A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a \"helicopter perspective\".

OBJECTIVE: To update the description of current objective structured clinical examination (OSCE) practices within pharmacy schools in the United States and identify barriers to OSCE implementation and expansion.
METHODS: A survey was deployed to all accredited Doctor of Pharmacy programs within the United States. The survey was designed to collect information regarding the curricular mapping of OSCEs, OSCE design, OSCE delivery, assessment of OSCE performance, and barriers to OSCE implementation and expansion.
RESULTS: Of the 135 US-accredited programs identified, 109 (81%) programs completed the survey. In total, 93 (85%) programs reported using OSCEs to assess students; however, implementation throughout the curriculum and current practices varied by institution. Most programs place OSCEs within specific courses (96%), with the applied skills coursework being the most used (80%). The most common number of OSCEs that occur throughout a curriculum is 6 (18%), however, 20 (22%) programs execute 10 or more OSCEs throughout their curriculum. Forty (43%) programs use OSCEs as high-stakes assessments where poor performance could prevent a student from progressing to advanced pharmacy practice experiences. Of the responding programs, over half (56%) use teaching objective structured examinations to enhance learning. Common barriers to OSCE expansion exist and are related to resource utilization.
CONCLUSIONS: Significant expansion of OSCE development and implementation has occurred over the last decade. There is substantial variability in implementation and utilization among programs. Although standards of best practice for OSCEs exist for other health professions, best practices in pharmacy education have not been widely accepted or adopted.

UNASSIGNED: The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies.
UNASSIGNED: Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218).
UNASSIGNED: Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings.
UNASSIGNED: These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research.
UNASSIGNED: None.

This review delves into the challenge of pediatric anesthesia, underscoring the necessity for tailored perioperative approaches due to children\'s distinctive anatomical and physiological characteristics. Because of the vulnerability of pediatric patients to critical incidents during anesthesia, provider skills are of primary importance. Yet, almost equal importance must be granted to the adoption of a careful preanesthetic mindset toward patients and their families that recognizes the interwoven relationship between children and parents. In this paper, the preoperative evaluation process is thoroughly examined, from the first interaction with the child to the operating day. This evaluation process includes a detailed exploration of the medical history of the patient, physical examination, optimization of preoperative therapy, and adherence to updated fasting management guidelines. This process extends to considering pharmacological or drug-free premedication, focusing on the importance of preanesthesia re-evaluation. Structural resources play a critical role in pediatric anesthesia; components of this role include emphasizing the creation of child-friendly environments and ensuring appropriate support facilities. The results of this paper support the need for standardized protocols and guidelines and encourage the centralization of practices to enhance clinical efficacy.

Globally, people living with the Human Immunodeficiency Virus (HIV) are over-represented in incarcerated populations. The current study aimed to provide a national (Australian) snapshot of current HIV prison policies against the United Nations\' (UN) 15 key HIV interventions for prisons. Publicly available policies, reports, and data were obtained, and interviews were conducted with prison health staff in five of eight Australian jurisdictions. We rated whether policies were compliant, partially compliant, or not compliant to the UN interventions and assigned an overall grade (A to E, where A = most compliant and E = least compliant) for each jurisdiction. Three jurisdictions received a B grade, three received a C grade, and two were not assessed due to insufficient data. In all jurisdictions HIV policies fell short of full compliance to most UN interventions. Prison-based needle and syringe programs and initiatives beyond education to reduce HIV transmission from body modification procedures (eg, tattooing) were absent in all jurisdictions. No condom programme existed in one jurisdiction and access issues were reported in others. Opioid substitution therapy, and peer-education access varied across and within most jurisdictions. Findings indicate that more action is required to meet the UN recommended interventions for HIV prevention in prisons.

OBJECTIVE: Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally.
METHODS: A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included.
RESULTS: There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance.
CONCLUSIONS: This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.

HIV self-testing (HIVST) has been proposed as an innovative strategy to diagnose human immunodeficiency virus (HIV). While HIVST offers the potential to broaden accessibility of early HIV diagnosis and treatment initiation, this testing strategy incurs additional cost and requires confirmatory testing and treatment. We have conducted the first systematic review to summarize the current economic literature for HIVST in low- and middle-income countries (LMICs).
A search strategy was developed including key terms for HIV, self-testing and cost-effectiveness and was conducted in Medline and Embase databases. Studies were included that reported costs per outcome and included both cost-effectiveness and cost-utility outcome measures. The search strategy identified publications up until August 15, 2023 were included. Abstract and full text screening was conducted and a standardized data abstraction form was used for included studies. Costs are reported in USD, 2020.
Our search strategy identified 536 total titles from the search strategy, which were screened down to 25 relevant studies that provided both cost and outcome data on HIVST. There was significant heterogeneity in the HIVST intervention, study population, costs and outcomes reported among included studies. Cost per person tested ranged from $1.09-155. Cost per case diagnosed ranged from $20-1,277. Cost-utility estimates ranged from cost-saving to $1846 per DALY averted. Higher cost-effectiveness estimates were associated with more expensive testing algorithms with increased support for linkage to care and post-test counseling.
All studies considered HIVST cost-effective although major drivers were identified included underlying HIV prevalence, testing cost and linkage to care. HIVST is likely to be cost-effective in a LMIC context, however policy makers should be aware of the drivers of cost-effectiveness when implementing HIVST programs as these underlying factors can impact the overall cost-effectiveness of HIVST.

