| 1. |
- Aga, Cathrine, et al.
(författare)
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Risk of Revision Was Not Reduced by a Double-bundle ACL Reconstruction Technique: Results From the Scandinavian Registers
- 2017
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Ingår i: Clinical Orthopaedics and Related Research. - : Ovid Technologies (Wolters Kluwer Health). - 0009-921X .- 1528-1132. ; 475:10, s. 2503-2512
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Tidskriftsartikel (refereegranskat)abstract
- © 2017, The Association of Bone and Joint Surgeons®. Background: Double-bundle anterior cruciate ligament (ACL) reconstruction has demonstrated improved biomechanical properties and moderately better objective outcomes compared with single-bundle reconstructions. This could make an impact on the rerupture rate and reduce the risk of revisions in patients undergoing double-bundle ACL reconstruction compared with patients reconstructed with a traditional single-bundle technique. The National Knee Ligament Registers in Scandinavia provide information that can be used to evaluate the revision outcome after ACL reconstructions. Questions/purposes: The purposes of the study were (1) to compare the risk of revision between double-bundle and single-bundle reconstructions, reconstructed with autologous hamstring tendon grafts; (2) to compare the risk of revision between double-bundle hamstring tendon and single-bundle bone-patellar tendon-bone autografts; and (3) to compare the hazard ratios for the same two research questions after Cox regression analysis was performed. Methods: Data collection of primary ACL reconstructions from the National Knee Ligament Registers in Denmark, Norway, and Sweden from July 1, 2005, to December 31, 2014, was retrospectively analyzed. A total of 60,775 patients were included in the study; 994 patients were reconstructed with double-bundle hamstring tendon grafts, 51,991 with single-bundle hamstring tendon grafts, and 7790 with single-bundle bone-patellar tendon-bone grafts. The double-bundle ACL-reconstructed patients were compared with the two other groups. The risk of revision for each research question was detected by the risk ratio, hazard ratio, and the corresponding 95% confidence intervals. Kaplan-Meier analysis was used to estimate survival at 1, 2, and 5 years for the three different groups. Furthermore, a Cox proportional hazard regression model was applied and the hazard ratios were adjusted for country, age, sex, meniscal or chondral injury, and utilized fixation devices on the femoral and tibial sides. Results: There were no differences in the crude risk of revision between the patients undergoing the double-bundle technique and the two other groups. A total of 3.7% patients were revised in the double-bundle group (37 of 994 patients) versus 3.8% in the single-bundle hamstring tendon group (1952 of 51,991; risk ratio, 1.01; 95% confidence interval (CI), 0.73–1.39; p=0.96), and 2.8% of the patients were revised in the bone-patellar tendon-bone group (219 of the 7790 bone-patellar tendon-bone patients; risk ratio, 0.76; 95% CI, 0.54–1.06; p=0.11). Cox regression analysis with adjustment for country, age, sex, menisci or cartilage injury, and utilized fixation device on the femoral and tibial sides, did not reveal any further difference in the risk of revision between the single-bundle hamstring tendon and double-bundle hamstring tendon groups (hazard ratio, 1.18; 95% CI, 0.85–1.62; p=0.33), but the adjusted hazard ratio showed a lower risk of revision in the single-bundle bone-patellar tendon-bone group compared with the double-bundle group (hazard ratio, 0.62; 95% CI, 0.43–0.90; p=0.01). Comparisons of the graft revision rates reported separately for each country revealed that double-bundle hamstring tendon reconstructions in Sweden had a lower hazard ratio compared with the single-bundle hamstring tendon reconstructions (hazard ratio, 1.00 versus 1.89; 95% CI, 1.09–3.29; p=0.02). Survival at 5 years after index surgery was 96.0% for the double-bundle group, 95.4% for the single-bundle hamstring tendon group, and 97.0% for the single-bundle bone-patellar tendon-bone group. Conclusions: Based on the data from all three national registers, the risk of revision was not influenced by the reconstruction technique in terms of using single- or double-bundle hamstring tendons, although national differences in survival existed. Using bone-patellar tendon-bone grafts lowered the risk of revision compared with double-bundle hamstring tendon grafts. These findings should be considered when deciding what reconstruction technique to use in ACL-deficient knees. Future studies identifying the reasons for graft rerupture in single- and double-bundle reconstructions would be of interest to understand the findings of the present study. Level of Evidence: Level III, therapeutic study.
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| 2. |
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| 3. |
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| 4. |
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| 5. |
- Bahr, Roald, et al.
(författare)
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International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS))
- 2020
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 54:7, s. 372-389
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Tidskriftsartikel (refereegranskat)abstract
- Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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| 6. |
- Chola, Lumbwe, et al.
(författare)
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Cost-Effectiveness of Peer Counselling for the Promotion of Exclusive Breastfeeding in Uganda.
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Community based breastfeeding promotion programmes have been shown to be effective in increasing breastfeeding prevalence. However, there is limited data on the cost-effectiveness of these programmes in sub-Saharan Africa. This paper evaluates the cost-effectiveness of a breastfeeding promotion intervention targeting mothers and their 0 to 6 month old children.METHODS: Data were obtained from a community randomized trial conducted in Uganda between 2006-2008, and supplemented with evidence from several studies in sub-Saharan Africa. In the trial, peer counselling was offered to women in intervention clusters. In the control and intervention clusters, women could access standard health facility breastfeeding promotion services (HFP). Thus, two methods of breastfeeding promotion were compared: community based peer counselling (in addition to HFP) and standard HFP alone. A Markov model was used to calculate incremental cost-effectiveness ratios between the two strategies. The model estimated changes in breastfeeding prevalence and disability adjusted life years. Costs were estimated from a provider perspective. Uncertainty around the results was characterized using one-way sensitivity analyses and a probabilistic sensitivity analysis.FINDINGS: Peer counselling more than doubled the breastfeeding prevalence as reported by mothers, but there was no observable impact on diarrhoea prevalence. Estimated incremental cost-effectiveness ratios were US$68 per month of exclusive or predominant breastfeeding and U$11,353 per disability adjusted life year (DALY) averted. The findings were robust to parameter variations in the sensitivity analyses.CONCLUSIONS: Our strategy to promote community based peer counselling is unlikely to be cost-effective in reducing diarrhoea prevalence and mortality in Uganda, because its cost per DALY averted far exceeds the commonly assumed willingness-to-pay threshold of three times Uganda's GDP per capita (US$1653). However, since the intervention significantly increases prevalence of exclusive or predominant breastfeeding, it could be adopted in Uganda if benefits other than reducing the occurrence of diarrhoea are believed to be important.
