Predictors of Pediatric Anterior Cruciate Ligament Injury: The Influence of Steep Lateral Posterior Tibial Slope and Its Relationship to the Lateral Meniscus.

PURPOSE: To examine the relationship between posterior tibial slope and lateral meniscal bone angle (LMBA) on anterior cruciate ligament (ACL) tear risk in a pediatric population. METHODS: In this case-control study, non-contact ACL-injured pediatric patients with no significant lateral meniscal lesions were matched by age and sex in a 1:1 ratio to a group of radiologically normal controls. Knee magnetic resonance imaging (MRI) studies were analyzed by 3 independent, blinded observers measuring the medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), and LMBA. Sagittal slope asymmetry was calculated as the absolute difference in degrees between slopes, and the relationship between LMBA and LTS was calculated as a ratio. Binary logistic regressions identified independent predictors of ACL injury. Receiver operator characteristics were performed to determine predictive accuracy. RESULTS: 20 study patients were compared with 20 sex- and age-matched controls (age 14.8 ± 2.42, mean ± standard deviation). LTS was significantly higher in the ACL-injured group (11.30° ± 3.52° versus 7.00° ± 2.63°, P = .0001), as were the absolute slope difference (7.10 ± 2.92° versus 3.14 ± 3.25°, P = .0002) and LTS:LMBA ratio (0.46 ± 0.17 versus 0.26 ± 0.12, P = .0001). No significant differences were observed for MTS or LMBA. Independent predictors were LTS (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.18 to 2.13, P = .002), LTS:LMBA ratio (OR 3.13, 95% CI 1.48 to 6.62, P = .003), and absolute slope difference (OR 1.65, 95% CI 1.17 to 2.32, P = .005). LTS:LMBA ratio was the strongest predictor variable (area under the curve 0.86). CONCLUSION: This study suggests that LTS, absolute slope difference, and LTS:LMBA ratio are significant pediatric ACL-injury risk factors. All 3 demonstrate good predictive accuracy; however, the relationship between steep LTS and shallow LMBA was the strongest predictor. LEVEL OF EVIDENCE: III, case-control study.

PROTOCOL: Effects of interventions to improve access to financial services for micro-, small- and medium-sized enterprises in low- and middle-income countries: An evidence and gap map.

