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To identify, describe and account for the incidence of spin in systematic reviews and meta-analyses of tendon transfer for the treatment of massive, irreparable rotator cuff tears. The secondary objective was to characterize the studies in which spin was identified and to determine whether identifiable patterns exist among studies with spin. This study was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each abstract was assessed for the presence of the 15 most common types of spin derived from a previously established methodology. General data that were extracted included study title, authors, publication year, journal, level of evidence, study design, funding source, reported adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, preregistration of the study protocol, and methodologic quality per A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2). The search yielded 53 articles, of which 13 were included in the final analysis. Articles were excluded if they were not published in a peer reviewed journal, not written in English, utilized cadaveric or nonhuman models, or lacked an abstract with accessible full text. 53.8% (7/13) of the included studies contained at least 1 type of spin in the abstract. Type 5 spin ("The conclusion claims beneficial effect of the experimental treatment despite a high risk of bias in primary studies") was the most common, appearing in 23.1% (3/13) of included abstracts. Nine of the spin categories did not appear in any of the included abstracts. A lower AMSTAR 2 score was significantly associated with the presence of spin in the abstract (P <.006). Spin is highly prevalent in the abstracts of systematic reviews and meta-analyses concerning tendon transfer for massive rotator cuff tears. A lower overall AMSTAR 2 rating was associated with a higher incidence of spin. Future studies should continue to explore the prevalence of spin in orthopedic literature and identify any factors that may contribute to its presence. [ABSTRACT FROM AUTHOR]

To analyze reporting bias in the form of spin present in systematic reviews and meta-analyses on the topic of primary anterior cruciate ligament (ACL) repair. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed throughout this study. Peer-reviewed systematic reviews were collected from 3 databases (PubMed, Scopus, and SPORTDiscus), and their abstracts were assessed for the 15 most common types of spin. Articles were excluded if they were not published in English, had no evidence, were retracted, were published without an abstract, did not have full text available, or included cadaveric or nonhuman subjects. Full text quality was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews Version 2). Fisher exact tests were used to examine associations between the different types of spin and other study characteristics such as AMSTAR 2 confidence rating, study design, and level of evidence. Spin was present in the abstracts of 13 of 15 articles (86.7%). There were significant associations between PRISMA adherence and lower incidences of spin types 3, 6, and 8 (P =.029 for each). A critically low AMSTAR 2 confidence rating was significantly associated with an increased incidence of spin type 9 (P =.01), and a higher AMSTAR 2 score was significantly associated with decreased spin type 4 and type 5 (P =.039 and P =.048, respectively). A more recent year of publication was correlated with a lower incidence of spin type 14 (P =.044). Spin is present in most systematic reviews and meta-analyses regarding primary repair of the ACL, with two-thirds of abstracts spinning evidence in favor of ACL repair. Standardized guidelines including the PRISMA guidelines and the AMSTAR 2 assessment tool were negatively correlated with spin. More recently published articles were found to contain significantly less spin, as were articles published in journals with higher Clarivate Impact Factors and Scopus CiteScores. Level V, systematic review of Level III-V studies. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty (rTSA) remains a viable treatment option in elderly patients with proximal humerus fractures (PHF). However, the risk profile of this procedure in this patient population has not been well established by prior studies. The aim of this study is to examine whether there are differences in sociodemographic variables, underlying medical comorbidities, and 90-day outcomes between patients undergoing rTSA for osteoarthritis (OA) vs. PHF. We hypothesized that patients with PHF would be older and have higher comorbidity burden compared to glenohumeral OA controls. Furthermore, we hypothesized that rTSA would yield inferior outcomes and higher costs of care in patients with PHF compared to glenohumeral OA. Patients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. PHF patients were identified using the International Classification of Diseases, Tenth Revision diagnosis codes and compared to OA controls. All patients < 18 years old and those who underwent rTSA for other indications were excluded. Patients were matched in a 2:1 fashion based on age (± 3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, comorbidities and 90-day surgical (wound complications, dislocation, periprosthetic fracture, periprosthetic joint infection, stiffness, loosening, mechanical complications, and revision) and medical (deep vein thrombosis/pulmonary embolism, pneumonia, respiratory failure, renal failure, stroke, myocardial infarction, and sepsis) complications and readmission were compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at P <.05. Odds ratio (OR) and 95% confidence interval were calculated. Before matching 51,150 OA controls and 11,394 PHF cases were identified. After matching, 8661 PHF cases were matched to 17,332 controls. Regarding surgical complications, PHF patients were at significantly increased risk of periprosthetic fracture (OR 2.35), dislocation (OR 2.87), superficial wound infection (OR 5.51), periprosthetic joint infection (OR 1.91) and 90-day revision (OR 4.76). PHF patients were at increased risk of all medical complications examined including hemorrhage (OR 2.20), anemia (OR 2.78) deep vein thrombosis (OR 3.10), pulmonary embolism (OR 2.83), pneumonia (OR 2.93), respiratory failure (OR 3.37), pneumonia (OR 2.93), stroke (OR 2.61), myocardial infarction (OR 2.79), acute renal failure (OR 4.06), urinary tract infection (OR 5.50) and sepsis (OR 3.71) as well as 90-day readmission (OR 2.13). Patients undergoing rTSA for PHF are at significantly increased risk of complications compared to OA controls. Furthermore, these patients are at increased risk of 90-day readmission. These findings should prompt diligent preoperative risk stratification by surgeons and healthcare providers to prevent patient morbidity. [ABSTRACT FROM AUTHOR]