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| 7. |
- Chola, Lumbwe, et al.
(författare)
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Infant feeding survival and Markov transition probabilities among children under age 6 months in Uganda.
- 2013
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Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 177:5
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Tidskriftsartikel (refereegranskat)abstract
- Infant feeding studies are typically presented as single-event models, without considering the dynamic nature of feeding. We analyzed the determinants of infant feeding duration using both single- and multiple-event Cox regression models. The Cox model was compared with parametric survival models, which were used to estimate feeding-state transition probabilities. Data were taken from a community randomized trial promoting exclusive breastfeeding (EBF) in Uganda from 2005 to 2008. Peer counselors visited intervention mothers once antenatally and 4 times after birth. Results showed that children in the control group were more likely to be switched from exclusive breastfeeding (EBF)/predominant breastfeeding (PBF) to mixed feeding (MF)/replacement feeding (RF). Children in intervention clusters (hazard ratio = 0.33, 95% confidence interval: 0.26, 0.42) and rural areas (hazard ratio = 0.79, 95% confidence interval: 0.63, 0.99) had a lower risk of EBF/PBF cessation. Based on the Akaike Information Criterion, parametric models were better fitted than the Cox model. The analytical approach to assessing infant feeding duration used in this study takes into account transitions between feeding categories, allowing for multiple events. This will enhance understanding of infant feeding practices and give policy-makers a better picture of the versatility of infant feeding.
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| 8. |
- Diermeier, T., et al.
(författare)
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Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group
- 2021
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Ingår i: Journal of Isakos Joint Disorders & Orthopaedic Sports Medicine. - : Elsevier BV. - 2059-7754. ; 6:3, s. 129-137
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative veresus non-operative treatment of ACL injury reached consensus during the symposium. Nine statements achieved unanimous support; two reached strong consensus; one did not achieve consensus; and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical anterior cruciate ligament reconstruction (ACLR) is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability or when episodes of giving way occur, anatomical ACLR is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury. Level of evidence: V
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| 9. |
- Diermeier, Theresa, et al.
(författare)
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Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group
- 2020
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Ingår i: Orthopaedic Journal of Sports Medicine. - 2325-9671. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of ACL injuries, representing 18 countries, who were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the scientific organizing committee and session chairs for the 3 working groups. Panel participants reviewed preliminary statements before the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Ultimately, 80% agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus nonoperative treatment of ACL injury reached consensus during the symposium. Overall, 9 statements achieved unanimous support, 2 reached strong consensus, 1 did not achieve consensus, and 1 was removed because of redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended because of the high risk of secondary meniscal and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight-plane activities, nonoperative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and nonoperative treatment with patients after an ACL injury.
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| 10. |
- Doherty, Tanya, et al.
(författare)
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Early cessation of breastfeeding amongst women in South Africa : an area needing urgent attention to improve child health
- 2012
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 12, s. 105-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Breastfeeding is a critical component of interventions to reduce child mortality. Exclusive breastfeeding practice is extremely low in South Africa and there has been no improvement in this over the past ten years largely due to fears of HIV transmission. Early cessation of breastfeeding has been found to have negative effects on child morbidity and survival in several studies in Africa. This paper reports on determinants of early breastfeeding cessation among women in South Africa.Methods: This is a sub group analysis of a community-based cluster-randomized trial (PROMISE EBF) promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008 (ClinicalTrials.gov no: NCT00397150). Infant feeding recall of 22 food and fluid items was collected at 3, 6, 12 and 24 weeks postpartum. Women's experiences of breast health problems were also collected at the same time points. 999 women who ever breastfed were included in the analysis. Univariable and multivariable logistic regression analysis adjusting for site, arm and cluster, was performed to determine predictors of stopping breastfeeding by 12 weeks postpartum.Results: By 12 weeks postpartum, 20% of HIV-negative women and 40% of HIV-positive women had stopped all breastfeeding. About a third of women introduced other fluids, most commonly formula milk, within the first 3 days after birth. Antenatal intention not to breastfeed and being undecided about how to feed were most strongly associated with stopping breastfeeding by 12 weeks (Adjusted odds ratio, AOR 5.6, 95% CI 3.4 - 9.5 and AOR 4.1, 95% CI 1.6 - 10.8, respectively). Also important was self-reported breast health problems associated with a 3-fold risk of stopping breastfeeding (AOR 3.1, 95% CI 1.7 - 5.7) and the mother having her own income doubled the risk of stopping breastfeeding (AOR 1.9, 95% CI 1.3 - 2.8).Conclusion: Early cessation of breastfeeding is common amongst both HIV-negative and positive women in South Africa. There is an urgent need to improve antenatal breastfeeding counselling taking into account the challenges faced by working women as well as early postnatal lactation support to prevent breast health problems.
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| 11. |
- Ekas, Guri Ranum, et al.
(författare)
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Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury
- 2020
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 54:9, s. 520-
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Forskningsöversikt (refereegranskat)abstract
- Objective To investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction. Design Prognosis systematic review (PROSPERO registration number CRD42016036788). Methods We searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology. Results Of 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%-21% when follow-up was <2 years, 0%-29% when follow-up was 2 to 5 years, 5%-52% when follow-up was 5 to 10 years and 4%-31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low. Conclusion New meniscal tears occurred in 0%-52% of patients between 4 months and 20 years (mean 4.9 +/- 4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.
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| 12. |
- Ekas, Guri Ranum, et al.
