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The contemporary literature suggests that a primary feature of recurrence of rotator cuff tear after arthroscopic repair is failure of tendon healing, which can occur for multiple reasons, including compromised tissue quality. Recently, the use of augmentation implants, grafts, or scaffolds has emerged as a strategy to address the issue of deficient rotator cuff tissue. A resorbable bio-inductive collagen implant (REGENETEN; Smith & Nephew, Andover, MA) has been shown to increase tendon thickness when applied in rotator cuff repair. This article presents an experienced surgeon’s tips for implanting this device. In addition, we review the current literature about this bio-inductive implant., Technique Video Video 1

Previous studies have demonstrated residual complement-mediated deposits in repeat kidney biopsies of C3 glomerulopathies (C3G) (dense deposit disease (DDD) and C3 glomerulonephritis) following eculizumab treatment, despite some clinical improvement. With residual complement deposition, it is difficult to determine whether there is a reduced complement-mediated endothelial cell injury. We validated that myeloperoxidase (MPO) immunohistochemical staining identified glomerular endothelial cell injury in crescentic glomerulonephritis and C3G. We report that MPO staining in the glomerular endothelium of the post-treatment kidney biopsy was significantly reduced after 3 years of eculizumab treatment and clinical improvement in a 5-year-old boy with initial DDD and secondary crescent formation. We find that immunostaining for MPO is a useful method to compare glomerular endothelial injury in C3G following eculizumab treatment. This finding also supports the notion that eculizumab, a C5 blocker, may not mainly block C3 deposits in the glomeruli but significantly blocks final activation of the complement cascade, thus reducing glomerular endothelial cell injury.

Supplemental Digital Content is available in the text., Background and Purpose: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. Methods: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis. Results: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55–1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61–1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19–1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20–1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53–1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82–1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89–1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30–0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49–1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71–0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (

Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment. There is a paucity of data and societal guidelines with regard to the management of SVC syndrome. This paper aims to update the practicing interventionalists with the contemporary and the evolving therapeutic approach to SVC syndrome. In addition, the review will focus on endovascular techniques, including catheter-directed thrombolysis, angioplasty, and stenting, and their associated complications.

Introduction The reclassification of membranoproliferative glomerulonephritis (MPGN) into immune-complex MPGN (IC-MPGN) and C3 glomerulopathy (C3G) has provided insights into 2 distinct diseases. Although outcomes in adults are poor in both diseases, the pediatric literature is scarce and limited to small, single-center cohorts. Methods We conducted a retrospective analysis of 165 pediatric patients across 17 hospitals to compare outcomes between children with IC-MPGN and C3G. Results Forty-two percent of patients initially diagnosed with MPGN were reclassified as C3G after a review of renal biopsy reports. There was a trend toward higher serum creatinine levels in patients with C3G compared with IC-MPGN both at diagnosis (mean 168.9 [range 45.4–292.4] vs. 93.7 [range 70.7–116.6] μmol/l, P = 0.25) and after a mean follow-up time of 4 years (mean 145.0 (range −8.1 to 298.1) vs 99.1 (range 46.3–151.9) μmol/l, P = 0.47), although the estimated glomerular filtration rate (eGFR) was not significantly different. Steroid treatment was associated with a significant improvement in eGFR versus no steroids in C3G (mean +43.0 (range 12.9–73.0) vs. −3.0 (range −23.1 to 17.2) ml/min per 1.73 m2, P = 0.02) but not in IC-MPGN. Overall kidney function was preserved in both groups although hypertension remained prevalent in 42.5% of the cohort at the last follow-up, and the urine protein/creatinine ratio remained elevated (mean 253.8 [range 91.9–415.7] mg/mmol). Conclusion This large pediatric IC-MPGN/C3G cohort revealed nearly half of the patients were misclassified, and there may be a trend toward worse renal prognosis in C3G although they may have greater steroid responsiveness. The overall prognosis appears to be more favorable than in adults; however, persistent hypertension and proteinuria suggest suboptimal disease control., Graphical abstract

Adequate interference fit and mechanical stability through optimal surgical technique are essential to prevent subsidence and loosening in cementless total hip arthroplasty. The purpose of this study is to determine the effect of surgical technique on radiographic subsidence and subsequent stability of a modern taper-wedge cementless stem.A retrospective review of 250 consecutive cementless primary total hip arthroplasties performed by 2 surgeons was completed. Surgeon A vigorously broached, maximizing the mediolateral stem dimension and confirmed final broach stability with a torsional test, whereas Surgeon B did not. All patients received identical taper-wedge stems. Preoperative bone morphology (canal flare index), postoperative subsidence, and canal fill were radiographically assessed.Canal flare index was not different between groups (P = .747). There was significantly less subsidence at 1 month for Surgeon A (0.3 vs 1.3 mm, P.001). Additional subsidence at 1 year occurred in only 0.8% of Surgeon A (1/119) compared to 51.6% of Surgeon B stems (33/64, P.001). Surgeon technique and canal fill measured at 60 mm below the lesser trochanter were the only variables predictive for subsidence, where Surgeon A and B had a mean canal fill of 95% and 86%, respectively. Surgeon B had 2 cases of aseptic loosening (2%) at 2 and 3 years postoperatively.These observations support that maximizing mediolateral canal fill and avoiding under-sizing the femoral implant with meticulous broaching technique minimizes subsidence and optimizes stability of modern cementless taper-wedge stems. Failure to optimize canal fill with appropriate broaching and surgical technique may predispose femoral components to failure from aseptic loosening.