It is well known that socioeconomic and demographic variables can greatly affect health outcomes. Previous studies across medical and surgical subspecialties have demonstrated that these variables are frequently under-reported in randomized controlled trials (RCTs). No such study currently exists that examines rates of reporting of sociodemographic variables in shoulder arthroplasty RCTs. This study aims to present these rates and explore the impact of failing to report socioeconomic variables in shoulder arthroplasty RCTs. The PubMed database was queried for the term shoulder arthroplasty. Sixty-five RCTs from the past 10 years were identified for inclusion from 5 high-impact orthopedic surgery journals. Each RCT was analyzed for patient age and sex or gender as well as the following sociodemographic variables: race, ethnicity, insurance status, income, work status, and education. It was also noted whether each of the above variable was mentioned in the results section of the article. Data were presented in a descriptive fashion as well as analyzed using χ2 and Fisher exact tests where appropriate. From 2014 to 2023, the 65 shoulder arthroplasty RCTs published reported age in 40 of 65 (61.5%) in their results sections and 61 of 65 (93.8%) in any section. Sex or gender was reported in 27 of 65 (41.5%) in their results sections and 61 of 65 (93.8%) in any section. No articles included any sociodemographic variables in the results section. Reporting rates for sociodemographic variables in any section were as follows: race, 6 of 65 (9.2%); ethnicity, 5 of 65 (7.7%); work status, 4 of 65 (6.2%); and insurance status, 1 of 65 (1.5%). No studies included income or education of the enrolled patients. There was no difference in reporting sociodemographic variables by journal (P =.45) or by year of publication (P =.57). However, no study prior to 2020 included any sociodemographic variable (0 of 27, 0%), whereas from 2020 onward 6 studies included at least 1 (6 of 38, 15.8%). Sociodemographic variables were reported significantly less frequently than age and sex or gender (P =.001). Our study found sociodemographic variables are rarely reported in shoulder arthroplasty RCTs, whereas age and sex or gender are reported with great frequency. In order to understand the results of shoulder arthroplasty RCTs, apply their findings to the care of our patients, and address health disparities, we must ensure these studies include patient sociodemographic data. [ABSTRACT FROM AUTHOR]

The article focuses on the potential of geothermal energy, particularly through Enhanced Geothermal Systems (EGS), which aim to harness deep Earth heat for electricity and heating/cooling. It discusses the historical context of geothermal technologies, the current state of EGS technology, including challenges and recent innovations, and initiatives like the FORGE project aimed at advancing EGS from experimental stages to commercial viability.

Inflammatory arthritis (IA) represents a less common indication for anatomic and reverse total shoulder arthroplasty (TSA) than osteoarthritis (OA). The safety and efficacy of anatomic and reverse TSA in this population has not been as well studied compared to OA. We analyzed the differences in outcomes between IA and OA patients undergoing TSA. Patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) from 2016-2020 were identified in the Premier Healthcare Database. Inflammatory arthritis (IA) patients were identified using International Classification of Diseases, Tenth Revision , diagnosis codes and compared to osteoarthritis controls. Patients were matched in a 1:8 fashion by age (±3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, and patient comorbidities were compared. Multivariate regression was performed following matching to account for any residual confounding and 90-day complications were compared between the 2 cohorts. Descriptive statistics and regression analysis were employed with significance set at P <.05. Prior to matching, 5685 IA cases and 93,539 OA controls were identified. Patients with IA were more likely to be female, have prolonged length of stay and increased total costs (P <.0001). After matching and multivariate analysis, 4082 IA cases and 32,656 controls remained. IA patients were at increased risk of deep wound infection (OR 3.14, 95% CI 1.38-7.16, P =.006), implant loosening (OR 4.11, 95% CI 1.17-14.40, P =.027), and mechanical complications (OR 6.34, 95% CI 1.05-38.20, P =.044), as well as a decreased risk of postoperative stiffness (OR 0.36, 95% CI 0.16-0.83, P =.002). Medically, IA patients were at increased risk of PE (OR 2.97, 95% CI 1.52-5.77, P =.001) and acute blood loss anemia (OR 1.27, 95% CI 1.12-1.44, P <.0001). Inflammatory arthritis represents a distinctly morbid risk profile compared to osteoarthritis patients with multiple increased surgical and postoperative medical complications in patients undergoing aTSA and rTSA. Surgeons should consider these potential complications and employ a multidisciplinary approach in preoperative risk stratification of IA undergoing shoulder replacement. [ABSTRACT FROM AUTHOR]