(författare)
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New meniscal tears after ACL injury: what is the risk? A systematic review protocol
- 2018
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 52:6
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Forskningsöversikt (refereegranskat)abstract
- Background Secondary meniscal tears after ACL injuries increase the risk of knee osteoarthritis. The current literature on secondary meniscal injuries after ACL injury is not consistent and may have methodological shortcomings. This protocol describes the methods of a systematic review investigating the rate of secondary meniscal injuries in children and adults after treatment (operative or non-operative) for ACL injury. Methods We will search electronic databases (Embase, Ovid Medline, Cochrane, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, PEDro and Google Scholar) from database inception. Extracted data will include demographic data, methodology, intervention details and patient outcomes. Risk of bias will be assessed using the Newcastle Ottawa checklist for cohort studies. Article screening, eligibility assessment, risk of bias assessment and data extraction will be performed in duplicate by independent reviewers. A proportion meta-analysis will be performed if studies are homogeneous (I-2 amp;lt; 75%). If meta-analysis is precluded, data will be synthesised descriptively using best-evidence synthesis. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development and Evaluation working group methodology. Ethics and dissemination This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses, and was registered in the International Prospective Register of Systematic Reviews on 22 March 2016.
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| 13. |
- Engebretsen, Ingunn Marie S, et al.
(författare)
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Early infant feeding practices in three African countries : the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors.
- 2014
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Ingår i: International Breastfeeding Journal. - : Springer Science and Business Media LLC. - 1746-4358. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Immediate and exclusive initiation of breastfeeding after delivery has been associated with better neonatal survival and child health and are recommended by the WHO. We report its impact on early infant feeding practices from the PROMISE-EBF trial.METHODS: PROMISE-EBF was a cluster randomised behaviour change intervention trial of exclusive breastfeeding (EBF) promotion by peer counsellors in Burkina Faso, Uganda and South Africa implemented during 2006-2008 among 2579 mother-infant pairs. Counselling started in the last pregnancy trimester and mothers were offered at least five postnatal visits. Early infant feeding practices: use of prelacteal feeds (any foods or drinks other than breast milk given within the first 3 days), expressing and discarding colostrum, and timing of initiation of breastfeeding are presented by trial arm in each country. Prevalence ratios (PR) with 95% confidence intervals (95%CI) are given.RESULTS: The proportion of women who gave prelacteal feeds in the intervention and control arms were, respectively: 11% and 36%, PR 0.3 (95% CI 0.2, 0.6) in Burkina Faso, 13% and 44%, PR 0.3 (95% CI 0.2, 0.5) in Uganda and 30% and 33%, PR 0.9 (95% CI 0.6, 1.3) in South Africa. While the majority gave colostrum, the proportion of those who expressed and discarded it in the intervention and control arms were: 8% and 12%, PR 0.7 (95% CI 0.3, 1.6) in Burkina Faso, 3% and 10%, PR 0.3 (95% CI 0.1, 0.6) in Uganda and 17% and 16%, PR 1.1 (95% CI 0.6, 2.1) in South Africa. Only a minority in Burkina Faso (<4%) and roughly half in South Africa initiated breastfeeding within the first hour with no large or statistically significant differences between the trial arms, whilst in Uganda the proportion of early initiation of breastfeeding in the intervention and control arms were: 55% and 41%, PR 0.8 (95% CI 0.7, 0.9).CONCLUSIONS: The PROMISE-EBF trial showed that the intervention led to less prelacteal feeding in Burkina Faso and Uganda. More children received colostrum and started breastfeeding early in the intervention arm in Uganda. Late breastfeeding initiation continues to be a challenge. No clear behaviour change was seen in South Africa.TRIAL REGISTRATION: NCT00397150.
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| 14. |
- Engebretsen, Ingunn Marie Stadskleiv, et al.
(författare)
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Growth effects of exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa : the cluster-randomised PROMISE EBF trial
- 2014
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14, s. 633-
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Tidskriftsartikel (refereegranskat)abstract
- Background: In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities. Methods: A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-for-length (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < -2), stunting (LAZ < -2) and underweight (WAZ < -2) were calculated at each data collection point. Results: The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso -0.20 (95% CI -0.39 to -0.01) and in Uganda -0.23 (95% CI -0.43 to -0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95% CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95% CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different. Conclusions: There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms.
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| 15. |
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| 16. |
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| 17. |
- Engebretsen, Lars
(författare)
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Bipartite multigraphs with expander-like properties
- 2007
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Ingår i: Discrete Applied Mathematics. - : Elsevier BV. - 0166-218X .- 1872-6771. ; 155:13, s. 1667-1677
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Tidskriftsartikel (refereegranskat)abstract
- This note considers the following combinatorial question: "For which integers d and functions f(d) does there exist, for every large enough v, a bipartite d-regular multigraph on 2v nodes with node sets V and W having the following property: For every U that is a subset of either V or W, the cardinality of the set of neighbours of U is at least f(d)(vertical bar U vertical bar)?" Graphs with the above property seem to behave well also with respect to other, more complicated, expander-like properties. We provide results for d in (5,6,7,81 and give a description of a fairly general methodology for devising computer-assisted proofs for a wide class of mathematical claims using interval arithmetic.
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| 18. |
- Engebretsen, Lars, et al.
(författare)
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Harmonic broadcasting is bandwidth-optimal assuming constant bit rate
- 2006
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Ingår i: Networks. - : Wiley. - 0028-3045 .- 1097-0037. ; 47:3, s. 172-177
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Tidskriftsartikel (refereegranskat)abstract
- Harmonic broadcasting was introduced by Juhn and Tseng in 1997 as a way to reduce the bandwidth requirements required for video-on-demand broadcasting. In this article, we note that harmonic broadcasting is actually a special case of the priority encoded transmission scheme introduced by Albanese et al. in 1996, and prove-using an information theoretic argument-that it is impossible to achieve the design goals of harmonic broadcasting using a shorter encoding.
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| 19. |
- Engebretsen, Lars, et al.
