Return to Golf After Hip Arthroscopy: A Systematic Review of the Literature.

CONTEXT: Patients experiencing pain from femoral acetabular impingement and considering hip arthroscopy may be concerned about their timeline to resume activities they enjoy, such as golf. OBJECTIVE: The purpose of this study was to review current literature on return-to-play data after hip arthroscopy and to provide clinicians with data to set proper expectations with patients. DATA SOURCES: The following terms were used to search PubMed and Embase electronic databases on October 18, 2023: hip, arthroscopy, arthroscopic, golf. STUDY SELECTION: Studies were included if they were in the English language, of Level 1 to 4 evidence, and contained data specific to golfers undergoing hip arthroscopy. Studies were excluded if they did not designate participants as golfers or did not specify return-to-play data. Editorials, case reports, and review articles were excluded. Screening was completed by 2 authors in a blind and duplicate manner. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level II. DATA EXTRACTION: The following datapoints were extracted from each study: hip pathology and arthroscopic procedure data; number of players returning to golf and time from surgery to return; outcome score(s); and rehabilitation details. Descriptive statistics were calculated using Comprehensive Meta-Analysis software. RESULTS: The search returned 400 studies, of which 4 were included for analysis. Of these 4 studies, 2 specified return-to-play time. Of 95 golfers, 90 (94.7%) returned to golf successfully after arthroscopic hip surgery. Subjective and objective outcome scores improved postoperatively, including an increased average drive distance. CONCLUSION: Return to golf after hip arthroscopy is highly probable, with approximately 95% of patients throughout literature returning to play. A mean return time of 4.7 months for professional golfers and 7.2 months for amateurs, alongside improved subjective outcomes and performance metrics postsurgery, suggest patients can expect a relatively quick return to the course with similar or improved performance.

Evapotranspiration-linked silica deposition in a basal tracheophyte plant (Lycopodiaceae: Lycopodiella alopecuroides): implications for the evolutionary origins of phytoliths.

Phytoliths, microscopic deposits of hydrated silica within plants, play a myriad of functional roles in extant tracheophytes - yet their evolutionary origins and the original selective pressures leading to their deposition remain poorly understood. To gain new insights into the ancestral condition of tracheophyte phytolith production and function, phytolith content was intensively assayed in a basal, morphologically conserved tracheophyte: the foxtail clubmoss Lycopodiella alopecuroides. Wet ashing was employed to perform phytolith extractions from every major anatomical region of L. alopecuroides. Phytolith occurrence was recorded, alongside abundance, morphometric information, and morphological descriptions. Phytoliths were recovered exclusively from the microphylls, which were apicodistally silicified into multiphytolith aggregates. Phytolith aggregates were larger and more numerous in anatomical regions engaging in greater evapotranspirational activity. The tissue distribution of L. alopecuroides phytoliths is inconsistent with the expectations of proposed adaptive hypotheses of phytolith evolutionary origin. Instead, it is hypothesized that phytoliths may have arisen incidentally in the L. alopecuroides-like ancestral plant, polymerizing from intraplant silicon accumulations arising via bulk flow and 'leaky' cellular micronutrient channels. This basal, nonadaptive phytolith formation model would provide the evolutionary 'raw material' for later modification into the useful, adaptative, phytolith deposits seen in later-diverging plant clades.

Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers.

INTRODUCTION: Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care. MATERIALS AND METHODS: The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military. RESULTS: The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers. CONCLUSIONS: Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to "red flags," primary care providers can manage most of these injuries with short-term follow-up with orthopedics.

Microstructurally driven self-sharpening mechanism in beaver incisor enamel facilitates their capacity to fell trees.

