Revision Strategies Research Articles

Writing and Revision Strategies of Students With and Without Dyslexia

Previous work suggests that written text produced by university students with dyslexia is scored lower than that produced by their peers. The present study used a digital writing tablet to examine the writing process and the quality of text written by university students with dyslexia. Revision behavior during and after writing was also investigated. Thirty-two university students with dyslexia (mean age, 20 years), were compared with 32 typically developing (TD) students matched by age. Students composed a written text in response to an expository essay prompt. In line with previous research, students with dyslexia made a higher number of spelling errors and their essays were rated as poorer than TD students. However, students with dyslexia were comparable to their peers on measures of time spent writing, amount of text produced, and the temporal analyses (handwriting execution, pause times). Students with dyslexia made significantly more revisions to spelling during and after transcription than their peers, although other revision behavior was similar across groups. Explanations for the finding of poor writing quality are explored. Importantly, the findings suggest that continued support with spelling and writing is needed for university students with dyslexia. Instruction directed toward effective revision strategies may also prove useful. Limitations and directions for future research are discussed.

Revision strategies for failed adult spinal deformity surgery.

The aim of this study is to analyse the results of revision surgery for failed adult spinal deformity patients and to describe the surgical strategy selection process, based on the identification of the main clinical diagnosis responsible for failure. We retrospectively reviewed the clinical and radiological data of 77 consecutive patients treated in a 3-year time (2016-2019) for surgical revision of long fusion (more than five levels fused) for adult spinal deformity in a high-volume spine centre, divided into four groups based on the diagnosis: rod breakage (RB) group, proximal junctional failure (PJF) group, distal junctional failure (DJF) group and loss of correction (LOC) group with symptomatic sagittal or coronal malalignment (including iatrogenic flatback). Seventy-seven patients met our inclusion criteria, with a female prevalence (66 F vs. 11 M). The mean age at revision surgery was 63. Fused levels before surgery were averagely 12, and revision added averagely two levels to the preexisting fusion area. Clinical status was apparently improved in ODI scores and VAS scores, while it was slightly worsened in SF36 scores. Different diagnosis groups have been addressed with different surgical strategies, according to the different surgical goals: interbody cages and multi-rod construct to improve stiffness and favour bony fusion, "kickstand" rod and "tie" rod to correct coronal and sagittal malalignment, specific rod contouring and proximal hooks in "claw" configuration to reduce mechanical stress at the proximal junctional area. Intraoperative complications occurred in 18% of patients and perioperative complications in 39%. Revision surgery in long fusions for adult spinal deformity is a challenging field. Surgical strategy should always be planned carefully. A successful treatment is a direct consequence of a correct preoperative diagnosis, and surgery should address the primary cause of failure. All the above-mentioned surgical techniques and clinical skills should be part of surgeon's expertise when managing these patients. These slides can be retrieved under Electronic Supplementary Material.

A Semantic Characterization ASP Base Revision

The paper deals with base revision for Answer Set Programming (ASP). Base revision in classical logic is done by the removal of formulas. Exploiting the non-monotonicity of ASP allows one to propose other revision strategies, namely addition strategy or removal and/or addition strategy. These strategies allow one to define families of rule-based revision operators. The paper presents a semantic characterization of these families of revision operators in terms of answer sets. This semantic characterization allows for equivalently considering the evolution of syntactic logic programs and the evolution of their semantic content. It then studies the logical properties of the proposed operators and gives complexity results.

일본 헌법 9조 개정의 정치: 아베 총리의 개헌전략을 중심으로

일본 헌법 9조 개정의 정치: 아베 총리의 개헌전략을 중심으로

Long-term clinical outcome of two revision strategies for failed total disc replacements

