Who Reaches the NHL? A 20-Year Retrospective Analysis of Junior and Adult Ice Hockey Success in Relation to Biological Maturation in Male Swedish Players.

OBJECTIVES: This study investigated the relationship between biological maturation and success in adolescence and adulthood in male Swedish ice hockey players. METHODS: Anthropometric records of players in certified ice hockey high schools between 1998 and 2017 were retrieved (n = 4787). The database was complemented with records of Swedish junior national teams (U16, U18, U20) and National Hockey League (NHL) appearances. Biological maturation was recorded as a percentage of adult height (%AH), and selection probabilities were estimated using a generalised linear mixed effects model. Biological age was determined by comparing players with age-matched growth reference values. Categories of %AH, standard deviation z-scores and biological age offset describing early, on-time and late maturation were created. RESULTS: A total of 217 players had played on the U16 national team (junior success), and 96 reached the NHL (adult success). The difference [95% confidence interval (CI)] in baseline %AH between players with junior versus adult success was - 0.75 (- 0.39, - 1.11). Looking at age-offset categories in junior success, 30% of players were early maturing and 19% of players were late maturing, showing a bias towards early maturation (p < 0.01). In contrast, more late-maturing players (40%) achieved adult success than early-maturing players (25%), and NHL players had significantly later maturation [%AH: - 0.48 (- 0.80, - 0.16)] than non-NHL players. CONCLUSION: This unique 20-year analysis shows that junior success in male ice hockey is positively related to early maturation, while adult success is inversely related to advanced maturation. Ice hockey organisations should implement maturation assessments to optimise the development of both late- and early-matured players.

Skating on thin ice? Mental health and well-being in women's ice hockey.

Objectives: First, to map the prevalence of symptoms of positive mental health, anxiety, depression and sleep difficulties, along with the coexistence of these symptoms, among players in the Swedish Women's Hockey League (SDHL). Second, to investigate relationships between these mental health symptoms and demographic variables (ie, age, injuries, dual careers), social support and psychological flexibility. Methods: Players from nine teams in SDHL (n=182; mean age 22.3±SD 4.8, range 16-35) participated in this cross-sectional study. An online survey, including validated self-assessment questionnaires, conducted data collection. The questionnaires were distributed just before the play-offs started in the 2022-2023 season. Mental health variables were presented as descriptive statistics, and associations were investigated through multivariate binary logistic regression analyses. Results: The response rate was 91%. Moderate or severe symptoms were reported among 29.7% for sleep difficulties, 20.9% for anxiety and 18.1% for depression. Nineteen per cent reported comorbidities. Sixty percent reported flourishing mental health. Lower psychological flexibility was associated with lower odds of flourishing mental health and higher odds of symptoms of anxiety, depression and sleep difficulties. Social support was associated with higher odds of flourishing mental health and lower odds of sleep difficulties. Conclusion: 6 of every 10 players reported not reaching the ideal state of mental health (ie, flourishing mental health without mental illness). Mental health symptoms were statistically significantly associated with psychological flexibility and social support, suggesting that these factors will be beneficial to consider when preventing mental illness and promoting mental health in this population.

Clinicians' Use of Quantitative Information while Assessing the Rate of Functional Progression in Glaucoma.

PURPOSE: Clinicians use both global and point-wise information from visual fields to assess the rate of glaucomatous functional progression. We asked which objective, quantitative measures best correlated with subjective assessment by glaucoma experts. In particular, we aimed to determine how much that judgment was based on localized rates of change vs. on global indices reported by the perimeter. DESIGN: Prospective cohort study. PARTICIPANTS: Eleven academic, expert glaucoma specialists independently scored the rate of functional progression, from 1 (improvement) to 7 (very rapid progression), for a series of 5 biannual clinical printouts from 100 glaucoma or glaucoma suspect eyes of 51 participants, 20 of which were scored twice to assess repeatability. METHODS: Regression models were used to predict the average of the 11 clinicians' scores based on objective rates of change of mean deviation (MD), visual field index (VFI), pattern standard deviation (PSD), the Nth fastest progressing location, and the Nth fastest progressing of 10 anatomically defined clusters of locations after weighting by eccentricity. MAIN OUTCOME MEASURES: Correlation between the objective rates of change and the average of the 11 clinicians' scores. RESULTS: The average MD of the study eyes was -2.4 dB (range, -16.8 to +2.8 dB). The mean clinician score was highly repeatable, with an intraclass correlation coefficient of 0.95. It correlated better with the rate of change of VFI (pseudo-R2 = 0.73, 95% confidence interval [CI, 0.60-0.83]) than with MD (pseudo-R2 = 0.63, 95% CI [0.45-0.76]) or PSD (pseudo-R2 = 0.41, 95% CI [0.26-0.55]). Using point-wise information, the highest correlations were found with the fifth-fastest progressing location (pseudo-R2 = 0.71, 95% CI [0.56-0.80]) and the fastest-progressing cluster after eccentricity weighting (pseudo-R2 = 0.61, 95% CI [0.48-0.72]). Among 25 eyes with an average VFI of > 99%, the highest observed pseudo-R2 value was 0.34 (95% CI [0.16-0.61]) for PSD. CONCLUSIONS: Expert academic glaucoma specialists' assessment of the rate of change correlated best with VFI rates, except in eyes with a VFI near the ceiling of 100%. Sensitivities averaged within clusters of locations have been shown to detect change sooner, but the experts' opinions correlated more closely with global VFI. This could be because it is currently the only index for which the perimeter automatically provides a quantitative estimate of the rate of functional progression.

