Search results for: Atholl Johnston
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13

Search results for: Atholl Johnston

13 A Randomised, Single-Dose, Two-Period, Cross-Over Phase I Pharmacokinetic Study to Compare TDS®-Diazepam with Rectal Diazepam in Healthy Adult Subjects

Authors: Faisal O. Al-Otaibi, Arthur T. Tucker, Richard M. Langford, Stuart Ratcliffe, Atholl Johnston, Terry D. Lee, Kenneth B. Kirby, Chandan A. Alam

Abstract:

The Transdermal Delivery System (TDS®) is a proprietary liquid formulation that can be applied to intact skin via a metered pump spray to facilitate drug delivery to the circulation. The aim of this study was to assess the ability of the TDS preparation to deliver diazepam systemically, and to characterize the pharmacokinetic profile of the drug in healthy adult subjects. We conducted a randomized, single-dose, two-period, crossover phase I (pharmacokinetic) comparative study in twelve healthy volunteers. All volunteers received both 10 mg TDS-diazepam topically to the upper chest and 10 mg of the rectal diazepam preparation (Diastat®, 10 mg diazepam gel), with a minimum washout of 14 days between dosing episodes. Both formulations were well tolerated in all volunteers. Following topical application of TDS-diazepam, the mean AUC0-72h was 1241 ng/mL.h and the Cmax 34 ng/mL. The values for rectal Diastat were 4109 ng/mL.h and 300 ng/mL respectively. This proof of concept study demonstrates that the TDS preparation successfully delivered diazepam systemically to adults. As expected, the concentration of diazepam following the TDS application was lower and not bioequivalent to rectal gel. Future development of this unique system is required.

Keywords: transdermal delivery system, diazepam, seizure, bioequivalence, pharmacokinetic

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12 Comparison of Leeway Space Predictions Using Moyers and Tanaka-Johnston Upper Jaw and Lower Jaw on Batak Tribe Between Male and Female in Elementary School Students in Medan City, Sumatera Utara, Indonesia: A Cross-sectional Study

Authors: Hilda Fitria Lubis, Erna Sulistyawati

Abstract:

Objective: The study aims to compare Leeway space averages between Moyers and Tanaka-Johnston's analysis of elementary school students from the Batak tribe in Medan City. Material and Methods: The study involved 106 students from the Batak tribe elementary school in Medan, comprising 53 male and 53 female students. The samples obtained were then printed on both jaws to obtain a working model, and the mesiodistal width of the four permanent biting teeth of the lower jaw and the amount of space available on the canine-premolar region, as well as the predicted mesiodistal number of the canine-premolar on the Moyers probability table with a 75% degree of confidence and the Tanaka-Johnston formula. Results: Using Moyers analysis, students at Batak Elementary School in Medan City have an average Leeway space value of 2 mm on the upper jaw and 2.78 mm on the lower jaw. The average Leeway spatial value using Tanaka-Johnston analysis in the Batak tribe in elementary school in Medan City is 1.33 mm on the top jaw and 2.39 mm on the bottom jaw. Conclusion: According to Moyers and Tanaka-Johnsnton's analysis of both the upper and lower jaws in elementary school students of the Batak tribe in Medan City, there is a significant difference between Leeway's average space.

Keywords: leeways space, batak tribe, genders, diagnosis

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11 Does Creatine Supplementation Improve Swimming Performance?

Authors: Catrin Morgan, Atholl Johnston

Abstract:

Creatine supplementation should theoretically increase total muscle creatine and so enhance the generation of intramuscular phosphocreatine and subsequent ATP formation. The use of creatine as a potential ergogenic aid in sport has been an area of significant scientific research for a number of years. However the effect of creatine supplementation and swimming performance is a relatively new area of research and is the subject of this review. In swimming creatine supplementation could help maintain maximal power output, aid recovery and increase lean body mass. After investigating the underlying theory and science behind creatine supplementation, a literature review was conducted to identify the best evidence looking at the effect of creatine supplementation on swimming performance. The search identified 27 potential studies, and of these 17 were selected for review. The studies were then categorised into single sprint performance, which involves swimming a short distance race, or repeated interval performance, which involves swimming a series of sprints with intervals of rest between them. None of the studies on the effect of creatine controlled for the multiple confounding factors associated with measurement of swimming performance. The sample size in the studies was limited and this reduced the reliability of the studies and introduced the possibility of bias. The studies reviewed provided insufficient evidence to determine if creatine supplementation is beneficial to swimming performance. However, what data there was supported the use of creatine supplementation in repeated interval swimming rather than in single sprint swimming. From a review of the studies, it was calculated on average, there was a 1.37% increase in swimming performance with the use of creatine for repeated intervals and a 0.86% increase in performance for single sprint. While this may seem minor, it should be remembered that swimming races are often won by much smaller margins. In the 2012 London Olympics the Men’s 100 metres freestyle race was won by a margin of only 0.01 of a second. Therefore any potential benefit could make a dramatic difference to the final outcome of the race. Overall more research is warranted before the benefits of creatine supplementation in swimming performance can be further clarified.

