Influence of residual anterior laxity on functional outcomes after anterior cruciate ligament reconstruction.

INTRODUCTION: Residual laxity can persist after anterior cruciate ligament (ACL) reconstruction. This increased anterior translation can be measured with a knee arthrometer. Nevertheless, the measurement parameters and functional impact of this residual laxity are not well understood. The aims of this study were to (1) evaluate the effect of applying loads of 134N, 200N and 250N on the measured residual laxity after ACL reconstruction and (2) evaluate the prognostic ability of the various measurement parameters on the functional outcomes. HYPOTHESIS: After ACL reconstruction, the functional outcomes will be correlated to the postoperative residual laxity. METHODS: We did a prospective study of 61 recreational athletes who underwent surgical reconstruction of their ACL with the Kenneth-Jones technique between 2016 and 2019. The mean age of these patients was 27±7 years, and most were men (75%). The side-to-side difference in laxity was measured pre- and postoperatively using the GNRB® arthrometer at three load levels: 134N, 200N and 250N. The functional outcomes were determined based on the return to sports and the KOOS, IKDC and ARPEGE scores. The mean follow-up was 30±10 months. RESULTS: Half the patients had returned to sport at their pre-injury levels, while 25% had returned to a lower level and 25% had stopped doing any physical activity. At 134N, a 1-mm increase in side-to-side difference was associated with a 2-fold higher risk of not returning to sports (OR 2; 95% CI 1.22-3.23; p<0.01). At 200N, a 1-mm increase in side-to-side difference was associated with a 50% higher probability of having a poor/fair ARPEGE score (OR 1.5; 95% CI 1.05-2.02; p=0.02). At 200N, a 4-mm side-to-side difference was the prognostic threshold for failure to return to sports with a positive predictive value of 86% and specificity of 98%. CONCLUSIONS: This case series found a strong correlation between residual laxity and the functional outcomes after ACL reconstruction. A threshold of 4mm residual laxity evaluated on the GNRB® at 200N was predictive of adverse outcomes and failure to return to sports in our population of recreational athletes. LEVEL OF EVIDENCE: IV, retrospective study.

"Twenty-first birthday drinking: Extreme drinking episodes and white matter microstructural changes in the fornix and corpus callosum": Retraction of Boness et al. (2019).

Reports the retraction of "Twenty-first birthday drinking: Extreme-drinking episodes and white matter microstructural changes in the fornix and corpus callosum" by Cassandra L. Boness, Ozlem Korucuoglu, Jarrod M. Ellingson, Anne M. Merrill, Yoanna E. McDowell, Constantine J. Trela, Kenneth J. Sher, Thomas M. Piasecki and John G. Kerns (Experimental and Clinical Psychopharmacology, 2020[Oct], Vol 28[5], 553-566). The explanation for the retraction: In preparing to use the DTI images for secondary data analysis, it was discovered that multiple participants had the wrong DTI data included for Session 1 analyses. This was due to a file transfer error that incorrectly substituted another participant's DTI data for the correct DTI data. In correcting the error and reanalyzing the data, our findings changed in ways that were nontrivial and, thus, exceed what would be appropriate for a corrigendum. (The following abstract of the original article appeared in record 2019-72844-001.) The 21st birthday celebration is characterized by extreme alcohol consumption. Accumulating evidence suggests that high-dose bingeing is related to structural brain changes and cognitive deficits. This is particularly problematic in the transition from adolescence to adulthood when the brain is still maturing, elevating the brain's sensitivity to the acute effects of alcohol intoxication. Heavy drinking is associated with reduced structural integrity in the hippocampus and corpus callosum and is accompanied by cognitive deficits. However, there is little research examining changes in the human brain related to discrete heavy-drinking episodes. The present study investigated whether alcohol exposure during a 21st birthday celebration would result in changes to white matter microstructure by utilizing diffusion tensor imaging measures and a quasi-experimental design. By examining structural changes in the brain from pre- to postcelebration within subjects (N = 49) prospectively, we were able to more directly observe brain changes following an extreme-drinking episode. Region of interest analyses demonstrated increased fractional anisotropy in the posterior fornix (p < .0001) and in the body of the corpus callosum (p = .0029) from pre- to postbirthday celebration. These results suggest acute white matter damage to the fornix and corpus callosum following an extreme-drinking episode, which is especially problematic during continued neurodevelopment. Therefore, 21st birthday drinking may be considered an important target event for preventing acute brain injury in young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Neglected sexual dysfunction symptoms amongst chronic patients during routine consultations in rural clinics in the North West province.