BACKGROUND: Maximal lower-body strength can be assessed both dynamically and isometrically; however, the relationship between the changes in these 2 forms of strength following resistance training is not well understood.
OBJECTIVE: To systematically review and analyze the effects of resistance training on changes in maximal dynamic (1-repetition-maximum back squat, deadlift, and power clean) and position-matched isometric strength (isometric midthigh pull and the isometric squat). In addition, individual-level data were used to quantify the agreement and relationship between changes in dynamic and isometric strength.
METHODS: Databases were systematically searched to identify eligible articles, and meta-analysis procedures were performed on the extracted data. The raw results from 4 studies were acquired, enabling bias and absolute reliability measures to be calculated using Bland-Altman test of agreement.
RESULTS: Eleven studies met the inclusion criteria, which resulted in 29 isometric-dynamic change comparisons. The overall pooled effect was 0.13 in favor of dynamic testing; however, the prediction interval ranged from g = -0.49 to 0.75. There was no evidence of bias (P = .825) between isometric and dynamic tests; however, the reliability coefficient was estimated to be 16%, and the coefficient of variation (%) was 109.27.
CONCLUSIONS: As a range of future effects can be expected when comparing isometric to dynamic strength changes following resistance training, and limited proportionality exists between changes in these 2 strength qualities, there is strong evidence that isometric and dynamic strength represent separate neuromuscular domains. These findings can be used to inform strength-assessment models in athlete populations.

We conducted a systematic literature review of general population testing, contact tracing, case isolation and contact quarantine interventions to assess their effectiveness in reducing SARS-CoV-2 transmission, as implemented in real-world settings. We designed a broad search strategy and aimed to identify peer-reviewed studies of any design provided there was a quantitative measure of effectiveness on a transmission outcome. Studies that assessed the effect of testing or diagnosis on disease outcomes via treatment, but did not assess a transmission outcome, were not included. We focused on interventions implemented among the general population rather than in specific settings; these were from anywhere in the world and published any time after 1 January 2020 until the end of 2022. From 26 720 titles and abstracts, 1181 were reviewed as full text, and 25 met our inclusion criteria. These 25 studies included one randomized control trial (RCT) and the remaining 24 analysed empirical data and made some attempt to control for confounding. Studies included were categorized by the type of intervention: contact tracing (seven studies); specific testing strategies (12 studies); strategies for isolating cases/contacts (four studies); and \'test, trace, isolate\' (TTI) as a part of a package of interventions (two studies). None of the 25 studies were rated at low risk of bias and many were rated as serious risk of bias, particularly due to the likely presence of uncontrolled confounding factors, which was a major challenge in assessing the independent effects of TTI in observational studies. These confounding factors are to be expected from observational studies during an on-going pandemic, when the emphasis was on reducing the epidemic burden rather than trial design. Findings from these 25 studies suggested an important public health role for testing followed by isolation, especially where mass and serial testing was used to reduce transmission. Some of the most compelling analyses came from examining fine-grained within-country data on contact tracing; while broader studies which compared behaviour between countries also often found TTI led to reduced transmission and mortality, this was not universal. There was limited evidence for the benefit of isolation of cases/contacts away from the home environment. One study, an RCT, showed that daily testing of contacts could be a viable strategy to replace lengthy quarantine of contacts. Based on the scarcity of robust empirical evidence, we were not able to draw any firm quantitative conclusions about the quantitative impact of TTI interventions in different epidemic contexts. While the majority of studies found that testing, tracing and isolation reduced transmission, evidence for the scale of this impact is only available for specific scenarios and hence is not necessarily generalizable. Our review therefore emphasizes the need to conduct robust experimental studies that help inform the likely quantitative impact of different TTI interventions on transmission and their optimal design. Work is needed to support such studies in the context of future emerging epidemics, along with assessments of the cost-effectiveness of TTI interventions, which was beyond the scope of this review but will be critical to decision-making. This article is part of the theme issue \'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence\'.

We conducted a scoping review to examine the barriers and facilitators accessing Chlamydia trachomatis and Neisseria gonorrhoeae testing among female sex workers. A literature search was conducted in Embase, Medline, and Web of Science for studies published from the date of creation of database to 17 March 2023, without restrictions for publication date. We used thematic synthesis to identify common affecting factors across included studies and then linked them into categories of the socioecological framework. Among the 14 articles included, 3 utilized qualitative methods, 7 utilized quantitative surveys, 2 were mixed methods, and 2 were randomized controlled trials. Several important affecting factors stood out during this review, including stigma and discrimination, as well as social support at the societal level, and financial costs at the service level. This review suggested that interventions on addressing societal- and service-level determinants are needed, which includes reducing stigma and discrimination toward sex work and cost for facility testing, as well as increasing social support and community engagement.