Background: Micro-, small-, and medium-sized enterprises (MSMEs) account for the vast majority of firms in most economies, particularly in developing nations, and are key contributors to job creation and global economic development. However, the most significant impediment to MSME development in low- and middle-income countries is a lack of access to both investment and working capital financing. Due to a lack of essential track record, appropriate collateral, and credit history, MSMEs are frequently denied business loans by traditional lending institutions. In addition, SMEs' inability to access funding is hindered by institutional, structural, and non-financial factors. To address this, both the public and private sectors employ indirect and direct finance interventions to help MSMEs in developing and emerging economies enhance and increase their financing needs. Given the importance of MSMEs in the economy, a comprehensive overview of and systematic synthesizing of the evidence of the effects of financial access interventions for MSMEs, capturing a wide variety of outcome variables, is useful. Objectives: The objective of this evidence and gap map (EGM) is to describe the existing evidence on the effects of various interventions dedicated to supporting and improving MSMEs' access to credit, as well as the corresponding firm performance and/or welfare outcomes. Methods: An EGM is a systematic evidence product that displays the existing evidence relevant to a specific research question. An EGM's end product is a research article or report, but it can also be shared via an interactive map drawn as a matrix of included studies and their corresponding interventions and outcomes. Interventions in low- and middle-income countries that target specific population subgroups are included on the map. The EGM considers five types of interventions: (i) strategy, legislation and regulatory; (ii) systems and institutions; (iii) facilitate access; (iv) lending instruments or financial products; and (v) demand-side interventions. The map, on the other hand, covers outcome domains for policy environment, financial inclusion, firm performance, and welfare. Impact evaluations or systematic reviews of relevant interventions for a previously defined target population are included in the EGM. Studies using experimental or non-experimental designs, as well as systematic reviews, are eligible. The EGM excludes before-and-after study designs with no suitable comparison group. Furthermore, the map excludes literature reviews, key informant interviews, focus group discussions, and descriptive analyses. Search strings were used to conduct electronic searches in databases. To ensure that the research team had identified a significant portion of relevant research works, the search strategy was supplemented with gray literature searches and systematic review citation tracking. We have compiled studies that are either completed or in progress. For practical reasons, studies are limited to papers written in English and are not restricted by publication date. Selection Criteria: We included studies that examined interventions to enhance MSMEs' access to finance in low- and middle-income countries targeting MSMEs including households, smallholder farmers and single person enterprise as well as financial institutions/agencies and their staff. The EGM considers five types of interventions that aim to: (i) deliver strategy, legislation, and regulatory aspects; (ii) systems and institutions that enable financing; (iii) facilitate access to finance; (iv) deliver different lending instruments or financial products, including traditional forms of microcredit; and (v) demand-side interventions such as programs on financial literacy. The map includes outcome domains surrounding policy environment, financial inclusion, firm performance, and welfare. Eligible studies must be experimental, non-experimental, or systematic reviews. In addition, the study designs must have a suitable comparison group before and after the implementation of interventions. Results: The EGM includes 413 studies. The majority of the studies (379 studies) analyzed microenterprises, such as households and smallholder farmers; 7 studies analyzed community groups; while 109 studies analyzed small and medium enterprises. There were 147 studies on interventions that targeted multiple firm sizes. Lending instruments/financial products are the most common intervention across all firm types. When it comes to the types of firms that receive the said financial intervention, the data is overwhelmingly in favor of microenterprises (278 studies), followed by systems and organizations (138 studies) that support better access to such financial products and services. Welfare outcomes have the most evidence out of all of the outcomes of interest, followed by firm performance and financial inclusion. Among all firm types, welfare outcomes are primarily targeted at microenterprises. With 59 studies, we can say that small businesses have a significantly large number of enterprise performance outcomes. of the 413 studies, 243 used non-experimental or quasi-experimental designs (mainly propensity score matching and instrumental variable approaches), 136 used experimental methods, and 34 were systematic reviews. 175 studies (43%) provided evidence from Sub-Saharan Africa, 142 studies (35%) from South Asia, 86 studies (21%) from East Asia and the Pacific, 66 studies (16%) from Latin America and the Caribbean, 28 studies (7%), Europe and Central Asia, and 21 studies (5%) from the Middle East and North Africa. Most of the included evidence covers low-income (26%) and lower-middle income countries (66%), and to a lesser extent upper-middle-income countries (26%). Conclusion: This map depicts the existing evidence and gaps on the effects of interventions to enhance MSMEs' access to financial services in low and middle-income countries. Interventions directed at microenterprises with welfare outcomes have a significant number of research outcomes in the literature. SME evaluations have looked at firm performance, with less focus to employment and the welfare effects on owners and employees, including poverty reduction. Microcredit/loans have been the focus of a large number of research papers (238 studies), indicating the field's growing popularity. However, emerging financial interventions such as facilitating access to digital financial services are relatively under-studied. Several studies also investigate rural or population in remote areas with 192 studies, 126 studies on poor and disadvantaged, and 114 papers on women. Most of the research is conducted in Sub-Saharan Africa (175 studies) and South Asia (142 studies) so further research in other regions could be conducted to allow a more holistic understanding of the effects of financial inclusion interventions. Credit lines, supply chain finance, and trade financing, which are some of the ADB's financial tools have limited evidence. Future studies should look into strategy, law, and regulation interventions, as well as interventions targeted at SMEs, and examine policy and regulatory environment outcomes as well as welfare outcomes. Interventions on the demand side and their impact on the policy and regulatory environment, as well as facilitating access are relatively understudied.

