Relationship between anthropometric measurements and hamstring autograft diameter in anterior cruciate ligament reconstruction.

The role of anthropometric measurements in the prediction of hamstring autograft size remains unclear. In this internal review board - approved study, we evaluated medical records for patients receiving anterior cruciate ligament (ACL) reconstruction with hamstring autograft at our institution between 2006 and 2008. One hundred and thirty-two patients received hamstring autografts. Correlation coefficients and step-wise multiple linear regression analysis were used to determine the relationships between sex, age, height, body mass index (BMI), and hamstring graft diameter. Women had significantly smaller grafts than men (P < .00001). Twenty-four patients had grafts less than 7 mm in diameter and 18 of those patients were female. Age and BMI did not correlate with graft diameter in women. Height correlated to graft diameter in women (P = .002, R(2) = 0.14). Women shorter than 65 in had significantly smaller graft diameters (mean [SD], 6.94 [0.45] mm), than those women 65 in and taller (mean [SD], 7.20 0.49] mm; (P = .03). Age and height did not correlate with graft size in men. BMI greater than 25 kg/m(2) correlated with larger graft diameter, but BMI less than 18 kg/m(2) did not predict graft sizes less than 7 mm. Therefore, alternative graft options should be considered in women less than 65 in tall.

Results of arthroscopic repair of type II superior labral anterior posterior lesions in overhead athletes: assessment of return to preinjury playing level and satisfaction.

BACKGROUND: The majority of the literature on surgical outcomes of superior labral anterior posterior (SLAP) repairs has focused on short-term follow-up of 1 to 2 years, not allowing adequate time for full rehabilitation and return to maximum level of competition for all types of athletes. Also, previous studies have concentrated on using questionnaires that primarily evaluate patients' activities of daily living, which do not focus on sport-specific performance. PURPOSE: To determine the midterm results of type II SLAP repairs in overhead athletes, focusing primarily on athletic performance as well as activities of daily living. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review of 30 overhead athletes, who underwent an arthroscopic superior labral repair for a symptomatic type II SLAP tear between 2002 and 2007, was performed. Our study population included 22 male and 8 female patients with a mean age at the time of surgery of 24 years. Twenty-one patients participated in baseball or softball, and the remainder of patients were involved in javelin throwing or tennis. The average follow-up was 3.5 years. The outcome of treatment was evaluated using the American Shoulder and Elbow Society (ASES) scoring system, assessing activities of daily living, and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) score, assessing sport-specific performance. In addition, the length of time to return to sport and the degree of successful performance were evaluated. RESULTS: Repairs resulted in ASES scores comparable with those from prior published studies (average ASES score, 87.9). The KJOC score averaged 73.6. The athletes' perception was that they returned to approximately 84.1% of their preinjury level of function with a mean time to return to play of 11.7 months. There was a significant drop in the ASES to KJOC score for the baseball/softball players (87.9 ± 14.94 and 72 ± 19.24, respectively; P = .006). Patients reported an overall satisfaction rate of 93.3% with the procedure, with the majority being very satisfied. CONCLUSION: Arthroscopic SLAP repairs show excellent results and a high rate of overall satisfaction; however, the outcomes are less reliable in throwers. The KJOC score provides a more stringent assessment of overhead athletes' function after SLAP repair than the ASES score. Our findings also indicate that SLAP repairs lead to improved shoulder function during routine daily activities but that consistent return to elite throwing sports may still remain somewhat problematic.

Can an Internet-based system assist with administration and distance learning for third- and fourth-year rural clinical rotations?

This article describes the experience of the West Virginia School of Osteopathic Medicine during the past 5 years in using Internet technology to communicate with osteopathic medical students on remote, community-based clinical rotations. Federal funding initially supported creation of a new Internet-based system to connect students on their rural family medicine rotations. Accomplishments during and after federal funding include development of systems for remote submission and student access to feedback about clinical sites; on-line access to rotation objectives, policies, housing information, maps, and affiliated internship opportunities; access to medical journals and texts; secured access to rotation grades and rotation schedules; on-line reading lists for family medicine and pediatrics rotations; and Internet-based test administration. Remaining challenges include identification or development of interactive learning materials; development of test banks; flawless administration of Web-based examinations; and finding the right balance between patient care-based learning and didactics.

Relationship between climate and psychiatric inpatient length of stay in Veterans Health Administration hospitals.

