Career Length Research Articles

The effect of stress fracture occurring within the first 12 months of training on subsequent race performance in Thoroughbreds in Hong Kong.

Racehorses are at an increased risk of stress fracture within the first 12months of racing and when resuming training after a break. Research in these high-risk periods and on the effect of performance post-recovery is limited. To describe the occurrence of stress fractures, diagnosed by nuclear scintigraphy (NS), in racehorses' first 12months training in Hong Kong, and their impact on racing performance and career length. Retrospective 1:2 matched case-control study. Clinical records of horses with NS-diagnosed stress fractures within 365days of import between 2006 and 2018 were collated. Cases and controls were matched on import date. Univariable conditional logistic regression compared signallment, pre-fracture training and post-recovery racing performance between cases and matched controls. Shared Frailty Cox regression analysed time from import to fracture and total career length. Eighty-seven horses sustained a NS-diagnosed fracture within their first year in Hong Kong (incidence risk 1.7% [95% confidence interval (CI) 1.4%-2.1%; N=5180]). The humerus (42.0%; 95% CI 31.8%-52.6%; n=39) and tibia (28.0%; 95% CI 19.1%-38.2%; n=26) were the most common stress fracture sites. Cases missed a median of 63days (Interquartile range (IQR) 49-82) of training because of fracture. Within the 12months following diagnosis, case horses had a median of four (IQR 2-4, P<.0001) fewer race starts and were down HK$ 206188 (IQR HK$ 0-436800, P=.007) in race earnings compared to controls. Career length did not significantly differ between cases and controls (median 2years and 3months; IQR 15.3-39.1months; P=.2). Only stress fractures diagnosed by NS were included, hence, the study is not representative of all stress fractures occurring in racehorses in Hong Kong. Racehorses sustaining a stress fracture within 1year of entering Hong Kong lost significant time in training, earnings and race starts. However, overall career length was unaffected.

Return to Play and Performance After Primary ACL Reconstruction in American Football Players: A Systematic Review.

Background:Anterior cruciate ligament (ACL) injuries are among the most common sports-related injuries, and they can have a negative impact on players’ ability to return to play (RTP). There is a paucity of literature focused on RTP after ACL reconstruction (ACLR) in collision sports.Purpose:To characterize the impact that an ACL injury has on the ability to RTP and the post-ACLR performance level in American football players.Study Design:Systematic review; Level of evidence, 4.Methods:An electronic search was performed using the following databases: the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature. Included studies were written in English; were published since the year 2000; examined only American football players; and reported on RTP, performance, and/or career length after primary ACLR.Results:The initial search yielded 442 unique studies. Of these, 427 were removed after screening, leaving 15 studies that met inclusion criteria. An additional 2 studies were identified in these studies’ references, yielding a total of 17. The rate of RTP after ACLR for football players was 67.2% (1249/1859), and the mean time to return was 11.6 months (range, 35.8-55.8 weeks). Although considerable heterogeneity existed in the study design and outcomes measured, in general, a majority of football players experienced greater declines from their preinjury performance level than controls over the same time period.Conclusion:An ACL injury negatively affected football players’ ability to RTP and their post-ACLR performance. The degree of effect varied by several factors, including playing position, preinjury performance level, and National Football League Draft round. These results may be used by physicians and football players to develop reasonable expectations for returning to play and performance after an ACL injury.

Teaching clinicians practical genomic medicine: 7 years’ experience in a tertiary care center

PurposeIncreased implementation of complex genetic technologies in clinical practice emphasizes the urgency of genomic literacy and proficiency for medical professionals. We evaluated our genomic education model. MethodsWe assessed the 5-day, extended format program, encompassing lectures, videos, interactive tests, practice cases, and clinical exercises. Pre- and post questionnaires assessed knowledge change, using t-tests to compare groups. Satisfaction on program completion and after 3 years were evaluated. Implementation in other centers determined acceptability. ResultsDuring 2012–2018, 774 clinicians from multiple disciplines and career stages attended 35 programs; 334 (43%) attended the 5-day extended format. Evaluations showed significant improvement of genomic literacy (mean 15.05/100 points, p<0.001). Residents initially had higher scores than specialists (pre: 66.3±17.3 vs. 58.7±16.6, respectively, p=0.002); both significantly improved, with specialists “catching up” (post: 79.1±17.2 vs. 75.7±15.9, nonsignificant (NS)); there was a similar trend between fellows and subspecialists (pre: 70±18 vs. 59.4±16.4, respectively, p=0.007; post: 78.6±16.4 vs. 73.2±17.7, respectively, NS). Younger specialists (≤10 years residency) had significantly higher pre- and post scores. Absolute improvement in scores did not depend on medical specialties. ConclusionOur program is effective in improving genomics literacy for clinicians, irrespective of career length or expertise, and could be a model for improving skills in practical genomics for all medical professionals.