Purpose To define the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression computer adaptive tests (CATs) in patients undergoing knee cartilage surgical procedures. Methods The PROMIS PF, PI, and Depression CATs were administered preoperatively and at 6 months alongside legacy knee patient-reported outcome measures (PROMs) in patients undergoing knee cartilage surgical procedures. Statistical analysis consisted of the time to completion, psychometric analysis for correlative strengths, absolute and relative floor and ceiling effects, and Cohen effect size. Results Our study included 250 patients (57.2% male patients), averaging 1.87, 1.53, and 1.91 minutes for completion of the PF, PI, and Depression CATs, respectively. Preoperatively, the PROMIS PF and PI CATs showed wide ranges of correlation coefficients with respect to function (r = 0.14-0.72 and r = 0.29-0.77, respectively) and health-related quality-of-life PROMs (r = 0.64-0.70). At 6 months, the PROMIS PF CAT (r = 0.82-0.93) and PI CAT (r = 0.77-0.93) both exhibited excellent correlations with respect to legacy function and health-related quality-of-life PROMs except for the Marx Activity Rating Scale (r = 0.36-0.44). None of the PROMIS instruments exhibited any significant floor or ceiling effects. Conclusions The PROMIS PF, PI, and Depression CATs performed better with respect to legacy PROMs in the postoperative period than the preoperative period. In addition, the PROMIS PF and PI measures performed best with respect to the International Knee Documentation Committee questionnaire, and no floor or ceiling effects were identified for the PROMIS instruments. The PROMIS instruments may be more suited to track outcomes postoperatively than to establish preoperative baselines in cartilage surgery patients. Level of Evidence Level IV, retrospective case series.

Purpose: Osteoarthritis (OA) of the knee is a debilitating, expensive, and prevalent disease, and interest in the non-surgical management of knee OA has grown recently. Our objective was to systema...

Meniscus allograft transplantation is an established surgical treatment indicated in symptomatic meniscus-deficient patients with minimal to no arthritis. Treatment decision making should be individualized after a thorough history and physical examination, with diagnostic imaging and arthroscopy to assess the status of the meniscus. The senior author prefers to use a bridge-in-slot technique, where osseous fixation of the allograft is completed through passage of a bone bridge to a tibial slot. Outcomes in meniscus allograft transplantation are favorable, with reported significant improvements in clinical outcome and low failures in short- and midterm follow-up studies.

A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes.

Unsupervised exploratory data analysis (EDA) is often the first step in understanding complex data sets. While summary statistics are among the most efficient and convenient tools for exploring and describing sets of data, they are often overlooked in EDA. In this paper, we show multiple case studies that compare the performance, including clustering, of a series of summary statistics in EDA. The summary statistics considered here are pattern recognition entropy (PRE), the mean, standard deviation (STD), 1-norm, range, sum of squares (SSQ), and X4, which are compared with principal component analysis (PCA), multivariate curve resolution (MCR), and/or cluster analysis. PRE and the other summary statistics are direct methods for analyzing data-they are not factor-based approaches. To quantify the performance of summary statistics, we use the concept of the "critical pair," which is employed in chromatography. The data analyzed here come from different analytical methods. Hyperspectral images, including one of a biological material, are also analyzed. In general, PRE outperforms the other summary statistics, especially in image analysis, although a suite of summary statistics is useful in exploring complex data sets. While PRE results were generally comparable to those from PCA and MCR, PRE is easier to apply. For example, there is no need to determine the number of factors that describe a data set. Finally, we introduce the concept of divided spectrum-PRE (DS-PRE) as a new EDA method. DS-PRE increases the discrimination power of PRE. We also show that DS-PRE can be used to provide the inputs for the k-nearest neighbor (kNN) algorithm. We recommend PRE and DS-PRE as rapid new tools for unsupervised EDA.

BACKGROUND: Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium-glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS: In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin-angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and induded incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017,1.2 million (95% uncertainty interval [UI] 1.2 to 1.3) people died from CKD. The global all-age mortality rate from CKD increased 41.5% (95% UI 35.2 to 46.5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2.8%, -1.5 to 6.3). In 2017,697.5 million (95% UI 649.2 to 752.0) cases of all-stage CKD were recorded, for a global prevalence of 9.1% (8.5 to 9.8). The global all-age prevalence of CKD increased 29.3% (95% UI 26.4 to 32.6) since 1990, whereas the age-standardised prevalence remained stable (1.2%, -1.1 to 3.5). CKD resulted in 35.8 million (95% UI 33.7 to 38.0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1.4 million (95% UI 1.2 to 1.6) cardiovascular disease-related deaths and 25.3 million (22.2 to 28.9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Isolated soft tissue stabilization procedures for treatment of recurrent shoulder instability are often not appropriate when the patient demonstrates bone loss of greater than 15% and in situations where there is recurrent instability after multiple attempts at arthroscopic stabilization. Current techniques for glenoid reconstruction include autografts with coracoid transfers, both Latarjet and Bristow techniques, autografts from the iliac crest, and allografts. Recent focus is on the use of distal tibial allografts for glenoid reconstruction. Distal tibial allografts provide a nearly identical radius of curvature to the glenoid with the addition of a thick cartilaginous surface that helps to restore the natural arc of the glenoid, ultimately leading to improved contact pressures by increasing the contact area. Additionally, these grafts are readily available and offer exceptional bone strength for fixation with a screw. This article discusses the surgical technique of distal tibial allograft augmentation for recurrent shoulder instability as well as the pre- and postoperative management of these patients.

Hyaline articular cartilage is critical for the normal functioning of the knee joint. Untreated focal cartilage defects have the potential to rapidly progress to diffuse osteoarthritis. Over the last several decades, a variety of interventions aiming at preserving articular cartilage and preventing osteoarthritis have been investigated. Reparative cartilage procedures, such as microfracture, penetrate the subchondral bone plate in effort to fill focal cartilage defects with marrow elements and stimulate fibrocartilaginous repair. In contrast, restorative cartilage procedures aim to replace the defective articular surface with autologous or allogeneic hyaline cartilage. This review focuses on the preservation of articular cartilage, and discusses the current reparative and restorative surgical techniques available for treating focal cartilage defects.