Beavers (Castor) stand out among mammals for their unique capacity to fell trees using their large, ever-growing incisors. This routine consumption of resistant fodder induces prodigious wear in the lower incisors, despite this blunting effect the incisors maintain a remarkably sharp cutting edge. Notably, the enamel edges of their incisors show a highly complex two-part microstructure of which the biomechanical import is unknown. Here, using fracture analysis, nanoindentation, and wear testing on North American beaver (C. canadensis) incisors we test the microstructure's possible contribution to maintaining incisal sharpness. Although comparable in hardness, the inner enamel preferentially fails and readily wears at 2.5 times the rate of the outer enamel. The outer microstructure redirects all fractures in parallel, decreasing fracture coalescence. Conversely, the inner microstructure facilitates crack coalescence increasing the wear rate by isolating layers of enamel prisms that readily fragment. Together these two architectures form a microstructurally driven self-sharpening mechanism contained entirely within the thin enamel shell. Our results demonstrate that enamel microstructures exposed at the occlusal surface can markedly influence both enamel crest shape and surface texture in wearing dentitions. The methods introduced here open the door to exploring the biomechanical functionality and evolution of enamel microstructures throughout Mammalia. STATEMENT OF SIGNIFICANCE: Enamel microstructure varies significantly with the diversity of diets, bite forces, and tooth shapes exhibited by mammals. However, minimal micromechanical exploration of microstructures outside of humans, leaves our understanding of biomechanical functions in a nascent stage. Using biologically informed mechanical testing, we demonstrate that the complex two-part microstructure that comprises the cutting edge of beaver incisors facilitates self-sharpening of the enamel edge. This previously unrecognized mechanism provides critical maintenance to the shape of the incisal edge ensuring continued functionality despite extreme wear incurred during feeding. More broadly, we show how the architecture of prisms and the surrounding interprismatic matrix dictate the propagation of fractures through enamel fabrics and how the pairing of enamel fabrics can result in biologically advantageous functions.

Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review.

Background: Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening. Methods: This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures). Results: The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%. Conclusion: This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.

The effects of acute pain on cognitive skills in emergency department patients.

INTRODUCTION: Effective pain management results in improved patient satisfaction, reduced anxiety, and improved comfort. However, concern exists regarding the effects of pain medications on cognition and patient ability to consent for procedures, hospital admission, or to refuse recommended medical interventions. METHODS: This prospective, case-control study was conducted at a Level 1 Trauma Center. Eligible subjects included ED patients ages 18 and older with a triage pain score of 1 or higher, who received non-narcotic analgesic agents. Cognition was measured before and after non-narcotic pain medication using the Digit Symbol Substitution Test (DSST). A control group consisted of 35 healthy volunteers who completed the DSST at baseline and one hour. RESULTS: Among 46 subjects, the mean age was 33. The mean triage pain score was 7. Before medication, the average DSST score was 39.5. After medication, the average DSST score was 42.9. There was a significant within-subject average change in DSST score (pre-post) of 3.4 (95% confidence interval: 1.6, 5.2), p < 0.001. Among the control group, the mean baseline DSST score was 64.2 (SD 10.7). One hour later the mean DSST score had increased to 71.1 (SD 10.4). Overall, the mean within-subject change over time in DSST was 6.9 (SD 8.0) with 95% CI 4.2 to 9.7. There was not enough evidence to detect relationships between change in DSST scores and age, triage pain, triage HR, triage RR, change in pain scores, gender, ethnicity, mode of arrival nor insurance (all with p > 0.05). CONCLUSIONS: We found significant variation in DSST scores among ED patients with pain. Treatment of pain with nonsedating analgesic agents was not associated with improved scores on the Digit Symbol Substitution Test among ED patients with acute painful conditions, compared to control subjects.

Femoral Neck Stress Fractures in Athletes and the Military.

➤: Femoral neck stress fractures (FNSFs) are an infrequent condition in athletic and military populations. ➤: A high index of suspicion with liberal use of magnetic resonance imaging (MRI) is vital for early recognition and treatment initiation. ➤: An associated hip effusion on MRI is a risk factor for an evolving stress injury and requires close assessment and consideration for repeat MRI. ➤: Stress reactions and stable, incomplete FNSFs (<50% of femoral neck width) can be treated nonsurgically. ➤: Surgical intervention is accepted for high-risk, incomplete (≥50% of femoral neck width), and complete FNSFs. ➤: Overall, there is a paucity of high-quality literature on the rates of return to activity following FNSF.

Analysis of Social Media Perceptions Among Orthopaedic Surgery Residency Applicants and Social Media Use by Residency Programs During the 2020 to 2021 Cycle.

