical exams and validation of this testing on cadavers. Methods . Mercury strain gauges were sutured in seven locations on shoulders from cadavers. An electromagnetic tracker quantified humeral head translations during laxity exams. Strain and humeral position were acquired during performance of Sulcus, Feagin, Apprehension, Load and Shift, Drawer, and Hawkins tests. Results . Anterior humeral head translation in neutral position was primarily constrained by the coracohumeral ligament. With the arm abducted, anterior middle and inferior ligaments also became active. External rotation and abduction activated inferior and middle capsules. Posterior capsule constrained motion for posterior tests in neutral and abduction. Superior and inferior capsular ligaments were active during inferior tests in neutral position. With abduction, inferior ligaments provided primary translation constraint. Conclusion . Study of kinematics and strain evaluation on cadavers can yield useful information on mechanisms of glenohumeral instability. Relevance This study clarifies the contribution of specific structures of the shoulder to strain in the joint capsule. It also identifies which structures are challenged by provocative laxity exams commonly used by orthopaedic physicians.

Linking the Interests of Families and Teachers (LIFT), a prevention program designed for delivery to children and parents within the elementary school setting, is described. The LIFT targets for change those child and parent behaviors thought to be most relevant to the development of adolescent delinquent and violent behaviors, namely child oppositional, defiant, and socially inept behavior and parent discipline and monitoring.The three major components of the LIFT are (a) classroom-based child social and problem skills training, (b) playground-based behavior modification, and (c) group-delivered parent training.The results of a randomized controlled evaluation of the LIFT are reviewed.To date, the program has positively impacted the targeted antecedents. Most importantly, during the 3 years following the program, the LIFT delayed the time that participants first became involved with antisocial peers during middle school, as well as the time to first patterned alcohol use, to first marijuana use, and to first police arrest.

Objective: The primary goal of the present research was to determine whether retrospective reports of childhood disciplinary experiences and perceptions of that discipline correspond to actual childhood events and whether the accuracy of that report was influenced by the affective state of the respondent. Method: Eighty-three adolescent and young adult males completed a retrospective measure of physical child maltreatment, Assessing Environments (AEIII), and the Brief Symptom Inventory (BSI). As children the participants had been observed naturalistically in their homes interacting with their parents an average of 10 years earlier. Results: Analyses were consistent with the hypothesis that both current mood and actual observations of parent-child interactions during childhood predict self-reported recollections of childhood maltreatment by one’s parents. Further the veridicality of such recollections appears to depend upon the objective specificity versus the perceptive nature of the questions used to elicit the recollections. Conclusions: The findings suggest that assessment instruments suitable for obtaining information regarding earlier childhood victimization must utilize behaviorally specific items. Thus, items that are either global or intimate a normative comparison should be avoided.

A population-based randomized intervention trial for the prevention of conduct problems (i.e., oppositional defiant disorder and conduct disorder) is described. The LIFT (Linking the Interests of Families and Teachers) intervention was designed for all first- and fifth-grade elementary school boys and girls and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. The 10-week intervention strategy was carefully targeted at proximal and malleable antecedents in three social domains that were identified by a developmental model of conduct problems. From 12 elementary schools, 671 first and fifth graders and their families participated either in the theory-based universal preventive intervention or in a control condition. The intervention consisted of parent training, a classroom-based social skills program, a playground behavioral program, and systematic communication between teachers and parents. A multiple measure assessment strategy was used to evaluate participant satisfaction and participation, fidelity of implementation, and the immediate impacts of the program on targeted antecedents.

