Faculty Bibliography

Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.

Active transport of substrates across cytoplasmic membranes is of great physiological, medical and pharmaceutical importance. The glycerol-3-phosphate (G3P) transporter (GlpT) of the E. coli inner membrane is a secondary active antiporter from the ubiquitous major facilitator superfamily that couples the import of G3P to the efflux of inorganic phosphate (P(i)) down its concentration gradient. Integrating information from a novel combination of structural, molecular dynamics simulations and biochemical studies, we identify the residues involved directly in binding of substrate to the inward-facing conformation of GlpT, thus defining the structural basis for the substrate-specificity of this transporter. The substrate binding mechanism involves protonation of a histidine residue at the binding site. Furthermore, our data suggest that the formation and breaking of inter- and intradomain salt bridges control the conformational change of the transporter that accompanies substrate translocation across the membrane. The mechanism we propose may be a paradigm for organophosphate:phosphate antiporters

Claims championing exotic substances that produce healing or ergogenic powers have been around for centuries. The competitive, peer-pressured environment enveloping today's athletes and adolescence makes these groups particularly susceptible to the uproar surrounding the current ergogenic aid market. Presently, it seems that rumor and anecdotal information overwhelms the available scientific data. While there is evidence that some touted ergogenic aids do indeed enhance performance, there are many unanswered questions about product safety, efficacy, and long-term consequences. A working knowledge of specific ergogenic aids is essential for the treating physician in order to best advise patients and athletes as to the possible benefits and risks of any substance they may be using

This study performed the first in vitro histological analysis of the effects of bipolar thermal energy on human meniscal tissue. Sixteen fresh human menisci were mounted on a cutting block and placed in a water bath simulating an arthroscopic environment. Each specimen was divided into four sections and randomized to one of four treatment options: 1. thermal ablation with a bipolar multielectrode 3 mm Covac wand (power 3 setting); 2. thermal ablation with a bipolar multielectrode 3 mm Covac wand (power setting 7); 3. resection with a scalpel blade; and 4. resection with a motorized 4.5 full-radius resector. Six micron sections were cut and stained with Hematoxylin and Eosin and Masson's trichrome stain. Menisci were evaluated for the contour of the cut edge: straight, jagged, frayed, or combined. The zone of thermal necrosis and zone of thermal alteration were determined by examining the differential staining of the connective tissue and measuring the affected area. Menisci treated with the bipolar thermal probe were noted to have a smoother contoured edge in comparison to motorized cutters. The zone of thermal penetration for the Arthrocare power setting 3 averaged 0.18 mm (range: 0.09 to 0.20; SD 0.04) and for Arthrocare power setting 7 averaged 0.33 mm (range: 0.26 to 0.36; SD 0.03). The difference in thermal penetration between Arthrocare power settings 3 and 7 was 0.15 mm. This was statistically significant at p < 0.0001 (95% CI: 0.11 to 0.19 mm). The zone of thermal penetration was non-existent for the shaver and scalpel groups. This study provides the first histological description of the effects of bipolar radiofrequency energy on meniscal tissue. It demonstrates that there is intra-substance thermal penetration and alteration of the meniscal tissue. Its clinical significance is unclear and further in vivo studies are needed to address its clinical applicability

This investigation compared the stability of 2 methods of fixation for acromioclavicular (AC) joint separations. A complete AC joint separation was simulated in 6 matched pairs of fresh-frozen human cadaveric shoulders. One specimen from each pair was repaired with two No. 5 nonabsorbable braided sutures passed around the base of the coracoid and the other with 2 suture anchors preloaded with the same suture material placed into the base of the coracoid process. The specimens were cyclically loaded for 10(4) cycles to simulate our early postoperative rehabilitation protocol for coracoclavicular repairs. Before cycling, the repairs had a mean superior laxity of 1.68 +/- 0.44 mm for the sutures alone and 1.23 +/- 0.31 mm for the suture anchors. After 10(4) cycles, the laxity was 1.32 +/- 0.59 mm and 1.33 +/- 0.94 mm, respectively. These differences were not statistically significant (P =.2). This study demonstrated that similar stability can be achieved for coracoclavicular fixation with suture anchors or with sutures placed around the base of the coracoid for the treatment of AC joint separations. The clinical relevance includes the following: (1) the potentially diminished risk of neurovascular injury with the use of suture anchors compared with the passage of sutures around the base of the coracoid and (2) the potentially reduced surgical time associated with the use of suture anchors

The lack of literature on residency selection criteria used by orthopaedic program directors has left medical students in the position of relying on rumor and anecdotal information as to what program directors value most highly when sorting through large candidate pools. The purpose of this study was to compare the perspectives on resident selection criteria solicited from orthopaedic program directors and residency applicants. A power analysis was done to determine adequate sample size. A 26-item questionnaire was mailed to 98 residency applicants who interviewed at our program and 156 orthopaedic program directors. The program directors were also asked to elaborate on those factors that were most important in their selection process. A two-tailed Student's t-test was employed to compare the two groups. Significance was set at p < 0.05. Statistically significant differences between applicant and program director ratings were found in 12 of the 26 questionnaire items. Applicants (n = 91) ranked the following criteria as most important: a letter of recommendation from an orthopaedic surgeon (8.6 on a scale of 1 to 10, 10 being most important), USMLE I score (7.7), and rank in medical school (7.6). The most important criteria for the directors (n = 109) were: the applicant performed a rotation at the director's program (7.9), USMLE I score (7.8), and rank in medical school (7.8). This study provides the most comprehensive empirical data to date as to the factors which orthopaedic program directors consider most important during the residency selection process. To our knowledge, this is the first study in the orthopaedic literature that compares the program directors 'and residency applicants' views on resident selection criteria. Significant differences were found between applicant and program director views on resident selection criteria

Intra-articular lipoma is an exceedingly rare diagnosis. There have been less than 15 documented cases of an intra-articular lipoma of the knee joint. This report presents the first description of an intra-articular knee lipoma treated entirely by arthroscopic methods. Preoperative history, examination, and imaging studies are reviewed. Intraoperative findings, treatment, and postoperative evaluation are discussed as well. Symptomatic intra-articular lipoma of the knee joint can be successfully treated by arthroscopic resection. Differentiating intra-articular lipoma from lipoma arborescens, a similar but more common condition, is important with regards to optimal treatment

Distal biceps tendon rupture is a relatively rare injury most commonly seen in the dominant extremity of men between 40 and 60 years of age. It occurs when an eccentric extension force is applied to a contracting biceps muscle. The hallmark finding is a palpable defect in the distal biceps, which is accentuated by elbow flexion. Radiographic evaluation is usually not necessary. Acute surgical repair is advocated for optimal return of function by either a one-incision or a modified two-incision muscle-splitting technique. The arm is protected for 6 to 8 eight weeks after surgery. Unrestricted range of motion and gentle strengthening may begin after the 6 - 8 week protection period. Return to unrestricted activity is usually allowed by 5 months after surgery