Serum Protein Biomarker Findings Reflective of Oxidative Stress and Vascular Abnormalities in Male, but Not Female, Collision Sport Athletes.

Studies have indicated that concussive and sub-concussive brain injuries that are frequent during collision sports may lead to long-term neurological abnormalities, however there is a knowledge gap on how biological sex modifies outcomes. Blood-based biomarkers can help to identify the molecular pathology induced by brain injuries and to better understand how biological sex affects the molecular changes. We therefore analyzed serum protein biomarkers in male (n = 50) and female (n = 33) amateur Australian rules footballers (i.e., Australia's most participated collision sport), both with a history of concussion (HoC) and without a history of concussion (NoHoC). These profiles were compared to those of age-matched control male (n = 24) and female (n = 20) athletes with no history of neurotrauma or participation in collision sports. Serum levels of protein markers indicative of neuronal, axonal and glial injury (UCH-L1, NfL, tau, p-tau, GFAP, BLBP, PEA15), metabolic (4-HNE) and vascular changes (VEGF-A, vWF, CLDN5), and inflammation (HMGB1) were assessed using reverse phase protein microarrays. Male, but not female, footballers had increased serum levels of VEGF-A compared to controls regardless of concussion history. In addition, only male footballers who had HoC had increased serum levels of 4-HNE. These findings being restricted to males may be related to shorter collision sport career lengths for females compared to males. In summary, these findings show that male Australian rules footballers have elevated levels of serum biomarkers indicative of vascular abnormalities (VEGF-A) and oxidative stress (4-HNE) in comparison to non-collision control athletes. While future studies are required to determine how these findings relate to neurological function, serum levels of VEGF-A and 4-HNE may be useful to monitor subclinical neurological injury in males participating in collision sports.

A study on the occupational challenges and coping strategies of the student athlete coaches

Purpose The purpose of this study was to understand student athletes coaches’ occupational challenges from the dual perspectives(social relationship-political system), to analyze the nature of the coping strategies for the challenges, and to provide implications for building a human rights-friendly student athletes club culture. Methods Five coaches(n=5, average career length= 19.2 years) were selected through purposeful sampling. Data were collected by semi-structured interviews with participants. The collected data were inductively analyzed(Patton, 2015). Results First, participants struggled with informal roles demanded by the interested parties(principals, athletic directors, parents, and university coaches). Second, the system for protecting student athletes’ learning rights, the 52-hour work system and the human rights system added difficulties to the coaches’ work environment. Third, the disharmony between interested parties’ demands and government agencies’ institutional ideals pushed participants to choose anti-institutional, un-ethical, un-educational coping strategies. Conclusion The findings suggest that the government, academia and the community should empower coaches as ‘the subject of reform’ who can solve the problem together rather than regarding them as ‘the object of reform.’ Furthermore, this conclusion is expected to provide implications to alleviate disharmony between interest parties’ demands and government agencies’ systems.’

Comparison of professionalism and job satisfaction between Korean midwives in birthing centers and midwives in hospitals.

PurposeMidwives working in hospitals (MWH) have limited roles in managing and assisting births independently. To find ways to successfully integrate midwifery into care systems, exploring midwives’ work-related perceptions might be the first step. The purpose of this study was to compare professionalism and job satisfaction between Korean midwives working in birthing centers (MWBC) and MWH.MethodsA descriptive comparative design was used, querying 19 MWBC and 53 MWH in Korea. Data were accrued from October to November 2017 using the Professionalism Inventory Scale and the Job Satisfaction Scale.ResultsAge, marital status, monthly income, length of career as a midwife, and length of career in the current workplace were significantly different between MWBC and MWH. The level of professionalism among MWBC showed significant differences by position at the birthing center (t=16.19, p=.001). Professionalism and job satisfaction among MWH showed significant differences depending on perceived professional performance (F=9.95, p<.001 and F=11.04, p<.001, respectively). Levels of professionalism and job satisfaction were higher for MWBC than for MWH.ConclusionEducational programs designed to enhance professionalism and expand the role of MWH are suggested. Also, policy changes that clearly define job roles and improvement of the legal system is required, so MWH in Korea can effectively perform their midwifery work and be properly reimbursed.

