Recovery Timeframes Research Articles

The aquaculture sustainability continuum – Defining an environmental performance framework

Abstract Estimating the magnitude and sustainability of aquaculture’s environmental impacts is challenging. A lack of quantifiable performance data on sustainability is limiting the industry’s ability to demonstrate the potential benefits of aquaculture as it plays an essential role in the future supply of seafood. Environmental Indicator Sets (EISs) have emerged as tools to express the sustainability of complex ecological systems. The intent of this work was to harness the collective expert input reflected in the EISs of global certification and ratings schemes to provide new tools to further define and advance the quantification of sustainable aquaculture. Every environmental indicator from four prominent schemes was analyzed and categorized by their level of application (site- and resource-level) and by their mode of action (status, control and risk). Impact-specific parameters were defined (Impact, Resource, Target, Limit Reference Point (LRP), and Recovery Timeframe) and used to develop a 0–100 performance scale for key environmental impacts. The resulting two-dimensional categorical-performance frameworks represent a formalized way to reflect on the different approaches of the certification and ratings schemes. Performance comparisons between schemes were avoided but the analysis indicates there is an opportunity for the different approaches to be considered complimentary. The novel parameters proposed here, particularly the LRP, highlight the incongruence between the common definitions of sustainable wild caught and farmed seafood. As such, the present work serves as an orientation point for further discussion on the quantification and ongoing development of sustainable aquaculture, anchored on the existing content of established aquaculture certification and ratings schemes.

The Stunned Brain: Neuroanatomical Correlates of an Acute Concussion in Boxing

The 2012 Zurich Consensus Statement defined concussion as a complex pathophysiological process affecting the brain induced by biomechanical forces. Concussive and post-concussion symptoms are currently thought to reflect a functional rather than structural disturbance typically resolving spontaneously with no imaging abnormality. The majority of patients with concussion recover within a 7-10 days period, in some symptoms persist beyond the 1 month generally accepted time frame for recovery. Some patients recover within the above generally accepted time frame but show reemergence of concussion symptoms after minor head bumps. Two such cases in amateur athletes are reported here.

Reemergence of Remote Concussion Symptoms in Amateur Athletes after Minor Head Bumps-AReport of 2 Cases

The 2012 Zurich Consensus Statement defined concussion as a complex pathophysiological process affecting the brain induced by biomechanical forces. Concussive and post-concussion symptoms are currently thought to reflect a functional rather than structural disturbance typically resolving spontaneously with no imaging abnormality. The majority of patients with concussion recover within a 7-10 days period, in some symptoms persist beyond the 1 month generally accepted time frame for recovery. Some patients recover within the above generally accepted time frame but show reemergence of concussion symptoms after minor head bumps. Two such cases in amateur athletes are reported here..

Necrotizing Group A Strep Following Use of Penile Constriction Ring

The development and management of necrotizing cellulitis following penile constriction ring use is described. Devastating injuries such as this can be highly distressing for patients and focused counseling is often needed to address concerns regarding cosmetic outcomes. The timeframe and appearance of recovery has not been previously captured. We present a photographic timeline covering the development, management, and postoperative recovery from penile constriction ring injury over the course of 1 month.

Detecting effects of herbicide runoff: The use of Cassiopea maremetens as a biomonitor to hexazinone

Herbicides are an integral part of global agricultural activity but can be advected into local drainages that can discharge to coastal marine systems. Herbicide runoff can impact coastal marine organisms, including those associated with coral reefs and coastal mangrove forests. In this study, the symbiotic sedentary jellyfish Cassiopea maremetens were exposed to analytical grade hexazinone to determine their sensitivity and potential for recovery after exposure to a press herbicide event of 14 days followed by a recovery period of matching duration. Bell surface area, photosynthetic yield (i.e. effective quantum yield, EQY), statolith count and zooxanthellae density were analyzed. Most metrics demonstrated significant decreases when exposed to higher concentrations of hexazinone, while EQY was significantly decreased at exposure concentrations from 31 μg/L hexazinone and above. In contrast, zooxanthellae density (cells/mm2) increased in the highest concentrations compared to control animals. At the end of the exposure period the EC50 for bell surface area, EQY, and statolith count were 176 μg/L, 81.96 μg/L, and 304.3 μg/L, respectively. Jellyfish were able to recover to similar start values for all measured metrics at the end of the 14-day recovery period, with EQY showing recovery by Day 7 of the recovery period. This study demonstrated that statolith counts as an estimate of age were not affected by herbicides. We conclude that the depressed metrics from herbicide related impacts of C. maremetens are effective indicators of a relatively recent herbicide perturbation in that the recovery timeframe for these jellyfish is relatively short.