Osteochondral injuries commonly occur after lateral patellar instability events. Recognition and early intervention of displaced fragments is key to maintaining the viability of the fragment and congruency of the articular surface. Multiple fixation techniques exist for achieving stable fixation of displaced osteochondral lesions, including metal or bioabsorbable screws and all suture techniques. In this Technical Note, we describe a technique for internal fixation of a displaced osteochondral fragment of the lateral femoral condyle using knotless suture anchors. This technique affords minimally invasive restoration of the native anatomy with excellent stability of the fracture fragment, allowing early range of motion and ambulation., Technique Video Video 1 Intraoperative video demonstrating diagnostic arthroscopy with identification of an osteochondral fragment in the posterolateral recess of the knee and the corresponding defect along the lateral femoral condyle. Subsequent removal of fragment and evaluation on the back table. Debridement of the base of the osteochondral defect followed by marrow stimulation of the defect bed. Placement of knotless fiberTak anchors (Arthrex, Naples, FL) was followed by preparation of the fragment on the back table for knotless suture anchor fixation. The fixation limb is fed through the drill holes in the osteochondral fragment and a knotless interconnection between anchors is created. Gentle passage and final fixation of the osteochondral fragment follows.

The tibial tubercle–trochlear groove (TT-TG) distance is currently utilized to evaluate knee alignment in patients with patellar instability. Sagittal plane pathology measured by the sagittal tibial tubercle–trochlear groove (sTT-TG) distance has been described in instability but may also be important to consider in patients with cartilage injury. This study aims to (1) describe interobserver reliability of the sTT-TG distance and (2) characterize the change in the sTT-TG distance with respect to changing knee flexion angles. In this cadaveric study, six nonpaired cadaveric knees underwent magnetic resonance imaging (MRI) studies at each of the following degrees of knee flexion: −5, 0, 5, 10, 15, and 20. The sTT-TG distance was measured on the axial T2 sequence. Four reviewers measured this distance for each cadaver at each flexion angle. Intraclass correlation coefficients were calculated to determine interobserver reliability and reproducibility of the sTT-TG measurement. Analysis of variance (ANOVA) tests and Friedman's tests with a Bonferroni's correction were performed for each cadaver to compare sTT-TG distances at each flexion angle. Significance was defined as p 0.9. The tibial tubercle progressively becomes more posterior in relation to the trochlear groove (more negative sTT-TG distance) with increasing knee flexion. The sTT-TG distance is a measurement that is reliable between attending surgeons and across training levels. The sTT-TG distance is affected by small changes in knee flexion angle. Awareness of knee flexion angle on MRI is important when this measurement is utilized by surgeons.

With average life expectancy and the rising prevalence of obesity, osteoarthritis (OA) is creating an increasingly large financial and physical burden on the U.S. population today. As the body ages and experiences trauma, articular cartilage surfaces in joints are gradually worn away, leading to OA. Traditionally, treatment options have included lifestyle modifications, pain management, and corticosteroid injections, with joint replacement reserved for those who have exhausted nonsurgical measures. More recently, hyaluronic acid, micronized dehydrated human amniotic/chorionic membrane tissue, and platelet-rich plasma (PRP) injections have started to gain traction. PRP has been shown to have both anti-inflammatory effects through growth factors such as transforming growth factor-β and insulin-like growth factor 1, and stimulatory effects on mesenchymal stem cells and fibroblasts. Multiple studies have indicated that PRP is superior to hyaluronic acid and corticosteroids in terms of improving patient-reported pain and functionality scores. Unfortunately, there are many variations in PRP preparation, and lack of standardization in factors, such as speed and duration of centrifugation, leads to wide ranges of platelet and leukocyte concentrations. This review examines the current literature addressing the use of PRP in symptomatic knee OA and addresses suggestions for future studies in this area.

In teams, some combinations of people work together better than others. A large body of literature with a rich history suggests that the configuration of team member attributes, called team composition, has a fundamental influence on teamwork. Team composition shapes the emergence of affective states, behavioral processes, and cognitive states (the ABCs of teamwork), which ultimately affect how teams meet their objectives. The purpose of this article is to describe what is known about team composition and its influence on the ABCs of teamwork. We discuss what team composition is, and why it is important. We then describe key discoveries related to how team composition shapes the ABCs of teamwork. Building on what we know, we outline important directions for future research. (PsycINFO Database Record

X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) are much used analytical techniques that provide information about the outermost atomic and molecular layers of materials. In this work, we discuss the application of multivariate spectral techniques, including principal component analysis (PCA) and multivariate curve resolution (MCR), to the analysis of XPS and ToF-SIMS depth profiles. Multivariate analyses often provide insight into data sets that is not easily obtained in a univariate fashion. Pattern recognition entropy (PRE), which has its roots in Shannon’s information theory, is also introduced. This approach is not the same as the mutual information/entropy approaches sometimes used in data processing. A discussion of the theory of each technique is presented. PCA, MCR, and PRE are applied to four different data sets obtained from: a ToF-SIMS depth profile through ca. 100 nm of plasma polymerized C3F6 on Si, a ToF-SIMS depth profile through ca. 100 nm of plasma polymerized PNIPAM (poly (N-isopropylacrylamide)) on Si, an XPS depth profile through a film of SiO2 on Si, and an XPS depth profile through a film of Ta2O5 on Ta. PCA, MCR, and PRE reveal the presence of interfaces in the films, and often indicate that the first few scans in the depth profiles are different from those that follow. PRE and backward difference PRE provide this information in a straightforward fashion. Rises in the PRE signals at interfaces suggest greater complexity to the corresponding spectra. Results from PCA, especially for the higher principal components, were sometimes difficult to understand. MCR analyses were generally more interpretable.