Jockey Career Length and Risk Factors for Loss from Thoroughbred Race Riding

Professional thoroughbred racing jockeys repeatedly work close to physiological capacity during races, whilst maintaining low body weights, on a daily basis with no off-season. The effects of this on their career length is unknown. The aim of this study was to examine the career lengths and reasons for loss from the industry of 674 jockeys and apprentices who rode over 14 racing seasons and 421,596 race day starts in New Zealand. Descriptors were compared between jockeys in short (1–2 years), middle (3–9 years) and long (&gt;10 years) career cohorts with descriptive statistics and Kaplan–Meier survival curves. The median career length for jockeys was 2 years (IQR 1–6). Long career cohort jockeys (11%) had lower carried weights (IQR 56–57 kg, p = 0.03), 40 times the median number of rides per season (248, IQR 61–434, p &lt; 0.001), half the rate per 1000 rides of falling (1.1, 95% CI 1.0–1.2, p = 0.009) and 1.3 times the rate of winning (100, 95% CI 99–101, p &lt; 0.01) than jockeys in the short career cohort. Jockeys who rode over 200 races per season had careers three times longer than jockeys with fewer races per season (p &lt; 0.001). Half of the 40% of jockeys who failed to complete their apprenticeship were lost from the industry in their first year of race riding. In conclusion, most jockeys had short careers where the workload of a jockey and their ability to obtain rides had greater impact on career longevity than their performance.

The Glass Ceiling in Plastic Surgery: A Propensity-Matched Analysis of the Gender Gap in Career Advancement.

Gender parity remains elusive in academic plastic surgery. It is unknown whether this disparity is attributable to differences in qualifications or to the glass ceiling of gender bias. To parse this, the authors compared academic titles and departmental leadership of female academic plastic surgeons to a matched group of their male counterparts. The authors conducted a cross-sectional analysis of academic plastic surgeons. The authors identified faculty, sex, academic rank, and leadership positions from plastic surgery residency program websites. The authors then collected details on training institution, advanced degrees, years in practice, and h-index for use as independent variables. The authors performed a propensity score analysis to 1:1 match male and female academic plastic surgeons. A total of 818 academic plastic surgeons were included. The cohort was predominately male [n = 658 (81 percent)], with a median 12 years in practice and a median h-index of 9. Before matching, men had more years in practice (13 years versus 9 years; p < 0.0001), a greater h-index (11 versus 5; p < 0.0001), were more likely to be professors (34 percent versus 13 percent; p < 0.0001), and held more leadership positions than women (41 percent versus 30 percent; p = 0.0221). Following matching, gender parity was demonstrated in academic rank and departmental leadership. Differences in training, qualifications, career length, and academic productivity may account for the leadership gap in academic plastic surgery. Gendered difficulties in reaching qualification benchmarks must be addressed before gender parity in promotion can be achieved.

Mentoring Relates to Job Satisfaction for Fish Biologists: A Longitudinal Study of the USDA Forest Service

Mentoring has had a recent resurgence as the key to achieving both individual and organizational goals, especially as workforce diversification efforts have led to the hiring of new talent. Few studies have evaluated mentoring within an organization or examined changes in mentoring practices over time. We describe the role and status of mentoring for current fish biologists in the USDA Forest Service, including correlations between participation in mentoring and gender, race/ethnicity, career level, time in career, and job satisfaction based on a survey of agency employees (n = 136). Mentoring relates to a more than two‐fold increase in job satisfaction. Neither gender, race/ethnicity, career length, nor position are reliable predictors of whether someone has a mentor, evidence that participation in mentoring is consistent across the workforce and, at least superficially, it is equitable. Respondents sought guidance from mentors regarding technical skills, program management, communication, and leadership. Fish biologists of color were more likely than others to look for mentoring to build self‐confidence, address conflicts, and inform professional values and ethics. More early‐career fish biologist respondents identify as women in 2019 compared to a 1984 assessment. Overall, our results suggest that mentoring plays an important and positive role in career development and job satisfaction for fish biologists in the USDA Forest Service.