Hot and cold springs contribute “dead” (14C free) dissolved inorganic carbon (DIC) to the Owens River and Hot Creek. Headwaters aquatic plants have modern 14C, but live plants downstream of the intracaldera springs are depleted in 14C, (as low as 19% modern, with apparent ages up to 13.3 kyrs). In an abandoned meander of the upper Owens River, preserved streambed plants are buried by 600 year old Inyo Craters pumice. Apparent 14C ages of these plants exceed true ages by ∼ 1100 years indicating that they also incorporated dead DIC as they grew. The preserved plants are downstream of Big Springs, whose elevated dead DIC may represent magmatic ‘CO2. The buried plants incorporated ∼10% dead carbon, although modern plants here have ∼50% dead carbon, suggesting that more magmatic CO2 is now entering the upper Owens River than at the time of the Inyo Craters eruptions 600 years ago.

This study developed and compared several mediated and direct-effects models proposed to link well-established correlates of physical child abuse to excessively punitive parenting in a population-based sample of 206 families recruited from high-risk areas of a medium-sized metropolitan area, Parents mere classified as exhibiting excessively punitive parenting based on home observations and parent reports of the use of physical punishment strategies other than spanking, We hypothesized that the levels of child coerciveness, parent irritability, and family stress would be mediated by disruptions in parent discipline in predicting excessively punitive parenting toward the child. Structural equation methodology was employed to test the hypothesized and alternative models. Results consistently supported the powerful mediational role of discipline in the hypothesized model over alternative models that posited separate, direct effects of child coerciveness, parent irritability, and parent stress on excessively punitive parenting behavior. Results are discussed in terms of the need for further examination of parenting behavior, as well as parents' perceptions of and affective reactions to parent-child interactions in the occurrence of physical abuse.

This paper evaluated the Pathways Home manualized selective preventive intervention designed to prevent reunification failures once children are returned home to their biological parent(s) after first time stays in foster care (n = 101). The theoretically based intervention focused on support and parent management practices designed to prevent the development of child behavior problems including internalizing and externalizing problems, and substance use. Intent to treat analyses employed probability growth curve approaches for repeated telephone assessments over 16 weeks of intervention. Findings showed that relative to services as usual reunification families, the Pathways Home families demonstrated better parenting strategies that were in turn associated with reductions in problem behaviors over time. Growth in problem behaviors in turn predicted foster care re-entry. Maternal substance use cravings were a risk factor for growth in problem behaviors that were buffered by participation in the Pathways Home intervention.

The joint, longitudinal trajectories of symptoms of disruptive behavior problems and of depression were examined in a community sample drawn from neighborhoods with elevated rates of delinquency. Growth mixture modeling was applied to a 6 year transition period from childhood to adolescence, age 10 to 16 years, to identify latent classes of trajectories for each symptom type. Several classes emerged for the two types of symptoms, namely a group of youth with high levels of disruptive behavior, a group with increasing levels, and a group with low levels, as well as a group with increasing levels of depression, a group with high levels, a group with decreasing levels, and a group with low levels. Within each symptom type, membership in either the high or in the increasing classes was related to a variety of problematic outcomes during emerging adulthood. The co-occurrence of the disruptive behavior and depression classes was then evaluated using parallel process analysis. Youth exhibiting high depressive symptoms were at increased risk for disruptive behavior problems, and youth with increasing disruptive behavior problems were at risk for depressive symptoms. However, only a very small number of youth had both a high depression trajectory and a high disruptive behavior trajectory. Implications of the findings for the design of prevention and treatment programs are discussed.

The current study examines the interplay between parental overreactivity and children's genetic backgrounds as inferred from birth parent characteristics on the development of negative emotionality during infancy, and in turn, to individual differences in externalizing problems in toddlerhood. The sample included 361 families linked through adoption (birth parents and adoptive families). Data were collected when the children were 9, 18, and 27 months old. Results indicated links between individual levels and changes in negative emotionality during infancy and toddlerhood to externalizing problems early in the third year of life. Findings also revealed an interaction between birth mother negative affect and adoptive mother overreactive parenting on children's negative emotionality. This Genotype × Environment interaction predicted externalizing problems indirectly through its association with negative emotionality and revealed stronger effects of genetic risk for children with less overreactive parenting from their mothers. Limitations of this study and directions for future research are discussed.