In thermoelectric industry, synthetic gypsum and coal ash are generated as industrial by-products. The objective of this work was to evaluate the effect of different mixtures of synthetic gypsum and coal ash on N mineralization in an Alfisol. Nitrogen mineralization was evaluated by soil incubations under controlled conditions and potential mineralization using the nonlinear first order kinetics model Nmt = N0 [1 - ℮(-k t )] , where Nmt is the mineral N accumulated at a specific time, N0 is the potentially mineralizable N, k is the mineralization rate, and finally t is the incubation time. Treatments consisted of different mixtures of synthetic gypsum, coal ash and urea (M1: 50% synthetic gypsum, 50% coal ash, M2: 50% synthetic gypsum, 35% coal ash, 15% urea, M3: 45% synthetic gypsum; 40% coal ash, 15% urea, M4: 65% synthetic gypsum, 20% coal ash, 15% urea, M5: 55% synthetic gypsum, 30% coal ash, 15% urea). Each mixture was applied to the soil at 2 t ha-1. The results shown the highest concentration (p < 0.05) of net mineral N (NMN) applying M3 (166.14 mg kg-1), while the lowest NMN (p < 0.05) was found applying M5 (98.30 mg kg-1). Treatment M1 presented the highest N0 value (579.0 mg kg-1) respect to treatments with urea in its composition, with exception of M3 (523.4 mg kg-1). Where the highest and lowest k were determined in M5 (k = 0.44990) and M3 (k = 0.04470), respectively. Mixtures of synthetic gypsum, coal ash and urea increased N mineralization over mixtures without urea. Respect N potential mineralization, in some cases N0 and k values would respond more to the fit of the mathematical model employed than to the biological process.

Focal chondral defects in the knee are prevalent in athletes and can occur from a variety of etiologies, including trauma, osteochondritis dissecans, and early degenerative changes. As these lesions are often symptomatic and debilitating, a variety of cartilage restoration procedures are available for treatment. While most patient goals include returning to basic activities of daily living, athletes are unique in that they also strive to return to sport at their preinjury level of play or higher. Cartilage restoration procedures as a whole have reported up to 79% return to sport with specific procedures showing up to 93% return to sport. However, not all athletes return at their preinjury level. It is extremely important to manage return to sport expectations, expected timeline for return to sport, and the likelihood of returning to their preinjury level of play. Evidence-based treatments are mandatory to help patients attain their recovery goals without compromising the knee.

Classical least squares (CLS) models are flexible, adaptable, and interpretable. Four forms of CLS are presented, and the mathematical relationships are reduced to showing differences in the weighting in the corresponding objective functions. The generalized least squares (GLS) weighting strategy is demonstrated using a Raman image of a tile from the space shuttle, and a second example shows how GLS and extended least squares (ELS) can be used synergistically to detect melamine particles in wheat gluten in a near-infrared image. A final example shows how GLS-ELS can be used to classify pixels in a Landsat image. In general, de-weighting of clutter signal using GLS improved sensitivity, and selectivity was enhanced using ELS—especially when targets were similar. A distinct advantage of these target detection approaches is that they are image specific. This means that image-to-image differences in sampling and interferences need not be accounted for.

Symptomatic pathology should be surgically addressed in an athlete that fails nonoperative management. Type II superior labrum anterior to posterior (SLAP) tears that fail nonoperative treatment should undergo SLAP repair in a majority of cases unless the patient is a non-throwing athlete with concomitant bicep tendonitis. In those patients, a primary biceps tenodesis can be considered. In all cases the patient should be counseled on the outcomes and expectations of each procedure in regard to general function and return to sport. This is especially true among throwers who demonstrated significantly worse return to sport and previous level compared to their non-throwing peers. Finally, in the event that a bicep tenodesis is required, overhead athletes can still return to high-level competitive play, but the prognosis remains more guarded than in the non-overhead athlete.

Objective: To assess the clinical relevance of regression to the mean for clinical trials and clinical practise. Methods: MEDLINE was searched until February 2018 for randomized trials of BP lowering with over 1000 patient-years follow-up per group. We estimated baseline mean BP, follow-up mean (usual) BP amongst patients grouped by 10 mmHg strata of baseline BP, and assessed effects of BP lowering on coronary heart disease (CHD) and stroke according to these BP levels. Results: Eighty-six trials (349,488 participants), with mean follow-up 3.7 years, were included. Most mean BP change was due to regression to the mean rather than treatment. At high baseline BP levels, even after rigorous hypertension diagnosis, downwards regression to the mean caused much of the fall in BP. At low baseline BP levels, upwards regression to the mean increased BP levels, even in treatment groups. Overall, a BP reduction of 6/3 mmHg lowered CHD by 14% (95% CI 11%-17%) and stroke by 18% (15%-22%), and these treatment effects occurred at follow-up BP levels much closer to the mean than baseline BP levels. In particular, more evidence was available in the systolic BP (SBP) 130-139 mmHg range than any other range. Benefits were apparent in numerous high-risk patient groups with baseline mean SBP Conclusion: Clinical practise should focus less on pre-treatment BP levels, which rarely predict future untreated BP levels or rule out capacity to benefit from BP lowering in high cardiovascular risk patients. Instead, focus should be on prompt, empirical treatment to maintain lower BP for those with high BP and/or high risk.

Objective Outflow venous stenting as an adjunct to catheter-directed thrombolysis (CDT) is performed to prevent recurrent thrombosis and to reduce the risk of post-thrombotic syndrome. Historical data show that stenting improves outcomes of surgical thrombectomy in patients with iliofemoral deep venous thrombosis (DVT), and recent observational data suggest that stenting improves long-term outcomes of CDT. However, the impact of stenting during CDT on acute safety outcomes is unknown. We sought to investigate the contemporary trends, safety outcomes, and resource utilization of adjunctive stent placement in patients undergoing CDT. Methods Patients with proximal lower extremity and caval DVT were identified within the National Inpatient Sample from January 2005 to December 2013. From this data set, we stratified our patients into three groups: patients who received CDT alone, patients who received CDT plus angioplasty, and patients who received CDT plus angioplasty with stenting. We used an inverse probability treatment weighting algorithm to create three weighted cohorts. Cochran-Armitage test was used to evaluate the trends of stent placement among patients treated with CDT. The primary outcome was a composite end point of all-cause mortality, gastrointestinal bleed, or intracranial hemorrhage. Results A total of 138,049 patients were discharged with a principal diagnosis of proximal and caval DVT; 7097 of these patients received CDT (5.1%). From this group, 2854 (40.2%) were treated with CDT alone, 2311 (32.6%) received adjunctive angioplasty alone, and 1932 (27.2%) received adjunctive angioplasty and stent. Adjunctive stenting had a significantly lower rate of primary composite outcome compared with CDT alone (2.7% vs 3.8%; P = .04). Stent placement was associated with a similar length of stay compared with angioplasty and CDT alone groups (6.8 vs 6.9 vs 7.1 days, respectively; P = .94) and higher in-hospital charges ($115,164.01 ± $76,985.31 vs $98,089.82 ± $72,921.94 vs $80,441.63 ± $74,024.98; P Conclusions This nationwide study suggests that one in four patients undergoing CDT is treated with adjunctive stent placement in the United States. This observational study showed that adjunctive stenting does not adversely affect the acute safety outcomes of CDT; however, it was associated with increased hospital charges.