BACKGROUND: Sexual dysfunction contributes to personal feelings of loss and despair and being a cause of exacerbated interpersonal conflict. Erectile dysfunction is also an early biomarker of cardiovascular disease. As doctors hardly ever ask about this problem, it is unknown how many patients presenting for routine consultations in primary care suffer from symptoms of sexual dysfunction. AIM: To develop an understanding of sexual history taking events, this study aimed to assess the proportion of patients living with symptoms of sexual dysfunction that could have been elicited or addressed during routine chronic illness consultations. SETTING: The research was carried out in 10 primary care facilities in Dr Kenneth Kaunda Health District, the North West province, South Africa. This rural area is known for farming and mining activities. METHODS: This study contributed to a broader research project with a focus on sexual history taking during a routine consultation. A sample of 151 consultations involving patients with chronic illnesses were selected to observe sexual history taking events. In this study, the patients involved in these consultations completed demographic and sexual dysfunction questionnaires (FSFI and IIEF) to establish the proportions of patients with sexual dysfunction symptoms. RESULTS: A total of 81 women (78%) and 46 men (98%) were sexually active. A total of 91% of the women reported sexual dysfunction symptoms, whilst 98% of men had erectile dysfunction symptoms. The youngest patients to experience sexual dysfunction were a 19-year-old woman and a 26-year-old man. Patients expressed trust in their doctors and 91% of patients did not consider discussion of sexual matters with their doctors as too sensitive. CONCLUSION: Clinical guidelines, especially for chronic illness care, must include screening for sexual dysfunction as an essential element in the consultation. Clinical care of patients living with chronic disease cannot ignore sexual well-being, given the frequency of problems. A referral to a sexual medicine specialist, psychologist or social worker can address consequences of sexual dysfunction and improve relationships.

