Injury Risk Estimation Expertise Assessing the ACL Injury Risk Estimation Quiz

Background: Available methods for screening anterior cruciate ligament (ACL) injury risk are effective but limited in application as they generally rely on expensive and time-consuming biomechanical movement analysis. A potential efficient alternative to biomechanical screening is skilled movement analysis via visual inspection (ie, having experts estimate injury risk factors based on observations of athletes’ movements). Purpose: To develop a brief, valid psychometric assessment of ACL injury risk factor estimation skill: the ACL Injury Risk Estimation Quiz (ACL-IQ). Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 660 individuals participated in various stages of the study, including athletes, physicians, physical therapists, athletic trainers, exercise science researchers/students, and members of the general public in the United States. The ACL-IQ was fully computerized and made available online (www.ACL-IQ.org). Item sampling/reduction, reliability analysis, cross-validation, and convergent/discriminant validity analysis were conducted to optimize the efficiency and validity of the assessment. Results: Psychometric optimization techniques identified a short (mean time, 2 min 24 s), robust, 5-item assessment with high reliability (test-retest: r = 0.90) and consistent discriminability (average difference of exercise science professionals vs general population: Cohen d = 1.98). Exercise science professionals and general population individuals scored 74% and 53% correct, respectively. Convergent and discriminant validity was demonstrated. Scores on the ACL-IQ were most associated with ACL knowledge and various cue utilities and were least associated with domain-general spatial/decision-making ability, personality, or other demographic variables. Overall, 23% of the total sample (40% exercise science professionals; 6% general population) performed better than or equal to the ACL nomogram. Conclusion: This study presents the results of a systematic approach to assess individual differences in ACL injury risk factor estimation skill; the assessment approach is efficient (ie, it can be completed in\3 min) and psychometrically robust. The results provide evidence that some individuals have the ability to visually estimate ACL injury risk factors more accurately than other instrument-based ACL risk estimation methods (ie, ACL nomogram). The ACL-IQ provides the foundation for assessing the efficacy of observational ACL injury risk factor assessment (ie, does simple skilled visual inspection reduce ACL injuries?). It also provides a representative task environment that can be used to increase our understanding of the perceptual-cognitive mechanisms underlying observational movement analysis and to improve injury risk assessment performance

Bone mineral density in vocational and professional ballet dancers

Summary: According to existing literature, bone health in ballet dancers is controversial. We have verified that, compared to controls, young female and male vocational ballet dancers have lower bone mineral density (BMD) at both impact and non-impact sites, whereas female professional ballet dancers have lower BMD only at non-impact sites. Introduction: The aims of this study were to (a) assess bone mineral density (BMD) in vocational (VBD) and professional (PBD) ballet dancers and (b) investigate its association with body mass (BM), fat mass (FM), lean mass (LM), maturation and menarche. Methods: The total of 152 VBD (13 ± 2.3 years; 112 girls, 40 boys) and 96 controls (14 ± 2.1 years; 56 girls, 40 boys) and 184 PBD (28 ± 8.5 years; 129 females, 55 males) and 160 controls (27 ± 9.5 years; 110 female, 50 males) were assessed at the lumbar spine (LS), femoral neck (FN), forearm and total body by dual-energy X-ray absorptiometry. Maturation and menarche were assessed via questionnaires. Results: VBD revealed lower unadjusted BMD at all anatomical sites compared to controls (p < 0.001); following adjustments for Tanner stage and gynaecological age, female VBD showed similar BMD values at impact sites. However, no factors were found to explain the lower adjusted BMD values in VBD (female and male) at the forearm (non-impact site), nor for the lower adjusted BMD values in male VBD at the FN. Compared to controls, female PBD showed higher unadjusted and adjusted BMD for potential associated factors at the FN (impact site) (p < 0.001) and lower adjusted at the forearm (p < 0.001). Male PBD did not reveal lower BMD than controls at any site. Conclusions: both females and males VBD have lower BMD at impact and non-impact sites compared to control, whereas this is only the case at non-impact site in female PBD. Maturation seems to explain the lower BMD at impact sites in female VBD

The cerebrospinal fluid proteome in HIV infection: change associated with disease severity