Acute kidney injury is a severe complication of cardiac surgery associated with increased morbidity and mortality; yet, acute kidney injury classification for neonates remains challenging. We characterized patterns of postoperative fluid overload as a surrogate marker for acute kidney injury and as a risk factor of poor postoperative outcomes in neonates undergoing cardiac surgery.Retrospective cohort study.Single, congenital heart center destination program.Four hundred thirty-five neonates undergoing cardiac surgery with cardiopulmonary bypass from January 2006 through December 2010.None.Demographics, diagnosis, and perioperative clinical variables were collected, including daily weights and serum creatinine levels. A composite poor clinical outcome (death, need for renal replacement therapy or extracorporeal life support within 30 postoperative days) was considered the primary outcome measure. Twenty-one neonates (5%) had a composite poor outcome with 7 (2%) requiring renal replacement therapy, 8 (2%) requiring extracorporeal life support, and 14 (3%) dying between 3 and 30 days post surgery. Neonates with a composite poor outcome had significantly higher maximum fluid overload (20%) and were slower to diurese. A receiver-operating characteristic curve determined that fluid overload greater than or equal to 16% and serum creatinine greater than or equal to 0.9 on postoperative day 3 were the optimal cutoffs for significant discrimination on the primary outcome (area under the curve = 0.71 and 0.76, respectively). In multivariable analysis, fluid overload greater than or equal to 16% (adjusted odds ratio = 3.7) and serum creatinine adjusted odds ratio 0.9 (adjusted odds ratio = 6.6) on postoperative day 3 remained an independent risk factor for poor outcome. Fluid overload greater than or equal 16% was also significantly associated with cardiac arrest requiring cardiopulmonary resuscitation, prolonged ICU stay, and chest reexploration.This study highlights the importance of monitoring fluid balance in the neonatal cardiac surgical population and suggests that daily fluid overload, a readily available, noninvasive marker of renal function, may be a sensitive and specific predictor of adverse outcomes.

In response to criticism regarding the objectivity and consistency of disciplinary sanctions, the Virginia Board of Health Professions decided to analyze sanctioning decisions and consider developing sanctioning reference points for boards to use in disciplinary cases. As a result, Virginia's Department of Health Professions and the independent consulting firm VisualResearch, Inc., jointly developed a sanctioning reference point system for and with each of the state's 13 professional boards, including the board of nursing. This article describes the system's development, implementation, and effectiveness.

Percutaneous transluminal angioplasty (PTA) for the treatment of pediatric renovascular hypertension (RVH) in contemporary practice is accompanied with ill-defined complications. This study examines the mode of pediatric renal PTA failures and the results of their surgical management. Twenty-four children underwent remedial operations at the University of Michigan from 1996 to 2014 for failures of renal PTA. Their clinical courses were retrospectively reviewed and results analyzed. Renal PTA of 32 arteries, including 13 with stenting, was performed for severe RVH in 12 boys and 12 girls, having a mean age of 9.3 years. Developmental ostial stenoses affected 22 children. PTA failures included: 27 restenoses and five thromboses. Remedial operations included: 13 renal artery-aortic reimplantations, one segmental renal artery—main renal artery reimplantation, ten aortorenal bypasses, one arterioplasty, one iliorenal bypass, and six nephrectomies for unreconstructable arteries; the latter all in children younger than 10 years. Follow-up averaged 2.1 years. Postoperatively, hypertension was cured, improved, or unchanged in 25, 54, and 21 %, respectively. There was no perioperative renal failure or mortality. Renal PTA for the treatment of pediatric RVH due to ostial disease may be complicated by failures requiring complex remedial operations or nephrectomy, the latter usually affecting younger children.

To study the potential utility of using near fiber (NF) jiggle as an assessment of neuromuscular transmission stability in healthy older subjects using decomposition-based quantitative electromyography (DQEMG).The tibialis anterior (TA) and vastus medialis (VM) muscles were tested in 9 older men (77 ± 5 years) and 9 young male control subjects (23 ± 0.3 years). Simultaneous surface and needle-detected electromyographic (EMG) signals were collected during voluntary contractions, and then analyzed using DQEMG. Motor unit potential (MUP) and NF MUP parameters were analyzed.NF jiggle was significantly increased for both the TA and VM in the old age group relative to the younger controls (P0.05). NF jiggle was significantly higher in the TA compared to VM (P0.05). For TA, NF jiggle was negatively correlated with MUNE, and positively correlated with S-MUP amplitude, NF count, MUP duration, MUP peak-to-peak voltage, and MUP area (P0.05). For VM, NF jiggle was positively correlated with NF count and MUP area (P0.05), and no significant correlations were found between NF jiggle and S-MUP amplitude, MUP duration, or MUP peak-to-peak voltage (MUNE was not calculated for VM, so no correlation could be made).Healthy aging is associated with neuromuscular transmission instability (increased NF jiggle) and MU remodeling, which can be measured using DQEMG.NF jiggle derived from DQEMG can be a useful method of identifying neuromuscular dysfunction at various stages of MU remodeling and aging.