Clinicians' Use of Quantitative Information When Assessing the Rate of Structural Progression in Glaucoma.

PURPOSE: OCT scans contain large amounts of information, but clinicians often rely on reported layer thicknesses when assessing the rate of glaucomatous progression. We sought to determine which of these quantifications most closely relate to the subjective assessment of glaucoma experts who had all the diagnostic information available. DESIGN: Prospective cohort study. PARTICIPANTS: Eleven glaucoma specialists independently scored the rate of structural progression from a series of 5 biannual clinical OCT printouts. METHODS: A total of 100 glaucoma or glaucoma suspect eyes of 51 participants were included; 20 were scored twice to assess repeatability. Scores ranged from 1 (improvement) to 7 (very rapid progression). Generalized estimating equation linear models were used to predict the mean clinician score from the rates of change of retinal nerve fiber layer thickness (RNFLT) or minimum rim width (MRW) globally or in the most rapidly thinning of the 6 sectors. MAIN OUTCOME MEASURES: The correlation between the objective rates of change and the average of the 11 clinicians' scores. RESULTS: Average RNFLT within the series of study eyes was 79.3 µm (range, 41.4-126.6). Some 95% of individual clinician scores varied by ≤ 1 point when repeated. The mean clinician score was more strongly correlated with the rate of change of RNFLT in the most rapidly changing sector in %/year (pseudo-R2 = 0.657) than the rate of global RNFLT (0.372). The rate of MRW in the most rapidly changing sector had pseudo-R2 = 0.149. CONCLUSIONS: The rate of change of RNFLT in the most rapidly changing sector predicted experts' assessment of the rate of structural progression better than global rates or MRW. Sectoral rates may be a useful addition to current clinical printouts.

Metastatic paraganglioma presenting as ajunctional scotoma.

PURPOSE: To report a unique case of metastatic paraganglioma presenting as a junctional scotoma. OBSERVATIONS: A 38-year-old Caucasian man with a history of abdominal paraganglioma presented with minimally blurred vision 20/25 visual acuity in the left eye. The patient was found to have a junctional scotoma upon visual field testing. Cranial MRI revealed a large peri-clival mass compressing the pre-chiasmal optic nerves and other loci of metastatic disease. Intracranial masses, including metastases, can present with a relatively intact central acuity and nonspecific visual symptoms. CONCLUSIONS AND IMPORTANCE: To the best of our knowledge, this is the first report of metastatic paraganglioma causing a junctional scotoma. In cases with junctional scotoma, careful neuro-ophthalmic assessment and imaging are of paramount importance, even in patients with excellent visual acuity.

Promoting college and career readiness among underserved adolescents: A mixed methods pilot study.

INTRODUCTION: Many underserved adolescents, defined as those with inequitable access to educational resources, face limited access to interventions that develop their college and career know-how. In our study, we implemented and evaluated a pilot college and career readiness curriculum intervention called Paths to the Future for All (P2F4A). P2F4A takes a developmental approach to college and career development, weaving together the procedural know-how of college and career planning with a broader focus on building social-emotional skills that support positive trajectories towards the future. We evaluated pre-post changes in adolescents' career-related and social-emotional outcomes alongside views of their personal growth. METHODS: We used a purposeful sample of five schools in the Western region of the United States and recruited a sample of adolescents (N = 61; Mage = 16.3 years; 57.4% female) who experienced challenging academic and life circumstances to participate in P2F4A. We conducted pre-post surveys as well as focus groups and interviews with adolescents. RESULTS: We detected significant (p < .05) pre-post gains in adolescents' knowledge of P2F4A curricular content and selected coping skills, such as relaxing and solving family problems. Our focus groups and interviews revealed that P2F4A helped adolescents build stronger interpersonal relationships with peers and the content was directly applicable to real life. CONCLUSION: Our new findings suggest that college and career readiness curriculum interventions-if appropriately developed for and targeted to underserved adolescents-have strong potential to build underserved adolescents' foundational skills that they can apply towards realizing their future college and career aspirations.