Owing to the coronavirus 2019 pandemic limiting both applicants and residency programs in their ability to connect in-person, it is likely that a shift toward virtual connections was made. We aimed to query applicants regarding their perspectives of orthopaedic residency program social media use. Furthermore, we aimed to quantify the number of orthopaedic surgery residency programs with active social media accounts. METHODS: All applicants to a single orthopaedic surgery residency were surveyed regarding their perceptions of social media use by orthopaedic surgery residency programs. After this, we evaluated social media use by orthopaedic surgery residency programs. RESULTS: Of total, 54.3% of applicants indicated that an orthopaedic surgery residency program they followed on social media posted content that increased their interest in the program. Furthermore, 77.8% of the applicants believed that orthopaedic surgery residency programs should have social media accounts, specifically Instagram. Of the orthopaedic surgery residencies identified, 113 (58.9%) had Instagram, 84 (43.8%) had Twitter, and 21 (10.9%) had Facebook accounts. DISCUSSION: Applicants largely feel that orthopaedic surgery residencies should have social media accounts. Orthopaedic surgery residencies saw the value in connecting with students virtually, as shown by nearly 90% of the programs, with social media starting their accounts this year.

Neuroapraxia and early complications after reverse shoulder arthroplasty with glenoid bone grafting.

BACKGROUND: Bone grafting during primary reverse shoulder arthroplasty (RSA) is a technique used to restore poor glenoid bone, increase lateralization, and restore abnormal inclination or version. The purpose of this article is to analyze early outcomes of bone grafting during RSA, assessing the influence of technical and patient considerations. METHODS: In a 4.5-year time period, 137 RSAs with glenoid bone grafting were performed with a minimum 3 months' follow-up. The mean follow-up was 17 months (range, 3-38). The mean age was 71 years (range, 45-89), and body mass index was 28 (range, 19-44). The source of the autografts were humeral head (n = 113) and iliac crest autograft (ICBG; n = 24). The humeral components included 84 onlay and 53 inlay designs. RESULTS: Overall, there were 16 complications (12%), of which 6 were major (5%) (3 graft nonunions and 3 infections) and 10 minor (8%) (1 carpal tunnel syndrome and 9 transient axillary neuropraxias). Of the 9 axillary neuropraxias, 8 resolved by the most recent follow-up, whereas 1 patient was lost to follow-up. There were 4 reoperations (3%): 2 for glenoid baseplate loosening, 1 for severe notching associated with severe glenoid bone loss, and 1 for deep periprosthetic infection. One additional patient had a baseplate failure and is undergoing further treatment. There was no difference in the occurrence of graft nonunions, revision surgery, or glenoid component loosening when comparing type of graft or humeral component used. There was an association of revision surgery (P = .02) with ICBG and older age at the time of surgery (P = .02) and an association of transient neuroapraxia with onlay humeral components (P = .01) and workers' compensation cases (P = .04). CONCLUSIONS: There is a high union rate and low complication rate after bone grafting of the glenoid performed with RSA. Transient neuropraxias are the most frequent complication, but the majority resolve within the first postoperative year. These early findings can serve as the basis for future long-term, comprehensive analysis of complications and outcomes after bone grafting during RSA.

Capsular release following total shoulder arthroplasty: an analysis of early outcomes.

BACKGROUND: The purpose of this study is to analyze the outcomes of open and arthroscopic capsular release following total shoulder arthroplasty. METHODS: Over 15 years, 19 patients experienced persistent shoulder stiffness after anatomic total shoulder arthroplasty refractory to nonoperative treatment, requiring either open (n = 5) or arthroscopic (n = 14) capsular release. There were seven (39%) patients who had a prior diagnosis of stiffness before the primary arthroplasty. RESULTS: At a follow-up of 2.3 years (1-5.5), there were changes in range of motion, including forward flexion (77°-117°), abduction (49°-98°), external rotation (9°-19°), internal rotation at 0° (Sacrum to L1), and pain (4.1-2.3) scores (p < 0.01). There were seven (37%) patients that required a reoperation following the initial capsular release. The survival-free of reoperation at 2 and 5 years was 76% and 53%, respectively, while the survival-free of revision surgery at 2 and 5 years was 83%. Furthermore, three (16%) patients required a repeat capsular release. Overall, there were 11 (58%) complications, including stiffness (n = 9), infection (n = 1), subscapularis rupture (n = 2), glenoid loosening (n = 3), and pain with weakness requiring reoperation (n = 1). CONCLUSIONS: Shoulder stiffness after total shoulder arthroplasty is a very difficult pathology to treat, with high rates of complications and reoperations after capsular release. Overall, in patients that do not develop glenoid loosening, capsular release does improve the patient's pain and shoulder motion. Furthermore, when patients develop stiffness, it is critical to rule out other etiologies, such as glenoid loosening, prior to proceeding with capsular release. LEVEL OF EVIDENCE IV: Retrospective case series.