Robotic Surgery: A Boon or a Bane to Medical Science

Purpose: The study aims at assessing the robotic surgery awareness among the patients and challenges concerning the cost involved in the current scenario. Design/Methodology/Approach: Convenience sampling was adopted to derive the sample size of 60 respondents, who were the specialized surgeons performing robotic surgery in the vicinity of urban Bangalore working in leading hospitals. The research is confined to the primary source of data collection considering awareness, communication, time, cost, affordability, recovery time, formal training, gender and number of surgeons as variables. Factor Analysis, Cluster Analysis, and Chi-square tests were applied to justify the hypothesis. Findings: Sampling and adequacy test resulted (KMO = 0.609) statistically significant at 0.01 per cent. Level of awareness the technology among the patients proves to be the most influencing factor for the success of robotic surgery with extraction loading being 0.817. The attitude of the surgeons and patients constitutes 36.85 per cent variance that is explained by the variables. There is no important statistical relationship between genders, cost of surgery, age of the surgeon and recovery time frame for the successful medical surgery. Originality/Value: Robotic surgery employs Artificial Intelligence to sustain tremors in the surgeon’s movements to facilitate accuracy in performing medical surgery. The future is extremely promising to witness the medical profession to ensure a sense of complex digital signatures associated with robotic and videoscopic procedures to provide actionable feedback to surgeons on the improvement and performance.

Improved and standardized method for assessing years lived with disability after burns and its application to estimate the non-fatal burden of disease of burn injuries in Australia, New Zealand and the Netherlands

BackgroundBurden of disease estimates are an important resource in public health. Currently, robust estimates are not available for the burn population. Our objectives are to adapt a refined methodology (INTEGRIS method) to burns and to apply this new INTEGRIS-burns method to estimate, and compare, the burden of disease of burn injuries in Australia, New Zealand and the Netherlands.MethodsExisting European and Western-Australian health-related quality of life (HRQL) datasets were combined to derive disability weights for three homogenous burn injury groups based on percentage total body surface area (%TBSA) burned. Subsequently, incidence data from Australia, New Zealand, and the Netherlands from 2010 to 2017 were used to compute annual non-fatal burden of disease estimates for each of these three countries. Non-fatal burden of disease was measured by years lived with disability (YLD).ResultsThe combined dataset included 7159 HRQL (EQ-5D-3 L) outcomes from 3401 patients. Disability weights ranged from 0.046 (subgroup < 5% TBSA burned > 24 months post-burn) to 0.497 (subgroup > 20% TBSA burned 0–1 months post-burn). In 2017 the non-fatal burden of disease of burns for the three countries (YLDs/100,000 inhabitants) was 281 for Australia, 279 for New Zealand and 133 for the Netherlands.ConclusionsThis project established a method for more precise estimates of the YLDs of burns, as it is the only method adapted to the nature of burn injuries and their recovery. Compared to previous used methods, the INTEGRIS-burns method includes improved disability weights based on severity categorization of burn patients; a better substantiated proportion of patients with lifelong disability based; and, the application of burn specific recovery timeframes. Information derived from the adapted method can be used as input for health decision making at both the national and international level. Future studies should investigate whether the application is valid in low- and middle- income countries.

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area.

Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.