Glenohumeral osteoarthritis is one of the most common causes of shoulder pain. As such, the American Academy of Orthopaedic Surgeons (AAOS) has developed clinical practice guidelines (CPGs) to address the management of glenohumeral osteoarthritis. These CPG recommendations stem from the findings of randomized controlled trials (RCTs), which have been shown to influence clinical decision making and health policy. Therefore, it is essential that trial outcomes, including harms data (ie, adverse events), are adequately reported. We intend to evaluate the reporting quality of harms-related data in orthopedic literature specifically relating to AAOS CPG recommendations on the management of glenohumeral osteoarthritis. We adhered to the Preferred Reporting Items for Systematic Reviews (PRISMA) as well as guidance for reporting meta-research. The AAOS CPGs for glenohumeral osteoarthritis were obtained from orthoguidelines.org , and 2 authors independently screened the guidelines for the RCTs referenced. A total of 14 studies were identified. Data were extracted from the 14 included studies independently by the same 2 authors. Adherence to the Consolidated Standards of Reporting Trials (CONSORT) Extension for Harms Checklist was assessed using an 18-item scoring chart, with 1 point being awarded for meeting a checklist item and 0 points being awarded for not meeting a checklist item. Descriptive statistics, such as frequencies, percentages, and 95% confidence intervals were used to summarize RCT adherence to the CONSORT checklist. The average score among the studies included was 7.36/18 items (39% adherence). No study adhered to all criteria, with the highest-performing study meeting 11 of 18 items (58%) and the lowest meeting 3 of 18 items (16%). A positive correlation between checklist score and year of publication was observed, with studies published more recently receiving a higher score on the CONSORT checklist (P <.05). Studies that disclosed funding information received a higher score than those that did not (P <.05), but there was no significant difference when the different funding sources were compared. Finally, double-blinded studies scored higher on the checklist than those with lower levels of blinding (single or no blinding, P <.05). Adverse events are poorly reported amongst RCTs cited as supporting evidence for AAOS Management of Glenohumeral Osteoarthritis CPGs, evidenced by a CONSORT checklist compliance rate of only 41% in this study. We recommend the development of an updated checklist with information that makes it easier for authors to recognize, evaluate, and report on harms data. Additionally, we encourage authors to include information about adverse events or negative outcomes in the abstract. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Tau is a key pathology in chronic traumatic encephalopathy (CTE). Here, we report our findings in tau positron emission tomography (PET) measurements from the DIAGNOSE CTE Research Project. METHOD: We compare flortaucipir PET measures from 104 former professional players (PRO), 58 former college football players (COL), and 56 same‐age men without exposure to repetitive head impacts (RHI) or traumatic brain injury (unexposed [UE]); characterize their associations with RHI exposure; and compare players who did or did not meet diagnostic criteria for traumatic encephalopathy syndrome (TES). RESULTS: Significantly elevated flortaucipir uptake was observed in former football players (PRO+COL) in prespecified regions (p < 0.05). Association between regional flortaucipir uptake and estimated cumulative head impact exposure was only observed in the superior frontal region in former players over 60 years old. Flortaucipir PET was not able to differentiate TES groups. DISCUSSION: Additional studies are needed to further understand tau pathology in CTE and other individuals with a history of RHI. [ABSTRACT FROM AUTHOR]

The burgeoning field of gender affirmation surgery (GAS) has become increasingly complex, challenging plastic surgeons to meet high standards for their patients. During the COVID-19 pandemic, the emphasis on remote learning ushered in the increased use of surgical simulation training, offering residents the opportunity to trial challenging procedures before treating patients. This systematic review seeks to summarize current simulation training models used in GAS. A systematic review was conducted according to PRISMA-P guidelines using the following databases: PubMed , Medline , Scopus , Embase , Web of Science , and Cochrane. Inclusion criteria were English-language peer-reviewed articles on surgical simulation techniques or training related to the field of gender surgery. Skills and techniques taught and assessed, model type, equipment, and cost were abstracted from articles. Our search criteria identified 1650 articles, 10 of which met the inclusion criteria for data extraction. Simulation models included those that involved cadavers (n = 2), synthetic benchtop (n = 5), augmented/virtual reality (n = 2), and 3D-printed interfaces (n = 1). The most common procedure involved breast or pectoral reconstruction and/or augmentation (n = 5), followed by vaginal reconstruction (n = 3). One simulation model involved facial GAS. All models focused on surgical technique and anatomy, three on suture skills or knot-tying, and one on surgical decision-making. The evolving field of GAS requires that plastic surgery trainees be knowledgeable on surgical techniques surrounding this scope of practice. Surgical simulation not only teaches residents how to master techniques but also helps address the sensitive nature of GAS. [ABSTRACT FROM AUTHOR]

Aim: This article aims to review the literature on medical social work practice in hospital settings. The overall goal of medical social work practice in hospitals is to prevent and reduce negative psychosocial-spiritual consequences as a result of diseases and teach patients and families how to mobilize the available resources. Undeniably, medical social work practice is an integral part of medical and hospital settings, predominantly when working in a team to improve the patient's treatment outcome. Methods: This article reviewed online research articles and reports on medical social work practice in hospital settings. Keywords used in conducting the literature review were: medical social work practice, hospital, health practitioners, roles of medical social workers, and inter-professional collaborative practice. The Boolean Operator conjunctive 'AND' was used in the mixture of these keywords to enlarge the search process. The databases used for electronic searches of the literature were Google Scholar, ProQuest Central, PubMed Central, and ResearchGate. Results and Conclusion: We conclude that medical social workers perform different roles in the hospital settings nevertheless they are not understood by health practitioners, no consensus amongst health practitioners as to whether inter-professional collaborative practice contributes to the treatment outcome of patients. Factors impeding medical social work practice in hospital settings are also discussed. We suggest that what remains to be explored are the medical practitioners' experiences in medical social work practice in hospital settings. Findings from this reviewed article contribute significantly to the field of medical social work which is in the infancy stage, particularly in Tanzania and comparable countries. [ABSTRACT FROM AUTHOR]

Clinical studies are often at risk of spin, a form of bias where beneficial claims are overstated while negative findings are minimized or dismissed. Spin is often more problematic in abstracts given their brevity and can result in the misrepresentation of a study's actual findings. The goal of this study is to aggregate primary and secondary studies reporting the clinical outcomes of the use of subacromial balloon spacers in the treatment of massive irreparable rotator cuff tears to identify the incidence of spin and find any significant association with study design parameters. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Independent searches were completed on 2 databases (PubMed and Embase) for primary studies, systematic and current concepts reviews, and meta-analyses and the results were compiled. Two authors independently screened the studies using a predetermined inclusion criteria and aggregated data including titles, publication journals and years, authors, study design, etc. Each study was independently assessed for the presence of 15 different types of spin. Statistical analysis was conducted to identify associations between study characteristics and spin. Twenty-nine studies met the inclusion criteria for our analysis, of which 10 were reviews or meta-analyses and 19 were primary studies. Spin was identified in every study except for 2 (27/29, 93.1%). Type 3 spin, "Selective reporting of or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention" and type 9 spin, "Conclusion claims the beneficial effect of the experimental treatment despite reporting bias" were most frequently noted in our study, both observed in 12/29 studies (41.4%). Date of publication, and adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses or "The International Prospective Register of Systematic Reviews" were study characteristics associated with a higher rate of certain types of spin. There was a statistically significant association between disclosure of external study funding source and the presence of spin type 4, but none of the other forms of spin. Spin is highly prevalent in the abstracts of primary studies, systematic reviews, and meta-analyses discussing the use of subacromial balloon spacer technology in the treatment of massive irreparable rotator cuff tears. Our findings revealed that spin in the abstract tended to favor the balloon spacer intervention. Further efforts are required in the future to mitigate spin within the abstracts of published manuscripts. [ABSTRACT FROM AUTHOR]