The impact of the reverse prosthesis on revision shoulder arthroplasty: analysis of a high-volume shoulder practice.

BACKGROUND: Since the approval of reverse shoulder arthroplasty (RSA) in 2004, the use of shoulder arthroplasty increased dramatically. Although the success of RSA in the revision setting has been demonstrated, there remains a paucity of studies examining the epidemiology of RSA in revision arthroplasty. This study describes trends of revision arthroplasty during the "era of the reverse," from 2005 through 2016. METHODS: In a multicenter retrospective analysis, we analyzed 274 revision shoulder arthroplasties converted to a RSA (n = 182), anatomic total shoulder arthroplasty (TSA, n = 68), or hemiarthroplasty (n = 24) from 2005 to 2016. Demographics, surgical indications, and types of prosthesis were analyzed. RESULTS: The number of revision arthroplasties increased over 12 years. From 2005 to 2010, TSA (33%) or hemiarthroplasty (16%) were used in similar rates as RSA (51%). From 2011 to 2016, there was a much higher incidence of revision arthroplasty with RSA (78%) compared with TSA (19%) or hemiarthroplasty (3%). Specifically, the number of RSAs increased in 2011 to 2016 compared with 2005 to 2010 in patients aged younger than 60 years, obese patients, patients with indications of glenoid loosening, and those with a diagnosis of diabetes mellitus or rheumatoid arthritis. CONCLUSIONS: The use of RSA for revision arthroplasty increased over the "era of the reverse" and became the majority by 2016. The reverse prosthesis has had expanding indications regarding both patient demographics and pathology. This study demonstrates the reverse prosthesis has had a similar and even more profound effect on revision shoulder arthroplasty than what has previously been well documented in the primary setting.

Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability.

Anterior glenohumeral instability is common, with 21.9 first-time dislocations per 100,000 individuals per year. Recurrent instability is more likely to occur in patients who are younger, of male sex, and have bone defects or ligament laxity. The open Latarjet procedure is effective for the treatment of recurrent anterior glenohumeral instability and is preferred over arthroscopic Bankart repair in the presence of glenoid bone loss. The Latarjet procedure involves transferring the coracoid to the anterior aspect of the glenoid in the following steps. Step 1: Preoperative planning includes an assessment of glenoid deformation and the integrity of the rotator cuff. The degree of bone loss is measured with use of the circle-line method. Step 2: The patient is in the beach-chair position with the arm in a pneumatic arm holder. A parallel drill guide system with 3.75-mm cannulated screws is utilized. Step 3: A 5-to-6-cm incision is made along the anterior axillary line. The deltopectoral interval is established, and the cephalic vein is mobilized laterally. The coracoacromial ligament is transected 15 mm lateral to the coracoid to allow later repair to the anterior capsule. The pectoralis minor is released subperiosteally off the medial coracoid. A 90° oscillating saw is used to transect the coracoid medially to laterally. The coracohumeral ligament is released. Step 4: Two 4.0-mm drill-holes are made 1 cm apart through the coracoid. The undersurface is decorticated. Step 5: The subscapularis is split at the junction of the upper two-thirds and lower one-third. A longitudinal capsulotomy is performed parallel to the glenoid. Step 6: Soft tissue, including the capsule and labrum, is removed from the anterior aspect of the glenoid. The bone is decorticated with an osteotome and a rasp. Step 7: The coracoid is positioned flush or 1 mm recessed relative to the glenoid. Two 1.6-mm guidewires are placed with use of a parallel drill guide followed by a cannulated reamer and two 3.75-mm cannulated screws. Step 8: The coracoacromial ligament is repaired to the capsule. Step 9: The subscapularis split is repaired laterally. The deltopectoral interval and skin are closed in a standard fashion. A standardized rehabilitation protocol is employed postoperatively. The Latarjet procedure results in significantly lower rates of recurrent glenohumeral instability and revision compared with the arthroscopic Bankart procedure (3% and 1% compared with 28.4% and 21%, respectively); however, complication rates as high as 30% have been reported, as well as a risk for nerve injury. The videos included in this article highlight the critical steps required to optimize outcomes and minimize complications when performing the Latarjet procedure.