Objectives: Medial patellofemoral ligament (MPFL) reconstruction is an effective surgical procedure for patients with recurrent lateral dislocations. Outcome measurements can identify the success of a surgical procedure but are shifting away from absolute values or deltas of patient-reported outcomes (PROs) towards the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS), representing the smallest clinical improvement that patients perceive as important, the threshold at which patients notice a considerable improvement, and patient satisfaction with their outcome, respectively. To our knowledge no prior study has defined these thresholds in MPFL reconstruction patients. Methods: An institutional database was reviewed for patients who underwent primary MPFL reconstruction between August 2015 to February 2018 with a minimum 6-month follow-up. IKDC, Kujala and KOOS were administered to all patients pre-operatively and at 6-months and 1-year post-operatively. An anchor-based approach with a receiver-operator curve/area under the curve analysis using the Youden index was performed to calculate the MCID, SCB and PASS. The predictive power was determined to be acceptable with AUC≥70% and excellent with AUC≥80%. Results: From 2015 to 2018, 93 of 162 patients (mean age 23.7±10.1 years; 25 males, 68 females) completed for 6-month follow-up. At 6-months follow-up, SCB and PASS were defined with acceptable predictive power for all scores listed, while MCID achieved this for KOOS pain and sports subscores only (Table 1). At 1-year follow-up, SCB and PASS were each defined with acceptable predictive power for all scores listed, while MCID achieved this mark for KOOS pain and quality of life subscores as well as both Kujala scales. Conclusion: This study establishes MCID, SCB and PASS for IKDC, Kujala, and KOOS subscores at 6-months and 1-year postoperatively with excellent predictive power for 19/23 PROMs investigated at 1-year. These findings represent important benchmarks in patients undergoing primary MPFL reconstruction.

Objectives: The lateral patellar restraints (lateral patellofemoral ligament [LPFL], lateral patellotibial ligament [LPTL] and lateral patellomeniscal ligament [LPML]) are relatively poorly understood entities, which are important in patellar stability. The purpose of this study is to perform a qualitative and quantitative anatomic evaluation of the LPFL, LPML, and LPTL attachment sites, with specific attention to their relationship to pertinent osseous and soft tissue landmarks. Methods: Six non-paired, fresh frozen human cadaveric knees (n = 6) were utilized for this study. Institutional review board approval was not required for this cadaveric study. Knees were dissected and a variety of anatomic locations and the LPFL, LPTL, and LPML attachment sites and attachment centers were marked with surgical marker. The knee was placed in a custom jig and the quadriceps tendon was loaded with a 1 kg weight. Ligament area was measured with a portable coordinate measuring device (Microscribe, Solution Technologies, Oella, MD) and ligament centers were identified at 0, 15, 30, 45, 60 and 90° of flexion. The 3D location via a ‘bird’s eye view’ was calculated in Rhinoceros 5.0 software (McNeel North America, Seattle, WA). Data analysis was performed in MATLAB (MathWorks, Natick, MA) and Microsoft Excel (Microsoft, Redmond, WA). Statistical analysis was conducted with one-way repeated measure ANOVAs and Spearman Rank Correlation, which was used for non-normally distributed data, in SPSS (v26, IBM, Armonk, NY). Results: The location of the LPFL on the femur was compared to local landmarks (Fig 1). In the sagittal plane, the center, anterior, and posterior aspect of the LPFL were a mean of 17.0±1.4, 11.8±2.0, and 8.0±1.9 mm from the lateral epicondyle, respectively. Distances to the anterior, central, and posterior cartilage from these locations were 14.3±1.8, 14.6±2.9, and 14.3±3.3mm, respectively. The area of the LPFL was a mean of 31.59±20.24mm2 in the vertical plane. The location of the LPFL on the patella was then analyzed. The superior aspect of the LPFL was 8.52±2.74 mm from the superior pole of the patella, while the distance from the inferior pole to the LPFL was 14.01±4.53mm. The average length of the patella was 4.10±0.34cm and the LPFL occupied 45.09% of its sagittal length. The distance from the LPML to the anterolateral root was 7.35±2.98mm. The center of the LPTL on the tibia was a mean distance of 5.88±3.00mm from Gerdy’s tubercle. LPFL length decreased in flexion with a mean length of 40.60±3.24mm at 0°, 36.27±6.29mm at 15°, 33.77±4.93mm at 30°, 31.41±4.72 mm at 45°, 30.05±4.10mm at 60°, and 26.05±3.02mm at 90°. Significant length changes through flexion were observed (p < 0.0005), pairwise comparison found significant differences between 0° and 45° (p=0.025), 0° and 60° (p=0.012), and 0° and 90° (p=0.005). However, a significant negative correlation between degree of flexion and length was observed (r=-0.734, p < 0.0005). Conclusions: To our knowledge, this is the first study to describe the anatomy of the components of the lateral stabilizers including the LPFL, LPTL, and LPML. Reproducible locations on the femur and patella were observed for the two LPFL attachments. In addition, the attachment sites were found to have consistent distances to anatomic landmarks. Our results demonstrate that the LPFL length significantly correlates with flexion and maintains isometry through flexion, in contrast to the medial patellofemoral ligament, which has the greatest length changes in the first 20° of flexion.

Focal chondral defects of the knee are extremely common and often result in pain, dysfunction, joint deterioration, and, ultimately, the development of osteoarthritis. Due to the limitations of conventional treatments for focal chondral defects of the knee, orthobiologics have recently become an area of interest. Orthobiologics used for cartilage defects include (but are not limited to) bone marrow aspirate concentrate, adipose-derived mesenchymal stem cells, platelet-rich plasma, and micronized allogeneic cartilage. Each of these products can be applied in the clinical setting, as an isolated surgical procedure, or as an augment to cartilage restoration surgery.