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3-week period (April 2020), 1,032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19) >7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B{middle dot}1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff. Appendix: The CITIID-NIHR COVID-19 BioResource CollaborationO_ST_ABSPrincipal InvestigatorsC_ST_ABSStephen Baker, John Bradley, Gordon Dougan, Ian Goodfellow, Ravi Gupta, Paul J. Lehner, Paul A. Lyons, Nicholas J. Matheson, Kenneth G.C. Smith, M. Estee Torok, Mark Toshner, Michael P. Weekes Infectious Diseases DepartmentNicholas K. Jones, Lucy Rivett, Matthew Routledge, Dominic Sparkes, Ben Warne SARS-CoV-2 testing teamJosefin Bartholdson Scott, Claire Cormie, Sally Forrest, Harmeet Gill, Iain Kean, Mailis Maes, Joana Pereira-Dias, Nicola Reynolds, Sushmita Sridhar, Michelle Wantoch, Jamie Young COG-UK Cambridge Sequencing TeamSarah Caddy, Laura Caller, Theresa Feltwell, Grant Hall, William Hamilton, Myra Hosmillo, Charlotte Houldcroft, Aminu Jahun, Fahad Khokhar, Luke Meredith, Anna Yakovleva NIHR BioResourceHelen Butcher, Daniela Caputo, Debra Clapham-Riley, Helen Dolling, Anita Furlong, Barbara Graves, Emma Le Gresley, Nathalie Kingston, Sofia Papadia, Hannah Stark, Kathleen E. Stirrups, Jennifer Webster Research nursesJoanna Calder, Julie Harris, Sarah Hewitt, Jane Kennet, Anne Meadows, Rebecca Rastall, Criona O,Brien, Jo Price, Cherry Publico, Jane Rowlands, Valentina Ruffolo, Hugo Tordesillas NIHR Cambridge Clinical Research FacilityKaren Brookes, Laura Canna, Isabel Cruz, Katie Dempsey, Anne Elmer, Naidine Escoffery, Stewart Fuller, Heather Jones, Carla Ribeiro, Caroline Saunders, Angela Wright Cambridge Cancer Trial CentreRutendo Nyagumbo, Anne Roberts Clinical Research Network EasternAshlea Bucke, Simone Hargreaves, Danielle Johnson, Aileen Narcorda, Debbie Read, Christian Sparke, Lucy Warboys Administrative staff, CUHKirsty Lagadu, Lenette Mactavous CUH NHS Foundation TrustTim Gould, Tim Raine, Ashley Shaw Cambridge Cancer Trials CentreClaire Mather, Nicola Ramenatte, Anne-Laure Vallier Legal/EthicsMary Kasanicki CUH Improvement and Transformation TeamPenelope-Jane Eames, Chris McNicholas, Lisa Thake Clinical Microbiology & Public Health Laboratory (PHE): Neil Bartholomew, Nick Brown, Martin Curran, Surendra Parmar, Hongyi Zhang Occupational HealthAilsa Bowring, Mark Ferris, Geraldine Martell, Natalie Quinnell, Giles Wright, Jo Wright Health and SafetyHelen Murphy Department of Medicine Sample LogisticsBenjamin J. Dunmore, Ekaterina Legchenko, Stefan Graf, Christopher Huang, Josh Hodgson, Kelvin Hunter, Jennifer Martin, Federica Mescia, Ciara ODonnell, Linda Pointon, Joy Shih, Rachel Sutcliffe, Tobias Tilly, Zhen Tong, Carmen Treacy, Jennifer Wood Department of Medicine Sample Processing and Acquisition: Laura Bergamaschi, Ariana Betancourt, Georgie Bowyer, Aloka De Sa, Maddie Epping, Andrew Hinch, Oisin Huhn, Isobel Jarvis, Daniel Lewis, Joe Marsden, Simon McCallum, Francescsa Nice, Ommar Omarjee, Marianne Perera, Nika Romashova, Mateusz Strezlecki, Natalia Savoinykh Yarkoni, Lori Turner Epic team/other computing supportBarrie Bailey, Afzal Chaudhry, Rachel Doughton, Chris Workman Statistics/modellingRichard J. Samworth, Caroline Trotter

Comparative Performance of Modified Kenneth Jones Criteria Scoring, World Health Organization Criteria, and Antibodies in Lymphocyte Supernatant for Diagnosing Tuberculosis in Severely Malnourished Children Presenting With Pneumonia.

Background: The diagnosis of childhood tuberculosis (TB) can be difficult in severely malnourished children. This is mainly due to the fact of our perceived notion that clinical signs of TB are often subtle in severely malnourished children and we may rely on laboratory investigation for the diagnosis. However, comparative data on the performance of clinical and laboratory diagnostics of TB in such population are also very limited. Objectives: To compare the performance of composite clinical criteria and a technique that measures antibodies in lymphocyte supernatant (ALS) for the diagnosis of TB in severely malnourished children with pneumonia. Methods: Severely malnourished children under five with radiological pneumonia admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh were enrolled consecutively following informed consent. We collected venous blood for ALS, gastric lavage fluid and induced sputum for microscopy, mycobacterial culture, and real-time PCR by Xpert MTB/RIF. We compared the sensitivity, specificity, positive, and negative predictive values, and accuracy of modified Kenneth Jones criteria (MKJC) score, World Health Organization (WHO) criteria, and ALS in diagnosing TB in severely malnourished children with pneumonia for "Confirmed TB" and "All TB" ("Confirmed TB" plus "Probable TB") vs. "Not TB." Results: Compared to culture confirmed TB, the sensitivity, and specificity (95% CI) for MKJC were 60 (27-86) and 84 (79-87)% and for WHO criteria were 40 (14-73) and 84 (80-87)%, respectively. Compared to culture and/or Xpert MTB/RIF positive TB, the sensitivity and specificity (95% CI) for the criteria were 37 (20-58) and 84 (79-87)%; and 22 (9-43) and 83 (79-87)%, respectively. For both these comparisons, the sensitivity and specificity of ALS were 50 (14-86) and 60 (53-67)%, respectively. Conclusion: Our data suggest that WHO criteria and MKJC scoring mainly based on clinical criteria are more useful than ALS in diagnosing TB in young severely malnourished children with pneumonia. The results underscore the importance of using clinical criteria for the diagnosis of TB in severely malnourished children that may help to minimize the chance of over treatment with anti-TB in such population, especially in resource limited TB endemic settings.