Establishing benchmarks for the volume-outcome relationship for common lumbar spine surgical procedures.

BACKGROUND CONTEXT: The importance of surgeon volume as a quality measure has been defined for a number of surgical specialties. Meaningful procedural volume benchmarks have not been established, however, particularly with respect to lumbar spine surgery. PURPOSE: We aimed to establish surgeon volume benchmarks for the performance of four common lumbar spine surgical procedures (discectomy, decompression, lumbar interbody fusion, and lumbar posterolateral fusion). STUDY DESIGN: A retrospective review of data in the Florida Statewide Inpatient Dataset (2011-2014) was carried out. PATIENT SAMPLE: Patients who underwent one of the four lumbar spine surgical procedures under study comprised the study sample. OUTCOME MEASURE: The development of a complication or hospital readmission within 90 days of the surgical procedure was the surgical outcome. METHODS: For each specific procedure, individual surgeon volume was separately plotted against the number of complications and readmissions in a spline analysis that adjusted for co-variates. Spline cut-points were used to create a categorical variable of procedure volume for each individual procedure. Log-binomial regression analysis was then separately performed using the categorical volume-outcome metric for each individual procedure and for the outcomes of 90-day complications and 90-day readmissions. RESULTS: In all, 187,185 spine surgical procedures met inclusion criteria, performed by 5,514 different surgeons at 178 hospitals. Spline analysis determined that the procedure volume cut-point was 25 for decompressions, 40 for discectomy, 43 for interbody fusion, and 35 for posterolateral fusions. For surgeons who failed to meet the volume metric, there was a 63% increase in the risk of complications following decompressions, a 56% increase in the risk of complications following discectomy, a 15% increase in the risk of complications following lumbar interbody fusions, and a 47% increase in the risk of complications following posterolateral fusions. Findings were similar for readmission measures. CONCLUSIONS: The results of this work allow us to identify meaningful volume-based benchmarks for the performance of common lumbar spine surgical procedures including decompression, discectomy, and fusion-based procedures. Based on our determinations, readily achievable goals for individual surgeons would approximate an average of four discectomy and lumbar interbody fusion procedures per month, three posterolateral lumbar fusions per month, and at least one decompression surgery every other week.

Do emotion regulation difficulties when upset influence the association between dietary restraint and weight gain among college students?

Obesity is a significant public health concern that affects more than one-fifth of adolescents aged 12-19 in the United States. Theoretical models suggest that prolonged dietary restraint leads to binge-eating behaviors, which in turn increases individuals' risk for weight gain or obesity. Results from the literature indicate a potential role for negative urgency (the tendency to act rashly when distressed) as a mediating variable that explains the link between dietary restraint and binge-eating episodes. The current study tested short-term, prospective longitudinal associations among dietary restraint, binge eating, negative urgency, and weight gain among college students - a population at increased risk for the development of overweight and obesity. We hypothesized that dietary restraint and weight gain would be mediated by negative urgency and binge eating, but only among participants with overweight and obesity. College students (N = 227) completed the Eating Pathology Symptoms Inventory, UPPS-P Impulsivity Scale, and self-reported weight and height to calculate body mass index. Results showed that the association between dietary restraint and weight gain was mediated by negative urgency and binge eating, but only among participants with overweight and obesity. Our findings indicated that negative urgency might represent a mechanism that explains why dietary restraint leads to future binge-eating episodes and weight gain among college students with overweight and obesity. Results suggest that future treatment and prevention programs for overweight and obesity may benefit from incorporating strategies to improve emotion regulation as a way to reduce binge eating and to prevent additional weight gain among 'at-risk' populations.

Predicting 1-Year Postoperative Visual Analog Scale Pain Scores and American Shoulder and Elbow Surgeons Function Scores in Total and Reverse Total Shoulder Arthroplasty.