PurposeTo compare the long-term clinical results and complications of two revision strategies for patients with failed total disc replacements (TDRs).MethodsIn 19 patients, the TDR was removed and the intervertebral defect was filled with a femoral head bone strut graft. In addition, instrumented posterolateral fusion was performed (removal group). In 36 patients, only a posterolateral instrumented fusion was performed (fusion group). Visual Analogue Scale (VAS) for pain and Oswestry Disability Index (ODI) were completed pre- and post-revision surgery. Intra- and post-operative complications of both revision strategies were assessed.ResultsThe median follow-up was 12.3 years (range 5.3–24.3). In both the removal and fusion groups, a similar (p = 0.515 and p = 0419, respectively) but significant decrease in VAS (p = 0.001 and p = 0.001, respectively) and ODI score (p = 0.033 and p = 0.013, respectively) at post-revision surgery compared to pre-revision surgery was seen. A clinically relevant improvement in VAS and ODI score was found in 62.5% and 43.8% in the removal group and in 43.5% and 39.1% in the fusion group (p = 0.242 and p = 0.773, respectively). Removal of the TDR was associated with substantial intra-operative complications such as major vessel bleeding and ureter lesion. The percentage of late re-operations for complications such as pseudarthrosis were comparable for both revision strategies.ConclusionsRevision of a failed TDR is clinically beneficial in about half of the patients. No clear benefits for additional TDR removal as compared to posterolateral instrumented fusion alone could be identified. In particular, when considering the substantial risks and complications, great caution is warranted with removal of the TDR.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.

Oсобливості перекладу виражальних засобів англомовних рекламних матеріалів

Abstract. Sublanguage of advertising is part of the language structure, while having a number of characteristic linguistic features that create the impression and imagery of advertising texts. To create imagery, all possible means of language are used: specific vocabulary, idioms, repetitions, allusions, elliptical constructions, unusual syntactic structure, wide use of verbs. Translators of ads face significant difficulties in transferring the pragmatic potential of the original. In particular, this is due to translating the facts and events related to the culture of nations, different national customs and names of dishes, clothes, etc. Today's realities compel to translate advertising texts more attentively in terms of their psychological impact on the audience. Ads contain clear factual data; are exhaustively outlined and therefore accurately understood. When translating them one should take into account: the purpose of the text, nature of the consumer, language qualities of the original text, cultural and individual capabilities of language in cultural aspect of the consumer and many other factors. The pragmatic function of the original text must be primarily preserved. Translation is successful, provided that it has the same effect on the recipient as the original. All language means that make advertising effective must be reflected somehow, mostly by compensation, in translation. However, the pragmatics of the translated material should necessarily coincide with that of original. Each of five strategies has its advantages and disadvantages. The first strategy - absence of translation – is unclear to all those who cannot read or accept it in original. The second borrowing strategy uses positive associations of the producer, which is unsuccessful method either, because different nations have their own picture of the world and perceive things differently. Casual and obvious things in one country can be taboo in another. The third strategy- direct translation - has its drawbacks, as it is not able to reproduce the complete emotional picture of the original ad. The fourth strategy of adaptation is most successful, since it retains everything the manufacturer wants to convey, that is, leaves the photo material unchanged, but adapts the text to the outlook and mentality of foreign consumers. The fifth revision strategy is very similar to the fourth, but its distinctive feature is a completely new presentation of ads. Its main disadvantage is that the information content of the source is completely lost. The translator only uses the ad idea and creates an entirely new slogan, in many cases unable to reproduce the entire essence of the original. Specifics of structure and components of ads text suggests that they contain clear factual data, exhaustively described for the sake of clear understanding their content. The content and form of ads obey the main goal - to cause interest in a product or service. A well-constructed ad attracts attention and creates a desire to purchase it. Excellency of successful ads can be attributed to the harmonious combination of the main ad idea with the expressive means that reflect it the best. The only true tone of ad found distinguishes it among others. Ads contain a number of extra-linguistic components and are adequately perceived in case of their harmonious combination. Literal translation is rarely used, as ad loses its meaning and power of influence. In translating ethical and psychological characteristics of the consumer are taken into account, as well as specific language and culture of the country to which they are intended. The choice of translation method depends even on the psychological characteristics of the translator, his preferences and attachment to a certain literary tradition. In search of original and effective means of expression new lexemes, consisting of parts of known words, representing the distorted or reshaped words of active vocabulary emerge. Another way to create neologisms is to borrow foreign language tokens. By content and association they are connected with the ad object. Translator's task is to use all professional skills to transfer the communicative function of the original.