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma: a surgery series from surgeon trainees at a tertiary teaching hospital.

BACKGROUND: To study the effect of an ab interno gelatin stent (XEN45 Gel Stent, Allergan Inc., Irvine, California, USA) on intraocular pressure (IOP) as placed by glaucoma fellowship trainees in eyes with refractory glaucoma. METHODS: A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees. Data was collected at baseline and postoperatively at day 1, week 1, and months 1, 3, 5, and 12. Primary outcome was mean IOP change. Secondary outcomes included change in number of glaucoma medication classes and visual acuity. Safety outcomes included needling rates. Surgical success was defined by achieving ≥20% reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal. RESULTS: At baseline, 28.6% (8/28) of the subjects had prior failed incisional glaucoma surgery in a study population that was 54% African-American, with 78% with severe glaucoma (average mean deviation of - 14.58 dB). Thirteen subjects terminated their clinic visits before their 12-month postoperative visit, leaving 15 subjects for end point analysis. Average IOP went from 21.6 mmHg (range 12.0-31.0, SD 6.6) at baseline to 12.5 mmHg (range 7.0-19.0, SD 3.6), a 42.1% reduction (p < 0.007). All subjects decreased the number of medication classes they were taking with an average reduction of 3.8 (range 2-5, SD 0.9) to 1.3 (range 0-3, SD 1.0) classes, or a 65.8% decrease (p < 0.006). Crude surgical success was 80.0% for the 15 subjects that followed up at 12 months. The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4% (95% CI: 44.7-85.8%). Regardless of the length of follow-up, 21.4% (6/28) met failure criteria: 3 subjects failed because they required secondary surgical intervention, and the other 3 did not have adequate IOP reduction. Initial bleb needling rate was 28.6% (8/28) and repeat was 17.9% (5/28). CONCLUSIONS: Compared to the reported literature with experienced ocular surgeons, ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP, topical medication reduction, surgical success, and needling rates at 12-month follow-up.

Intraoperative suprachoroidal hemorrhage during Xen gel stent implantation.

PURPOSE: To report a rare case of intraoperative suprachoroidal hemorrhage during Xen gel stent implantation with accompanying surgical video and subsequent 6-month follow-up. OBSERVATIONS: Our patient required incisional glaucoma surgery after inadequate pressure reduction with four classes of topical medication, methazolamide, and selective laser trabeculoplasty. The patient underwent Xen gel stent implantation and developed an intraoperative suprachoroidal hemorrhage, which was managed in the operating room. The patient recovered his baseline visual acuity with a functioning bleb out to 6 months postoperatively. CONCLUSIONS AND IMPORTANCE: Micro-invasive glaucoma surgeries offer a new repertoire of surgical options, purportedly with safer and less invasive techniques. Xen gel stent implantation may be a promising alternative to traditional trabeculectomies and tube shunt implants, providing similar IOP lowering results with potentially lower risk for complications. However, rare and severe complications such as suprachoroidal hemorrhage may still occur. Recognizing a suprachoroidal bleed, particularly intraoperatively, will still be necessary to help minimize the potential vision threatening sequelae often associated with this severe complication.

Rapid effectiveness of intravenous ketamine for ultraresistant depression in a clinical setting and evidence for baseline anhedonia and bipolarity as clinical predictors of effectiveness.

BACKGROUND: Intravenous ketamine has been established as an efficacious and safe treatment, with transient effect, for treatment-resistant depression. However, the effectiveness of intravenous ketamine in non-research settings and with ultraresistant depression patients remains understudied. AIMS: This study aims to measure the response and remission rates in ultraresistant depression patients in a clinical setting by means of a retrospective, open label, database study. Secondarily, the study will attempt to support previous findings of clinical predictors of effectiveness with intravenous ketamine treatment. METHODS: Fifty patients with ultraresistant depression were treated between May 2015-December 2016, inclusive, in two community hospitals in Edmonton using six ketamine infusions of 0.5 mg/kg over 40 min over 2-3 weeks. Data were collected retrospectively from inpatient and outpatient charts. Statistical analysis to investigate clinical predictors of effectiveness included logistic regression analysis using a dependent variable of a 50% reduction in rating scale score at any point during treatment. RESULTS: At baseline, the average treatment resistance was severe, with a Maudsley Staging Method score of 12.1 out of 15, 90.0% were resistant to electroconvulsive therapy, and the average Beck Depression Inventory score was 34.2. The response rate was 44% and remission rate was 16%. As a single predictor, moderate or severe anhedonia at baseline predicted a 55% increased likelihood of response. As a combined predictor, this level of anhedonia at baseline with a diagnosis of bipolar depression predicted a 73% increase in likelihood of response. CONCLUSION: In a clinical setting, intravenous ketamine showed effectiveness in a complex, severely treatment-resistant, depressed population on multiple medication profiles concurrently. This study gave support to anhedonia and bipolar depression as clinical predictors of effectiveness.