Foot and ankle injuries related to the use of E-scooters - A case series and a review of literature.

INTRODUCTION: As E-scooter use is increasing with the introduction of urban rental schemes in the United Kingdom, associated foot and ankle injuries will become more prevalent. The aim of this study is to assess the injury pattern and injury severity of foot and ankle trauma associated with E-scooter use. METHODS: A retrospective case analysis of all E-scooter foot and ankle injuries presenting to three London hospitals between 1st January and 31st December 2020 was conducted. Data including demographics, mechanism and location of injury sustained, management, duration of hospital stay and mortality were collected. RESULTS: 20 patients were identified with a total of 27 foot and ankle fractures. Eight patients had fracture dislocations, four sustained open injuries and 45% (9/20) of patients required surgical treatment. Those travelling over 15.5 mph were significantly more likely to require operative intervention (70%) than those travelling below 15.5 mph (20%) (P < 0.033) and were more likely to have an open fracture (40% compared to 0%) (P < 0.0886), however the latter was not of statistical significance. 85% (17/20) of rider's injuries involved the foot and/or ankle only. There were no mortalities at 30 days. CONCLUSIONS: E-scooter use can cause serious foot and ankle injuries. Robust guidelines and legislation restricting top speeds and enforcing the wearing of protective clothing could be implemented. This may protect the E-scooter user from significant foot and ankle injury.

Pediatric electric scooter injuries in the UK: Case series and review of literature.

OBJECTIVE: Electric scooters are being used worldwide as a new means of transport and e-scooter shared schemes are currently being piloted in cities across the UK. At present, there is no data published looking at pediatric e-scooter injuries within the UK. We aim to assess if e-scooters pose a risk to children and the patterns and severity of orthopedic injuries related to their use. METHODS: We performed a retrospective review of all orthopedic pediatric referrals relating to e-scooter use from January 1 to December 31, 2020 at two hospitals, including one pediatric Major Trauma Center in central London. Data including patient demographics, mechanism of injury, diagnosis, and treatment were collected. RESULTS: Ten patients were identified in this series, of which 5 required orthopedic surgery. Four patients required admission to hospital from the emergency department. The median age was 15 (range 13-17 years) and all were male. All e-scooters were privately owned and all sustained a fall whilst riding the e-scooter. No patient was wearing a helmet. Six sustained lower limb injuries and four upper limb injuries. Two patients were trauma called and one patient sustained an open fracture. There were no mortalities at 30 days. CONCLUSION: E-scooters pose a significant risk to children and can be associated with severe musculoskeletal injury. The risk they pose to the pediatric population should not be overlooked and these findings may inform public policy regarding the restriction of electric scooter use in children.

Studies of the effectiveness of transport sector interventions in low- and middle-income countries: An evidence and gap map.