Background: The NINDS criteria define Traumatic Encephalopathy Syndrome (TES) as the clinical manifestation of the neuropathologically diagnosed chronic traumatic encephalopathy (CTE). The core clinical features of TES include both cognitive and neuropsychiatric symptoms, the latter termed neurobehavioral dysregulation (NBD). We explored potential biological correlates of NBD by investigating fluid biomarkers of neuronal damage, astrogliosis, phosphorylated tau (pTau), neuroinflammation, and catecholamines in former American football players. Method: Our cohort consisted of former professional (PRO) and college (COL) American football players from the DIAGNOSE CTE Research Project. NBD was measured by four subscales (i.e., explosivity, emotional dyscontrol, impulsivity, affective lability) and a total NBD score, derived by factor analysis of multiple self‐report neuropsychiatric measures. Plasma neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), CSF total tau and pTau181/231/217, as well as CSF biomarkers related to neuroinflammation (IL‐6, CRP, TNF‐α, VEGF‐A), were measured with various well‐validated immunoassay methods. Catecholamines in CSF (dopamine, 3,4‐dihydroxyphenylacetic acid, 3,4‐dihydroxyphenylalanine, noradrenaline, 3,4‐dihydroxyphenylglycol) were measured with HPLC. Multivariate linear regression models assessed the relationships between biomarkers and NBD scales, adjusted for age, BMI, race, and APOE e4, including stratification by exposure group, i.e., PRO, COL. Result: Demographics and biomarker levels are displayed in Table 1. High levels of IL‐6 were significantly associated with higher scores of all NBD subscales, independent of exposure group. Other significant relationships included plasma NfL with emotional dyscontrol and impulsivity. Within the college group, CSF pTau181 was significantly associated with emotional dyscontrol and CSF noradrenaline with explosivity, emotional dyscontrol, impulsivity, and total NBD score. (Table 2 & Figure 1). IL‐6 models were repeated with measures of cognitive dysfunction (another core feature of TES) added as covariates; these analyses again found significant relationships between IL‐6 and NBD, irrespective of cognitive functioning. Conclusion: We observed specific fluid biomarkers related to NBD in former American football players. Of note were the associations between IL‐6 and all NBD subscales (and not with cognitive functioning), suggesting that neuroinflammation may be a specific component in the expression of NBD symptoms. Future studies will investigate how these neuroinflammatory processes are related to other biomarkers, level of RHI exposure, and neuropathology. [ABSTRACT FROM AUTHOR]

Background: Plasma‐to‐autopsy studies are essential for validation of plasma biomarkers for the detection of Alzheimer's disease (AD). Few such studies have been done and those that exist have had limited or no comparison of the different tau epitopes. This plasma‐to‐autopsy study is the first to use immunoprecipitation mass spectrometry (IP‐MS) to compare the accuracy of eight different plasma tau epitopes (six p‐tau, two total tau) in predicting autopsy‐confirmed AD. Method: The sample included 123 participants from the Boston University Alzheimer's Disease Research Center who had an available antemortem plasma sample and donated their brain for neuropathological examination. Plasma samples proximate to death were analyzed for six different plasma p‐tau (181+199+202+205+217+231) and two total tau (t‐tau) epitopes (195‐205, 212‐221) simultaneously using IP‐MS. NIA‐Reagan Institute criteria were used for the neuropathological diagnosis of AD. Binary logistic regressions tested the association between each plasma epitope and autopsy‐confirmed AD status. Area under the receiver operating curve (AUC) statistics were generated using predicted probabilities from the logistic regression models. Analyses were repeated stratified by Clinical Dementia Rating (CDR) score (i.e., <1 and ≥1) at the time of blood draw. Odds Ratio (OR) was used to study associations between the different plasma tau species and CERAD and Braak classifications. Result: Table 1 shows sample characteristics. Sixty‐nine of the 123 (56.1%) brain donors had autopsy‐confirmed AD and the average interval between blood draw and death was ∼5 years. Table 2 summarizes logistic regressions and Figure 1 displays ROC curves. Plasma p‐tau217 (AUC = 89.8), p‐tau231 (AUC = 83.4), and p‐tau205 (AUC = 81.3) all had excellent accuracy in discriminating AD from non‐AD brain donors. Among those with CDR≥1, p‐tau217, p‐tau231, and p‐tau205 had outstanding discrimination and all other epitopes had excellent discrimination. Among those with CDR<1, p‐tau217 (AUC = 86.3) and p‐tau231 (AUC = 80.6) still had excellent discrimination accuracy; p‐tau181, p‐tau205, and t‐tau195‐209 had acceptable discrimination. Furthermore, p‐tau217, p‐tau205 and p‐tau231 were the tau species that showed higher ORs with both CERAD (ORp‐tau217 = 15.29, ORp‐tau205 = 5.05 and ORp‐tau231 = 3.86) and Braak staging (ORp‐tau217 = 14.29, ORp‐tau205 = 5.27 and ORp‐tau231 = 4.02). Conclusion: Plasma levels of p‐tau217, p‐tau231, and p‐tau205 showed the best discrimination accuracy for AD confirmed neuropathology in both mild and severe cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease characterized by hyperphosphorylated tau (p‐tau) accumulation. The clinical features of CTE are heterogeneous and their association with CTE are unclear. We investigated the association of CTE p‐tau pathology density and location with cognitive and neuropsychiatric symptoms in brain donors with autopsy‐confirmed CTE. Method: 364 brain donors with autopsy confirmed CTE were evaluated to determine the density of p‐tau pathology in 10 cortical and subcortical regions using semi‐quantitative rating scales (score range: 0‐3). We summed ratings across 10 regions to form a global composite of p‐tau severity (score range:0‐30). Informants completed standardized scales of cognition (Cognitive Difficulties Scale, CDS; BRIEF‐A Metacognition Index, MI), activities of daily living (Functional Activities Questionnaire), neurobehavioral dysregulation (BRIEF‐A Behavioral Regulation Index, BRI; Barratt Impulsiveness Scale, BIS‐11), aggression (Brown‐Goodwin Aggression Scale), depression (Geriatric Depression Scale‐15, GDS‐15), and apathy (Apathy Evaluation Scale, AES). Multivariable linear regression analyses examined the association between global p‐tau severity and p‐tau severity in each region with each of the clinical scales, controlling for age at death, racial identity, education level, hypertension history, obstructive sleep apnea history, and substance use treatment history. Result: The sample predominantly consisted of football players (333; 91.2%) and 140 (38.5%) had low CTE and 224 (61.5%) had high CTE (Table 1). Figures 1‐2 are Forrest plots of the estimated effects between regional p‐tau and clinical scales. Global p‐tau severity was associated with cognitive and functional scales: MI (beta = 0.46, 95% CI = 0.11‐0.81), CDS (beta = 1.08, 95% CI = 0.31‐1.85), and FAQ (beta = 0.32, 95% CI = 0.16‐0.49). After false‐discovery rate (FDR) correction, p‐tau in the frontal, inferior parietal, superior temporal cortex, and the amygdala was significantly associated with the CDS and FAQ; frontal and inferior parietal cortex and amygdala p‐tau also was significantly associated with MI. Frontal cortex p‐tau was significantly associated with the BRI. There were no significant associations with the other neuropsychiatric scales after FDR correction. Entorhinal cortex, hippocampus, and locus coeruleus showed no significant associations. Conclusion: Accumulation of p‐tau aggregates, especially in the frontal cortex, are a driver of cognitive, function, and certain neurobehavioral symptoms in CTE. [ABSTRACT FROM AUTHOR]