Shared decision-making provides patients a measure of autonomy in making choices for their health and their future. Patient-reported outcome measures (PROMs) use clinically sensitive and specific metrics to evaluate a patient's self-reported pain, functional ability, and mental state. We conducted a study to create an evidence-based clinical decision-making tool. We used PROMs to create a predictive model of a patient's outcome to help set patient expectations and facilitate a collaborative decision-making environment for patient and physician. The study used a comprehensive prospective database that stores preoperative and 1-year postoperative patient demographics and total shoulder arthroplasty PROM data. Linear regression models were used to evaluate the predictive ability of each factor and the overall predictive ability of each model. One model predicts 1-year postoperative visual analog scale (VAS) pain scores; the other predicts 1-year postoperative American Shoulder and Elbow Surgeons (ASES) Function scores. The total number of observations was 1004 for modeling 1-year postoperative VAS pain scores and 986 for modeling 1-year postoperative ASES Function scores. Regression coefficients and P and ω2 values are reported. Preoperative VAS pain scores predicted 1-year postoperative VAS pain scores (P < .001) but not 1-year postoperative ASES Function scores (P = .485). Preoperative Veterans RAND 12-Item Health Survey (VR-12) mental health component summary (MCS) scores predicted self-reported pain and function (Ps < .001) 1 year after surgery. In these models, preoperative VR-12 MCS score was the most predictive PROM for 1-year postoperative VAS pain score (ω2 = .023) and 1-year postoperative ASES Function score (ω2 = .029). Together, a patient's preoperative VAS pain score, ASES Function score, VR-12 MCS score, age, sex, and type of arthroplasty can provide significant predictive value that may aid in setting appropriate expectations for pain and function 1 year after surgery.

Is "drunkorexia" an eating disorder, substance use disorder, or both?

Researchers have identified a specific behavior pattern labeled "drunkorexia" to describe recurrent inappropriate compensatory behaviors (e.g., fasting and self-induced vomiting) to avoid weight gain from consuming alcohol (referred to as ICB-WGA). Several studies have investigated the prevalence of these behaviors among college students, but few have tested whether this behavior pattern is more strongly related to substance use or disordered eating, which may have future implications for eating disorder and substance abuse research fields. The aim of this project was to test: (1) whether disordered eating or alcohol use adds incremental validity to the prediction of ICB-WGA when controlling for the other variable and (2) the effect of sex on ICB-WGA. College participants (N=579; 53% female) completed the Eating Pathology Symptoms Inventory (EPSI), the Alcohol Use Disorders Identification Test (AUDIT), and several questions designed to measure ICB-WGA. Results indicated that EPSI Restricting and Body Dissatisfaction scales were not significant predictors of ICB-WGA, whereas the AUDIT and EPSI Cognitive Restraint, Excessive Exercise, Purging, and Binge Eating scales significantly predicted ICB-WGAs. Results indicated that disordered eating and alcohol use both added incremental validity to the prediction of ICB-WGA; however, ICB-WGA was more strongly related to disordered eating, and this was particularly true for women. Our findings suggest that individuals engaging in ICB-WGA may be at-risk for future development of both eating and substance disorders. Notably, our findings highlight the need for future research to focus on trans-diagnostic prevention programs that target mechanisms that underlie both disordered eating and substance misuse.

Clinical features of neuromyelitis optica in children: US Network of Pediatric MS Centers report.

OBJECTIVE: To compare clinical features of pediatric neuromyelitis optica (NMO) to other pediatric demyelinating diseases. METHODS: Review of a prospective multicenter database on children with demyelinating diseases. Case summaries documenting clinical and laboratory features were reviewed by an adjudication panel. Diagnoses were assigned in the following categories: multiple sclerosis (MS), acute disseminated encephalomyelitis, NMO, and recurrent demyelinating disease not otherwise specified. RESULTS: Thirty-eight cases of NMO were identified by review panel, 97% of which met the revised International Panel on NMO Diagnosis NMO-SD 2014 criteria, but only 49% met 2006 Wingerchuk criteria. Serum or CSF NMO immunoglobulin G (IgG) was positive in 65% of NMO cases that were tested; however, some patients became seropositive more than 3 years after onset despite serial testing. No patient had positive CSF NMO IgG and negative serum NMO IgG in contemporaneous samples. Other than race (p = 0.02) and borderline findings for sex (p = 0.07), NMO IgG seropositive patients did not differ in demographic, clinical, or laboratory features from seronegatives. Visual, motor, and constitutional symptoms (including vomiting, fever, and seizures) were the most common presenting features of NMO. Initiation of disease-modifying treatment was delayed in NMO vs MS. Two years after onset, patients with NMO had higher attack rates, greater disability accrual measured by overall Expanded Disability Status Scale score, and visual scores than did patients with MS. CONCLUSION: The new criteria for NMO spectrum disorders apply well to the pediatric setting, and given significant delay in treatment of NMO compared to pediatric MS and worse short-term outcomes, it is imperative to apply these to improve access to treatment.