(författare)
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Inapproximability results for equations over finite groups
- 2004
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Ingår i: Theoretical Computer Science. - 0304-3975 .- 1879-2294. ; 312:1, s. 17-45
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Tidskriftsartikel (refereegranskat)abstract
- An equation over a finite group G is an expression of form w(1)w(2). . .w(k) = 1(G), where each w(i) is a variable, an inverted variable, or a constant from G; such an equation is satisfiable if there is a setting of the variables to values in G so that the equality is realized. We study the problem of simultaneously satisfying a family of equations over a finite group G and show that it is NP-hard to approximate the number of simultaneously satisfiable equations to within \G\ - epsilon for any epsilon > 0. This generalizes results of Hastad (J. ACM 48 (4) (2001) 798), who established similar bounds under the added condition that the group G is Abelian.
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| 20. |
- Engebretsen, Lars, et al.
(författare)
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Is constraint satisfaction over two variables always easy?
- 2004
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Ingår i: Random structures & algorithms (Print). - : Wiley. - 1042-9832 .- 1098-2418. ; 25:2, s. 150-178
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Tidskriftsartikel (refereegranskat)abstract
- By the breakthrough work of Hastad [J ACM 48(4) (2001), 798-859], several constraint satisfaction problems are now known to have the following approximation resistance property: Satisfying more clauses than what picking a random assignment would achieve is NP-hard. This is the case for example for Max E3-Sat, Max E3-Lin, and Max E4-Set Splitting. A notable exception to this extreme hardness is constraint satisfaction over two variables (2-CSP); as a corollary of the celebrated Goemans-Williamson algorithm [J ACM 42(6) (1995), 1115-1145], we know that every Boolean 2-CSP has a nontrivial approximation algorithm whose performance ratio is better than that obtained by picking a random assignment to the variables. An intriguing question then is whether this is also the case for 2-CSPs over larger, non-Boolean domains. This question is still open, and is equivalent to whether the generalization of Max 2-SAT to domains of size d, can be approximated to a factor better than (1 - 1/d(2)). In an attempt to make progress towards this question, in this paper we prove, first, that a slight restriction of this problem, namely, a generalization of linear inequations with two variables per constraint, is not approximation resistant, and, second, that the Not-All-Equal Sat problem over domain size d with three variables per constraint, is approximation resistant, for every d greater than or equal to 3. In the Boolean case, Not-All-Equal Sat with three variables per constraint is equivalent to Max 2-SAT and thus has a nontrivial approximation algorithm; for larger domain sizes, Max 2-SAT can be reduced to Not-All-Equal Sat with three variables per constraint. Our approximation algorithm implies that a wide class of 2-CSPs called regular 2-CSPs can all be approximated beyond their random assignment threshold.
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| 21. |
- Engebretsen, Lars, et al.
(författare)
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More Efficient Queries in PCPs for NP and Improved Approximation Hardness of Maximum CSP
- 2008
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Ingår i: Random structures & algorithms (Print). - : Wiley. - 1042-9832 .- 1098-2418. ; 33:4, s. 497-514
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Tidskriftsartikel (refereegranskat)abstract
- Samorodnitsky and Trevisan [STOC 2000, pp. 191-199] proved that there exists, for every positive integer k, a PCP for NP with O(log n) randomness, query complexity 2k + k(2), free bit complexity 2k, completeness 1 - epsilon, and soundness 2(-k2) + epsilon. In this article, we devise a new "outer verifier," based on the layered label cover problem recently introduced by Dinur et al. [STOC 2003, pp. 595-601], and combine it with a new "inner verifier" that uses the query bits more efficiently than earlier verifiers. Our resulting theorem is that there exists, for every integer f >= 2, every positive integer t <= f (f - 1)/2, and every constant epsilon > 0, a PCP for NP with O(log n) randomness, query complexity f + t, free bit complexity f, completeness 1 - epsilon, and soundness 2(-t) + epsilon. As a corollary, there exists, for every integer q >= 3 and every constant epsilon > 0, a q-query PCP for NP with amortized query complexity 1 + root 2/q + epsilon-we also show in this article that combining our outer verifier with any natural candidate for a corresponding inner verifier gives a PCP that is kess query efficient than the one we obtain.
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| 22. |
- Engebretsen, Lars, et al.
(författare)
-
More efficient queries in PCPs for NP and improved approximation hardness of maximum CSP
- 2005
-
Ingår i: STACS 2005, PROCEEDINGS. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 3540249982 ; , s. 194-205
-
Konferensbidrag (refereegranskat)abstract
- In the PCP model, a verifier is supposed to probabilistically decide if a given input belongs to some language by posing queries to a purported proof of this fact. The probability that the verifier accepts an input in the language given a correct proof is called the completeness C; the probability that the verifier rejects an input not in the language given any proof is called the soundness s. For a verifier posing q queries to the proof, the amortized query complexity is defined by q/log(2) (c/s) if the proof is coded in binary. It is a measure of the average "efficiency" of the queries in the following sense: An ideal query should preserve the completeness and halve the soundness. If this were the case for all queries, the amortized query complexity would be exactly one. Samorodnitsky and Trevisan [STOC 2000] gave a q-query PCP for NP with amortized query complexity 1 + 2/root q + epsilon for any constant epsilon > 0. In this paper, we examine to what extent their result can be sharpened. Using the layered label cover problem recently introduced by Dinur et al. [STOC 2003], we devise a new "outer verifier" that allows us to construct an "inner verifier" that uses the query bits more efficiently than earlier verifiers. This enables us to construct a PCP for NP that queries q positions in the proof and has amortized query complexity 1 + root 2/q + epsilon. As an immediate corollary, we also obtain an improved hardness of approximation result for the Maximum q-CSP problem. Since the improvement compared to previous work is moderate, we then examine if there is an underlying reason for this. Our construction in this paper follows a paradigm for query efficient PCPs for NP outlined by many previous researchers and it combines a state-of-the-art "outer verifier" with a natural candidate for a query efficient "inner verifier". We prove in the full version of this paper that all natural attempts to construct more query efficient versions of our verifier are doomed to fail. This implies that significantly new ideas regarding proof composition and A encoding of PCP proofs are required to construct PCPs for NP that are more query efficient than the one we propose in his paper.