Background and objectives The association between gut dysbiosis, high intestinal permeability, and endotoxemia-mediated inflammation is well established in CKD. However, changes in the circulating microbiome in patients with CKD have not been studied. In this pilot study, we compare the blood microbiome profile between patients with CKD and healthy controls using 16S ribosomal DNA sequencing. Design, setting, participants, & measurements Blood bacterial DNA was studied in buffy coat samples quantitatively by 16S PCR and qualitatively by 16S targeted metagenomic sequencing using a molecular pipeline specifically optimized for blood samples in a cross-sectional study comparing 20 nondiabetic patients with CKD and 20 healthy controls. Results There were 22 operational taxonomic units significantly different between the two groups. 16S metagenomic sequencing revealed a significant reduction in α diversity (Chao1 index) in the CKD group compared with healthy controls (127±18 versus 145±31; P =0.04). Proteobacteria phylum, Gammaproteobacteria class, and Enterobacteriaceae and Pseudomonadaceae families were more abundant in the CKD group compared with healthy controls. Median 16S ribosomal DNA levels did not significantly differ between CKD and healthy groups (117 versus 122 copies/ng DNA; P =0.38). GFR correlated inversely with the proportion of Proteobacteria ( r =−0.54; P ≤0.01). Conclusions Our pilot study demonstrates qualitative differences in the circulating microbiome profile with lower α diversity and significant taxonomic variations in the blood microbiome in patients with CKD compared with healthy controls.

Meniscal allograft transplantation is an effective treatment for the symptomatic, young, active patient with meniscal deficiency. Modern graft-preservation techniques may reduce clinical sequelae of meniscal shrinkage after transplantation. We prefer fresh-frozen nonirradiated allografts because of easier processing, lower immunogenicity, and lower cost, and on the basis of a 2-decade clinical experience with fresh-frozen meniscal allograft transplantations, we are pleased with our survivorship results.

We present a series of patients with discitis and osteomyelitis who were surgically treated via a minimally invasive lateral transpsoas approach to the lumbar spine. Surgical treatment for spinal discitis and osteomyelitis presents challenges because of comorbidities that are common in patients undergoing this procedure. A retrospective review found six patients who met strict operative criteria including instability, intractable pain, neurological deficit, and disease progression. All patients were non-ambulatory before surgery because of intractable back pain. The patients underwent standard lateral minimally invasive surgery using either the extreme lateral interbody fusion (NuVasive, San Diego, CA, USA) or direct lateral interbody fusion (Medtronic Sofamor Danek, Memphis, TN, USA) system. The patients underwent debridement with a discectomy and partial or complete corpectomy, with polyetheretherketone or titanium cage placement. Two patients had additional posterior fixation with percutaneous pedicle screws, and none had immediate perioperative complications. The postoperative CT scans demonstrated satisfactory debridement and hardware placement. All patients experienced significant pain improvement and could ambulate within a few days of surgery. So far, the 1 year follow-up data have demonstrated stable hardware with solid fusion and continued pain improvements. One patient demonstrated hardware failure secondary to refractory infection, 2 months postoperatively, and required additional posterior decompression and debridement with pedicle screw fixation. The lateral transpsoas approach permits debridement and fixation coupled with percutaneous pedicle screw fixation to further stabilize the spine in a minimally invasive fashion. Due to the significant comorbidities in this patient population, a minimally invasive approach is a suitable surgical technique. A close follow-up period is necessary to detect early hardware failure which may necessitate more extensive treatment.

BACKGROUND Future space exploration, such as a mission to Mars, will require space crews to live and work in extreme environments unlike those of previous space missions. Extreme conditions such as prolonged confinement, isolation, and expected communication time delays will require that crews have a higher level of interpersonal compatibility and be able to work autonomously, adapting to unforeseen challenges in order to ensure mission success. Team composition, or the configuration of member attributes, is an important consideration for maximizing crewmember well-being and team performance. METHODS We conducted an extensive search to find articles about team composition in long-distance space exploration (LDSE)-analogue environments, including a search of databases, specific relevant journals, and by contacting authors who publish in the area. RESULTS We review the team composition research conducted in analogue environments in terms of two paths through which team composition is likely to be related to LDSE mission success, namely by 1) affecting social integration, and 2) the team processes and emergent states related to team task completion. DISCUSSION Suggestions for future research are summarized as: 1) the need to identify ways to foster unit-level social integration within diverse crews; 2) the missed opportunity to use team composition variables as a way to improve team processes, emergent states, and task completion; and 3) the importance of disentangling the effect of specific team composition variables to determine the traits (e.g., personality, values) that are associated with particular risks (e.g., subgrouping) to performance.

Objective To determine the effect of therapeutic plasma exchange on hemodynamics, organ failure, and survival in children with multiple organ dysfunction syndrome due to sepsis requiring extracorporeal life support. Design A retrospective analysis. Setting A PICU in an academic children's hospital. Patients Fourteen consecutive children with sepsis and multiple organ dysfunction syndrome who received therapeutic plasma exchange while on extracorporeal life support from 2005 to 2013. Interventions Median of three cycles of therapeutic plasma exchange with median of 1.0 times the estimated plasma volume per exchange. Measurements and main results Organ Failure Index and Vasoactive-Inotropic Score were measured before and after therapeutic plasma exchange use. PICU survival in our cohort was 71.4%. Organ Failure Index decreased in patients following therapeutic plasma exchange (mean ± SD: pre, 4.1 ± 0.7 vs post, 2.9 ± 0.9; p = 0.0004). Patients showed improved Vasoactive-Inotropic Score following therapeutic plasma exchange (median [25th-75th]: pre, 24.5 [13.0-69.8] vs post, 5.0 [1.5-7.0]; p = 0.0002). Among all patients, the change in Organ Failure Index was greater for early therapeutic plasma exchange use than late use (early, -1.7 ± 1.2 vs late, -0.9 ± 0.6; p = 0.14), similar to the change in Vasoactive-Inotropic Score (early, -67.5 [28.0-171.2] vs late, -12.0 [7.2-18.5]; p = 0.02). Among survivors, the change in Organ Failure Index was greater among early therapeutic plasma exchange use than late use (early, -2.3 ± 1.0 vs late, -0.8 ± 0.8; p = 0.03), as was the change in Vasoactive-Inotropic Score (early, -42.0 [16.0-76.3] vs late, -12.0 [5.3-29.0]; p = 0.17). The mean duration of extracorporeal life support after therapeutic plasma exchange according to timing of therapeutic plasma exchange was not statistically different among all patients or among survivors. Conclusions The use of therapeutic plasma exchange in children on extracorporeal life support with sepsis-induced multiple organ dysfunction syndrome is associated with organ failure recovery and improved hemodynamic status. Initiating therapeutic plasma exchange early in the hospital course was associated with greater improvement in organ dysfunction and decreased requirement for vasoactive and/or inotropic agents.