Keywords: creatine supplementation, repeated interval, single sprint, swimming performance

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10 Representational Issues in Learning Solution Chemistry at Secondary School

Authors: Lam Pham, Peter Hubber, Russell Tytler

Abstract:

Students’ conceptual understandings of chemistry concepts/phenomena involve capability to coordinate across the three levels of Johnston’s triangle model. This triplet model is based on reasoning about chemical phenomena across macro, sub-micro and symbolic levels. In chemistry education, there is a need for further examining inquiry-based approaches that enhance students’ conceptual learning and problem solving skills. This research adopted a directed inquiry pedagogy based on students constructing and coordinating representations, to investigate senior school students’ capabilities to flexibly move across Johnston’ levels when learning dilution and molar concentration concepts. The participants comprise 50 grade 11 and 20 grade 10 students and 4 chemistry teachers who were selected from 4 secondary schools located in metropolitan Melbourne, Victoria. This research into classroom practices used ethnographic methodology, involved teachers working collaboratively with the research team to develop representational activities and lesson sequences in the instruction of a unit on solution chemistry. The representational activities included challenges (Representational Challenges-RCs) that used ‘representational tools’ to assist students to move across Johnson’s three levels for dilution phenomena. In this report, the ‘representational tool’ called ‘cross and portion’ model was developed and used in teaching and learning the molar concentration concept. Students’ conceptual understanding and problem solving skills when learning with this model are analysed through group case studies of year 10 and 11 chemistry students. In learning dilution concepts, students in both group case studies actively conducted a practical experiment, used their own language and visualisation skills to represent dilution phenomena at macroscopic level (RC1). At the sub-microscopic level, students generated and negotiated representations of the chemical interactions between solute and solvent underpinning the dilution process. At the symbolic level, students demonstrated their understandings about dilution concepts by drawing chemical structures and performing mathematical calculations. When learning molar concentration with a ‘cross and portion’ model (RC2), students coordinated across visual and symbolic representational forms and Johnson’s levels to construct representations. The analysis showed that in RC1, Year 10 students needed more ‘scaffolding’ in inducing to representations to explicit the form and function of sub-microscopic representations. In RC2, Year 11 students showed clarity in using visual representations (drawings) to link to mathematics to solve representational challenges about molar concentration. In contrast, year 10 students struggled to get match up the two systems, symbolic system of mole per litre (‘cross and portion’) and visual representation (drawing). These conceptual problems do not lie in the students’ mathematical calculation capability but rather in students’ capability to align visual representations with the symbolic mathematical formulations. This research also found that students in both group case studies were able to coordinate representations when probed about the use of ‘cross and portion’ model (in RC2) to demonstrate molar concentration of diluted solutions (in RC1). Students mostly succeeded in constructing ‘cross and portion’ models to represent the reduction of molar concentration of the concentration gradients. In conclusion, this research demonstrated how the strategic introduction and coordination of chemical representations across modes and across the macro, sub-micro and symbolic levels, supported student reasoning and problem solving in chemistry.

Keywords: cross and portion, dilution, Johnston's triangle, molar concentration, representations

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9 Performance of Coded Multi-Line Copper Wire for G.fast Communications in the Presence of Impulsive Noise

Authors: Israa Al-Neami, Ali J. Al-Askery, Martin Johnston, Charalampos Tsimenidis

Abstract:

In this paper, we focus on the design of a multi-line copper wire (MLCW) communication system. First, we construct our proposed MLCW channel and verify its characteristics based on the Kolmogorov-Smirnov test. In addition, we apply Middleton class A impulsive noise (IN) to the copper channel for further investigation. Second, the MIMO G.fast system is adopted utilizing the proposed MLCW channel model and is compared to a single line G-fast system. Second, the performance of the coded system is obtained utilizing concatenated interleaved Reed-Solomon (RS) code with four-dimensional trellis-coded modulation (4D TCM), and compared to the single line G-fast system. Simulations are obtained for high quadrature amplitude modulation (QAM) constellations that are commonly used with G-fast communications, the results demonstrate that the bit error rate (BER) performance of the coded MLCW system shows an improvement compared to the single line G-fast systems.

Keywords: G.fast, Middleton Class A impulsive noise, mitigation techniques, Copper channel model

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8 Evaluation of Technology Tools for Mathematics Instruction by Novice Elementary Teachers

Authors: Christopher J. Johnston

Abstract:

This paper presents the finding of a research study in which novice (first and second year) elementary teachers (grades Kindergarten – six) evaluated various mathematics Virtual Manipulatives, websites, and Applets (tools) for use in mathematics instruction. Participants identified the criteria they used for evaluating these types of resources and provided recommendations for or against five pre-selected tools. During the study, participants participated in three data collection activities: (1) A brief Likert-scale survey which gathered information about their attitudes toward technology use; (2) An identification of criteria for evaluating technology tools; and (3) A review of five pre-selected technology tools in light of their self-identified criteria. Data were analyzed qualitatively using four theoretical categories (codes): Software Features (41%), Mathematics (26%), Learning (22%), and Motivation (11%). These four theoretical categories were then grouped into two broad categories: Content and Instruction (Mathematics and Learning), and Surface Features (Software Features and Motivation). These combined, broad categories suggest novice teachers place roughly the same weight on pedagogical features as they do technological features. Implications for mathematics teacher educators are discussed, and suggestions for future research are provided.