Are common measures of dietary restraint and disinhibited eating reliable and valid in obese persons?

Disordered eating measures were developed and validated in primarily normal weight samples; thus, it is unclear if the psychometric properties are equivalent across weight groups. This study evaluated the reliability and validity of self-reported disinhibited eating and dietary restraint measures in a community-recruited sample of overweight individuals (N = 201) and obese individuals (N = 101) and normal weight matched controls. Coefficient alpha and average inter-item correlations were used to test internal consistency reliability. Correlations between lifetime disordered eating behaviors and measures of dietary restraint and disinhibited eating were used to test convergent validity. Disordered eating measures included: Eating Disorders Examination Questionnaire (EDE-Q), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behavior Questionnaire (DEBQ), Eating Disorders Inventory-3 (EDI-3), and Restraint Scale. Correlations between lifetime disordered eating behaviors and measures of non-disordered-eating-related psychopathology were used to test discriminant validity. Results indicated that most measures demonstrated acceptable internal consistency reliability across groups, with the exception of the Restraint Scale. Significantly higher convergent correlations between lifetime history of fasting and TFEQ Cognitive Restraint emerged for the overweight vs. obese group, and the magnitude of discriminant correlations between lifetime history of binge eating and the Inventory of Depression and Anxiety Symptoms (IDAS) Well Being scale was stronger in the normal weight vs. overweight group. Findings suggest the majority restrained and disinhibited eating measures are reliable and valid among weight groups, and are suitable to use in overweight and obese populations.

Quantile lower bounds to reliability based on locally optimal splits.

Extending the theory of lower bounds to reliability based on splits given by Guttman (in Psychometrika 53, 63-70, 1945), this paper introduces quantile lower bound coefficients λ 4(Q) that refer to cumulative proportions of potential locally optimal "split-half" coefficients that are below a particular point Q in the distribution of split-halves based on different partitions of variables into two sets. Interesting quantile values are Q=0.05,0.50,0.95,1.00 with λ 4(0.05)≤λ 4(0.50)≤λ 4(0.95)≤λ 4(1.0). Only the global optimum λ 4(1.0), Guttman's maximal λ 4, has previously been considered to be interesting, but in small samples it substantially overestimates population reliability ρ. The three coefficients λ 4(0.05), λ 4(0.50), and λ 4(0.95) provide new lower bounds to reliability. The smallest, λ 4(0.05), provides the most protection against capitalizing on chance associations, and thus overestimation, λ 4(0.50) is the median of these coefficients, while λ 4(0.95) tends to overestimate reliability, but also exhibits less bias than previous estimators. Computational theory, algorithm, and publicly available code based in R are provided to compute these coefficients. Simulation studies evaluate the performance of these coefficients and compare them to coefficient alpha and the greatest lower bound under several population reliability structures.

Brief report: independent validation of autism spectrum disorder case status in the Utah Autism and Developmental Disabilities Monitoring (ADDM) Network Site.

An independent validation was conducted of the Utah Autism and Developmental Disabilities Monitoring Network's (UT-ADDM) classification of children with autism spectrum disorder (ASD). UT-ADDM final case status (n = 90) was compared with final case status as determined by independent external expert reviewers (EERs). Inter-rater reliability (ICC = 0.84), specificity [0.83 (95 % CI 0.74-0.90)], and sensitivity [0.99 (95 % CI 0.96-1.00)] were high for ASD case versus non-case classification between UT-ADDM and EER. At least one EER disagreed with UT-ADDM on ASD final case status on nine out of 30 records; however, all three EERs disagreed with UT-ADDM for only one record. Findings based on limited data suggest that children with ASD as identified by UT-ADDM are consistently classified as ASD cases by independent autism experts.