Risk correlates for physical-mental multimorbidities in South Africa: a cross-sectional study.

AIMS: The aim of this study was to identify the risk correlates for coexisting common mental disorders (CMDs) in the chronic care population in South Africa, with the view to identifying particularly vulnerable patient populations. METHODS: The sample comprised 2549 chronic care patients enrolled in the baseline and endline rounds of a facility detection survey conducted by the Programme for Improving Mental Health Care in three large facilities in the Dr Kenneth Kaunda district in the North West province of South Africa. Participants were screened for depression using the Patient Health Questionnaire (PHQ9) and for alcohol misuse using the Alcohol Use Disorders Identification Test (AUDIT). Data were analysed according to the number of morbidities, disorder type (physical or mental) and demographic variables. Multimorbidity was defined as the presence of two or more disorders (physical and/or mental). RESULTS: Just over one-third of the sample reported two or more physical conditions. Women were more at risk of being depressed than were men, with men more at risk of alcohol misuse. Those who were employed were at lower risk of having coexisting CMDs, while being younger, HIV positive, and food deprived were all found to be associated with higher risk for having coexisting CMDs. CONCLUSION: In the face of the large treatment gap for CMDs in South Africa, and the role that coexisting CMDs can play in exacerbating the burden of chronic physical diseases, mental health screening and treatment interventions should target HIV-positive, younger patients living in circumstances where there is household food insecurity.

Detection and treatment initiation for depression and alcohol use disorders: facility-based cross-sectional studies in five low-income and middle-income country districts.

OBJECTIVES: To estimate the proportion of adult primary care outpatients who are clinically detected and initiate treatment for depression and alcohol use disorder (AUD) in low-income and middle-income country (LMIC) settings. DESIGN: Five cross-sectional studies. SETTING: Adult outpatient services in 36 primary healthcare facilities in Sodo District, Ethiopia (9 facilities); Sehore District, India (3); Chitwan District, Nepal (8); Dr Kenneth Kaunda District, South Africa (3); and Kamuli District, Uganda (13). PARTICIPANTS: Between 760 and 1893 adults were screened in each district. Across five districts, between 4.2% and 20.1% screened positive for depression and between 1.2% and 16.4% screened positive for AUD. 96% of screen-positive participants provided details about their clinical consultations that day. PRIMARY OUTCOMES: Detection of depression, treatment initiation for depression, detection of AUD and treatment initiation for AUD. RESULTS: Among depression screen-positive participants, clinical detection of depression ranged from 0% in India to 11.7% in Nepal. Small proportions of screen-positive participants received treatment (0% in Ethiopia, India and South Africa to 4.2% in Uganda). Among AUD screen-positive participants, clinical detection of AUD ranged from 0% in Ethiopia and India to 7.8% in Nepal. Treatment was 0% in all countries aside Nepal, where it was 2.2%. CONCLUSIONS: The findings of this study suggest large detection and treatment gaps for adult primary care patients, which are likely contributors to the population-level mental health treatment gap in LMIC. Primary care facilities remain unfulfilled intervention points for reducing the population-level burden of disease in LMIC.

Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol.

BACKGROUND: The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts. METHODS: One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy). DISCUSSION: Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.

A life in academia: My career in brief.

In this article I have summarized some of the main trends and topics of my research career, spanning a time period of 50 years, from its start as a master student at the Department of Psychology, University of Uppsala, Sweden to seeing the end of a long career, now at the University of Bergen, Norway. This journey has, apart from having been a journey across various disciplines and topics in experimental psychology, psychophysiology and neuropsychology, functional neuroimaging and cognitive neuroscience, also been a social class journey for me personally. I describe my academic career from my arrival as a young student at the University of Uppsala, Sweden in the late 1960s to my graduation as PhD in 1977 at the age of 29 years, brief postdoc period at the University of Pennsylvania, USA, and finally professor at the University of Bergen, Norway. The article focuses on my view of the research and research findings during these years, including studies of hemispheric asymmetry, dyslexia and language, dichotic listening, fMRI, and during the last years, studies of auditory hallucinations in schizophrenia. I have collaborated with numerous people, both nationally and internationally over the years, far too many to mention in a space-limited overview article. I apologize for this, and wish that I had time and space to mention all the fantastic colleagues and friends that I have met during my career. This article is what I recall of dates, places, encounters, etc., and any errors and misunderstandings are entirely due to my far from perfect memory, for which I also apologize.

Adolescent Daughters and Ritual Abjection: Narrative Analysis of Self-injury in Four US Films.

Media representations of illnesses, particularly those associated with stigma such as non-suicidal self-injury (NSSI), not only define health conditions for mass audiences, but generally do so in ways that are consistent with dominant ideologies. This article examines the construction of non-suicidal self-injury as practiced by female adolescents and young adults in four US films: Girl, Interrupted, Painful Secrets, Prozac Nation, and Thirteen. The methodology used to examine the films' narrative structure is Kenneth Burke's dramatism, while Julia Kristeva's concept of abjection informs the analysis. On one hand, a paradigmatic reading suggests that the films frame self-injury as resistance to repressive maternal domination of female adolescents. On the other hand, syntagmatic analysis reveals a privileged response to NSSI in the form of pacification administered by psychotherapists functioning as the return of the phallic-mother fantasy.

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision-making and quality improvement in implant services in SA, standardised reporting guidelines and data collection tools are needed, reinforced by staff training and quality assessment of data collection. Staff often took the initiative to fill gaps in reporting systems. Current systems are unable to accurately monitor uptake or discontinuation, or identify aspects of services requiring strengthening. Lack of pharmacovigilance data is especially concerning. Deficiencies noted in these monitoring systems may be common to family planning services more broadly, which warrants investigation.

Nature as the Most Important Coping Strategy Among Cancer Patients: A Swedish Survey.

The authors have conducted a quantitative survey to examine the extent to which the results obtained in a qualitative study among cancer patients in Sweden (Ahmadi, Culture, religion and spirituality in coping: The example of cancer patients in Sweden, Uppsala, Acta Universitatis Upsaliensis, 2006) are applicable to a wider population of cancer patients in this country. In addition to questions relating to the former qualitative study, this survey also references the RCOPE questionnaire (designed by Kenneth I Pargament) in the design of the new quantitative study. In this study, questionnaires were distributed among persons diagnosed with cancer; 2,355 people responded. The results show that nature has been the most important coping method among cancer patients in Sweden. The highest mean value (2.9) is the factor 'nature has been an important resource to you so that you could deal with your illnesses'. Two out of three respondents (68 %) affirm that this method helped them feel significantly better during or after illness. The second highest average (2.8) is the factor 'listening to 'natural music' (birdsong and the wind)'. Two out of three respondents (66 %) answered that this coping method significantly helped them feel better during illness. The third highest average (2.7) is the factor 'to walk or engage in any activity outdoors gives you a spiritual sense'. This survey concerning the role of nature as the most important coping method for cancer patients confirms the result obtained from the previous qualitative studies.