Supplemental Digital Content is available in the text., Background: Canagliflozin is a sodium glucose cotransporter 2 inhibitor that significantly reduces the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes mellitus and elevated cardiovascular risk. The comparative effects among participants with and without a history of cardiovascular disease (secondary versus primary prevention) were prespecified for evaluation. Methods: The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) randomly assigned 10 142 participants with type 2 diabetes mellitus to canagliflozin or placebo. The primary prevention cohort comprised individuals ≥50 years of age with ≥2 risk factors for cardiovascular events but with no prior cardiovascular event, and the secondary prevention cohort comprised individuals ≥30 years of age with a prior cardiovascular event. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included heart failure hospitalization and a renal composite (40% reduction in estimated glomerular filtration rate, renal replacement therapy, or renal death). Results: Primary prevention participants (N=3486; 34%) were younger (63 versus 64 years of age), were more often female (45% versus 31%), and had a longer duration of diabetes mellitus (14 versus 13 years) compared with secondary prevention participants (N=6656; 66%). The primary end point event rate was higher in the secondary prevention group compared with the primary prevention group (36.9 versus 15.7/1000 patient-years, P

Purpose Team composition research considers how configurations (e.g., team-level diversity) of team members’ attributes (e.g., personality, values, demographics) influence important outcomes. Our chapter describes key issues in understanding and effectively managing team composition over time. Methodology/approach We discuss how context shapes team composition. We review empirical research that examined relationships between team composition, and team processes and emergent properties over multiple time points. We review research that examined how composition can be effectively managed over the lifecycle of a team. Findings Context shapes the nature of team composition itself (e.g., dynamic composition). To the extent that membership change, fluid boundaries, and multiple team membership are present should be accounted for in research and practice. The research we reviewed indicated no, or fleeting effects for surface-level (e.g., demographics) composition on the development of team processes and emergent properties over time, although there were exceptions. Conversely, deep-level composition affected team processes and emergent properties early in a team’s lifespan as well as later. Team composition information can be used in staffing; it can also inform how to best leverage training, leadership, rewards, tasks, and technology to promote team effectiveness. Social implications Teams are the building blocks of contemporary organizations. Understanding and effectively managing team composition over time can increase the likelihood of team. Originality/value Our chapter provides novel insights into key issues in understanding and effectively managing team composition over time.

The direct anterior approach (DAA) in total hip arthroplasty is of significant interest to both patients and surgeons, largely due to intense marketing. This study addressed the question, "What is the level of promotion of DAA total hip arthroplasty on the internet by American Association of Hip and Knee Surgeons (AAHKS) members?"An internet search was performed to identify surgeon-specific websites for each member of the AAHKS using the members' full name and a previously published set of criteria. Each website was evaluated utilizing a questionnaire to systematically identify claims made regarding proposed DAA-specific risks, benefits, as well as the presence/absence of supporting data.We identified 1855 qualified websites. The DAA was referenced on 22.8% (423/1855) of these websites. Claims regarding DAA-specific benefits included less invasive/muscle sparing (46.3%), quicker recovery (45.2%), decreased pain (28.1%), decreased hospital stay (22.0%), and decreased dislocation risk (16.3%). Potential DAA risks including lateral femoral cutaneous nerve injury, periprosthetic/greater trochanteric fracture, and wound complication/hematoma were addressed on only 4.7%, 3.1%, and 1.7% of websites, respectively. Supporting peer-reviewed literature was identified on only 3.6% of DAA websites.Over one-fifth of AAHKS members promoted the DAA on the internet. Member websites claimed DAA benefits such as faster recovery and decreased pain approximately 9 times more frequently than any potential risk of the procedure (P.001). While AAHKS policy does not regulate member marketing, it is the responsibility of all orthopedic surgeons to disseminate accurate, validated information concerning the procedures we perform.

12 p., Background: The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams’ data collection plans. One year later all teams were asked which consensus measures had been implemented. Results: Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. Conclusions: Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences.

Arthritis and instability represent 2 of the most common pathological processes affecting the distal radioulnar joint (DRUJ). These conditions can present in isolation or as components of a multifactorial process. Nonoperative treatment is indicated for most acute injuries to the DRUJ. The joint should be immobilized in a position of stability to allow for ligament healing. Likewise, early arthritis responds favorably to rest, immobilization, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs). When DRUJ instability is refractory to nonoperative measures, native ligament repair is the preferable method of treatment. When this method is not possible, anatomical reconstruction of the distal radioulnar ligaments should be performed. For advanced DRUJ arthritis Darrach resection should be reserved for the elderly, low-demand patient. The Sauve-Kapandji procedure allows for arthrodesis of the DRUJ while maintaining forearm rotation and a stable base for the ulnar carpus. DRUJ hemiarthroplasty procedures have been associated with favorable preliminary results. These implants attempt to reproduce native biomechanics and may be used in lieu of or as a salvage procedure after resection arthroplasty. DRUJ arthroplasty should be used as a salvage procedure.

Maximum autocorrelation factors (MAF) and whitened principal components analysis are gaining popularity as tools for exploratory analysis of hyperspectral images. This paper shows that the two approaches are mathematically identical when signal and noise (clutter) are defined similarly. It also shows that the MAF metaphor can be generalized to encompass a wide variety of signal processing objectives referred to generically as maximum signal factors while retaining the interpretability of principal components analysis. A subspace projection approximation of the data prior to decomposition is also introduced, which reduces computational memory requirements. For the hyperspectral images studied, it was demonstrated to bring more signal of interest into the first factor as compared with the approach that did not use the subspace approximation. Also, it is expected to significantly reduce the number of scores images needed to be inspected during exploratory analysis. Copyright © 2014 John Wiley & Sons, Ltd.