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| 23. |
- Engebretsen, Lars
(författare)
-
Platform-independent code conversion within the C++ locale framework
- 2006
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Ingår i: Software, practice & experience. - : Wiley. - 0038-0644 .- 1097-024X. ; 36:15, s. 1643-1654
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes some of the author's experiences from a C++ implementation of a concordance program for texts in Old West Norse (also known as Old Icelandic) and Runic Swedish. Since the input to the program used a character repertoire that no standard one-byte character encoding covers, it was natural to use Unicode to represent data both inside the program and in external files. Inside the program, each character was represented with C++ 'wide characters'; the input and output was represented in UTF-8. The author constructed C++ code conversion facets that convert data between those two representations during file I/O. This enabled him to successfully compile, and run, the concordance program on both Linux (Fedora Core 3 with gcc 3.4.2) and Windows XP (using Visual C++ NET 2003). The only necessary change to the source when changing platform was isolated to the lines selecting which code conversion facet to use-all other pieces of code remained unchanged. In particular, the author could still use the standard C++ locale framework for collation and code conversion, in spite of the fact that the library-provided code conversion facets had been replaced.
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| 24. |
- Engebretsen, Lars
(författare)
-
Simplified tight analysis of Johnson's algorithm
- 2004
-
Ingår i: Information Processing Letters. - : Elsevier BV. - 0020-0190 .- 1872-6119. ; 92:4, s. 207-210
-
Tidskriftsartikel (refereegranskat)abstract
- In their paper "Tight bound on Johnson's algorithm for maximum satisfiability" [J. Comput. System Sci. 58 (3) (1999) 622-640] Chen, Friesen and Zheng provided a tight bound on the approximation ratio of Johnson's algorithm for Maximum Satisfiability [J. Comput. System Sci. 9 (3) (1974) 256-278]. We give a simplified proof of their result and investigate to what extent it may be generalized to non-Boolean domains.
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| 25. |
- Engebretsen, Lars
(författare)
-
The nonapproximability of non-Boolean predicates
- 2004
-
Ingår i: SIAM Journal on Discrete Mathematics. - 0895-4801 .- 1095-7146. ; 18:1, s. 114-129
-
Tidskriftsartikel (refereegranskat)abstract
- Constraint satisfaction programs where each constraint depends on a constant number of variables have the following property: The randomized algorithm that guesses an assignment uniformly at random satisfies an expected constant fraction of the constraints. Combining constructions from interactive proof systems with harmonic analysis over finite Abelian groups, Hastad [J. ACM, 48 ( 2001), pp. 798 - 859] showed that for several constraint satisfaction programs this naive algorithm is essentially the best possible unless P = NP. While most of the predicates analyzed by Hastad depend on a small number of variables, Samorodnitsky and Trevisan [ Proceedings of the 32nd Annual ACM Symposium on Theory of Computing, Portland, OR, 2000, pp. 191 - 199] recently extended Hastad's result to predicates depending on an arbitrarily large, but still constant, number of Boolean variables. We combine ideas from these two constructions and prove that there exists a large class of predicates on finite non-Boolean domains such that for predicates in the class, the naive randomized algorithm that guesses a solution uniformly is essentially the best possible unless P = NP. As a corollary, we show that it is NP-hard to approximate the Maximum k-CSP problem over domains with size d within d(k-2k1/2) - epsilon, for every constant epsilon > 0, unless P = NP. This lower bound extends the previously known bound for the case d = 2 and matches well with the best known upper bound, d(k-1), of Serna, Trevisan, and Xhafa [ Proceedings of the 15th Annual Symposium on Theoretical Aspects of Computer Science, Lecture Notes in Comput. Sci. 1373, M. Morvan, C. Meinel, and D. Krob, eds., Springer-Verlag, Berlin, 1998, pp. 488 - 498].
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| 26. |
- Engebretsen, Lars, et al.
(författare)
-
Three-query PCPs with perfect completeness over non-Boolean domains
- 2005
-
Ingår i: Random structures & algorithms (Print). - : Wiley. - 1042-9832 .- 1098-2418. ; 27:1, s. 46-75
-
Tidskriftsartikel (refereegranskat)abstract
- We study non-Boolean PCPs that have perfect completeness and query three positions in the proof. For the case when the proof consists of values from a domain of size d for some integer constant d >= 2, we construct a nonadaptive PCP with perfect completeness and soundness d(-1) + d(-2) + epsilon, for any constant epsilon > 0, and an adaptive PCP with perfect cornpleteness and soundness d(-1) + epsilon, for any constant epsilon > 0. The latter PCP can be converted into a nonadaptive PCP with perfect completeness and soundness d(-1) + epsilon, for any constant epsilon > 0, where four positions are read from the proof. These results match the best known constructions for the case d = 2 and our proof's also show that the particular predicates we use in our PCPs are nonapproximable beyond the random assignment threshold.
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| 27. |
- Engebretsen, Lars, et al.
(författare)
-
TSP with bounded metrics
- 2006
-
Ingår i: Journal of computer and system sciences (Print). - : Elsevier BV. - 0022-0000 .- 1090-2724. ; 72:4, s. 509-546
-
Tidskriftsartikel (refereegranskat)abstract
- The general asymmetric TSP with triangle inequality is known to be approximable only within logarithmic factors. In this paper we study the asymmetric and symmetric TSP problems with bounded metrics, i.e., metrics where the distances are integers between one and some constant upper bound. In this case, the problem is known to be approximable within a constant factor. We prove that it is NP-hard to approximate the asymmetric TSP with distances one and two within 321/320 - epsilon and that it is NP-hard to approximate the symmetric TSP with distances one and two within 741/740 - epsilon for every constant epsilon > 0. Recently, Papadimitriou and Vempala announced improved approximation hardness results for both symmetric and asymmetric TSP with graph metric. We show that a similar construction can be used to obtain only slightly weaker approximation hardness results for TSP with triangle inequality and distances that are integers between one and eight. This shows that the Papadimitriou-Vempala construction is "local" in nature and, intuitively, indicates that it cannot be used to obtain hardness factors that grow with the size of the instance.
