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Heterotopic ossification is ectopic lamellar bone formation within soft tissue and can result in significant functional limitations. There are multiple underlying etiologies of HO including musculoskeletal trauma and traumatic brain injury. Intra‐articular HO of the knee is rare and is typically located within the cruciate ligaments. We report a case of a 24‐year‐old female who presented with worsening right knee pain and limited knee extension two and a half years after a motor vehicle crash with multiple lower extremity fractures. Physical examination of the knee revealed anterior pain, limited extension, and a palpable infrapatellar prominence. Imaging showed a retropatellar tendon, intra‐articular excrescence of bone proximal to the anterior tibial plateau. Diagnostic arthroscopy with a 70° arthroscope identified HO at the proximal anterior tibial plateau, which was excised with a high‐speed burr under direct visualization. At the three‐month follow‐up, the patient remained asymptomatic and returned to sport. Retropatellar tendon, intra‐articular anterior knee HO is a rare but debilitating clinical entity that can be successfully and safely managed with excision under direct visualization using a 70° arthroscope.

Objectives: Soccer is one of the most popular youth sports in the United States and worldwide. Due to growing concerns regarding repeated head trauma, in 2015 the United States Soccer Federation (USSF) banned headers for athletes aged 10 and under and limited athletes aged 11 to 13 to practicing headers for 30 minutes per week. The purpose of this study was to assess whether the USSF header policy was associated with fewer soccer-related concussions that presented to emergency departments following the 2015 season. Methods: A retrospective cohort from the National Electronic Injury Surveillance System database was assessed. Age, sex, and injury type were extracted for all soccer-related emergency department visits between January 1st, 2012, and December 31st, 2023. Univariate and multivariable regression analyses were conducted to assess concussions as a percentage of all soccer-related injuries based on sex, age, and year. Results: The number of concussions as a percentage of all soccer-related injuries decreased from 8.2% in 2012-2015 to 6.1% in 2020-2023 (p<0.01). From 2012-2023, the concussion rate among 14-17-year-olds and 10-13-year-olds was higher than 6-9-year-olds (8.9% and 6.6% compared to 4.9%, p<0.01). Despite a lower soccer-related injury rate overall, females were diagnosed with a greater proportion of concussions than males (9.6% compared to 6.2%, p<0.01). In a multivariable regression analysis, injuries that occurred in the years 2020-2023 were associated with lower odds of concussion compared to 2012-2015 (OR: 0.75, 95% CI: 0.69- 0.81). The 10-13-year-old age group, 14-17-year-old age group, and female sex were associated with higher odds of concussion compared to the 6-9-year-old age group and male sex respectively (OR: 1.30, 95% CI: 1.16- 1.45; OR: 1.79, 95% CI: 1.61- 1.99; OR: 1.53, 95% CI: 1.43- 1.63). Conclusions: The USSF youth soccer header policy introduced in 2015 was associated with a 25.6% relative risk reduction to sustain a soccer-related concussion and present to the emergency department in 2020-2023 compared to 2012-2015. A header ban in players under 10 years old and limitation to 30 minutes of header practice a week in players under 13 years old may improve player safety by reducing head impacts in the youth population.

Background: Because of growing concerns regarding repeated head trauma, in 2016, the United States Soccer Federation (USSF) banned headers for athletes aged ≤10 years and limited athletes aged 11 to 13 years to practicing headers for 30 minutes per week. Purpose: To assess whether the USSF header policy was associated with fewer soccer-related concussions after the 2015 season. Study Design: Descriptive epidemiology study. Methods: A retrospective cohort from the National Electronic Injury Surveillance System database was assessed. Age, sex, and injury type were extracted for all soccer-related emergency department visits between January 1, 2012, and December 31, 2023. Univariate and multiple regression analyses were used to assess concussions as a percentage of all soccer-related injuries based on sex, age group (6-9, 10-13, and 14-17 years), and year. The following time frames were assessed: 2012-2015, 2016-2019, and 2020-2023. Results: The proportion of concussions decreased from 8.2% of all soccer-related injuries in 2012-2015 to 6.1% in 2020-2023 (P < .01). The relative risk reduction for soccer-related concussions presenting to an emergency department in 2020-2023 compared with 2012-2015 was 25.6%. Overall, the proportion of concussions among 10- to 13-year-old and 14- to 17-year-old players was higher than for 6- to 9-year-old players (6.6% and 8.9% vs 4.9%, respectively; P < .01). Despite having a lower frequency of soccer-related injuries overall, female players had a greater proportion of concussions than male players (9.6% vs 6.2% of all soccer-related injuries; P < .01). In the multiple regression analysis, injuries that occurred in 2020-2023 were associated with lower odds of concussion compared with 2012-2015 (odds ratio [OR], 0.75 [95% CI, 0.69-0.81]). Compared with 6- to 9-year-old and male players, the 10- to 13-year-old (OR, 1.30 [95% CI, 1.16-1.45]), 14- to 17-year-old (OR, 1.79 [95% CI, 1.61-1.99]), and female players (OR, 1.53 [95% CI, 1.43-1.63]) were associated with higher odds of concussion. Conclusion: A 25.6% reduction in the relative risk of presenting to the emergency department with a soccer-related concussion was found when comparing 2020-2023 (after USSF header policy implementation) with 2012-2015 (before policy implementation). The USSF youth soccer header policy may improve player safety by reducing head impacts in the pediatric population.