A Green COVID-19 Recovery of the EU Basic Materials Sector: Identifying Potentials, Barriers and Policy Solutions

This paper explores which climate-friendly projects could be part of the COVID-19 recovery while jump-starting the transition of the European basic materials industry. Findings from a literature review on technology options in advanced development stages for climate-friendly production and enhanced sorting and recycling of steel, cement, aluminium and plastics are combined with insights from interviews with 31 European industry stakeholders about the practical and economic feasibility of these technology options. Results indicate that with an estimated investment of 28.9 billion Euro, about 20% of EU’s basic materials could be produced through low-emission processes or additional recycling by 2025 with technologies that are commercially available or at pilot scale today. However, our stakeholder consultation also shows that in order to make these short-term investments viable in the long term, six main barriers need to be addressed, namely i) the lack of effective and predictable carbon pricing, ii) the limited availability of affordable green electricity, iii) the lack of a regulatory framework for circularity, iv) low technology readiness and funding, v) the lack of infrastructure for hydrogen, CO2 and power, and vi) the lack of demand for climate-friendly and recycled materials. Based on these insights, the paper proposes elements of a policy package that can create a long-term framework favourable for investments in these technologies and should ideally accompany the recovery package to give credibility to investors that the business case will last beyond the recovery timeframe.

Understanding parental perspectives on outcomes following paediatric encephalitis: A qualitative study.

BackgroundEncephalitis, characterised as inflammation of the brain tissue, is an important cause of acquired brain injury in children. Objective clinical outcomes vary significantly between affected patients, however they do not always correlate with quality of life as reported by parents. The aim of this study was to explore how parents experience and interpret outcomes in relation to their child who has been affected by encephalitis.MethodsData were derived from in-depth, semi-structured interviews, with 15 parents of 12 children and young people affected by encephalitis. Paediatric cases were identified from the retrospective arm of the research programme ‘ENCEPH-UK-Understanding and Improving the Outcome of Encephalitis’, and from the prospective UK childhood meningitis and encephalitis cohort study (UK-ChiMES, 2012 to 2016). Data were analysed thematically.ResultsParents’ perspectives on important outcomes for their child and family changed during the different stages of the encephalitis illness trajectory: from acute illness, recovery and rehabilitation, then reintegration into everyday life. Parents’ understanding of their children’s overall outcome was informed by their own experiences, involving comparisons with other children and reflections on their child’s problems before, during and after the acute illness.ConclusionOutcomes in paediatric encephalitis need to be understood in terms of the context of the patient and family experience as well as the timeframe of recovery. The research highlights the need to include more patient, parent and/or carer reported outcome measures during patient assessment, and that assessment should be repeated during recovery as family concerns change. In the longer term, these parameters could be included in clinical and rehabilitation practice to further support child recovery.

The Natural History of Postconcussion Recovery Among High School Athletes.

Evaluate postconcussive symptom reporting and recovery. Public high school. Unmatched controls (n = 760); students who sustained a sports-related concussion (n = 77); matched controls (gender, grade, sport) (n = 77). Prospective longitudinal cohort study. Immediate Postconcussion Assessment and Cognitive Testing. At baseline, athletes who went on to sustain concussions were more likely than unmatched controls to be younger (P = .02), male (P = .001), and participate in different sports (P < .0001) such as football (concussed = 52%, unmatched controls = 20%). Differences were also noted regarding a previous history of concussion (P = .045; concussed athletes = 26%; unmatched control athletes = 16%) and lifetime number of concussions (P = .05). At baseline, those whose sustained concussions during the study period were more likely than matched controls to report numbness (P = .01) and concentration problems (P = .01) and more likely than unmatched controls to report dizziness (P = .02), sensitivity to light (P = .01), sensitivity to noise (P = .002), and numbness (P = .02). However, when data were reanalyzed and those with a previous history of concussion were removed, differences between those who sustained concussions during the study period and matched controls were no longer significant; when compared to unmatched controls, sensitivity to light (P = .01) and vision problems (P = .04) remained significant. Among those who sustained concussions, median time to recovery was 6 days (95% confidence interval: 4-9), and 71 out of 77 (92%) recovered by the fourth postinjury evaluation (median: 20 days postinjury). Course and time frame of recovery were variable. Data also suggest that a previous history of concussion may be contributing to baseline symptom reporting and highlight the potential enduring impact of history of concussion on sensorimotor function. However, further research as to whether preinjury measures of sensorimotor function may increase understanding regarding concussion risk is warranted.