Background: There are great disparities in the quantity and quality of infrastructure. European countries such as Denmark, Germany, Switzerland, and the UK have close to 200 km of road per 100 km2, and the Netherlands over 300 km per 100 km2. By contrast, Kenya and Indonesia have <30, Laos and Morocco <20, Tanzania and Bolivia <10, and Mauritania only 1 km per 100 km2. As these figures show, there is a significant backlog of transport infrastructure investment in both rural and urban areas, especially in sub-Saharan Africa. This situation is often exacerbated by weak governance and an inadequate regulatory framework with poor enforcement which lead to high costs and defective construction.The wellbeing of many poor people is constrained by lack of transport, which is called "transport poverty". Lucas et al. suggest that up to 90% of the world's population are transport poor when defined as meeting at least one of the following criteria: (1) lack of available suitable transport, (2) lack of transport to necessary destinations, (3) cost of necessary transport puts household below the income poverty line, (4) excessive travel time, or (5) unsafe or unhealthy travel conditions. Objectives: The aim of this evidence and gap map (EGM) is to identify, map, and describe existing evidence from studies reporting the quantitative effects of transport sector interventions related to all means of transport (roads, rail, trams and monorail, ports, shipping, and inland waterways, and air transport). Methods: The intervention framework of this EGM reframes Berg et al's three categories (infrastructure, prices, and regulations) broadly as infrastructure, incentives, and institutions as subcategories for each intervention category which are each mode of transport (road, rail trams and monorail, ports, shipping, and inlands waterways, and air transport). This EGM identifies the area where intervention studies have been conducted as well as the current gaps in the evidence base.This EGM includes ongoing and completed impact evaluations and systematic reviews (SRs) of the effectiveness of transport sector interventions. This is a map of effectiveness studies (impact evaluations). The impact evaluations include experimental designs, nonexperimental designs, and regression designs. We have not included the before versus after studies and qualitative studies in this map. The search strategies included both academic and grey literature search on organisational websites, bibliographic searches and hand search of journals.An EGM is a table or matrix which provides a visual presentation of the evidence in a particular sector or a subsector. The map is presented as a matrix in which rows are intervention categories (e.g., roads) and subcategories (e.g., infrastructure) and the column outcome domains (e.g., environment) and subcategories as (e.g., air quality). Each cell contains studies of the corresponding intervention for the relevant outcome, with links to the available studies. Included studies were coded according to the intervention and outcomes assessed and additional filters as region, population, and study design. Critical appraisal of included SR was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR -2) rating scale. Selection Criteria: The search included both academic and grey literature available online. We included impact evaluations and SRs that assessed the effectiveness of transport sector interventions in low- and middle-income countries. Results: This EGM on the transport sector includes 466 studies from low- and middle-income countries, of which 34 are SRs and 432 impact evaluations. There are many studies of the effects of roads intervention in all three subcategories-infrastructure, incentives, and institutions, with the most studies in the infrastructure subcategories. There are no or fewer studies on the interventions category ports, shipping, and waterways and for civil aviation (Air Transport).In the outcomes, the evidence is most concentrated on transport infrastructure, services, and use, with the greatest concentration of evidence on transport time and cost (193 studies) and transport modality (160 studies). There is also a concentration of evidence on economic development and health and education outcomes. There are 139 studies on economic development, 90 studies on household income and poverty, and 101 studies on health outcomes.The major gaps in evidence are from all sectors except roads in the intervention. And there is a lack of evidence on outcome categories such as cultural heritage and cultural diversity and very little evidence on displacement (three studies), noise pollution (four studies), and transport equity (2). There is a moderate amount of evidence on infrastructure quantity (32 studies), location, land use and prices (49 studies), market access (29 studies), access to education facilities (23 studies), air quality (50 studies), and cost analysis including ex post CBA (21 studies).The evidence is mostly from East Asia and the Pacific Region (223 studies (40%), then the evidence is from the sub-Saharan Africa (108 studies), South Asia (96 studies), Latin America & Caribbean (79 studies). The least evidence is from Middle East & North Africa (30 studies) and Europe & Central Asia (20 studies). The most used study design is other regression design in all regions, with largest number from East Asia and Pacific (274). There is total 33 completed SRs identified and one ongoing, around 85% of the SR are rated low confidence, and 12% rated as medium confidence. Only one review was rated as high confidence. This EGM contains the available evidence in English. Conclusion: This map shows the available evidence and gaps on the effectiveness of transport sector intervention in low- and middle-income countries. The evidence is highly concentrated on the outcome of transport infrastructure (especially roads), service, and use (351 studies). It is also concentrated in a specific region-East Asia and Pacific (223 studies)-and more urban populations (261 studies). Sectors with great development potential, such as waterways, are under-examined reflecting also under-investment.The available evidence can guide the policymakers, and government-related to transport sector intervention and its effects on many outcomes across sectors. There is a need to conduct experimental studies and quality SRs in this area. Environment, gender equity, culture, and education in low- and middle-income countries are under-researched areas in the transport sector.