Background: Sex differences have consistently been identified on autopsy, neuroimaging, and cerebrospinal fluid outcomes related to Alzheimer's disease (AD). Mechanisms for these associations are unclear. Blood‐based biomarkers are practical alternatives for the investigation of mechanisms of AD, in addition to accurate disease detection and monitoring. The objective of this study was to examine sex differences across a panel of blood‐based plasma biomarkers in participants with and without cognitive impairment due to AD. Methods: The sample included 567 participants (248 males, 319 females) from the Boston University AD Research Center (BUADRC). Participants completed a battery of neuropsychological tests. Cognitive diagnoses were adjudicated during multidisciplinary diagnostic consensus conferences. All participants had at least one blood draw between 2008 and 2018 at the BUADRC. Plasma samples were analyzed using Simoa for phosphorylated tau (p‐tau181), total tau (t‐tau), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL). Linear regression models tested associations between sex and each plasma biomarker, controlling for age, racial identity, education, and APOE ε4 carrier status. Analyses were repeated stratified by APOE ε4 carrier and CDR status. Results: Table 1 shows sample characteristics (mean age = 74.41, 13.3% Black/African American). As shown in Table 2, the multivariable linear regressions showed significant sex effects for plasma GFAP, such that females had higher plasma GFAP levels than males (p<.001). Among APOE ε4 carriers (n = 223) and participants with a CDR≥1 (n = 111), the associations with GFAP remained and the magnitude of associations were stronger compared to APOE ε4 non‐carriers and those with a CDR<1. Figure 1 shows plots of the association between sex and each plasma biomarker. There were no other sex effects across the other plasma biomarkers in the entire sample or when stratified by APOE ε4 carrier or CDR status. Conclusions: Females had higher plasma GFAP levels than males regardless of APOE ε4 status and cognitive status. Reactive astrocyte processes associated with neurodegenerative diseases can be measured by plasma GFAP. Biological differences in these processes may explain observed associations between sex and risk for AD. The study highlights the dynamic utility of plasma biomarkers for the study of AD and longitudinal analyses of this cohort are planned. [ABSTRACT FROM AUTHOR]

Despite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no studies have quantified the impact of the pandemic on the number of inpatient anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (rTSA) and hemiarthroplasty cases. The purpose of this study is to analyze the impact of COVID-19 on aTSA, rTSA and hemiarthroplasty case volumes in the United States. The Premier Health-care Database was used to identify adults undergoing primary inpatient aTSA, rTSA and hemiarthroplasty from January 2017 to December 2020. Patients undergoing revision total shoulder arthroplasty surgery were excluded. The monthly case volume variance in 2020 was calculated by subtracting the 2017-2019 monthly mean from each respective monthly mean in 2020. Differences in patient and hospital characteristics between subgroups were analyzed using analysis of variance for continuous variables and chi-squared for categorical variables. All statistical analysis was done using STATA (version 17BE; StataCorp LLC, College Station, TX, USA). A total of 127,496 cases were identified using the Premier Healthcare Database from January 2017 to December 2020. Anatomic TSA accounted for 30.67% of all cases, rTSA represented 63.55%, and hemiarthroplasty accounted for 5.78%. A precipitous decline in cases was observed in March and April of 2020, with aTSA declining by 97%, rTSA declining by 83% and hemiarthroplasty declining by 77% from their prepandemic monthly averages. Cases rebounded in May and peaked by June (rTSA and hemiarthroplasty) or July (aTSA). Cases slightly declined in August, rebounded in September, and declined again at the end of the year. The average length of stay in 2020 was slightly longer for aTSA (1.87 to 2.12 days, P <.0001) and hemiarthroplasty (2.08 to 2.49 days, P =.0021), but slightly shorter for rTSA (1.92 to 1.64 days, P <.0001). We estimated that a total of 29,951 cases were performed in 2020, representing a 7.8% decrease compared with the average from 2017 through 2019, with roughly 2564 patients either delayed or unable to undergo arthroplasty in 2020. Based on data from the Premier database, COVID-19 had a negative impact on the case volume of inpatient shoulder replacement (aTSA, rTSA and hemiarthroplasty) surgery in the United States. By the end of 2020, rTSA cases had returned to its monthly average in the years preceding the pandemic, while aTSA and hemiarthroplasty recovered to roughly 75% of their prepandemic case volumes. [ABSTRACT FROM AUTHOR]

