The role of human behavior to thwart transmission of infectious diseases like COVID-19 is evident. Psychological and behavioral science are key areas to understand decision-making processes ...underlying engagement in preventive health behaviors. Here we adapt well validated methods from behavioral economic discounting and demand frameworks to evaluate variables (e.g., delay, cost, probability) known to impact health behavior engagement. We examine the contribution of these mechanisms within a broader response class of behaviors reflecting adherence to public health recommendations made during the COVID-19 pandemic. Four crowdsourced samples (total N = 1,366) completed individual experiments probing a response class including social (physical) distancing, facemask wearing, COVID-19 testing, and COVID-19 vaccination. We also measure the extent to which choice architecture manipulations (e.g., framing, opt-in/opt-out) may promote (or discourage) behavior engagement. We find that people are more likely to socially distance when specified activities are framed as high risk, that facemask use during social interaction decreases systematically with greater social relationship, that describing delay until testing (rather than delay until results) increases testing likelihood, and that framing vaccine safety in a positive valence improves vaccine acceptance. These findings collectively emphasize the flexibility of methods from diverse areas of behavioral science for informing public health crisis management.
Category:
Sports; Midfoot/Forefoot
Introduction/Purpose:
Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with ...dislocation. While studies have shown it is possible to return to sport (RTS) after low- energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals. We present a novel surgical technique for repair of homolateral Lisfranc fracture/dislocation of the 1st-5th metatarsals. Fusion of the 2nd and 3rd TMT joints provides stability of the middle column. Internal bracing of the 1st TMT joint gives stability while preserving greater physiologic motion in a high-level athlete.
Methods:
A dorsal approach is used for fusion of the 2nd and 3rd TMT joints with medial approach for internal bracing of the 1st TMT joint. 2nd and 3rd metatarsals were denuded of cartilage, and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites. Guidewire for the cannulated Internal Brace system is inserted into the base of the 1st metatarsal. Fluoroscopic imaging confirmed positioning and the 3.4mm drill is passed over the wire, followed by the cannulated tap. A 4.75mm Swivelock anchor with Fibertape suture is inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm Swivelock is then loaded with the Fiberwire from the 1st metatarsal. Tensioning is performed, and the 3.5 mm Swivelock is inserted into the medial cuneiform.
Results:
The athlete was cleared to return to full competition 9 months following surgery with physical exam demonstrating stability in both dorsiflexion and abduction. Weight bearing x-rays showed no evidence of hardware failure and no instability in the 1st TMT joint. CT scan demonstrated solid fusion of 2nd and 3rd TMT joints and maintained anatomic reduction of the 1st TMT joint. At 1-year post-op, patient was having pain over the 4th TMT joint. He had a second surgery to remove an exostosis at the 4th TMT joint as well as remove the screw from the 3rd metatarsal to the middle cuneiform. His pain had resolved at most recent follow up. He returned to game action in the final game of his senior season.
Conclusion:
The literature demonstrates return to sport is possible for athletes with Lisfranc injuries though the data focuses on either purely ligamentous injuries or Myerson type B and C fractures. This case study demonstrates a novel surgical approach to homolateral fracture/dislocation. While return to sport in this athlete took longer than lower-energy injuries, it is possible for athletes with homolateral displacement to return to full competition.
Objectives: This study sought to determine whether shortened recovery periods between regularly scheduled Sunday NFL games and Thursday Night Football games significantly increased the incidence of ...injury in NFL players.
Methods: NFL injury reports and injury reserve data were collected for every NFL player, on all 32 NFL teams, for each week during the regular season, for the 2012-2013, 2013-2014, 2014-2015, 2015-2016, and 2016-2017 NFL seasons. Injuries were defined as any reported injury, not previously documented in an injury report prior to said injury. Calculated injury rates per 1000 athletic exposures for Sunday and Monday night games versus Thursday night games was used to generate relative risk of injury using 95% confidence intervals.
Results: The all-cause injury rate during NFL Sunday and Monday Night Football games was found to be 7,598 per 1000 athletic exposures, while the all-cause injury rate during Thursday Night Football games was found to be 6,072 per 1,000 athletic exposures. The relative risk of injury during Thursday Night Football games was calculated to be 0.97 compared to Sunday and Monday night games. Therefore, the rate of injury during Thursday Night Football games was significantly less than the rate of injury during Sunday and Monday night games, despite the lack of additional recovery time.
Conclusion: This study suggests that eliminating Thursday Night Football is unlikely to improve the statistical injury rate among NFL players.
