Background: A major goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is restoring quadriceps muscle strength. Unfortunately, current rehabilitation paradigms fall short of this goal, such that substantial quadriceps muscle strength deficits can limit return to play and increase the risk of recurrent injuries. Blood flow restriction training (BFRT) involves the obstruction of venous return to working muscles during exercise and may lead to better recovery of quadriceps muscle strength after ACLR. Purpose: To examine the efficacy of BFRT with high-intensity exercise on the recovery of quadriceps muscle function in patients undergoing ACLR. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 34 patients (19 female, 15 male; mean age, 16.5 ± 2.7 years; mean height, 169.0 ± 19.7 cm; mean weight, 73.2 ± 17.7 kg) scheduled to undergo ACLR were randomly assigned to 1 of 4 groups: concentric (n = 8), eccentric (n = 8), concentric with BFRT (n = 9), and eccentric with BFRT (n = 9). The exercise component of the intervention consisted of patients performing a single-leg isokinetic leg press, at an intensity of 70% of the patients’ 1-repetition maximum during either the concentric or eccentric action, for 4 sets of 10 repetitions 2 times per week for 8 weeks beginning at 10 weeks postoperatively. Patients randomized to the BFRT groups performed the leg-press exercise with a cuff applied to the thigh, set to a limb occlusion pressure of 80%. Isometric and isokinetic (60 deg/s) quadriceps peak torque, quadriceps muscle activation, and rectus femoris muscle volume were assessed before ACLR, after BFRT, and at the time that patients returned to activity and were converted to the change in values from baseline for analysis. Also, 1-way analyses of covariance were used to compare the change in values for each dependent variable between groups after BFRT and at return to activity ( P ≤ .05). Results: No significant differences were found between groups for any outcome measures at either time point ( P > .05). Conclusion: An 8-week BFRT plus high-intensity exercise intervention did not significantly improve quadriceps muscle strength, activation, or volume. On the basis of our findings, the use of BFRT in conjunction with high-intensity resistance exercise in patients undergoing ACLR to improve quadriceps muscle function may not be warranted. Registration: NCT03141801 ( ClinicalTrials.gov identifier)

Objective To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. Design A multicentre, open, two arm randomised controlled trial. Setting University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. Main outcome measures Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. Results There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI -8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients' preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference -3.15% (-16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). Conclusions Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts. Trial registration Current Controlled Trials ISRCTN18994246, National Research Register N0484189151. INTRODUCTIONVerrucae (or plantar warts) are extremely common, being experienced by most people at some time during their lives. Studies that have examined the prevalence of warts or verrucae have produced a wide range of estimates-from 0.84% in the US, 1 3.3% to 4.7% in the UK, 2 3 and up to 24% in 16-18 year olds in Australia.

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Purpose The delivery of high-quality service is critical for the success, or otherwise, of many retailers. However, despite calls to examine the efficacy of the dimensions of quality in different service contexts, it is still largely unknown how dimensions such as empathy and responsiveness interact to determine consumers’ perceptions of service quality. Recent research also suggests that loyalty strategies may not be equally effective across all services contexts. The purpose of this paper is, therefore, to contribute to the service quality literature by providing a better understanding of how marketing strategy is effectively operationalised into improved services and consumer loyalty in physical stores. Design/methodology/approach Consumers from ten stores of one pharmacy retailer were surveyed. The retailer provides high-service levels at present and is examining ways of how to deliver a better quality service to its prescription and non-prescription account holding consumers. By examining consumer loyalties in high-services contexts in pharmacy retailing, the authors also propose how retailers in other sectors can learn to operationalise services quality into increased loyalties. Findings The findings of this research demonstrate that empathy, rather than responsiveness, is more important in a high service delivery context such as pharmacy retailing. Non-prescription account holding and non-store loyal consumers also do not perceive that high service responsiveness is compromised by offering of a highly empathetic (and possibly more time consuming) service by the retailer. Originality/value These findings present specific implications for retailers in the development of consumer loyalty in a high-service context. Moreover, the findings of this research also illustrate how retailers can more effectively target their investments in service design to enhance service quality and consumer loyalty.

Context:Patients who undergo anterior cruciate ligament reconstruction (ACLR) present with strength and biomechanical deficits at return to activity (RTA). Deficits in strength and biomechanical symmetry impair function during activity and may predispose patients to subsequent injury.Objective: To compare strength and biomechanical function in patients with ACLR at RTA and more than 12 months post-ACLR.Design: Descriptive laboratory study. Intervention(s): Strength was measured during knee extension and evaluated by the isometric and isokinetic quadriceps index. Biomechanical function was evaluated using symmetry values for sagittal-plane knee-joint rotations, changes in sagittal-plane knee-joint rotation, knee-extension moments, and changes in knee-extension moment that were recorded during a single-legged forward hop.Main Outcome Measure(s): Self-reported function was measured using the International Knee Documentation Committee Subjective Knee Evaluation Form. Participants were assessed at RTA (212.25 6 28.11 days) and more than 12 months post-ACLR (556.25 6 230.89 days).Results: At RTA, strength and biomechanical values were less than 80% symmetric. We observed improvements from RTA to more than 12 months post-ACLR for the isometric quadriceps index (F 1,18 ¼ 29.22, P , .001), isokinetic quadriceps index (F 1,18 ¼ 10.88, P ¼ .004), sagittal-plane knee-joint rotations (F 1,19 ¼ 9.58, P ¼ .006), change in sagittal-plane knee-joint rotations (F 1,19 ¼ 7.83, P ¼ .01), knee-extension moments (F 1,19 ¼ 5.73, P ¼ .03), change in knee-extension moments (F 1,19 ¼ 21.10, P , .001), and self-perceived function (F 1,19 ¼ 11.50, P ¼ .003). Of the 7 variables that showed improvement at more than 12 months post-ACLR, only 3 met the recommended criteria (!90%).Conclusions: Patients with ACLR showed asymmetry in strength and biomechanics at RTA. These asymmetries, along with self-perceived function, improved over time. However, despite improvements in strength and biomechanics at RTA, asymmetries of more than 10% were still present more than 12 months post-ACLR.