Assessing Ecological Risks from Atmospheric Deposition of Nitrogen and Sulfur to US Forests Using Epiphytic Macrolichens.

Critical loads of atmospheric deposition help decision-makers identify levels of air pollution harmful to ecosystem components. But when critical loads are exceeded, how can the accompanying ecological risk be quantified? We use a 90% quantile regression to model relationships between nitrogen and sulfur deposition and epiphytic macrolichens, focusing on responses of concern to managers of US forests: Species richness and abundance and diversity of functional groups with integral ecological roles. Analyses utilized national-scale lichen survey data, sensitivity ratings, and modeled deposition and climate data. We propose 20, 50, and 80% declines in these responses as cut-offs for low, moderate, and high ecological risk from deposition. Critical loads (low risk cut-off) for total species richness, sensitive species richness, forage lichen abundance and cyanolichen abundance, respectively, were 3.5, 3.1, 1.9, and 1.3 kg N and 6.0, 2.5, 2.6, and 2.3 kg S ha−1 yr−1. High environmental risk (80% decline), excluding total species richness, occurred at 14.8, 10.4, and 6.6 kg N and 14.1, 13, and 11 kg S ha−1 yr−1. These risks were further characterized in relation to geography, species of conservation concern, number of species affected, recovery timeframes, climate, and effects on interdependent biota, nutrient cycling, and ecosystem services.

Stratification of reactivity determines nitrate removal in groundwater

Biogeochemical reactions occur unevenly in space and time, but this heterogeneity is often simplified as a linear average due to sparse data, especially in subsurface environments where access is limited. For example, little is known about the spatial variability of groundwater denitrification, an important process in removing nitrate originating from agriculture and land use conversion. Information about the rate, arrangement, and extent of denitrification is needed to determine sustainable limits of human activity and to predict recovery time frames. Here, we developed and validated a method for inferring the spatial organization of sequential biogeochemical reactions in an aquifer in France. We applied it to five other aquifers in different geological settings located in the United States and compared results among 44 locations across the six aquifers to assess the generality of reactivity trends. Of the sampling locations, 79% showed pronounced increases of reactivity with depth. This suggests that previous estimates of denitrification have underestimated the capacity of deep aquifers to remove nitrate, while overestimating nitrate removal in shallow flow paths. Oxygen and nitrate reduction likely increases with depth because there is relatively little organic carbon in agricultural soils and because excess nitrate input has depleted solid phase electron donors near the surface. Our findings explain the long-standing conundrum of why apparent reaction rates of oxygen in aquifers are typically smaller than those of nitrate, which is energetically less favorable. This stratified reactivity framework is promising for mapping vertical reactivity trends in aquifers, generating new understanding of subsurface ecosystems and their capacity to remove contaminants.

Neurologic recovery after deep hypothermic circulatory arrest in rats: A description of a long-term survival model without blood priming.

Brain injury associated with deep hypothermic circulatory arrest (DHCA) has been recognized in patients with congenital heart diseases and those undergoing aortic arch surgeries. However, the preclinical investigation of long-term cerebral injury and recovery mechanisms related to DHCA has been restricted to a satisfactory recovery animal model with a determined recovery time. This study aimed to evaluate the feasibility of a long-term surviving DHCA model without blood priming in rats, in order to investigate the pathophysiology of long-term complications in further studies. Twelve Sprague-Dawley rats were divided into 2 groups: sham group (n=3) and DHCA group (n=9). The DHCA group was further assigned to the surviving time of postoperative day 2, 14, and 30 (n=3, respectively). The entire cardiopulmonary bypass (CPB) circuit consisted of a modified reservoir, a custom-designed small-volume membrane oxygenator, a roller pump and a heater/cooler. A 24-G catheter was cannulated in the branch of the left femoral artery for arterial blood pressure monitoring. Cardiopulmonary bypass was established via the right external jugular vein-right atrium and tail artery. Rats were cooled to a rectal temperature of 18°C, followed by 30minutes of DHCA with global ischemia. After re-warming for approximately 40minutes, the animals were weaned from the CPB at 35.5°C. Blood gas and hemodynamic parameters were recorded preoperatively and intraoperatively, and at 2, 14, and 30 days postoperatively. Thereafter, the brains were perfusion fixed and histologically analyzed. All DHCA processes were successfully achieved, and none of the rats died. Blood gas analysis and hemodynamic parameters at each time point were normal, and vital signs of all rats were stable. Histopathologic deficits in the hippocampus (pathological score, surviving hippocampal neurons, and Ki67-positive neurons) manifested after 30 minutes of DHCA, which persisted for at least 14 days and recovered after 30 days. A novel and simple long-term recovery model of DHCA in rats was established in the present study, and histopathologic deficits were observed after clinically relevant 30-minute DHCA durations, in order to determine the 30-day recovery time frame.