Ensuring high vaccination and even booster vaccination coverage is critical in preventing severe Coronavirus Disease 2019 (COVID-19). Among the various COVID-19 vaccines currently in use, the mRNA vaccines have shown remarkable effectiveness. However, systemic adverse events (AEs), such as postvaccination fatigue, are prevalent following mRNA vaccination, and the underpinnings of which are not understood. Herein, we found that higher baseline expression of genes related to T and NK cell exhaustion and suppression were positively correlated with the development of moderately severe fatigue after Pfizer-BioNTech BNT162b2 vaccination; increased expression of genes associated with T and NK cell exhaustion and suppression reacted to vaccination were associated with greater levels of innate immune activation at 1 day postvaccination. We further found, in a mouse model, that altering the route of vaccination from intramuscular (i.m.) to subcutaneous (s.c.) could lessen the pro-inflammatory response and correspondingly the extent of systemic AEs; the humoral immune response to BNT162b2 vaccination was not compromised. Instead, it is possible that the s.c. route could improve cytotoxic CD8 T-cell responses to BNT162b2 vaccination. Our findings thus provide a glimpse of the molecular basis of postvaccination fatigue from mRNA vaccination and suggest a readily translatable solution to minimize systemic AEs.

When it comes to Chinese transformational leadership behavior, the focus seems to be Confucian work value; nonetheless, it represents only one of the Chinese traditions. In order to have a better understanding the relationship between Chinese traditional values and transformational leadership behavior, Taoist work value should also be taken into consideration. Thus, this study firstly develops Confucian and Taoist work value scale (study 1) and then applies this scale to examine its relationship with transformational leadership (study 2). The results show that while Confucian work value is the most consistent predictor of core transformational leader behavior and high-performance expectations, Taoist work value is the most consistent predictor of intellectual stimulation.

PurposeThis study employed the commitment–trust theory in social psychology and relationship marketing to explore female customers' perception of channel integration quality in omnichannel retailing and its influence on their relationship commitment to and trust in the relationship with retailers, and thus on their stickiness. Channel integration quality consists of two dimensions: channel service configuration (channel choice breadth and channel service transparency) and integrated interactions (content consistency, process consistency and perceived fluency).Design/methodology/approachThe study was carried out via a questionnaire survey, to which 868 valid responses were collected. The partial least squares technique was used to test the hypotheses.FindingsChannel service transparency and perceived fluency influence relationship commitment; content consistency, process consistency and perceived fluency all have significant effects on trust. Interestingly, although less influential than integrated interactions, channel service configuration is the foundation of channel integration quality, testifying to its significant role.Originality/valueThis study provides strong evidence on how channel integration quality affects customer stickiness. Moreover, this study replicates the finding of significant relationships among relationship commitment, trust and stickiness in omnichannel retailing.

Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements. Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities. Rigorously evaluated, evidence-based structural interventions are needed to address multilevel structural determinants that systemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.

Genetic association studies have linked ATP10A and closely related type IV P-type ATPases (P4-ATPases) to insulin resistance and vascular complications, such as atherosclerosis. ATP10A translocates phosphatidylcholine and glucosylceramide across cell membranes, and these lipids or their metabolites play important roles in signal transduction pathways regulating metabolism. However, the influence of ATP10A on lipid metabolism in mice has not been explored. Here, we generated gene-specific Atp10A knockout mice and show that Atp10A −/− mice fed a high-fat diet did not gain excess weight relative to wild-type littermates. However, Atp10A −/− mice displayed female-specific dyslipidemia characterized by elevated plasma triglycerides, free fatty acids and cholesterol, as well as altered VLDL and HDL properties. We also observed increased circulating levels of several sphingolipid species along with reduced levels of eicosanoids and bile acids. The Atp10A −/− mice also displayed hepatic insulin resistance without perturbations to whole-body glucose homeostasis. Thus, ATP10A has a sex-specific role in regulating plasma lipid composition and maintaining hepatic liver insulin sensitivity in mice.

Viruses must evade the host innate defenses for replication and dengue is no exception. During secondary infection with a heterologous dengue virus (DENV) serotype, DENV is opsonized with sub- or nonneutralizing antibodies that enhance infection of monocytes, macrophages, and dendritic cells via the Fc-gamma receptor (FcγR), a process termed antibody-dependent enhancement of DENV infection. However, this enhancement of DENV infection is curious as cross-linking of activating FcγRs signals an early antiviral response by inducing the type-I IFN-stimulated genes (ISGs). Entry through activating FcγR would thus place DENV in an intracellular environment unfavorable for enhanced replication. Here we demonstrate that, to escape this antiviral response, antibody-opsonized DENV coligates leukocyte Ig-like receptor-B1 (LILRB1) to inhibit FcγR signaling for ISG expression. This immunoreceptor tyrosine-based inhibition motif-bearing receptor recruits Src homology phosphatase-1 to dephosphorylate spleen tyrosine kinase (Syk). As Syk is a key intermediate of FcγR signaling, LILRB1 coligation resulted in reduced ISG expression for enhanced DENV replication. Our findings suggest a unique mechanism for DENV to evade an early antiviral response for enhanced infection.