Building Meaningful Patient Engagement in Research: Case Study From ADVANCE Clinical Data Research Network.

BACKGROUND: Strategies to engage patients to improve and enhance research and clinical care are increasingly being implemented in the United States, yet little is known about best practices for or the impacts of meaningful patient engagement. OBJECTIVE: We describe and reflect on our patient stakeholder groups, engagement framework, experiences, and lessons learned in engaging patients in research, from generating proposal ideas to disseminating findings. SETTING: The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network is the nation's largest clinical dataset on the safety net, with outpatient clinical data from 122 health systems (1109 clinics) in 23 states. RESULTS: Patients stakeholders codeveloped the ADVANCE engagement framework and its implementation in partnership with network leaders. In phase I of ADVANCE, patients were involved with designing studies (input on primary outcome measures and methods) and usability testing (of the patient portal). In phase II, the network is prioritizing research training, dissemination opportunities, an "ambassador" program to pair more experienced patient stakeholders with those less experienced, and evaluation of engagement activities and impacts. DISCUSSION: The ADVANCE framework for patient engagement has successfully involved a diverse group of patients in the design, implementation, and interpretation of comparative effectiveness research. Our experience and framework can be used by other organizations and research networks to support patient engagement activities.

Review of the Xen Gel Stent and InnFocus MicroShunt.

PURPOSE OF REVIEW: Two new translimbal glaucoma devices (Xen Gel Stent and InnFocus MicroShunt) have been developed with the goal of optimizing the predictability and safety for subconjunctival glaucoma surgery. RECENT FINDINGS: The new subconjunctival glaucoma implants are manufactured from nonsilicone, biocompatible materials, which may reduce the postoperative inflammatory and fibrotic reactions that can lead to failure. Early data suggests a favorable safety profile with significant reductions in intraocular pressure (IOP). The prevention of chronic hypotony has been a hallmark of the devices, which utilize an intrinsic flow-limiting design based on the tube length and internal lumen diameter. SUMMARY: Early data with the XEN Gel Stent and InnFocus MicroShunt show promising results. Prospective comparative studies comparing these devices with tube shunt and trabeculectomy will be needed.

Patch graft materials for glaucoma tube implants.

PURPOSE OF REVIEW: Patch graft materials serve multiple purposes in glaucoma surgery. There are several choices of patch graft materials from which the surgeon can choose. Therefore, knowledge as to the choices and the potential risks and benefits of patch graft materials is imperative for the glaucoma surgeon. RECENT FINDINGS: Recent studies evaluate both patch graft materials and techniques. This evaluation is timely as facility reimbursement changes may also impact utilization and technique. SUMMARY: Successful operative outcomes require profound understanding of all potential risks and benefits of patch graft materials and surgical techniques.

Assessment of risk factors for oxacillin-resistant ocular flora in eyes having cataract surgery.

PURPOSE: To assess the risk factors for eyes of cataract surgery patients harboring oxacillin-resistant Staphylococcus species on the ocular surface. SETTING: Ambulatory surgical center, Saint Louis University, Saint Louis, Missouri, USA. DESIGN: Prospective in vitro laboratory study of a patient cohort. METHODS: Conjunctival cultures were obtained on the day of surgery from eyes scheduled for cataract surgery. Patients answered a questionnaire about risk factors that might lead to having oxacillin-resistant Staphylococcus organisms in their eyes. The factors tested were age, sex, race, recent systemic and topical antibiotic usage, recent hospitalization, and exposure to healthcare and institutional settings. Logistic regression analysis was performed. RESULTS: Of the 183 eyes cultured, 128 (70.0%) tested positive for Staphylococcus organisms, of which 70 (54.7%) were oxacillin-resistant. Only recent antibiotic usage was statistically significantly associated with the presence of oxacillin-resistant organisms (odds ratio, 8.2; 95% confidence interval, 2.2-30.5; P=.002). The other risk factors were not statistically significantly associated: age (P=.06), sex (P=.33), race (P=.34), recent hospitalization (P=.94), and exposure to healthcare and institutional settings (P=.10). CONCLUSIONS: Although the nonophthalmic literature has reported various risk factors for the harboring of oxacillin-resistant organisms, in the eyes in this study, only antibiotic usage within 30 days preoperatively was significantly associated with the colonization of oxacillin-resistant organisms on the ocular surface. This finding is important to ophthalmic surgeons when considering perioperative antibiotic prophylaxis. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Ocular flora and their antibiotic resistance patterns in the midwest: a prospective study of patients undergoing cataract surgery.