A Survey of Information Needs and Preferences of Patients With Head and Neck Cancer.

To determine the information needs and preferences of patients who had human papillomavirus-associated head and neck cancer (HNC) and who were aged 18-65 years in the post-treatment phase of recovery. 205 patients who completed treatment for HNC at two large cancer centers in Western Canada. A self-administered survey was completed in paper or online format. Participants were asked about information considered most important, sources of information used during recovery, and sources considered most helpful. Participants wanted information on signs and symptoms of recurrence, cure rates, post-treatment rehabilitation, treatment and recovery time frames, and financial assistance. They identified healthcare providers as the most frequently used and helpful source of information, but also reported that the Internet was useful and that an online information resource would be helpful during recovery. Nurses can provide more personalized information for survivors of HNC by contributing to the development of reliable Internet-based resources. The developers of these resources could also consider creating ways to directly link healthcare providers and survivors of HNC who are experiencing problems stemming from diagnosis and treatment.

Potential for and timing of recovery in children with dilated cardiomyopathy

ObjectiveUnderstanding the clinical course and time-frame for recovery is helpful to guide management and counselling following a diagnosis of Dilated Cardiomyopathy (DCM). We aimed to document outcomes and time to recovery for a cohort of patients with a dilated cardiomyopathy phenotype. MethodsAn observational cohort methodology was used to collect retrospective data from the departmental database for those identified with DCM. Data relating to mode of presentation, echocardiographic parameters, clinical management and outcome were collated and analysed. Predictors and time-scale for recovery were investigated and reported. Results209 new referrals were included within the time frame. 82 children median age 1.0years (IQR 3.4) required intensive care (ICU) and their survival without death or transplant was 51% to one year and 45% to five years. 127 children presented to the pediatric heart failure clinic. Excluding 58 with neuromuscular disease, median age was 4.1years (IQR 11.3) & survival without death or transplant 85% to 1year and 50% to 5years. NT-proBNP normalized in survivors before echocardiographic parameters. Predictors of recovery included younger age, female sex and smaller left ventricular end diastolic Z score on echocardiogram at presentation. ConclusionTransplant-free survival to one year is significantly better for patients presenting to clinic, but longer-term survival is better amongst those presenting to ICU due to a late attrition in those with less severe heart failure at presentation. Falling NT-proBNP is the earliest marker of recovery. Recovery of cardiac function remains possible up to three years from presentation.

Temperature affects lag period and growth of bacteria in soil according to a Ratkowsky (square root) model after a drying/rewetting episode