One- and two-stage surgical revision of infected elbow prostheses following total joint replacement: a systematic review

BackgroundProsthetic joint infection (PJI) is a challenging complication of total elbow replacement (TER). Potential surgical treatments include one- or two-stage revision; however, the best treatment for elbow PJI is not clearly defined. We conducted a systematic review in accordance with PRISMA guidelines to compare the clinical effectiveness of one- and two-stage revision surgery for elbow PJI using re-infection (recurrent and new infections) rates; mortality; clinical measures of function, pain, and satisfaction; and non-infection related adverse events.MethodsMEDLINE, Embase, Web of Science, and The Cochrane Library were searched up to June 2019 to identify observational cohort studies and randomised controlled trials (RCTs) that had recruited patients with elbow PJI following TER and treated with one- or two-stage revision. Of 96 retrieved articles, 2 one-stage and 6 two-stage revision studies were eligible. No RCT was identified. Arcsine transformation was used in estimating rates with 95% confidence intervals (CIs).ResultsStaphylococcus aureus was the most common causative organism for PJI of the elbow (24 of 71 elbow PJIs). The re-infection rate (95% CI) for one-stage (7 elbows) ranged from 0.0% (0.0–79.3) to 16.7% (3.0–56.4) and that for two-stage revision (87 elbows) from 0.0% (0.0–49.0) to 20.0% (3.6–62.4). Non-infection related adverse event rate for one-stage (based on a single study) was 16.7% (3.0–56.4) and that for two-stage ranged from 11.8% (4.7–26.6) to 20.0% (3.6–62.4). There were no mortality events recorded following one- or two-stage revision surgery and postoperative clinical measures of function, pain, and satisfaction could not be effectively compared because of limited data.ConclusionsNo strong conclusions can be drawn because of limited data. The one-stage revision may be potentially at least as clinically effective as two-stage revision, but further data is needed. There are clear gaps in the existing literature and studies are urgently warranted to assess the clinical effectiveness of one- and two-stage revision strategies for PJI following TER.Systematic review registrationPROSPERO 2018: CRD42018118002.

Green supplier selection in electronics manufacturing: An approach based on consensus decision making

Abstract Due to the continuous cost reduction and technological innovation, electronic products are easily accessible to individuals and become omnipresent in our day-to-day lives. For electronics manufacturing enterprises, the pressure to maintain a competitive edge and the urgency to implement sustainable development makes the optimal selection of green supplier a necessity during operations. Although some studies have given some methods for green supplier selection, the consensus problem has not been sufficiently studied in the existing methods. In order to solve this problem, we propose a group consensus decision making framework to help choosing the best green supplier for electronics manufacturing. Firstly, decision makers’ preferences between the alternatives considered with respect to each criterion are elicited by the paired comparison method, and expressed as probabilistic linguistic preference relations. Secondly, a new consistency measure is defined and a convergent algorithm is described to aid the consistency improvement process in a given probabilistic linguistic preference relation. The algorithm adopts a local revision strategy and can be easily interpreted. Further, for the consensus model, in each round of this dynamic and interactive model, the most incompatible expert is asked to revise his/her judgment according to judgment feedback mechanism. If the expert rejects the suggestion, his/her weight of importance will be decreased based on the weighting feedback mechanism. Finally, a case study of selecting green supplier is provided to illustrate the application of the proposed group consensus decision making framework.

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

ObjectiveThe aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. MethodsOur revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. ResultsA total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35–63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2–24 months. The follow-up time was 12–30 months, and the operation time was 120–300 min. All patients received bone union at the last follow-up. The healing time was 3–6 months. The postoperative Rasmussen score was 19–29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60–110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. ConclusionBecause revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion. Level of EvidenceLevel IV, Therapeutic Study.

Management strategy and indications for revisionary internal fixation after percutaneous kyphoplasty/percutaneous vertebroplasty in cancellous vertebral fractures