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| 28. |
- Engebretsen, Lars
(författare)
-
Using easy optimization problems to solve hard ones
- 2004
-
Ingår i: Classical and New Paradigms of Computation and Their Complexity Hierarchies. - DORDRECHT : SPRINGER. - 1402027753 ; , s. 77-93
-
Konferensbidrag (refereegranskat)abstract
- In combinatorial optimization one typically wants to minimize some cost function given a set of constraints that must be satisfied. A classical example is the so called Traveling Salesman Problem (TSP), in which we are given a set of cities with certain distances between them and we are asked to find the shortest possible tour that visits every city exactly once and then returns to the starting point. This problem is believed to be hard to solve exactly-it has been shown to belong to a certain class of notoriously hard problems, the so called NP-hard problems. Despite huge efforts, there is no currently known efficient algorithm that solves any of the NP-hard problems and it is widely believed that no such algorithm exists. However, it is always possible to find an approximation to the optimum tour by solving a much easier problem, the so called Minimum Spanning Tree problem. This is an example of a general paradigm in the field of approximation algorithms for optimization problems: Instead of solving a very hard problem we solve an easy one and then convert the optimal solution to the easy problem into an approximately optimal solution to the hard one. Obviously, it is important to be careful when converting the optimal solution to the easy problem into an approximately optimal solution to the hard one. In many applications, the analysis of the algorithm is greatly simplified by the use of random selections. Typically, we then use information obtained from the solution to the easy problem to bias our selection of a solution to the hard one.
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| 29. |
- Gokeler, Alli, et al.
(författare)
-
Proprioceptive deficits after ACL injury: are they clinically relevant?
- 2012
-
Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 46:3, s. 180-192
-
Forskningsöversikt (refereegranskat)abstract
- Objective To establish the clinical relevance of proprioceptive deficits reported after anterior cruciate ligament (ACL) injury. Material and methods A literature search was done in electronic databases from January 1990 to June 2009. Inclusion criteria for studies were ACL deficient (ACL-D) and ACL reconstruction (ACL-R) articles written in English, Dutch or German and calculation of correlation(s) between proprioception tests and clinical outcome measures. Clinical outcome measures were muscle strength, laxity, hop test, balance, patient-reported outcome, objective knee score rating, patient satisfaction or return to sports. Studies included in the review were assessed on their methodological quality. Results In total 1161 studies were identified of which 24 met the inclusion criteria. Pooling of all data was not possible due to substantial differences in measurement techniques and data analysis. Most studies failed to perform reliability measurements of the test device used. In general, the correlation between proprioception and laxity, balance, hop tests and patient outcome was low. Four studies reported a moderate correlation between proprioception, strength, balance or hop test. Conclusion There is limited evidence that proprioceptive deficits as detected by commonly used tests adversely affect function in ACL-D and ACL-R patients. Development of new tests to determine the relevant role of the sensorimotor system is needed. These tests should ideally be used as screening tests for primary and secondary prevention of ACL injury.
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| 30. |
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| 31. |
- Hamrin Senorski, Eric, 1989, et al.
(författare)
-
Factors that affect patient reported outcome after anterior cruciate ligament reconstruction-a systematic review of the Scandinavian knee ligament registers.
- 2019
-
Ingår i: British journal of sports medicine. - : BMJ. - 1473-0480 .- 0306-3674. ; 53:7
-
Tidskriftsartikel (refereegranskat)abstract
- To perform a systematic review of findings from the Scandinavian knee ligament registers with regard to factors that affect patient reported outcome after anterior cruciate ligament (ACL) reconstruction.Systematic review.Four electronic databases: PubMed, EMBASE, the Cochrane Library and AMED were searched, and 157 studies were identified. Two reviewers independently screened the titles, abstracts and full text articles for eligibility. A modified version of the Downs and Black checklist was applied for quality appraisal.Studies published from the Scandinavian registers from their establishment in 2004 and onwards that documented patient reported outcome and provided information on concomitant injuries were eligible.A total of 35 studies were included. Younger age at ACL reconstruction, male sex, not smoking and receiving a hamstring tendon autograft positively influenced patient reported outcome. Patients with concomitant cartilage and meniscal injuries reported inferior subjective knee function compared with patients with an isolated ACL tear. One study reported that patients treated non-reconstructively reported inferior knee function compared with patients who had ACL reconstruction.Younger age, male sex, not smoking, receiving a hamstring tendon autograft and the absence of concomitant injuries were associated with superior patient reported outcomes after ACL reconstruction.
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| 32. |
- Hamrin Senorski, Eric, 1989, et al.
(författare)
-
“I never made it to the pros…” Return to sport and becoming an elite athlete after pediatric and adolescent anterior cruciate ligament injury - Current evidence and future directions
- 2018
-
Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:4, s. 1011-1018
-
Tidskriftsartikel (refereegranskat)abstract
- The management of anterior cruciate ligament (ACL) injuries in the skeletally immature and adolescent patient remains an area of controversy in sports medicine. This study, therefore, summarizes and discusses the current evidence related to treating pediatric and adolescent patients who sustain an ACL injury. The current literature identifies a trend towards ACL reconstruction as the preferred treatment option for ACL injuries in the young, largely justified by the risk of further structural damage to the knee joint. Worryingly, a second ACL injury is all too common in the younger population, where almost one in every three to four young patients who sustain an ACL injury and return to high-risk pivoting sport will go on to sustain another ACL injury. The clinical experience of these patients emphasizes the rarity of an athlete who makes it to elite level after a pediatric or adolescent ACL injury, with or without reconstruction. If these patients are unable to make it to an elite level of sport, treatment should possibly be modified to take account of the risks associated with returning to pivoting and strenuous sport. The surveillance of young athletes may be beneficial when it comes to reducing injuries. Further research is crucial to better understand specific risk factors in the young and to establish independent structures to allow for unbiased decision-making for a safe return to sport after ACL injury. Level of evidence V.