Temperature does not only affect bacterial growth in soil under stable conditions, but will also affect the time frame of recovery of growth after a perturbation, like a drying/rewetting event. To properly predict growth and activity of microorganisms during and after disturbances, environmental effects on possible lag periods, as well as on resulting growth and activity, have to be considered. We studied the temperature sensitivity of the lag period (λ) and the exponential growth of bacteria (μ) after rewetting an air-dried soil showing a type 2 response sensu Meisner et al. (2017). Varying the temperature between 0 and 30 °C did not affect the response type after drying/rewetting, but lower temperatures increased the length of λ and the time to recover bacterial growth to that in the moist control soil. At 25 and 30 °C, λ was around 12 h, increasing to almost 200 h at 0 °C. √(1/λ) was linearly related to temperature between 0 and 25 °C, following the inverse Ratkowsky (square root) model, with a calculated Tmin of -10.2 °C. This is similar to the Tmin of -8.7 °C calculated for bacterial growth using the Ratkowsky model, suggesting that both bacterial growth and length of λ after rewetting have the same temperature sensitivity. This would then result in μ x λ = Constant, in the temperature interval 0–25 °C. Furthermore, a similarity of temperature sensitivity of μ and λ would allow prediction of the temperature sensitivity of λ in different climate zones, as well as effects of increasing global temperatures, using Tmin estimated from growth.

Assessing functional recovery in the first six months after acute ischemic stroke: a prospective, observational study.

Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established. This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery. Prospective observational study. Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period. A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old. Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS). Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS. Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program. This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.

Clinical Outcome Measures and Return-to-Sport Timing in Adolescent Athletes After Anterior Cruciate Ligament Reconstruction.

Multiple factors are likely associated with an adolescent athlete's ability to return to play after anterior cruciate ligament (ACL) reconstruction (ACLR). To investigate the relationship between self-reported and functional outcome measures on return-to-play timing in an adolescent population, in athletes who returned and those who did not return to sport, and to identify a cutoff value for isometric quadriceps strength that could serve as a clinical target for maximizing the odds of returning to play after ACLR. Cross-sectional study. Outpatient clinic. Adolescent athletes who underwent ACLR and completed clinical measures at their 3- and 6-month follow-up appointments were included. Clinical measures included functional outcomes of isometric and isokinetic strength tests and the Anterior Cruciate Ligament Return to Sport After Injury scale and the pediatric version of the International Knee Documentation Committee subjective form. Physician clearance dates for return to play were obtained from patient records. Higher strength measures were associated with better scores on the Anterior Cruciate Ligament Return to Sport After Injury and the pediatric version of the International Knee Documentation Committee instruments at each follow-up. Differences were found in isometric extension strength ( P = .001) and isokinetic extension strength at 180°/s ( P = .03) and 300°/s ( P = .002) between patients who returned to sports and those who did not. A 6-month isometric extension deficit (mean Limb Symmetry Index = 85.48 ± 23.15) displayed high accuracy (area under the curve = 0.82, 95% confidence interval = 0.68, 0.95) for identifying patients who returned to play after ACLR. Higher strength measures at both 3 and 6 months after ACLR were associated with greater self-reported knee function and greater readiness to return to functional activities at 6 months and ultimately earlier return to sport in adolescent athletes. These results provide evidence that self-reported outcome scores should be used as an additional screening tool in conjunction with quadriceps strength testing to help provide realistic recovery timeframes for adolescent patients.

Timing of surgery in traumatic spinal cord injury: a national, multidisciplinary survey

PurposeThe optimal surgical timeframe for neurological recovery in traumatic spinal cord injury (tSCI) still remains unknown. Recent guidelines have recommended performing surgery within 24 h for all patients with tSCI regardless of initial neurological deficit. It remains unclear whether patients with complete, incomplete tSCI, or traumatic central cord injury (TCCI) will experience the same degree of improvement after urgent surgical intervention. We investigated if the severity of initial neurological injury influenced surgeons on their decision-making of surgical timing in tSCI.MethodsWith a web-based survey, we investigated the current opinion in The Netherlands on timing of surgical decompression and stabilization, depending on the initial degree of neurological injury.ResultsSurgeons prefer to perform more urgent surgery for incomplete tSCI compared to complete tSCI. In addition, 43% of patients with complete tSCI are not preferably operated within the recommended 24 h. Even though TCCI is the most common form of incomplete tSCI, these patients are preferably managed less urgently than patients with other types of incomplete tSCI.ConclusionThe severity of initial neurological injury seems to play an important role in the urgency of surgical timing for tSCI. A substantial number of patients with complete tSCI are not preferably treated within the recommended surgical timeframe, while patients with incomplete tSCI are preferably operated far more urgent than recommended in the current guidelines.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.