Increasing vaccine utilization is critical for numerous diseases, including COVID-19, necessitating novel methods to forecast uptake. Behavioral economic methods have been developed as rapid, ...scalable means of identifying mechanisms of health behavior engagement. However, most research using these procedures is cross-sectional and evaluates prediction of behaviors with already well-established repertories. Evaluation of the validity of hypothetical tasks that measure behaviors not yet experienced is important for the use of these procedures in behavioral health. We use vaccination during the COVID-19 pandemic to test whether responses regarding a novel, hypothetical behavior (COVID-19 vaccination) are predictive of later real-world response. Participants (N = 333) completed a behavioral economic hypothetical purchase task to evaluate willingness to receive a hypothetical COVID-19 vaccine based on efficacy. This was completed in August 2020, before clinical trial data on COVID-19 vaccines. Participants completed follow-up assessments approximately 1 year later when the COVID-19 vaccines were widely available in June 2021 and November 2021 with vaccination status measured. Prediction of vaccination was made based on data collected in August 2020. Vaccine demand was a significant predictor of vaccination after controlling for other significant predictors including political orientation, delay discounting, history of flu vaccination, and a single-item intent to vaccinate. These findings show predictive validity of a behavioral economic procedure explicitly designed to measure a behavior for which a participant has limited-to-no direct prior experience or exposure. Positive correspondence supports the validity of these hypothetical arrangements for predicting vaccination utilization and advances behavioral economic methods.
Purpose of Review
Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip ...arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature.
Recent Findings
Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies—including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population.
Summary
Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play.
Response to letter to the editor Baker, Hayden P.; Young-Hoon Lee, Kenneth; Dayton, Steven R. ...
The Physician and sportsmedicine,
04/2020, Letnik:
48, Številka:
2
Journal Article
ImportanceClinical practice guidelines (CPGs) relating to concussion management are published by various healthcare specialties, including but not limited to orthopaedic surgery, family medicine, ...neurology and athletic trainers. A systematic analysis can help identify high quality CPGs for clinical use by sports medicine physicians.ObjectiveThe purpose of this study is to systematically identify and appraise relevant CPGs related to sports-related concussion in adult patients.Evidence reviewPredetermined selection criteria were used by two reviewers who independently identified published CPGs before 1 November 2018. CPGs were excluded if they focused only on paediatric patients or their scope was greater than concussion in the setting of sports. The remaining guidelines were analysed by five independent reviewers with different levels of training using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines were deficient if they earned scores less than 50%. The Spearman correlation coefficient was used to assess interobserver agreement between the evaluators. Scores were compared by publishing institution and healthcare discipline using Kruskal-Wallis tests.FindingsSeven CPGs met the inclusion criteria. Guidelines came from neurologists, athletic therapists/trainers and interdisciplinary sports medicine bodies. Interobserver agreement was strong and mean scores between surgical trainees (124.5) and board-certified surgeons (125.9) were not statistically different. Guideline quality was variable but not deficient (>50%), except regarding ‘editorial independence’. No statistical difference was found between guidelines from different publishing institutions. Additionally, no statistical difference was found between guidelines published by different healthcare professionals.Conclusions and relevanceOverall, CPG quality was variable but not deficient, except for the domain of editorial independence. Bias due to poor editorial independence is a concern, particularly in CPGs published by non-physicians. Given the similarity in content and methodological quality, consideration should be given to condense evidence into a single CPG to be used by all healthcare professionals in the management of sports concussion.Level of evidence1, Systematic Review.