Objective To explore the management strategy and indications for revisionary internal fixation after percutaneous kyphoplasty/percutaneous vertebroplasty (PKP/PVP) in cancellous vertebral fractures. Methods A retrospective analysis was made of the 676 cases of single-segment PKP/PVP at Department of Orthopaedics, The Affiliated Hospital to Qingdao University from January 2008 to January 2019. They were subjected to 4 different managements after their primary PKP/PVP: rehabilitation without any treatment in 637 cases, conservative treatment in 19 cases (including 3 ones who refused any revision), KP/VP revision in 12 cases and internal fixation revision in 8 cases. The rate of volume reduction after bone cement dispersion (Vx) was calculated using software Mimics 17.0 on the basis of primary CT data of all the patients. The correlation regression analysis was made between the revision rate and the approximate quantization value of Vx. The Glasgow Coma Score (GCS) of conscious state was used to evaluate the 39 patients after failure of their primary surgery before the surgical strategy for revision was worked out. The cobb angle, pelvic incidence angle (PI), pelvic inclination angle (PT), sacral inclination angle (SS), sagittal deviation (SVA), pain visual analogue scale (VAS) were measured and recorded before operation and at the last follow-up for the KP/VP revision group and internal fixation revision group, indicated as Δcobb, ΔPI, ΔPT, ΔSS, ΔSVA and ΔVAS, respectively. The indexes were compared between the 2 groups. Results The incidence of osteoporotic vertebral fractures treated with internal fixation revision was 1.18% (8/676). The correlation between Vx and revision rate was y=0.53+0.04x (P 0.05). There was a significant difference in Δcobb between the 2 revision groups (6.3°±7.5° versus 19.2°±14.8°) (P 0.05). Conclusions The outcomes of primary PKP/PVP have a great impact on the decision-making of internal fixation revision. The mode and extent of diffusion after initial vertebral cement perfusion are particularly related to the revision rate. The revision plan should depend on clinical symptoms. The internal fixation revision should be individualized to ensure the quality of life of the patients in line with the principles of resolving symptoms and moderate correction . Key words: Osteoporosis; Vertebroplasty; Fracture fixation, internal; Revision; Indication

How to Revise a True War Story: Tim O'Brien's Process of Textual Production

How to Revise a True War Story: Tim O'Brien's Process of Textual Production

Reoperation strategy of malunited tibial plateau fracture

Objective To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect. Methods From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy. Results All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation. Conclusion It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients. Key words: Tibial fracture; Intra-articular fractures; Osteotomy; Joint deformities, acquired; Reoperation

My Theory of Writing

The research is based on analysis of the writing produced throughout the GSW 1110 class. Students were asked to evaluate the writing through reflection of ideas supported and making connections to key rhetorical terms to create our own theory of writing. To start with, in the article “Shitty First Drafts,” Anne Lamott supports the idea of the importance on shaping the writing and self-assurance according to the audience’s demands. Secondly, writing process and revision strategies are approached, reinforced by Nancy Sommers in her article “Revision Strategies of Student Writers and Experienced Adult Writers.” The final aspect addressed is critical thinking, reading and writing in composing papers and analyzing sources, where this idea is highlighted by Laurie Kirszner and Stephen Mandell in their article “Thinking Critically.” It concludes with the emphasis of the importance of the lessons taught in this course, preparing the student for the GSW 1120 class.

Revising revising and a focus on double vision in drafting

At the comprehensive research university described in this study, some students taking a required, first-semester, composition course in the fall make great progress in their ability to draft and revise the curriculum’s major essays. Yet, they still fail the class. Many of these students are on their way to becoming practiced writers but require additional assistance to move beyond a definition of revision consisting solely of editing and proofreading strategies. To support such students, I created a voluntary, spring-semester, Composition I course foregrounding both lower- and higher-order revision practices in which students could continue to work on previous assignment drafts from fall. In a three-year, mixed methods, case study involving an experimental course-design model, students enrolling in a Composition I class focused on revision strategies demonstrated both positive revision-related drafting and course outcomes, according to findings. This article includes a description of the course’s framework and its assessment practices. The results of this study have implications for teaching revision in first-year composition.

RE-CONCEPTUALIZING L2 WRITING REVISION STRATEGIES FROM AN ECOLOGICAL PERSPECTIVE: AN INTERVIEW BASED INQUIRY

This study examines an ESL writer�s revision activity in composing an argumentative essay from an ecological perspective. The study aimed to explore how sociomaterial conditions present in the pedagogical context lead to the writer�s use of revision strategies in responding to instructor feedback. By using an interview-based case study approach, data were collected from one ESL writer and instructor in an ESL freshman composition class at a large public university in the US. Based on the analysis of field-notes, transcripts from interviews and writing conferences, and various cultural artifacts, the study found that the writer�s goal-oriented agency foregrounded his engagement with instructor feedback, which narrowed down the problem space perceived to be important by the writer to achieve his goal in writing. The writer�s selective attention to the specific writing issues to be attended in his revision attempt provided an essential perceptual pretext for the concoctions of several sociomaterially-afforded revision strategies. The study also found that sociomaterial interactions inherent within one strategy use conditioned the emergence of another strategy while showcasing that the writer�s strategy use could be emergent and generative in nature. Based on the findings, the study discusses the emergence of the revision strategies as a result of collective interplay of student agency and student-perceived sociomaterial affordances in the writer�s attempt to establish sociocognitive alignment with the instructor�s expectations delivered through feedback. Implications for ecologically-oriented L2 revision strategy research are discussed.

