Differences in treatment strategies in the management of acute appendicitis in a county hospital in Guatemala and an academic teaching institution in the United States.

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Background Patellofemoral pain is highly prevalent across the lifespan, and a significant proportion of people report unfavourable outcomes years after diagnosis. Previous research has implicated patellofemoral joint loading during gait in patellofemoral pain and its sequelae, patellofemoral osteoarthritis. Biomechanical foot-based interventions (e.g., footwear, insoles, orthotics, taping or bracing) can alter patellofemoral joint loads by reducing motions at the foot that increase compression between the patella and underlying femur via coupling mechanisms, making them a promising treatment option. This systematic review will summarise the evidence about the effect of biomechanical foot-based interventions on patellofemoral joint loads during gait in adults with and without patellofemoral pain and osteoarthritis. Methods MEDLINE (Ovid), the Cumulative Index to Nursing and Allied Health Literature CINAHL, The Cochrane Central Register of Controlled Trials (CENTRAL), SPORTdiscus (EBSCO) and Embase (Ovid) will be searched. Our search strategy will include terms related to ‘patellofemoral joint’, ‘loads’ and ‘biomechanical foot-based interventions’. We will include studies published in the English language that assess the effect of biomechanical foot-based interventions on patellofemoral joint loads, quantified by patellofemoral joint pressure, patellofemoral joint reaction force and/or knee flexion moment. Two reviewers will independently screen titles and abstracts, complete full-text reviews, and extract data from included studies. Two reviewers will assess study quality using the Revised Cochrane Risk of Bias (RoB 2) tool or the Cochrane Risk Of Bias In Non-Randomized Studies – of Interventions (ROBINS-I) tool. We will provide a synthesis of the included studies’ characteristics and results. If three or more studies are sufficiently similar in population and intervention, we will pool the data to conduct a meta-analysis and report findings as standardised mean differences with 95% confidence intervals. If a meta-analysis cannot be performed, we will conduct a narrative synthesis of the results and produce forest plots for individual studies. Discussion This protocol outlines the methods of a systematic review that will determine the effect of biomechanical foot-based interventions on patellofemoral joint loads. Our findings will inform clinical practice by identifying biomechanical foot-based interventions that reduce or increase patellofemoral joint loads, which may aid the treatment of adults with patellofemoral pain and osteoarthritis. Trial registration Registered with PROSPERO on the 4th of May 2022 (CRD42022315207).

joint injury such as anterior cruciate ligament (ACL) injury. Therefore, the purpose of this study was to determine the association between physical activity levels and biomechanical knee joint loading with articular cartilage T2 relaxation times in young, uninjured individuals. We hypothesized that a greater number of steps per day, total minutes of vigorous intensity physical activity, and larger measures of knee joint loading will be associated with lower T2 relaxation times. Methods: Twelve healthy individuals without prior knee injury (age 22.9±3.3, body mass index (BMI) 22.0±3.1, 41.7% female) completed quantitative MRI (3-Tesla Siemens), physical activity, and biomechanical gait testing. T2 relaxation times at each pixel were computed from multi-echo MRI data using custom computer programs written in Interactive Data Language (IDL; Harris Geospatial Solutions Inc, Broomfield, CO, USA). Sixteen regions of interest in the tibial and femoral articular cartilage were manually segmented using ITK-SNAP (free, open-source software) to identify T2 relaxation times in weightbearing and non-weightbearing regions. T2 relaxation was analyzed within a single, randomly chosen knee of each participant. Physical activity data were collected using a 3-axis Actigraph accelerometer (wGT3X-BT; Actigraph Corporation, Pensacola, FL) that was worn consecutively for 1 week during all waking hours (except when in water). Variables of interest were steps per day and daily minutes of sedentary, light, moderate, and vigorous intensity exercise. Biomechanical data were collected while walking at self-selected speed using a 12-camera motion capture system (Qualisys AB, Sweden) with 2 embedded force plates (Bertec Corporation, Columbus, OH). Peak knee adduction and flexion moment of stance phase was calculated using custom processing developed within Visual 3D software (C-Motion, Germantown, MD). Subject weight was also calculated from force plate data during static standing. Separate univariate linear regression models were used to compare independent variables of steps per day, total daily minutes of light, moderate, and vigorous intensity physical activity, biomechanical variables (peak vertical ground reaction force, knee flexion moment, knee adduction moment during first 50% of stance phase of gait), and subject weight with the dependent variable of T2 relaxation time in each region of interest in the articular cartilage. A p-value less than 0.05 was considered statistically significant. Results: Figure 1 depicts all statistically significant correlations between weight, measures of physical activity, and biomechanical variables with T2 relaxation values. Subject weight was correlated with 8 articular cartilage regions of interest (r¼0.60-0.87). Steps per day was correlated with 2 regions of interest (r¼0.61-0.66). Minutes of light intensity physical activity was correlated with 1 region of interest (r¼0.74), moderate intensity physical activity was correlated with 5 regions of interest (r¼0.58-0.74), and vigorous intensity physica...

Objective There is little consistency between commercial grade footwear brands for determining shoe sizing, and no universally accepted descriptors of common types or features of footwear. The primary aim of this research was to develop a footwear taxonomy about the agreed types of footwear commonly worn by children under the age of six. Secondary aims were to gain consensus of the common footwear features, when different types of footwear would be commonly worn, common terms for key footwear parts, and how movement at some of these footwear parts should be described. Materials and methods Opinions were collected through a three-round modified Delphi international online survey from parents, health professionals, researchers, and footwear industry professionals. The first survey displayed generic pictures about different footwear types and asked participants to provide a grouping term, when the footwear would be worn (for what type of activity) and any grouping features. The second and third rounds presented consensus and gathered agreement on statements. Results There were 121 participants who provided detailed feedback to open-ended questions. The final round resulted in consensus and agreement on the names of 14 different footwear types, when they are commonly worn and their common features. Participants also reached consensus and agreement on the terms heel counter to describe the back part of footwear and fixtures as the collective term for features allowing footwear adjustability and fastening. They also agreed on terms to quantify the flexibility at footwear sole (bend or twist) or the heel counter. Conclusion This first taxonomy of children’s footwear represents consensus amongst different stakeholders and is an important step in promoting consistency within footwear research. One shoe does not fit all purposes, and the recommendations from this work help to inform the next steps towards ensuring greater transparency and commonality with footwear recommendations.