Background: Data from the National Collegiate Athletic Associ-ation (NCAA) Injury Surveillance Program (ISP) has indicated that ankle injuries are the most common injuries among NCAA soccer players. Objective:To review 10 years of NCAA-ISP data for soccer players’ ankle injuries to understand how the time period (2004-2005 through 2008-2009 versus 2009-2010 through 2013-2014), anatomical structure injured, and sex of the athlete affected the injury rate, mechanism, and prognoses. Design:Descriptive epidemiology study. Setting: Online injury surveillance. Main Outcome Measure(s): The NCAA-ISP was queriedfor men’s and women’s soccer ankle data from 2004 to 2014. Ankle injury rates were calculated on the basis of injuries per 1000 athlete-exposures. Rate ratios (RRs) were used to compare injury rates. Injury proportion ratios (IPRs) were used to compare injury characteristics. Results: When compared with the 2004-2005 through 2008-2009 seasons, the 2009-2010 through 2013-2014 seasons showed a similar rate of injuries (RR¼0.94, 95% confidence interval [CI]¼0.85, 1.04) but fewer days missed (P,.001) and fewer recurrent injuries (IPR¼0.55, 95% CI¼0.41,0.74). The 4 most common ankle injuries, which accounted for 95% of ankle injuries, were lateral ligament complex tears(65.67%), tibiofibular ligament (high ankle) sprains (10.3%), contusions (10.1%), and medial (deltoid) ligament tears (9.77%). Of these injuries, high ankle sprains were most likely to cause athletes to miss 30þdays (IPR¼1.9, 95% CI¼1.24, 2.90). Men and women had similar injury rates (RR¼1.02, 95% CI¼0.94, 1.11). Men had more contact injuries (IPR¼1.28, 95% CI¼1.16, 1.41) and contusion injuries (IPR¼1.34, CI¼1.03, 1.73) but fewer noncontact injuries (IPR¼0.86, 95% CI¼0.78, 0.95) and lateral ligamentous complex injuries (IPR¼0.92, 95% CI¼0.86, 0.98). Conclusions: Although the rate of ankle injuries did not change between the 2004-2005 through 2008-2009 seasons and the 2009-2010 through 2013-2014 seasons, the prognoses improved. Among the 4 most common ankle injuries, high anklesprains resulted in the worst prognosis. Overall, male and female NCAA soccer players injured their ankles at similar rates; however, men were more likely to sustain contact injuries.

OBJECTIVE: We describe and quantitatively assess minimally invasive keyhole retrosigmoid approaches targeted to the upper, middle, and lower cranial nerve (CN) complexes of the cerebellopontine angle (CPA). METHODS: Anatomic dissections were performed on 10 sides of 5 fixed, silicone-injected cadaver heads. Surgical views through various trajectories were assessed in endoscopic videos and 3-dimensional (3D) interactive virtual reality microscope views. Surgical freedom and angles of attack to the proximal and distal areas of CN complexes of the CPA were compared among upper and lower keyholes and conventional retrosigmoid craniotomy using neuronavigation. RESULTS: Compared with keyholes, the conventional approach had superior surgical freedom to most areas except for the distal CN V, the root of CN VII, and the root of CN IX, where differences were not significant. The conventional retrosigmoid approach provided a larger horizontal angle of attack than either the upper or lower keyholes for all selected areas; however, the vertical angles of attack were not different. Splitting the petrosal fissure resulted in a significant increase in the vertical angle of attack to the root zones of CNs V and VII but not to the distal areas of these nerves or CN IX. Illustrative cases of endoscope-assisted keyhole retrosigmoid approaches for the treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia are presented. - CONCLUSIONS: Targeted keyhole retrosigmoid approaches require detailed understanding of the 3D anatomy of the CPA to create appropriate locations of corridors, including skin incisions and keyholes. Endoscope assistance complements the standard microsurgical technique by maximizing the visualization and identification of the delicate neurovascular structures.