A Case Study of Teacher Feedback on Thai University Students’ Essay Writing

The effectiveness of written feedback on writing is influenced by various variables, includingstudents’ proficiency levels, prior learning experiences, expectations and educational contexts. Although Thai students are reported to have serious problems in English writing, which are partly caused by their culturally-based English learning styles, few studies have been conducted to find out how teachers assist them through their feedback. This study thus reports on the practice of teacher feedback in terms of its forms, locations, types and purposes with a consideration of several influential factors in an essay writing class at a university in Thailand. Furthermore, the levels of the students’ reactions to the teacher feedback, the effects of their revisions and their revision strategies were also examined. To learn about these students’ opinions on the effectiveness of the feedback strategies employed, a survey with the whole class and a focus-group interview were also conducted at the end of the course. The results showed the students’ active engagement in responding to the teacher feedback, and this tends to assert the crucial roles of teachers’ knowledge of students’ learning experiences, English proficiency levels, feedback preferences and classroom settings on the success of written corrective feedback. Though the findings might not be generalized in other EFL settings, they show how in-service teachers adjust feedback strategies in their actual teaching situations to prepare EFL students to become self-regulating writers.

Cement augmentation as revision strategy for loosened thick-diameter non-fenestrated iliac screws – A biomechanical analysis

BackgroundLoosened/pulled-out iliac screws can be a challenging complication, as revision opportunities are limited because more distal anchorage is impossible. Insertion of thick-diameter screws is an option in cases with loosened thin-diameter screws. However, this is occasionally infeasible in patients with loosened thick-diameter screws. Therefore, this study aimed to biomechanically analyze whether loosened/pulled-out thick iliac screws regain strong anchorage following cement augmentation. MethodsSix human pelvis specimens were dissected to isolate 12 hemipelves, and 9 × 80 mm iliac screws were implanted. The pullout maneuver was performed followed by cement augmentation of the same screw within the same screw hole. After cement hardening, pullout was performed again. Forces needed for pullout and the insertion torque were measured for the 12 iliac screws. FindingsCement augmentation significantly increased stability, with the pullout forces required being as high as 953.23 N (standard deviation [SD] 1070.46 N; median 306.30 N) for the uncemented screws and 2897.53 N (SD 585.83 N; median 2907.81 N) after cement augmentation (p < 0.001). No correlation was found between insertion torques and pullout forces. InterpretationWhile revision of loosened iliac screws can often be achieved using higher diameters, this method is limited by the thickness of the screws already in place. We demonstrated that cement augmentation significantly increases stability even in thick-diameter screws, achieving more pullout stability than before the initial pullout. This method may be a cost-effective and rapid option for revision, even with significant defects and with no thicker-diameter iliac screw being available.

Planning, execution, and revision in mathematics problem solving: Does the order of the phases matter?

The present study analysed the mathematical problem-solving processes, in terms of linearity and recursion, and the relationship with actual and self-perceived performances of a sample of 524 students of upper elementary students. The results showed a more linear than recursive process while performing the tasks, mainly characterized by continuity. The use of planning strategies before execution and the use of revision strategies after this phase were both significantly related to good performance, even if rates of success were low. The presence of a linear and hierarchical resolution process was related to students’ judgments of success, while recursion, or going back in the process, was associated with judgments of failure. Results are discussed in the light of current research on mathematics problem-solving.

Revision ACL reconstruction using quadriceps or hamstring autografts leads to similar results after 4 years: good objective stability but low rate of return to pre-injury sport level.