<p>Abstract</p> <p>Background</p> <p>Central nervous system (CNS) infection is a nearly universal feature of untreated systemic HIV infection with a clinical spectrum that ranges from chronic asymptomatic infection to severe cognitive and motor dysfunction. Analysis of cerebrospinal fluid (CSF) has played an important part in defining the character of this evolving infection and response to treatment. To further characterize CNS HIV infection and its effects, we applied advanced high-throughput proteomic methods to CSF to identify novel proteins and their changes with disease progression and treatment.</p> <p>Results</p> <p>After establishing an <it>accurate mass and time </it>(AMT) tag database containing 23,141 AMT tags for CSF peptides, we analyzed 91 CSF samples by LC-MS from 12 HIV-uninfected and 14 HIV-infected subjects studied in the context of initiation of antiretroviral therapy and correlated abundances of identified proteins a) within and between subjects, b) with all other proteins across the entire sample set, and c) with "external" CSF biomarkers of infection (HIV RNA), immune activation (neopterin) and neural injury (neurofilament light chain protein, NFL). We identified a mean of 2,333 +/- 328 (SD) peptides covering 307 +/-16 proteins in the 91 CSF sample set. Protein abundances differed both between and within subjects sampled at different time points and readily separated those with and without HIV infection. Proteins also showed inter-correlations across the sample set that were associated with biologically relevant dynamic processes. One-hundred and fifty proteins showed correlations with the external biomarkers. For example, using a threshold of cross correlation coefficient (Pearson's) ≤ -0.3 and ≥0.3 for potentially meaningful relationships, a total of 99 proteins correlated with CSF neopterin (43 negative and 56 positive correlations) and related principally to neuronal plasticity and survival and to innate immunity. Pathway analysis defined several networks connecting the identified proteins, including one with amyloid precursor protein as a central node.</p> <p>Conclusions</p> <p>Advanced CSF proteomic analysis enabled the identification of an array of novel protein changes across the spectrum of CNS HIV infection and disease. This initial analysis clearly demonstrated the value of contemporary state-of-the-art proteomic CSF analysis as a discovery tool in HIV infection with likely similar application to other neurological inflammatory and degenerative diseases.</p

Physical Activity and Sedentary Behavior Subsequent to Serious Orthopedic Injury: A Systematic Review

Objective: To systematically review and synthesize the evidence on physical activity and sedentary behavior after serious orthopedic injury. Data Sources: Eight electronic databases and reference lists of relevant articles were searched from inception to March 2016. Study Selection: Studies on physical activity and sedentary behavior measured objectively or via self-report among patients with a serious orthopedic injury (acute bone or soft tissue injury requiring emergency hospital admission and/or nonelective surgery) were included. Data Extraction: Data extraction and methodological quality assessment were independently performed by 2 reviewers using standardized checklists. Data Synthesis: Twelve of 2572 studies were included: 8 were on hip fractures and 4 on other orthopedic injuries. Follow-up ranged from 4 days to 2 years postinjury. When measured objectively, physical activity levels were low at all time points postinjury, with individuals with hip fracture achieving only 1% of recommended physical activity levels 7 months postinjury. Studies using objective measures also showed patients to be highly sedentary throughout all stages of recovery, spending 76% to 99% of the day sitting or reclining. For studies using self-report measures, no consistent trends were observed in postinjury physical activity or sedentary behavior. Conclusions: For studies using objective measures, low physical activity levels and high levels of sedentary behaviors were found consistently after injury. More research is needed not only on the impact of immobility on long-term orthopedic injury outcomes and the risk of chronic disease, but also the potential for increasing physical activity and reducing sedentary behavior in this population

Sedentary behaviour and physical activity patterns in adults with traumatic limb fracture

Objective: To describe patterns of sedentary behaviour and physical activity in adults two weeks post-hospital discharge following an upper or lower limb fracture, and identify associated predictive factors. Design: Observational study. Setting: Level 1 Trauma Centre. Participants: Adults aged 18–69 years with an isolated upper (UL) or lower (LL) limb fracture. Main Outcome Measures: Sitting time and steps measured via a triaxial accelerometer and inclinometer-based device (activPAL) (anterior thigh); and moderate-intensity physical activity (MPA) measured via triaxial accelerometer (ActiGraph) (hip) for ten days. Results: Of 83 participants, 63% were men and 55% had sustained LL fractures; mean (SD) age was 41 (14) years. Participants sat for a mean (SD) of 11.07 (1.89) h/day, took a median (IQR) of 1575 (618–3445) steps/day and had only 5.22 (1.50–20.78) mins/day of MPA. Multivariable regression analyses showed participants with LL fracture, had increased adjusted mean sitting time of 2.5 h/day relative to UL fracture (β = 2.5 hours, p < 0.001). For each day since surgery/injury there was reduced adjusted mean sitting time of 4 mins/day (β = −0.06 hours, p = 0.048). LL fracture was associated with 80% fewer steps/day (Ratio of Geometric Means (RGM) = 0.20, p < 0.001) and 89% less MPA (RGM = 0.11, p < 0.001) relative to UL fracture. Older age was associated with 59–62% less MPA relative to the youngest participants (RGM = 0.38–0.41, p = 0.01). There was no association between the predictive variables sex, BMI and pre-injury physical activity and any outcome. Conclusions: At two weeks post-hospital discharge, participants were engaged in high amounts of sitting and were physically inactive. Injury location was the strongest predictor of outcome, indicating that patients with LL fracture are most in need of encouragement to reduce sitting time and gradually increase activity, within the bounds of clinical safety

Do non-steroidal anti-inflammatory drugs impair fracture healing? A survey of Australian orthopaedic surgeons

There is currently a lack of clear evidence on the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing post-operatively. Australian orthopaedic surgeons were surveyed about their perceptions of the relationship between NSAIDs and fracture healing to determine whether equipoise exists within the profession. Results demonstrated divergence of opinion amongst Australian orthopaedic surgeons, lending support to the commencement of randomised controlled trials testing the influence of NSAIDs on fracture healing within Australia.Christina L. Ekegren, Melissa J. Hart, Peter A. Cameron, Elton R. Edwards, Andrew Oppy, Richard de Steiger, Richard Page, Susan Liew, Raphael Hau, Andrew Bucknill, Belinda J. Gabb