Background: The most vulnerable populations for human subjects research are those living in the most resource poor settings. As technology has progressed to support convenient long-distance travel, international communication, and data sharing via the internet, international research has become a more manageable task. While some dismiss the ethical guidelines for human subjects research as necessary only for the most barbaric researchers, history demonstrates the need for ethical guidelines as well as oversight of adherence to such guidelines. Methods: Forty-eight countries designated as least developed countries (LDCs) were identified and selected for analysis. An internet search was utilized to identify research guidelines for LDCs available online or primary research studies conducted in such countries to determine to what extent authors noted ethical considerations. Council for the International Organizations of Medical Sciences (CIOMS) guidelines were distilled into keywords by the authors and compared to guidelines for LDCs. Frequencies and percentages of comparison to CIOMS guidelines were tabulated across the 48 LDCs. Findings: Of the 48 LDCs identified, 22 did not have published research guidelines or mention of a Research Ethics Committee (REC). An additional 10 countries had documentation of some sort of REC, 3 countries had at least one ethical guideline in addition to a REC, and 13 countries had no mention of a REC but did have established ethical guidelines available online. Overall, the average number of guidelines per country was 5 with a SD of 4.11. Conclusion: Over half of countries had online documentation of limited ethics oversight for research, indicating a clear lack of thoroughness in the available guidelines as compared to the international gold standard guidelines from CIOMS. The majority of primary research articles reviewed showed no mention of ethical considerations despite some of the articles using chart review or engaging in patient care interventions. Based on the findings of this study, authors recommend the adoption of existing ethical guidelines by countries still lacking individualized guidelines, as well as a movement toward journals requiring documentation of ethical approval or ethical considerations as a requirement prior to approving articles for publication.

Background: Chronic inadequate sleep is associated with increased risk for cardiovascular disease, hypertension, obesity, immunosuppression and overall mortality. There is an abundance of research on the effects of exercise on sleep, but there is currently no data on the impact of sedentary interventions in the workplace on acute and long-term sleep quality/quantity. Purpose: The purpose of this study is to determine if increased standing and/or light-intensity physical activity (LPA) at work will improve sleep quality and duration in sedentary office-workers with mild to moderate sleep complaints. Methods: For this group randomized trial, 51 participants with mild-to-moderate sleep complaints were selected from the Stand and Move at Work Trial. Participants were randomized into two groups: MOVE+ (a multilevel individual, social, environmental, and organizational intervention targeting increases in LPA in the workplace) and STAND+ (MOVE+ intervention with the addition of the installation of sit-stand workstations). Sedentary behavior/LPA and sleep were measured objectively at baseline, 3 and 12 months with the activPAL3 micro accelerometer (PAL Technologies, Glasgow, United Kingdom) and the GeneActiv (GeneActiv, Activinsight, Wimbolton, UK) wrist-worn actigraphy sensor. Results: The sit-stand workstation intervention was effective, with the STAND+ participants sitting on average 70 minutes/day less than the MOVE+ participants at 12 months (p<0.05). There were no statistically significant differences between intervention groups in objectively or subjectively measured time in bed, total sleep time, sleep onset latency, wake after sleep onset, or sleep efficiency at the 3 or 12-month timepoints. On the individual level, adjusting for group assignment, there was no correlation between change in sedentary behavior and sleep measures, objective or subjective. Conclusion: This study found no correlation between a decrease in sedentary behavior at work and changes in objective or subjective measures of sleep. Limitations of this study include underpowering due to small sample size, potential significance of difference in baseline demographics and sleep/sedentary behavior between in groups, and the nature of the intervention being low-dose.

Methods: The quality of NRs for endoscopic sinus surgery (ESS) was evaluated by studying 90 NRs for ESS written between 2014-2017. Thirty-three elements that the attending surgeon regards as “critical” variables, or quality indicators (QIs), that should be documented in the NR, were studied to evaluate quality. “NR efficiency” (average percent of QIs dictated / total word count) was studied. Subgroup analysis by the level of training was additionally performed. Results: Surgical indications, procedural steps and immediate postoperative findings were accurately documented in 71%, 84%, and 82% of patients, respectively. The attending surgeon had the highest quality (proportion of included key elements) of NR (89% +/- 6.2%) followed by junior residents (87% +/- 5.7%) and then senior residents (80% +/- 14%) [p=0.008]. The attending surgeon also demonstrated the highest degree of “NR efficiency”, followed by senior and then junior residents (p<0.0001). Conclusions: The quality of NRs was found to be high overall, but not “perfect” for either the attending or trainee surgeon. NR efficiency amongst residents was expectedly lower than the attending surgeon. We propose that a synoptic reporting system that ensures inclusion of key elements may be helpful in training residents (and attendings) in creating comprehensive and efficient NRs.