The Comparison of Perfectionism and Commitment between Professional and Amateur Golfers and the Association between Perfectionism and Commitment in the Two Groups.

This study investigated differences in perfectionist traits and commitment between professional and amateur golfers, as well as correlations among perfectionist traits, commitment, and golf handicap. Using simple random sampling, 486 professional golfers (mean age = 22.1 ± 3.0, 52.1% female) and 233 amateur golfers (mean age = 44.8 ± 10.2, 55.8% female) were recruited and assessed using the Multidimensional Perfectionism Scale (MPS) and Expansion of Sports Commitment Model (ESCM). An ANCOVA, controlling for age, golf career length, and training time, revealed lower MPS self-oriented scores (10.3%; F = 8.9, p < 0.01; effect size [ES] = 0.498) and higher ESCM-Cognition (12.6%; F = 9.4, p < 0.01; ES = 0.691) and ESCM-Behavior (9.4%; F = 4.6, p = 0.03; ES = 0.479) scores in professional golfers than in amateur golfers. In partial correlations controlling for age, golf career length, and training time, professional golfers’ MPS scores were negatively associated with ESCM-Cognition scores (r = -0.30, p < 0.001). Professional golfers’ mean golf handicap was positively correlated with MPS total (r = 0.33, p < 0.01). Altogether, golfers seeking to attain high levels of performance must consider the mental aspect of golfing and find ways to maximize commitment levels while minimizing perfectionist traits.

Arthroscopic debridement of short frontal plane proximal phalanx fractures preserves racing performance.

Outcomes have been reported for a limited number of short frontal plane fractures of the proximal phalanx following nonsurgical treatment and internal fixation. To describe a new approach, arthroscopic debridement, of short frontal plane fractures of the proximal phalanx in flat-racing Thoroughbreds and post-operative racing outcome. Retrospective case-control study. Medical records of 81 Thoroughbred racehorses treated with arthroscopic debridement for frontal plane fractures of the proximal phalanx were reviewed. Diagnostic images and operative reports were used to characterise lesions and a technique for arthroscopic treatment was described. Post injury racing career length, starts, earnings and race quality are compared with matched controls. Of 81 treated horses, 74 (91%) raced post-operatively. Treated horses had fewer post-operative starts compared with controls (median 12, 95% CI 9-16 vs median 19, 95% CI 15-23; P<.001), but there was no difference in post-operative earnings (median $51465, 95% CI $39868-$85423 vs median $68017, 95% CI $54247-$87870, P=.7) or career length (median 7 quarters, 95% CI 5-8 vs median 9 quarters, 95% CI 8-10, P=.1). Retrospective studies prevent prospective control of sampling bias and limit selection of matched controls. Treatment of frontal plane fractures of the proximal phalanx by arthroscopic debridement results in racing performance comparable to uninjured controls with respect to longevity and earnings.

Return to play and performance after surgical repair of distal biceps tendon ruptures in National Football League athletes

The purpose of this study was to determine whether surgical repair of distal biceps tendon ruptures in professional football players would lead to a decrease in postinjury performance when compared to preinjury performance and control-matched peers. We also sought to define return to sport, postinjury career length, and games played per season in National Football League players following surgical repair of distal biceps tendon ruptures. Data for National Football League players who underwent surgical repair of distal biceps tendon ruptures during a 20-year time period were collected. A total of 25 cases in 22 players were included in the analysis. Matched controls based on player position, age, experience, and performance statistics were identified. Performance scores for cases and controls were calculated using a standardized scoring system specific to player position. Of the 25 cases, 21 (84%) were able to return to sport in the National Football League. The overall 1-year survival rate of return to play in players undergoing surgical repair of distal biceps tendon ruptures was 76% and overall 2-year survival was 56%. Players who underwent surgical repair of distal biceps tendon ruptures had significantly shorter postinjury career lengths and played fewer games per season postinjury than matched controls. There was no significant difference by position in postinjury performance scores when compared to matched controls. National Football League players undergoing surgical repair of distal biceps tendon ruptures have a high rate of return to sport, though many retire within the next few seasons following surgery. Players who do return to competition can be expected to perform at a level comparable to their peers.