This study aimed to examine the accuracy with which multiple natural language processing artificial intelligence models could predict discharge and readmissions after general surgery. Natural language processing models were derived and validated to predict discharge within the next 48 hours and 7 days and readmission within 30 days (based on daily ward round notes and discharge summaries, respectively) for general surgery inpatients at 2 South Australian hospitals. Natural language processing models included logistic regression, artificial neural networks, and Bidirectional Encoder Representations from Transformers. For discharge prediction analyses, 14,690 admissions were included. For readmission prediction analyses, 12,457 patients were included. For prediction of discharge within 48 hours, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.86 and 0.86 for Bidirectional Encoder Representations from Transformers, 0.82 and 0.81 for logistic regression, and 0.82 and 0.81 for artificial neural networks. For prediction of discharge within 7 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.82 and 0.81 for Bidirectional Encoder Representations from Transformers, 0.75 and 0.72 for logistic regression, and 0.68 and 0.67 for artificial neural networks. For readmission prediction within 30 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.55 and 0.59 for Bidirectional Encoder Representations from Transformers and 0.77 and 0.62 for logistic regression. Modern natural language processing models, particularly Bidirectional Encoder Representations from Transformers, can effectively and accurately identify general surgery patients who will be discharged in the next 48 hours. However, these approaches are less capable of identifying general surgery patients who will be discharged within the next 7 days or who will experience readmission within 30 days of discharge. [ABSTRACT FROM AUTHOR]

Assessment tools for grading technical and nontechnical skills, such as operative technique and professionalism, are well established in general surgery. Less is known regarding the application of these tools in plastic surgery training. This study is a comparative review of the most prevalent assessment tools and rubrics utilized in general and plastic surgery. Two parallel systematic reviews of the literature utilizing PubMed and Cochrane were conducted for articles published between 1990 and 2022. Searches used Boolean operators specific to assessment tools in general and plastic surgery. Fourteen studies met the inclusion criteria for general surgery assessment tools, and 21 studies were included for plastic surgery assessment tools. Seven studies (50%) evaluated technical skills in general surgery, whereas 15 studies (71%) assessed technical skills in plastic surgery with commonality found in the evaluation of principles, such as tissue and instrument handling and operative flow. Task-specific evaluation tools were described for both general and plastic surgeries. Five studies evaluated nontechnical skills, such as communication and leadership in general surgery, whereas no plastic surgery studies solely examined nontechnical assessment tools. Our literature review demonstrates that standardized skill assessments in plastic surgery are lacking compared with those available in general surgery. Plastic surgery programs should consider implementing competency-based assessment tools in surgical coaching and training for technical and nontechnical skills. More research is necessary in plastic surgery to optimize the evaluation of nontechnical skills. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure that has continued to evolve. Since it is a complex procedure, it carries a risk of a range of complications. To ensure optimal results, there are many important considerations to take such as the choice of graft, tunnel positioning, graft preparation, and many others. In this technical note, we elucidate our top 10 pearls to consider for a successful ACL reconstruction. [Display omitted] [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty (rTSA) has become popularized in the management of acute proximal humerus fractures (PHFs). Limited evidence exists to compare the outcomes of acute rTSA to management following failed open reduction and internal fixation. We aimed to analyze the differences between acute rTSA for PHF compared to subsequent rTSA for nonunion/malunion. Patients who underwent primary rTSA from 2016 to 2020 were identified in the Premier Healthcare Database. Nonunion, malunion, and hardware complication patients were identified using International Classification of Diseases Tenth Revision diagnosis codes and compared to acute PHF controls. Patients were matched in a 1:1 fashion to acute fracture based on age (±3 years), sex, race, and presence of pertinent comorbidities. Patient demographics, hospital factors, patient comorbidities, and 90-day complications were assessed and compared between the two cohorts. Descriptive statistics and regression analysis were employed with significance set at P <.05. Prior to matching, 8561 nonunion/malunion cases and 11,134 acute rTSA controls were identified. Patients undergoing acute rTSA for PHF were older, had longer length of stay, and higher total costs (P <.0001). When compared to acute rTSA for fracture, nonunion/malunion patients were at increased risk of multiple surgical complications including periprosthetic joint infection (odds ratio [OR]: 4.56; 95% confidence interval [CI]: 2.95-7.04; P <.0001), periprosthetic fracture (OR: 2.86; 95% CI: 2.09-3.93), stiffness (OR: 2.01; 95% CI: 1.17-3.44; P =.01), and dislocation (OR: 2.37; 95% CI: 1.80-3.12; P <.0001). However, patients undergoing acute rTSA had higher rates of all medical complications investigated, including deep vein thrombosis, pulmonary embolism, pneumonia, myocardial infarction, acute kidney infection, and sepsis (P <.001). rTSA after nonunion/malunion of PHFs is associated with increased risk of surgical complications compared to acute rTSA. Initial rTSA for PHFs may mitigate subsequent increased risk of surgical complication and should be considered as the initial treatment option in patients with PHFs. However, the increased risk of medical complications seen in acute PHF warrants attention and diligent medical optimization from providers. [ABSTRACT FROM AUTHOR]