Due to the increased importance of revision ACL reconstruction, this study aims to evaluate the outcome 4years after the surgery, compare two revision strategies and identify factors that influence the results. Seventy-nine patients who received a revision ACL reconstruction were retrospectively evaluated. All patients were assessed with an average follow-up of 4.4years (range 3.3-5.5years). The results of patients treated with a quadriceps autograft were compared with those treated with a hamstring autograft. Ninety-seven percent of patients had a KT-1000 side-to-side difference of ≤ 5mm (mean 1.7 ± 2.0mm). Pivot-shift test was absent or minor in 95%. In the SLTH-test, 70% of patients reached 90% of the contralateral side. The mean Lysholm score on follow-up was 83 ± 12 (56% excellent/good). The mean IKDC 2000 subjective evaluation score was 81 ± 14 (58% normal/almost normal). The median Tegner activity score was 6 (range 3-10), a median of 2 levels worse than before the first injury. Return to sport rate was 89% but only 34% of patients reached their pre-injury sport level. Most common cause for this reduction was fear of another injury. Three patients suffered a re-rupture. Patients with a hamstring autograft performed pivoting sports more often, but had worse pivot-shift results compared to those with a quadriceps autograft. No significant influence was seen for other parameters. Young, male patients with a high activity level and no chondral damage had the best results. Through revision ACL reconstruction, the goal of stabilizing the knee can be achieved in the majority of patients. However, a good function and a high activity level are significantly less common in these patients. The main reason for this is fear of a renewed ACL-injury. Both quadriceps and hamstring autografts were able to achieve a good outcome. Young, male, patients with a normal BMI, a high activity level and without cartilage damage seem to benefit the most from revision ACL surgery. The discrepancy between the good laxity restoration and the lower activity rate should therefore be a main point in clinical counseling when deciding for or against revision ACL-Reconstruction. III.

Formalization of a Specialty-Specific Military Unique Curriculum: A Joint United States Army and United States Air Force Infectious Disease Fellowship Program.

There are many unique aspects to the practice of military Infectious Diseases (ID). San Antonio Uniformed Services Health Consortium Infectious Disease (ID) Fellowship is a combined Army and Air Force active duty program. Program leadership thought ID military unique curriculum (MUC) was well integrated into the program. We sought to verify this assumption to guide the decision to formalize the ID MUC. This study describes our strategy for the refinement and implementation of ID specific MUC, assesses the fellow and faculty response to these changes, and provides an example for other programs to follow. We identified important ID areas through lessons learned from personal military experience, data from the ID Army Knowledge Online e-mail consult service, input from military ID physicians, and the Army and Air Force ID consultants to the Surgeons General. The consultants provided feedback on perceived gaps, appropriateness, and strategy. Due to restrictions in available curricular time, we devised a three-pronged strategy for revision: adapt current curricular practices to include MUC content, develop new learning activities targeted at the key content area, and sustain existing, effective MUC experiences.Learners were assessed by multiple choice question correct answer rate, performance during the simulation exercise, and burn rotation evaluation. Data on correct answer rate were analyzed according to level of training by using Mann-Whitney U test. Program assessment was conducted through anonymous feedback at midyear and end of year program evaluations. Twelve military unique ID content areas were identified. Diseases of pandemic potential and blood borne pathogen management were added after consultant input. Five experiences were adapted to include military content: core and noon conference series, simulation exercises, multiple choice quizzes, and infection control essay questions. A burn intensive care unit (ICU) rotation, Transport Isolation System exercise, and tour of trainee health facilities were the new learning activities introduced. The formal tropical medicine course, infection prevention in the deployed environment course, research opportunities and participation in trainee health outbreak investigations were sustained activities. Ten fellows participated in the military-unique spaced-education multiple-choice question series. Twenty-seven questions were attempted 814 times. 50.37% of questions were answered correctly the first time, increasing to 100% correct by the end of the activity. No difference was seen in the initial correct answer rate between the four senior fellows (median 55% [IQR 49.75, 63.25]) and the six first-year fellows (median 44% [IQR 39.25, 53]) (p = 0.114). Six fellows participated in the simulated deployment scenario. No failure of material synthesis was noted during the simulation exercise and all of the fellows satisfied the stated objectives. One fellow successfully completed the piloted burn ICU rotation. Fellows and faculty reported high satisfaction with the new curriculum. Military GME programs are required by congress to address the unique aspects of military medicine. Senior fellow knowledge using the spaced interval multiple-choice quizzes did not differ from junior fellow rate, supporting our concern that the ID MUC needed to be enhanced. Enhancement of the MUC experience can be accomplished with minimal increases to curricular and faculty time.