Precision astrometry at microarcsecond accuracy has applications for a wide range of astrophysical problems. This paper is a study of the science questions that can be addressed using an instrument ...with flexible scheduling that delivers parallaxes at about 4 muas on targets as faint as V = 20, and differential accuracy of 0.6 muas on bright targets. The science topics are drawn primarily from the team key projects, selected in 2000, for the Space Interferometry Mission PlanetQuest (SIM PlanetQuest). We use the capabilities of this mission to illustrate the importance of the next level of astrometric precision in modern astrophysics. SIM PlanetQuest is currently in the detailed design phase, having completed in 2005 all of the enabling technologies needed for the flight instrument. It will be the first space-based long-baseline Michelson interferometer designed for precision astrometry. SIM PlanetQuest will contribute strongly to many astronomical fields, including stellar and galactic astrophysics, planetary systems around nearby stars, and the study of quasar and AGN nuclei. Using differential astrometry SIM PlanetQuest will search for planets with masses as small as Earth orbiting in the 'habitable zone' around the nearest stars, and could discover many dozen if Earth-like planets are common. It will characterize the multiple-planet systems that are now known to exist, and it will be able to search for terrestrial planets around all of the candidate target stars in the Terrestrial Planet Finder and Darwin mission lists. It will be capable of detecting planets around young stars, thereby providing insights into how planetary systems are born and how they evolve with time. Precision astrometry allows the measurement of accurate dynamical masses for stars in binary systems. SIM PlanetQuest will observe significant numbers of very high- and low-mass stars, providing stellar masses to 1%, the accuracy needed to challenge physical models. Using precision proper-motion measurements, SIM PlanetQuest will probe the Galactic mass distribution, and, through studies of tidal tails, the formation and evolution of the Galactic halo. SIM PlanetQuest will contribute to cosmology through improved accuracy of the Hubble constant. With repeated astrometric measurements of the nuclei of active galaxies, SIM PlanetQuest will probe the dynamics of accretion disks around supermassive black holes, and the relativistic jets that emerge from them.
There is limited literature investigating the reliability of magnetic resonance-based assessments of labral size. The goal of this study was to validate the reliability of magnetic resonance ...arthrography-based labral size measurements with intra-operative arthroscopic measurements.
Patients undergoing hip arthroscopy for femoroacetabular impingement and labral tears were prospectively enrolled. Preoperative magnetic resonance arthrograms were used to determine labral size at the anterior-superior portion (zone 2), mid-superior portion (zone 3), and posterior-superior portion (zone 4). Intra-operative labral widths were measured at the same anatomical zones of the acetabulum using an arthroscopic probe. Mean labral size was determined for each location and a Pearson correlation was used to determine the correlation between imaging-based measurements and intra-operative measurements.
117 patients were enrolled with 70% being female, an average age of 39.1 ± 13.3, and an average body mass index was 26.5 ± 5.4. The average labral sizes based on intraoperative measurements were 6.85 mm in zone 2, 7.45 mm in zone 3, and 7.29 mm in zone 4. The average labral sizes based on MRA were 6.95 mm in zone 2, 7.24 mm in zone 3, and 6.71 mm in zone 4. There was a poor correlation between MRA and intraoperative measurements in zones 2 and 3 (zone 2: R = 0.171, p = 0.065; zone 3: R = 0.335, p = 0.00022) and no correlation in zone 4 (R = −0.22, p = 0.82).
This study demonstrates a poor correlation in labral measurements between magnetic resonance arthrogram imaging and intraoperative measurements, suggesting that this imaging modality may be insufficient in providing accurate measurements of labral size.
To investigate opioid utilization after anterior cruciate ligament (ACL) reconstruction in the setting of a multimodal pain regimen and assess the feasibility of prescribing fewer opioids to achieve ...adequate postoperative pain control.
Patients undergoing ACL reconstruction in conjunction with a multimodal approach to pain control were randomized to receive either 30 or 60 tablets of hydrocodone (10 mg)–acetaminophen (325 mg). Patients were contacted at multiple time points up to 21 days after surgery to assess opioid utilization and medication side effects. We compared the mean number of tablets used between groups as the primary outcome. Preoperative variables associated with an increased risk of higher opioid pain medication requirements were also assessed.
The final analysis included 43 patients in the 30-tablet group and 42 in the 60-tablet group. There was no significant difference between groups in the number of tablets consumed (9.5 vs 12.2, P = .22), number of days opioids were required (4.5 vs 6.2, P = .14), 3-month opioid refill rates (12% vs 7%, P = .48), or postoperative pain control at any point up to 21 days after surgery. The 30-tablet group had a significantly smaller proportion of unused tablets compared with the 60-tablet group (69% of prescribed tablets 910 tablets vs 80% of prescribed tablets 2,027 tablets, P < .001). Opioids were required after surgery by 91% of patients (n = 77), and 81% could have had their pain medication requirements met with a prescription for 15 tablets. Risk factors for increased postoperative opioid use included a family history of substance abuse (β = 14.1; 95% confidence interval, 5.7-22.4; P = .0014) and increased pain score at 2 hours after surgery (β = 1.07; 95% confidence interval, 0.064-2.07; P = .037).
Orthopaedic surgeons may significantly reduce the number opioid tablets prescribed after ACL reconstruction without affecting postoperative pain control or refill rates.
Level I, randomized controlled trial.
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