Background: Repetitive head impact (RHI) exposure from the routine play of American football increases the risk of later‐life cognitive impairment and dementia from the neurodegenerative disease, chronic traumatic encephalopathy (CTE). Although neuropathological studies of CTE have found comorbid neurodegenerative and other pathologies, neuritic Aβ plaques are infrequent, particularly in early stages. However, amyloid PET imaging has not been fully characterized in cognitively impaired former American football players. Method: In this cross‐sectional, observational cohort study from the DIAGNOSE CTE Research Project, florbetapir PET mean cortical standard uptake value ratios (SUVR) and positivity (defined by average SUVR >1.10, indicative of moderate‐to‐frequent neuritic Aβ plaques), were analyzed in 119 former professional (PRO) National Football League players, 60 former college football players (COL), and 58 men unexposed (UE) to RHI who were cognitively asymptomatic. Former players were categorized into one of four diagnostic groups: cognitively normal (CN), subjective memory complaints (SMC), mild cognitive impairment (MCI), and dementia (DEM). All participants were 45‐74 yo. Multivariable linear and logistic regressions were conducted, with race, education, age, and APOE4 genotype included as covariates. A priori power calculations demonstrated adequate power to detect significant findings Result: No differences between the three exposure groups in average florbetapir SUVR or proportion of elevated florbetapir uptake were found. Pairwise group comparisons resulted in no differences in average SUVR between PRO and COL (‐0.01, 95% CI [‐0.033, 0.025], p = 0.95), PRO and UE (0.02, 95% CI [‐0.010, 0.029], p = 0.41), and COL and UE (0.02, 95% CI [0.0004, 0.039], p = 0.36). Analysis of covariance resulted in no differences among diagnostic groups (F = 0.94, p = 0.43). Neither years of playing football nor measures of cognition and daily functioning showed significant associations with florbetapir SUVR. Conclusion: Former professional and college American football players with cognitive impairment and dementia did not have elevated florbetapir amyloid PET compared to a group of men without RHI exposure. Their rates of florbetapir positivity in the football players were lower than expected for a group of men this age. These findings suggest that cognitive impairment in former elite football players may not be due to Alzheimer's disease pathology. [ABSTRACT FROM AUTHOR]

Background: Black self‐identified individuals are disproportionately affected by dementia, a phenomenon best attributable to differences in social determinants of health (SDOH). Plasma protein levels can serve as antemortem indicators of dementia pathology; recent findings indicate potential race‐specific differences in these biomarkers of tau and non‐tau pathologies between Black self‐identified or White individuals. Methods: This sample included 568 participants (77, 13.56% Black self‐identified, Table 1) from the Boston University Alzheimer's Disease and Research Center (BUADRC). Participants completed a battery of neuropsychological tests and cognitive diagnoses were made during multidisciplinary diagnostic consensus conferences. Plasma samples were analyzed using ELISA methods for YKL‐40 levels and using Simoa platform for phosphorylated tau (p‐tau 181, p‐tau231), total‐tau, glial fibrillary acidic (GFAP), and neurofilament light chain (NfL) levels. ANCOVAs tested for a cross‐sectional association between racial identity and each plasma biomarker and stratified by cognitive impairment status with covariates for age, education (in years), sex assigned at birth, and APOE ε4 carrier status. Cox proportional‐hazards models were used for longitudinal analyses of the interaction effect between racial identity and plasma biomarkers in the risk for conversion from normal cognition (NC) to mild cognitive impairment (MCI) and reversion from MCI to NC. Results: Baseline YKL‐40 was lower among Black self‐identified participants (adjusted mean diff = 0.37 SD, p<.001); this association was particularly salient within the MCI group (adjusted mean diff = 0.62 SD, p<.001). The longitudinal analysis revealed interaction effects between race and GFAP for risk for conversion from NC to MCI and reversion from MCI to NC. Among White participants, higher GFAP predicted increased risk for conversion from NC to MCI and lower levels predicted reversion. However, no significant effects were found among Black self‐identified participants; these findings might be limited by sample size (n = 18) resulting from the high occurrence of baseline MCI diagnoses and subsequent lack of conversion or reversion among Black self‐identified participants. Conclusion: In the context of an unrepresentative sample, we found trivial differences in plasma biomarkers between Black self‐identified and White participants. Recruitment of Black self‐identified participants representative of the population and further exploration of SDOH is essential in understanding the disproportionate risk for dementia carried by Black self‐identified individuals. [ABSTRACT FROM AUTHOR]