What’s drugs got to do with it? Examining the relationship between drug onset and duration with criminal outcomes in an African American cohort

BackgroundThe association of drug use onset and duration with criminal careers has rarely been studied over the life course among African Americans, who are disproportionately impacted by the criminal justice system. MethodsThis study uses data from a community cohort of urban African Americans, first assessed at age 6 (n = 1242) and followed into midlife. Data come from both self-reports (n = 1053 in adulthood) and official crime records (n = 1217). Regression analyses among those who used marijuana, cocaine, and/or heroin and had complete arrest data (n = 614) assess the association between adolescent vs. adult initiation, short vs. long duration of use, and their interaction with the outcomes of arrest, incarceration, and criminal career length, as well as meeting criteria for a drug use disorder. ResultsFindings show that onset and duration are highly related, but when independent effects of duration and onset are assessed, only duration is a statistically significant predictor of all four crime outcomes, as well as a predictor of meeting criteria for a drug use disorder in adjusted regression models. Associations of duration with arrests held for all crime types (i.e., drug, property, violence). Adolescent vs. adult drug onset only predicted meeting lifetime criteria for a drug use disorder. The interaction of onset and duration was not statistically significant in any models. No appreciable differences were observed in gender specific models. DiscussionFindings suggest that shortening drug use duration may have a greater impact on reducing the association of drug use with crime for African Americans than delaying onset.

What should be included in web-based simulation for new nurses?

PurposeThe purpose of this study was to investigate newly graduated nurses' educational needs for web-based simulation (WBS) education. MethodsA cross-sectional descriptive study was conducted with 132 registered nurses, regardless of their career length, working at a hospital in Korea. Data accrued through a self-reported questionnaire asking nurses about their educational needs. Data were analyzed using descriptive statistics, independent t-test ANOVA, and Scheffe test. ResultsAlmost all (96.2%) participants said that new nurses need simulation training, and 90.2% of participants said WBS is necessary. The highest ranked category was fundamental nursing knowledge, followed by fundamental nursing technique. Among 81 items of nursing education needs, top ranked items were cardiopulmonary resuscitation, care of artificial airways, oxygen therapy, and mechanical ventilation, which were mostly in the fundamental-nursing-techniques category. Educational needs significantly differed depending on participants' clinical experience (F = 5.37; p = .006), hospital types (t = −3.48; p = .001), and past experiences as a preceptor (t = 2.71; p = .008). Participants with 4 to 6 years of clinical experience, working in a hospital with more than 300 beds, and with experience as a preceptor, answered that new nurses have high educational needs WBS. ConclusionsWBS for new nurses should include fundamental nursing knowledge and techniques that can apply to clinical practice immediately after learning. Also, emergency nursing care should be included to prioritize adequately and cope with emergency situations. The use of WBS will help new nurses learn and adapt to the clinical setting, which can assist nurses in providing optimal care to patients with confidence.

Employer-Assigned Workload and Human Capital Deterioration: Evidence From the National Football League

We test whether human capital deterioration is a function of employer decision making with respect to workload allocation. We examine this question in the context of National Football League running backs, where the structure of nonguaranteed employment contracts has the potential to create divergent incentives for franchises and players. We empirically test how employer-assigned workloads impact changes in player productivity and career length. We find that larger employer-assigned workloads result in larger decreases in future productivity. However, players assigned larger workloads tend to have longer careers. These results suggest deleterious physical effects from increased workloads while also implying hiring decisions are partially based on status or exposure effects.

The Return on Investment of Orthopaedic Fellowship Training: A Ten-year Update.

Over 90% of graduating orthopaedic residents now pursue fellowship training, and only 15% of practicing orthopaedic surgeons now characterize themselves as generalists. Fellowship training has significant financial effects due to both opportunity cost of that year of training and changes in compensation throughout one's career. The purpose of this study was to estimate the financial return on investment by pursuing additional training in an orthopaedic fellowship versus general practice. Using described techniques of financial analysis, net present value (NPV), internal rate of return (IRR), and break-even point were estimated over the average working career length of an orthopaedic surgeon. Compensation data were drawn from the American Medical Group Association physician compensation surveys. Seven fellowships were studied and referenced to a career in general orthopaedic practice. Fellowship training in spine surgery yields the highest return on investment with a break-even point of 5 years. Adult reconstruction has a positive NPV and IRR, but when corrected for number of hours worked per week offers no productivity advantage to general practice. Sports medicine and trauma offer neutral returns, but when corrected for work hours, NPV and IRR both become negative. Hand, pediatrics, and foot and ankle never break even following the loss of compensation realized during fellowship year. The recent trend across all medical specialties has been for increased fellowship training and subspecialization. There are numerous reasons to pursue fellowship training, both personal and financial. This study presents an updated estimate of the financial impact of fellowship training in orthopaedics. This analysis demonstrates that selecting different fellowships can generate positive, negative, or neutral financial returns. This study has the potential to influence residents' decisions to pursue general practice versus fellowship training and identifies economic drivers, which may lead to preferential pursuit of certain subspecialties.