Decomposing growth in spending finds annual cost of treatment contributed most to spending growth, 1980-2006.

Researchers have disagreed about factors driving up health care spending since the 1980s. One camp, led by Kenneth Thorpe, identifies rising numbers of people being treated for chronic diseases as a major factor. Charles Roehrig and David Rousseau reach the opposite conclusion: that three-quarters of growth in average spending reflects the rising costs of treating given diseases. We reexamined sources of spending growth using data from four nationally representative surveys. We found that rising costs of treatment accounted for 70 percent of growth in real average health care spending from 1980 to 2006. The contribution of shares of the population treated for given diseases increased in 1997-2006, but even then it accounted for only one-third of spending growth. We highlight the fact that Thorpe's inclusion of population growth as part of disease prevalence explains the appreciable difference in results. An important policy implication is that programs to better manage chronic diseases may only modestly reduce average spending growth.

Patellar tendon autograft reconstruction of the anterior cruciate ligament with and without lateral plasty in advanced-stage chronic laxity. A clinical, prospective, randomized, single-blind study using passive dynamic X-rays.

PURPOSE: A prospective randomized study was performed to assess the influence of extra-articular ilio-tibial band tenodesis on the results of arthroscopic anterior cruciate ligament (ACL) reconstruction in patients with advanced-stage chronic anterior laxity of the knee. METHODS: Preoperatively, the two constituent groups of our series of 120 patients: group 1 (Kenneth Jones) and group 2 (Kenneth Jones+extra-articular ilio-tibial band tenodesis) were strictly comparable with regard to demographic data, activity level, interval between the injury and the operation, and even objective laxity. Through radiological measurements made by passive dynamic X-rays, we studied the evolution of the objective laxity on the two compartments (medial and lateral) of the knee before the surgery and in review. RESULTS: At 2 years follow-up, there was no significant difference between the two groups in terms of the subjective result, sports, and the overall international knee documentation committee score, however, In terms of objective laxity; Gain laxity obtained after surgery on the lateral compartment, was statistically higher in cases of extra-articular associated plasty (+29%), by cons in cases of intra-articular reconstruction alone, the laxity of the lateral compartment was poorly controlled and has continued to evolve despite the plasty of the ACL. CONCLUSION: The indication of an associated extra-articular plasty remains very discussed but we plead for an objective criterion with knowing the importance of preoperative objective laxity especially that of the lateral compartment to decide if it necessary, or not, being associated. LEVEL OF EVIDENCE: Level I, therapeutic prospective randomized trial.

"Mauled by a Bear": narrative analysis of self-injury among adolescents in US news, 2007-2012.

Self-injury among adolescents has been widely documented in the United States, Canada, Europe, and Asia; however, news coverage of self-injury has not been examined. This study analyzes 78 news accounts of self-injury among adolescents in the United States from 2007 to 2012, using critical cultural studies as a theoretical foundation and a methodology informed by Kenneth Burke's dramatism. Narrative elements within the sample are examined in relationship to one another in order to reveal implicit meanings within the news stories. Looking across the sample, I then use a framework developed by Labov and Waletzky to examine a dominant meta-narrative that downplays social causes of self-injury-notably, various forms of trauma such as childhood sexual abuse-and instead frames self-injury as a personal choice. As a result, the remedy to the problem is not constructed as redress of contemporary pressures placed upon young people, but rather, as the responsibility of adolescents to conform to the social system that causes them to hurt themselves.

Managing asthma in primary care through imperative outcomes.