Background: Repetitive head impacts (RHI) from American style football (ASF) and other contact sports are a known risk factor for the neurodegenerative disease chronic traumatic encephalopathy (CTE). RHI can also lead to mixed neuropathologies that uniquely contribute to clinical symptoms. Here, we compared various types of vascular and white matter pathologies between brain donors with and without exposure to RHI from different types of contact and collision sports (CCS). Methods: The sample included 79 deceased male ASF players (RHI‐ASF) and 49 deceased male non‐ASF CCS athletes (RHI‐CCS) from the UNITE brain bank. Each RHI group had a comparison group that included similar aged (+/‐ 5 years) male brain donors without RHI from the Boston University Alzheimer's Disease Research Center and Framingham Heart Study brain banks. The modified Ischemic Injury Scale (mIIS) served as a global indicator of vascular and white matter pathologies and is a sum of hippocampal sclerosis, infarct/lacune, microinfarct, microbleeds, laminar necrosis, arteriolosclerosis, atherosclerosis of Circle of Willis, cerebral amyloid angiopathy, and white matter rarefaction. Dementia diagnoses were made during consensus conferences. Linear or logistic regression compared the RHI vs non‐RHI groups on the mIIS and its subcomponents. Logistic regression models examined the association between mIIS and dementia. Models were adjusted for age. Results: Table 1 shows sample characteristics. The RHI‐CCS group was comprised of boxers, amateur wrestlers, and ice hockey, soccer, rugby, and lacrosse players. 94 decedents had CTE, all of whom were in an RHI exposed group. Of the mIIS components, arteriolosclerosis was the most common across all groups. White matter rarefaction was also the most frequent mIIS component for both RHI groups, but not for non‐RHI groups. Compared to their respective controls, RHI‐ASF and RHI‐CCS were associated with higher mIIS scores (Table 2). Higher mIIS scores corresponded to increased odds for having dementia in both the RHI‐ASF and RHI‐CCS groups (Table 2). White matter rarefaction best discriminated both RHI groups from non‐RHI; atherosclerosis also discriminated RHI‐CCS group (Table 3). Conclusion: These results support vascular and white matter pathologies, specifically white matter rarefaction, as prominent and clinically relevant sequelae of RHI from CCS. [ABSTRACT FROM AUTHOR]

Background: Repetitive head impacts (RHI) from American style football (ASF) and other contact sports are a known risk factor for the neurodegenerative disease chronic traumatic encephalopathy (CTE). RHI can also lead to mixed neuropathologies that uniquely contribute to clinical symptoms. Here, we compared various types of vascular and white matter pathologies between brain donors with and without exposure to RHI from different types of contact and collision sports (CCS). Methods: The sample included 79 deceased male ASF players (RHI‐ASF) and 49 deceased male non‐ASF CCS athletes (RHI‐CCS) from the UNITE brain bank. Each RHI group had a comparison group that included similar aged (+/‐ 5 years) male brain donors without RHI from the Boston University Alzheimer's Disease Research Center and Framingham Heart Study brain banks. The modified Ischemic Injury Scale (mIIS) served as a global indicator of vascular and white matter pathologies and is a sum of hippocampal sclerosis, infarct/lacune, microinfarct, microbleeds, laminar necrosis, arteriolosclerosis, atherosclerosis of Circle of Willis, cerebral amyloid angiopathy, and white matter rarefaction. Dementia diagnoses were made during consensus conferences. Linear or logistic regression compared the RHI vs non‐RHI groups on the mIIS and its subcomponents. Logistic regression models examined the association between mIIS and dementia. Models were adjusted for age. Results: Table 1 shows sample characteristics. The RHI‐CCS group was comprised of boxers, amateur wrestlers, and ice hockey, soccer, rugby, and lacrosse players. 94 decedents had CTE, all of whom were in an RHI exposed group. Of the mIIS components, arteriolosclerosis was the most common across all groups. White matter rarefaction was also the most frequent mIIS component for both RHI groups, but not for non‐RHI groups. Compared to their respective controls, RHI‐ASF and RHI‐CCS were associated with higher mIIS scores (Table 2). Higher mIIS scores corresponded to increased odds for having dementia in both the RHI‐ASF and RHI‐CCS groups (Table 2). White matter rarefaction best discriminated both RHI groups from non‐RHI; atherosclerosis also discriminated RHI‐CCS group (Table 3). Conclusion: These results support vascular and white matter pathologies, specifically white matter rarefaction, as prominent and clinically relevant sequelae of RHI from CCS. [ABSTRACT FROM AUTHOR]

PCL reconstructive techniques are constantly evolving, and further clinical studies are needed to definitively understand the potential benefits of internal brace augmentation and anatomic double-bundle PCL reconstruction. This Technical Note reports an arthroscopic all-inside anatomic double-bundle PCL reconstruction with internal brace augmentation that is effective and reproducible. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Guidance on COVID-19 quarantine duration is often based on the maximum observed incubation periods assuming perfect compliance. However, the impact of longer quarantines may be subject to diminishing returns; the largest benefits of quarantine occur over the first few days. Additionally, the financial and psychological burdens of quarantine may motivate increases in noncompliance behavior. Methods: We use a deterministic transmission model to identify the optimal length of quarantine to minimize transmission. We modeled the relation between noncompliance behavior and disease risk using a time-varying function of leaving quarantine based on studies from the literature. Results: The first few days in quarantine were more crucial to control the spread of COVID-19; even when compliance is high, a 10-day quarantine was as effective in lowering transmission as a 14-day quarantine; under certain noncompliance scenarios a 5-day quarantine may become nearly protective as 14-day quarantine. Conclusion: Data to characterize compliance dynamics will help select optimal quarantine strategies that balance the trade-offs between social forces governing behavior and transmission dynamics. [ABSTRACT FROM AUTHOR]

The article provides an introduction to a special issue on activism in college sport, the editors, representing different universities, highlight their role in compiling and curating the collection of articles that explore various aspects of activism within the context of collegiate sports.

The purpose of this manuscript is to examine the influence of activism in and through college sport during two prominent eras of Black social movements, the Civil Rights movement (CRM) and Black Power movement (BPM) of 1950s-1970s and the Black Lives Matter movement (BLMM) of 2010s-2020s. Using a race- and sport-based analytic framework, distinctive forms of activism are examined to highlight similarities and differences in strategies, focal areas, and outcomes across time, space, and context. College sport is a highly visible feature of the United States (U.S.) and thus has served as an influential space for championing equity and racial justice within and beyond athletic milieu. Yet, there is a dearth of scholarship focusing on the role of activism in and through college sport in redressing anti-Black racism at the institutional and societal levels. The critical examination of intergenerational activism in and through college sport revealed the power and limitations of efforts within this distinctive socio-political space. Recommendations for future efforts are presented. [ABSTRACT FROM AUTHOR]