Relationship between humeral retroversion and baseball positions during elementary and junior-high school

Humeral retroversion is greater in the dominant shoulder than in the nondominant shoulder in baseball players. However, the effect of different baseball positions during childhood on humeral retroversion remains unknown. The purpose of this study was to investigate the following: (1) the relationship between humeral retroversion and baseball positions played during elementary and junior-high schools; (2) the association between humeral retroversion and the prevalence of pain during the medical checkup and self-reported history of injuries in the dominant shoulder or elbow. We enrolled 149 male high-school baseball players who started playing baseball in elementary school. The subjects were classified into 3 groups according to their baseball positions in elementary and junior-high schools. All participants completed questionnaires regarding their current and past positions, current incidence and history of injuries in their shoulder or elbow joints, and the age they started playing baseball. Shoulder range of motion, humeral retroversion on ultrasonographic-assisted measurement, and the association between humeral retroversion and shoulder and elbow pain were evaluated. Humeral retroversion was significantly greater in the dominant shoulder than in the nondominant shoulder in all groups (P < .001). In addition, humeral retroversion in the dominant shoulder was significantly greater in players who were pitchers in both elementary and junior-high schools than in those who were fielders during both periods (96.2° and 89.4°, respectively; P = .02). Humeral retroversion in the dominant shoulder was positively correlated (P = .005, r = 0.23) with the length of career as a pitcher during elementary and junior-high schools. Humeral retroversion was not correlated with the prevalence of pain during the medical checkup or self-reported history of injuries in the dominant shoulder or elbow (P values ranging from 0.09-0.99). These results suggest that playing baseball as a pitcher during elementary school and junior-high school affects the increase in humeral retroversion in the dominant shoulder. Increased humeral retroversion in the dominant shoulder by repetitive throwing motion is an adaptive change, rather than a pathologic change.

Establishing the learning curve for elbow arthroscopy: surgeon and trainee perspectives on number of cases needed and optimal methods for acquiring skill

Elbow arthroscopy has increased in frequency as its indications have widened. Despite this growth, a learning curve has not yet been defined. We hypothesized that there would be significant differences in perspective between trainees and established surgeons for the number of cases needed to reach each skill level and what they felt are the most valuable training tools. Orthopedic attending physicians and trainees were asked to complete a questionnaire assessing participant demographics, case volumes required to reach defined skill levels (novice, safe, competent, proficient, and expert), and the efficacy of various learning methodologies for elbow arthroscopy. The value of educational methods was assessed using a 5-point Likert scale (1 = not at all valuable; 5 = extremely valuable). The study population consisted of 323 total participants, of whom 224 (69.3%) were attending surgeons and 99 (30.7%) were trainees (resident or fellow physicians). According to the attending physicians, the mean numbers of cases needed to reach each skill level were19 to be safe, 42 to be competent, 93 to be proficient, and 230 to be expert. These case numbers were not significantly different from the perspectives of trainees. Across the respondents, there were no significant differences in the number of cases needed to reach each level of skill based on the respondents' level of training, years of experience, type of fellowship, or self-reported skill level.Although both groups highly valued live surgery (4.7 of 5) and cadaveric practice (4.6 of 5) for acquiring skill, attendings placed higher value on reading (4.0 vs. 3.3, P < .001), videos/live demos (4.2 vs. 3.6, P< .001), and formal courses (4.5 vs. 4.1, P< .001) than trainees. Both groups place relatively low value on surgical simulators (2.8-3.6). There was considerable agreement amongattending surgeons and trainees in terms of the number of cases needed to attain various skill levels of elbow arthroscopy, which was consistent regardless of fellowship background, self-reported skill level, career length, and elbow arthroscopy case volume. However, there was some disagreement between attending surgeons and trainees over the most valuable methods for acquiring surgical skill with trainees placing less value on textbooks, surgical videos, and formal courses compared with attending surgeons. An understanding of the elbow arthroscopy learning curve will help trainees and their training programs establish case volume targets before safe, independent practice. Future studies should aim to clinically validate this learning curve.