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| 33. |
- Hägglund, Martin, 1976-
(författare)
-
Epidemiology and prevention of football injuries
- 2007
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to study the incidence, severity and pattern of injury in male and female elite football players; to study time trends in injury risk; to identify risk factors for injury; and to test the effectiveness of an intervention programme aimed at preventing re-injury.All studies followed a prospective design using standardised definitions and data collection forms. Individual training and match exposure was registered for all players participating. Time loss injuries were documented by each team’s medical staff.The amount of training increased by 68% between the 1982 and 2001 Swedish top male division seasons, reflecting the shift from semi-professionalism to full professionalism. No difference in injury incidence or injury severity was found between seasons. The injury incidence was 4.6 vs. 5.2/1000 training hours and 20.6 vs. 25.9/1000 match hours. The incidence of severe injury (absence >4 weeks) was 0.8/1000 hours in both seasons.The Swedish and Danish top male divisions were followed during the spring season of 2001. A higher risk for training injury (11.8 vs. 6.0/1000 hours, p<0.01) and severe injury (1.8 vs. 0.7/1000 hours, p=0.002) was observed among the Danish players. Re-injury accounted for 30% and 24% of injuries in Denmark and Sweden respectively.The Swedish top male division was studied over two consecutive seasons, 2001 and 2002, and comparison of training and match injury incidences between seasons showed similar results. Players who were injured in the 2001 season were at greater risk for injury in the following season compared to non-injured players (relative risk 2.7; 95% CI 1.7-4.3). Players with a previous hamstring injury, groin injury and knee joint trauma were two to three times more likely to suffer an identical injury to the same limb in the following season, but no such relationship was found for ankle sprain. Age was not associated with an increased injury risk.The effectiveness of a coach-controlled rehabilitation programme on the rate of re-injury was studied in a randomised controlled trial at amateur male level. In the control group, 23 of 79 injured players suffered a recurrence during the season compared to 10 of 90 players in the intervention group. There was a 75% lower re-injury risk in the intervention group for lower limb injuries (relative risk 0.25; 95% CI 0.11-0.57). The preventive effect was greatest during the first weeks after return to play.Both the male and female Swedish top divisions were followed during the 2005 season. Male elite players had a higher risk for training injury (4.7 vs. 3.8/1000 hours, p<0.05) and match injury (28.1 vs. 16.1/1000 hours, p<0.001) than women. However, no difference was observed in the rate of severe injury (0.7/1000 hours in both groups). The thigh was the most common site of injury in both men and women, while injury to the hip/groin was more frequent in men and to the knee in women. Knee sprain accounted for 31% and 37% of the time lost from training and match play in men and women respectively.
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| 34. |
- Kise, Nina Jullum, et al.
(författare)
-
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients : Randomised controlled trial with two year follow-up
- 2016
-
Ingår i: British journal of sports medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 50:23, s. 1473-1480
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS 4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results No clinically relevant difference was found between the two groups in change in KOOS 4 at two years (0.9 points, 95% confidence interval4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option. Trial registration www.clinicaltrials.gov (NCT01002794).
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| 35. |
- Kise, Nina Jullum, et al.
(författare)
-
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients : Randomised controlled trial with two year follow-up
- 2016
-
Ingår i: BMJ (International Edition). - : BMJ. - 0959-8146 .- 1756-1833. ; 354
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design: Randomised controlled superiority trial. Setting: Orthopaedic departments at two public hospitals and two physiotherapy clinics in Norway. Participants: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions: 12 week supervised exercise therapy alone or arthroscopic partial meniscectomy alone. Main outcome measures: Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS 4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee related quality of life) from baseline to two year follow-up and change in thigh muscle strength from baseline to three months. Results: No clinically relevant difference was found between the two groups in change in KOOS 4 at two years (0.9 points, 95% confidence interval â'4.3 to 6.1; P=0.72). At three months, muscle strength had improved in the exercise group (P≤0.004). No serious adverse events occurred in either group during the two year follow-up. 19% of the participants allocated to exercise therapy crossed over to surgery during the two year follow-up, with no additional benefit. Conclusion: The observed difference in treatment effect was minute after two years of follow-up, and the trial's inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.
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| 36. |
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| 37. |
- Lohmander, Stefan, et al.
(författare)
-
Osteoarthritis
- 2003
-
Ingår i: Textbook of sports medicine. - 0632065095 ; , s. 422-422:10, s. 1402-1430, s. 1301-1301
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 38. |
- Matheson, Gordon O, et al.
(författare)
-
Prevention and management of non-communicable disease : the IOC consensus statement, Lausanne 2013.
- 2013
-
Ingår i: British Journal of Sports Medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 47:16, s. 1003-11
-
Tidskriftsartikel (refereegranskat)abstract
- Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology and design thinking. The purpose of this paper is to summarise the results of a consensus meeting on NCD prevention sponsored by the IOC in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within healthcare systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: (1) Focus on behavioural change as the core component of all clinical programmes for the prevention and management of chronic disease. (2) Establish actual centres to design, implement, study and improve preventive programmes for chronic disease. (3) Use human-centred design in the creation of prevention programmes with an inclination to action, rapid prototyping and multiple iterations. (4) Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programmes for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. (5) Mobilise resources and leverage networks to scale and distribute programmes of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programmes within healthcare. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this agenda forward.
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| 39. |
- Matheson, Gordon O, et al.
(författare)
-
Prevention and Management of Non-Communicable Disease : The IOC Consensus Statement, Lausanne 2013.
- 2013
-
Ingår i: Sports Medicine. - : Springer Science and Business Media LLC. - 0112-1642 .- 1179-2035. ; 43:11, s. 1075-88
-
Tidskriftsartikel (refereegranskat)abstract
- Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology, and design thinking. The purpose of this paper is to summarize the results of a consensus meeting on NCD prevention sponsored by the International Olympic Committee (IOC) in April, 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within health care systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: 1. Focus on behavioural change as the core component of all clinical programs for the prevention and management of chronic disease. 2. Establish actual centres to design, implement, study, and improve preventive programs for chronic disease. 3. Use human-centered design in the creation of prevention programs with an inclination to action, rapid prototyping and multiple iterations. 4. Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programs for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. 5. Mobilize resources and leverage networks to scale and distribute programs of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programs within health care. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad-hoc Working Group charged with the responsibility of moving this agenda forward.
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| 40. |
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| 41. |
- Meredith, Sean J., et al.