OBJECTIVE: The study examined whether climate has an impact on inpatient psychiatric length of stay in Veterans Health Administration hospitals (VHA). METHOD: Data from the National Weather Service for eight climate variables for the locations of 134 VHA hospitals nationwide were factor analyzed, resulting in two climate factors representing temperature and precipitation. Factor scores were correlated with psychiatric mean lengths of stay from 1994 to 1998 for 99 VHA hospitals with inpatient psychiatric services and for the 22 VHA regional divisions (Veterans Integrated Service Networks). RESULTS: Climate factors correlated modestly but significantly with length of stay, with correlations ranging from -0. 25 to -0.37 at the hospital level and from -0.38 to -0.45 at the VHA regional level; hospitals in warmer and drier climates had shorter lengths of stay. Medical centers in colder climates had the longest lengths of stay in winter and fall. The significant correlation between climate and length of stay was not affected by recent reductions in length of stay in VHA hospitals. CONCLUSIONS: Higher clinical costs associated with longer lengths of stay in colder climates have implications for budget planning. Climate factors must also be recognized for their potential effect on performance monitoring systems focused on hospital utilization. Researchers must continue to consider broader contextual variables such as climate if they are to fully understand the determinants of health care utilization and psychiatric hospitalization costs.

Effects of the label "schizophrenia" on causal attributions of violence.

We investigated the relation between the label of "schizophrenia" and causal attributions of violence. Undergraduates read 1 of 10 scenarios in which two variables were manipulated: a psychiatric label and environmental stress. The scenario described an employee who acted violently toward his boss. Subjects made causal attributions for the employee's behavior by completing an adapted version of the Causal Dimension Scale II. Subjects also completed a questionnaire designed to explore several issues concerning the effects of the schizophrenia label on perceptions of behavior. Contrary to the primary hypothesis, the schizophrenia label did not lead subjects to make significantly more personality causal attributions for violent behavior. With increasing environmental stress, subjects did make significantly fewer personality attributions. A follow-up study using practicing clinicians as subjects yielded similar findings. The results of these studies are discussed in light of perceived stereotypes of persons with schizophrenia and conceptual issues in attribution research.

Mammalian chitinase-like proteins.

Mammals express genes coding for proteins that show significant similarity to chitinases of family 18 glycosyl hydrolases. These chitinase-like proteins have no chitinase activity due to changes in critical residues in the putative active center. One of these is oviductin, a high molecular weight glycoprotein most likely involved in fertilization and protection of the tubal epithelium owing to its mucin character. Another is YKL-40 (HCgp39) produced in association with tissue remodeling. Such proteins could have a general function in morphogenesis.

Community health screening as a teaching laboratory in physical diagnosis.

The West Virginia School of Osteopathic Medicine (WVSOM) provides sophomore medical students with an opportunity to perform history and physical examinations on actual patients through two free health screening clinics. Both a men's and a women's clinic are part of the physical diagnosis course and are preceded by lecture and laboratory teaching on the genitourinary system. Students are assigned to a patient whom they interview and examine under supervision by a faculty physician and clinic nurse. Women each receive a Papanicolaou (Pap) smear, digital rectal examination (DRE), and manual breast examination. Men each receive an examination for inguinal hernia, manual testicular examination, and DRE. Blood is drawn by the student for prostate-specific antigen determination. The health screening clinics are well accepted by the students and the community. They provide an excellent opportunity to expand our prevention education and early intervention services to the community.

Computer-facilitated therapy for inpatients with schizophrenia.

The authors present three case vignettes in which inpatients with schizophrenia participated in psychotherapy sessions that included three phases: traditional verbal psychotherapy, computer-facilitated therapy, and recapitulation of the session. In the computer-facilitated phase, the therapist typed the conversation between the patient and therapist, and the patient was able to look at the computer screen to review what was said. Clinical observation was used to determine patients' frequency of delusional symptoms during the first two phases. For all three patients, the frequency of delusional symptoms decreased from the first to the second phase. The computer, by visually representing words, may facilitate communication by compensating for deficits in auditory processing, information processing, attention, and memory often found among patients with schizophrenia.

Monoamine roles in retention and reversal of delayed response in cats.

Two experiments were performed to study the effects of manipulation of central monoamines upon behavior in a delayed response (DR) situation. In the first study, serotonin (5-HT) levels were increased by administration of 5-hydroxy-L-tryptophan (5-HTP) and RO4-4602, a decarboxylase inhibitor, to cats that had overlearned the DR. This intervention had no significant effect upon performance in the 0 sec delay condition, but significantly increase error and non-response scores during delay trials; the effect is specific to an "information holding" demand upon the animal and according to the neurochemical analysis appears to be due to a central effect of 5-HT. In a second experiment, dopamine levels were raised by L-DOPA administration during a reversal of the original DR situation, and the effect of L-DOPA on the evolution of response strategies was observed. All animals developed a position habit that proved impossible to correct but L-DOPA animals developed a significant position habit more quickly than controls, thus suggesting a possible relationship between the neostriatal dopamine accumulation and behavioral plasticity.