Association between Graduate Degrees and Publication Productivity in Academic Neurosurgery.

Many neurosurgeons pursue graduate degrees as part of their training. In some jurisdictions, graduate degrees are considered a necessary condition of employment in academic neurosurgery. However, the relationship between possession of a graduate degree and eventual research productivity is not well established. We used bibliometric methods to analyze publications from academic Canadian neurosurgeons, with an emphasis on level of graduate training. All neurosurgeons holding academic appointments at Canadian institutions from 2012-2016 were included. Over that time frame, Scopus was used to quantify the number of papers, number of citations, 5-year h-index and 5-year r-index, CiteScore, authorship position, and paper type (clinical or basic science). Publication output was compared between neurosurgeons grouped as MD-only, MD-Masters, or MD-PhD. In total, 2557 abstracts from 131 Canadian neurosurgeons were analyzed. We found that MD-Masters neurosurgeons published significantly more total papers, clinical papers, and first/last author papers than MD-only neurosurgeons. MD-PhD neurosurgeons had the same findings, in addition to more basic science papers, in journals with a higher CiteScore, 5-year h-index, and 5-year r-index than both other groups. These results were preserved even with significant outliers removed. There was no difference if graduate degrees were obtained before or after starting residency. There was no correlation with career length and number of recent papers published. The attainment of a graduate degree has an important association with future publication productivity for academic neurosurgeons. These data should be useful for hiring committees considering the value of graduate degrees from applicants for positions in academic neurosurgery.

Return to Play and Career Length After Anterior Cruciate Ligament Reconstruction Among Canadian Professional Football Players

Background: For many athletes, a tear of the anterior cruciate ligament (ACL) represents a significant injury that requires a prolonged period away from the sport with substantial rehabilitation. Hypothesis: There will be no difference in return to play (RTP) and career length after hamstring tendon (HT) ACL reconstruction in a group of Canadian Football League professional players as compared with what has been already been reported in the literature among professional football players. Study Design: Case-control study; Level of evidence, 3. Methods: Data on athletes who sustained an ACL injury were collected by team physicians and head athletic trainers from 2002 to 2017 from 2 Canadian Football League teams. Patient details included age at the time of injury, initial injury date, position, practice versus game injury, and primary versus rerupture with injury-specific data, such as affected limb, concomitant injuries, graft choice, and procedure performed. RTP rates and career length data were collected through publically available internet sources. Comparisons between the non-RTP and RTP groups were made with independent-sample t tests. Binomial logistic regression was performed to determine variables (ie, games preinjury, graft type, meniscal injury, collateral ligament injury) that contributed to players not being able to RTP. Results: A total of 44 ACL reconstructions were performed over the study period (HT, n = 32 [72.7%]; bone–patellar tendon–bone [BPTB], n = 8 [18.2%]; allograft, n = 4 [9.1%]). Overall, 69.8% (n = 30) were able to RTP in at least 1 game, while 30.2% (n = 13) did not return. Mean time to return was 316.1 days (range, 220-427 days), or 10.4 months. For those players who did RTP, mean career length after ACL reconstruction was 2.8 seasons, or 34.4 games. The majority (56.8%) of injuries occurred early in the season. Breakdown by graft type demonstrated RTP rates among HT, BPTB, and allograft of 64.5% (n = 20), 87.5% (n = 7), and 75% (n = 3), respectively. Career length among HT, BPTB, and allograft was 2.9, 2.4, and 3 seasons. Logistic regression analysis found only concomitant medial collateral ligament (MCL) injuries to be a negative predictor for RTP. Meniscal injuries were associated with a decreased RTP rate and career length, but this was not statistically significant. Conclusion: The RTP rates after ACL reconstruction in this study are similar to those reported in National Football League players. A concomitant injury to the MCL injury was a negative predictor of RTP. Meniscal injuries demonstrated a trend for decreased RTP rate and career length, but this was not a significant predictor. A large portion of injuries occur early in the season, and further study should be done to examine potential preventative strategies to reduce ACL injuries.