(författare)
-
Return to Sport After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Return to Sport Consensus Group
- 2020
-
Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 8:6
-
Tidskriftsartikel (refereegranskat)abstract
- Background: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sport and their previous activity level. Purpose: The aim of the Panther Symposium ACL Injury Return to Sport Consensus Group was to provide a clear definition of RTS after ACL injury and a description of the RTS continuum as well as provide clinical guidance on RTS testing and decision-making. Study Design: Consensus statement. Methods: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence. Results: Key points include that RTS is characterized by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS and, ultimately, return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum, with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors, and concomitant injuries. Conclusion: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing, and methods for the biological assessment of healing and recovery.
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| 42. |
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| 43. |
- Moksnes, Håvard, et al.
(författare)
-
Assessing implementation, limited efficacy, and acceptability of the BEAST tool : A rehabilitation and return-to-sport decision tool for nonprofessional athletes with anterior cruciate ligament reconstruction
- 2021
-
Ingår i: Physical Therapy in Sport. - : Elsevier BV. - 1466-853X .- 1873-1600. ; 52, s. 147-154
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess the implementation, limited efficacy, and acceptability of the BEAST (better and safer return to sport) tool - a rehabilitation and return-to-sport (RTS) decision tool after anterior cruciate ligament reconstruction (ACLR) in nonprofessional athletes.DESIGN: Prospective cohort.PARTICIPANTS: 43 nonprofessional pivoting sport athletes with ACLR.MAIN OUTCOME: Clinician- and athlete-experienced implementation challenges (implementation), changes in quadriceps power, side hop and triple hop performance from 6 to 8 months after ACLR (limited efficacy), athletes' beliefs about the individual rehabilitation and RTS plans produced by the BEAST tool (acceptability).RESULTS: The BEAST tool was developed and then implemented as planned for 39/43 (91%) athletes. Hop and quadriceps power performance improved significantly, with the largest improvement in involved quadriceps power (standardised response mean 1.4, 95% CI:1.1-1.8). Athletes believed the rehabilitation and RTS plan would facilitate RTS (8.2 [SD: 2.0]) and reduce injury risk (8.3 [SD: 1.2]; 0 = not likely at all, 10 = extremely likely).CONCLUSION: The BEAST tool was implemented with few challenges and adjustments were rarely necessary. Athletes had large improvements in quadriceps power and hop performance on the involved leg. Athletes believed that the individual rehabilitation and RTS plans produced by the tool would facilitate RTS and reduce injury risk.
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| 44. |
- Mountjoy, Margo, et al.
(författare)
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2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)
- 2023
-
Ingår i: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 57:17, s. 1073-1097
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
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| 45. |
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| 46. |
- Palbom, Anna, 1971-
(författare)
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On Approximating Asymmetric TSP and Related Problems
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis we study problems related to approximation of asymmetric TSP. First we give worst case examples for the famous algorithm due to Frieze, Gabiati and Maffioli for asymmetric TSP with triangle inequality. Some steps in the algorithm consist of arbitrary choices. To prove lower bounds, these choices need to be specified. We show a worst case performance with some deterministic assumptions on the algorithm and then prove an expected worst case performance for a randomised version of the algorithm. The algorithm by Frieze et al. produces a spanning cactus and makes a TSP tour by shortcuts. We have proven that determining if there is a spanning cactus in a general asymmetric graph is an NP-complete problem and that finding a minimum spanning cactus in a complete, directed graph with triangle inequality is equivalent to finding the TSP tour and the problems are equally hard to approximate. We also give three other results; we show a connection between asymmetric TSP and TSP in a bipartite graph, we show that it is NP-hard to find a cycle cover in a bipartite graph without cycles of length six or less and finally we present some results for a new problem with ordered points on the circle.
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| 47. |
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| 48. |
- Schwellnus, Martin, et al.
(författare)
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How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness
- 2016
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:17, s. 1043-1052
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Tidskriftsartikel (refereegranskat)abstract
- The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of loadincluding rapid changes in training and competition load, competition calendar congestion, psychological load and traveland health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.
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| 49. |
- Snaebjörnsson, Thorkell, 1982, et al.
(författare)
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Young age and high BMI are predictors of early revision surgery after primary anterior cruciate ligament reconstruction: a cohort study from the Swedish and Norwegian knee ligament registries based on 30,747 patients
- 2019
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 27:11, s. 3583-3591
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To analyse patient-related risk factors for 2-year ACL revision after primary reconstruction. The hypothesis was that younger athletes would have a higher incidence of an early ACL revision. Methods: This prospective cohort study was based on data from the Norwegian and Swedish National Knee Ligament Registries and included patients who underwent primary ACL reconstruction from 2004 to 2014. The primary end-point was the 2-year incidence of ACL revision. The impact of activity at the time of injury, patient sex, age, height, weight, BMI, and tobacco usage on the incidence of early ACL revision were described by relative risks (RR) with 95% confidence intervals (CI). Results: A total of 58,692 patients were evaluated for eligibility and 30,591 patients were included in the study. The mean incidence of ACL revision within 2 years was 2.82% (95% CI 2.64–3.02%). Young age (13–19) was associated with an increased risk of early ACL revision (males RR = 1.54 [95% CI 1.27–1.86] p < 0.001 and females RR = 1.58 [95% CI 1.28–1.96] p < 0.001). Females over 1 SD in weight ran an increased risk of early ACL revision (RR = 1.82, [95% CI 1.15–2.88] p = 0.0099). Individuals with a BMI of over 25 ran an increased risk of early ACL revision (males: RR = 1.78, [95% CI 1.38–2.30] p < 0.001 and females: RR = 1.84, [95% CI 1.29–2.63] p = 0.008). Conclusion: Young age, a BMI over 25, and overweight females were risk factors for an early ACL revision. Level of evidence: II.
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| 50. |
- Soligard, Torbjorn, et al.
(författare)
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How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury
- 2016
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Ingår i: British Journal of Sports Medicine. - : BMJ PUBLISHING GROUP. - 0306-3674 .- 1473-0480. ; 50:17, s. 1030-1041
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Tidskriftsartikel (refereegranskat)abstract
- Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.
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