RATIONALE, AIMS AND OBJECTIVES: To evaluate asthma management and control in primary care clinics so as to design improvements based on guideline-directed outcomes. METHODS: In this study, all medical records of asthma-diagnosed patients (children as well as adults, entire lifespan, asthma-related visits or not) were retrospectively reviewed as a basis for assessing the level of guideline adherence and asthma control. Six primary health care clinics were visited in the Dr Kenneth Kaunda Municipal District, Potchefstroom, South Africa during May to July 2008, 2009 and 2010. RESULTS: A total of 323 asthma patient records were reviewed over the three time slots, resulting in 125, 87, and 111 patients respectively. A suboptimal clinical asthma control picture, with a mere 16% (n = 20) of females and 2% (n = 3) of males with Peak Expiratory Flow (PEF) percentages above 60%, were observed in the initial assessment. Improvement in control was observed during the following time slot, but with an end result in 2010 of no PEF percentages above 60% for males and only 9% (n = 7) for females. CONCLUSION: Over all three of the data collection periods adherence to effectively applied management of asthma guidelines proved to be below the minimum recommended clinical evaluation work-up as set out by the Expert Panel Report 3 (EPR3) of the National Asthma Education and Prevention Program (NAEPP). Applying a greater focus on essential outcomes through different disease management documents resulted in an improved quality of managed care, but still requires dedicated and continuous education and motivation. (NWU-0052-08-A5).

Gait analysis in patients undergoing ACL reconstruction according to Kenneth Jones' technique.

The anterior cruciate ligament is essential for knee stability, and its injury, both acute and in the case of chronic knee instability, promotes meniscal degenerative alterations, as well as the onset and progression of gonarthrosis. In this retrospective study, young adults engaged in nonprofessional sportive activities undergoing ACL reconstruction by the Kenneth-Jones technique were assessed clinically and with gait analysis, to detect any deficits persisting even after rehabilitation at a follow- up of approximately 6 months. Eight patients who had undergone elective ligament reconstruction by Kenneth-Jones were assessed between the 5th and 7th month postsurgery with clinical-anamnestic investigation, including the Hughston Clinic subjective knee questionnaire and by gait analysis with the EL.I.Te. system. Gait analysis showed a reduction of ACL protection mechanisms during initial stance; furthermore, the operated limb globally exhibited greater difficulty in muscle recruitment. Residual deficits in muscle recruitment, exposing the reconstructed ligament to possible injuries, persist after a rehabilitation program and after resuming ofpre-surgery activities, thus adjustment of the rehabilitative program on the basis of these findings is recommended.

Long-term results of 2-flap palatoplasty.

The 2-flap palatoplasty is a single-stage surgical procedure described more than 35 years ago. There are few reports in the literature describing longitudinal speech results for either a single surgeon or a single surgical technique. This paper presents speech outcomes spanning the 28 years that Dr. Kenneth E. Salyer has been performing the 2-flap palatoplasty.

Growth response and sapwood hydraulic properties of young lodgepole pine following repeated fertilization.

We examined how tree growth and hydraulic properties of branches and boles are influenced by periodic (about 6 years) and annual fertilization in two juvenile lodgepole pine (Pinus contorta Dougl. var. latifolia Engelm.) stands in the interior of British Columbia, Canada. Mean basal area (BA), diameter at breast height (DBH) and height increments and percent earlywood and sapwood hydraulic parameters of branches and boles were measured 7 or 8 years after the initial treatments at Sheridan Creek and Kenneth Creek. At Sheridan Creek, fertilization significantly increased BA and DBH increments, but had no effect on height increment. At Kenneth Creek, fertilization increased BA, but fertilized trees had significantly lower height increments than control trees. Sapwood permeability was greater in lower branches of repeatedly fertilized trees than in those of control trees. Sapwood permeabilities of the lower branches of trees in the control, periodic and annual treatments were 0.24 x 10(-12), 0.35 x 10(-12) and 0.45 x 10(-12) m2 at Kenneth Creek; and 0.41 x 10(-12), 0.54 x 10(-12) and 0.65 x 10(-12) m2 at Sheridan Creek, respectively. Annual fertilization tended to increase leaf specific conductivities and Huber values of the lower branches of trees at both study sites. We conclude that, in trees fertilized annually, the higher flow capacity of lower branches may reduce the availability of water to support annual growth of the leader and upper branches.