PURPOSE: To determine the spectrum of conjunctival flora and the antibiotic susceptibility profiles of patients undergoing cataract surgery at a Midwestern university. DESIGN: Prospective in vitro laboratory investigation of a patient cohort. METHODS: Conjunctival cultures were obtained from patients undergoing cataract surgery at a single ambulatory center on the day of surgery before the instillation of any ophthalmic medications. Isolates and antibiotic susceptibility profiles were identified using standard microbiological techniques. RESULTS: A total of 183 eyes were cultured, yielding 225 isolates. Twenty-seven eyes (14.8%) showed no growth. Coagulase-negative staphylococci (CNS) were the most commonly isolated organisms (74.8%). Overall susceptibility was highest for gentamicin (94%), which was also true of the CNS isolates (95.0%). A total of 64.5% of CNS isolates were sensitive to ciprofloxacin; 30.1% of CNS isolates were resistant to ≥3 classes of antibiotics; 46.6% of CNS isolates were oxacillin-resistant, and they were more resistant to antibiotics than their oxacillin-sensitive counterparts (P < .001), including fluoroquinolones (P < .001). Among eyes with multiple CNS strains, 41.4% had different antibiotic susceptibility profiles even though they were the same species. CONCLUSIONS: Our cohort harbored organisms with similar rates of antibiotic resistance as elsewhere in the country, including oxacillin resistance; however, the rate of fluoroquinolone resistance was less than in other reports. A surprisingly large proportion of different CNS strains from the same eye harbored different antibiotic susceptibility profiles. Our in vitro results, along with those of other investigators, should prompt further dialogue regarding antibiotic of choice for perioperative surgical prophylaxis in ophthalmic surgery.

Surgical management of non-traumatic pediatric ectopia lentis: A case series and review of the literature.

PURPOSE: To report a small series of pediatric patients with ectopia lentis that underwent limbal-approach lensectomy and vitrectomy and scleral-fixated intraocular lens implantation and to review the literature on the topic of surgical management of ectopia lentis. METHOD: A retrospective review of 13 eyes of seven patients that underwent lensectomy, vitrectomy, and scleral-fixated intraocular lens implantation and a review of the ophthalmic literature. RESULTS: In our series, the average age at surgery was 70.3 ± 13.8 months and the average length of follow-up was 23.8 ± 5.9 months. The mean pre-operative visual acuity was 0.86 ± 0.17 which improved to 0.23 ± 0.09 post-operatively (p < 0.001). No complications were encountered in our series. A review of the literature found that amblyopia was the biggest vision-limiting factor. In general, the literature suggested that a higher percentage of eyes that were left aphakic achieved better vision than those implanted with a scleral-fixated intraocular lens. However, there may be selection bias in that more eyes receiving an intraocular lens may have pre-existing amblyopia. The complication rates for lensectomy or scleral-fixated intraocular lens implantation were low in the literature. In the latter group, suture breakage and resultant intraocular lens dislocation is a worrisome late complication. CONCLUSION: Surgical intervention for ectopia lentis via vitrectomy techniques yields good result. In cases of unilateral aphakia or in settings where compliance with aphakic refractive correction is questionable and amblyopia is a constant threat, scleral-fixated intraocular lens implantation is highly encouraged. However, long-term follow-up is required due to the risk of suture breakage and resultant intraocular lens dislocation over time.

Gender differences in brain functional organization during verbal and spatial cognitive challenges.

This is a quantitative EEG study of gender-related differences in brain function. It is novel in that to elicit gender differences, it was necessary to apply a spatial filter to the EEGs that was effective for suppressing components common to different cognitive states. The study involved estimates of both the source-current power density in the brain and the complex coherence between different regions in the brain, the latter probably unique in EEG source analysis. Gender effects are shown in terms of differences in both lateralized source power and complex coherence in response to verbal and spatial cognitive challenges. The results provide evidence that verbal and spatial challenges are more lateralized in males than in females, that females are more verbal than males, that males are more spatial than females, that females verbalize more interpretively than males and that males verbalize more consequentially than females.