Keywords: mathematics education, novice teachers, technology, virtual manipulatives

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7 Screening for Diabetes in Patients with Chronic Pancreatitis: The Belfast Trust Experience

Authors: Riyas Peringattuthodiyil, Mark Taylor, Ian Wallace, Ailish Nugent, Mike Mitchell, Judith Thompson, Allison McKee, Philip C. Johnston

Abstract:

Aim of Study: The purpose of the study was to screen for diabetes through HbA1c in patients with chronic pancreatitis (CP) within the Belfast Trust. Background: Patients with chronic pancreatitis are at risk of developing diabetes, earlier diagnosis with subsequent multi-disciplinary input has the potential to improve clinical outcomes. Methods: Clinical and laboratory data of patients with chronic pancreatitis were obtained through the Northern Ireland Electronic Healthcare Record (NIECR), specialist hepatobiliary, and gastrointestinal clinics. Patients were invited to have a blood test for HbA1c. Newly diagnosed patients with diabetes were then invited to attend a dedicated Belfast City Hospital (BCH) specialist chronic pancreatitis and diabetes clinic for follow up. Results: A total of 89 chronic pancreatitis patients were identified; Male54; Female:35, mean age 52 years, range 12-90 years. Aetiology of CP included alcohol 52/89 (58%), gallstones 18/89 (20%), idiopathic 10/89 11%, 2 were genetic, 1: post ECRP, 1: IgG autoimmune, 1: medication induced, 1: lipoprotein lipase deficiency 1: mumps, 1: IVDU and 1: pancreatic divisum. No patients had pancreatic carcinoma. Mean duration of CP was nine years, range 3-30 years. 15/89 (16%) of patients underwent previous pancreatic surgery/resections. Recent mean BMI was 25.1 range 14-40 kg/m². 62/89 (70%) patients had HbA1c performed. Mean HbA1c was 42 mmol/mol, range 27-97mmol/mol, 42/62 (68%) had normal HbA1c (< 42 mmol/mol) 13/62 (21%) had pre-diabetes (42-47mmol/mol) and 7/62 (11%) had diabetes (≥ 48 mmol/mol). Conclusions: Of those that participated in the screening program around one-third of patients with CP had glycaemic control in the pre and diabetic range. Potential opportunities for improving screening rates for diabetes in this cohort could include regular yearly testing at gastrointestinal and hepatobiliary clinics.

Keywords: pancreatogenic diabetes, screening, chronic pancreatitis, trust experience

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6 Combining in vitro Protein Expression with AlphaLISA Technology to Study Protein-Protein Interaction

Authors: Shayli Varasteh Moradi, Wayne A. Johnston, Dejan Gagoski, Kirill Alexandrov

Abstract:

The demand for a rapid and more efficient technique to identify protein-protein interaction particularly in the areas of therapeutics and diagnostics development is growing. The method described here is a rapid in vitro protein-protein interaction analysis approach based on AlphaLISA technology combined with Leishmania tarentolae cell-free protein production (LTE) system. Cell-free protein synthesis allows the rapid production of recombinant proteins in a multiplexed format. Among available in vitro expression systems, LTE offers several advantages over other eukaryotic cell-free systems. It is based on a fast growing fermentable organism that is inexpensive in cultivation and lysate production. High integrity of proteins produced in this system and the ability to co-express multiple proteins makes it a desirable method for screening protein interactions. Following the translation of protein pairs in LTE system, the physical interaction between proteins of interests is analysed by AlphaLISA assay. The assay is performed using unpurified in vitro translation reaction and therefore can be readily multiplexed. This approach can be used in various research applications such as epitope mapping, antigen-antibody analysis and protein interaction network mapping. The intra-viral protein interaction network of Zika virus was studied using the developed technique. The viral proteins were co-expressed pair-wise in LTE and all possible interactions among viral proteins were tested using AlphaLISA. The assay resulted to the identification of 54 intra-viral protein-protein interactions from which 19 binary interactions were found to be novel. The presented technique provides a powerful tool for rapid analysis of protein-protein interaction with high sensitivity and throughput.

Keywords: AlphaLISA technology, cell-free protein expression, epitope mapping, Leishmania tarentolae, protein-protein interaction

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5 Examining Predictive Coding in the Hierarchy of Visual Perception in the Autism Spectrum Using Fast Periodic Visual Stimulation

Authors: Min L. Stewart, Patrick Johnston

Abstract:

Predictive coding has been proposed as a general explanatory framework for understanding the neural mechanisms of perception. As such, an underweighting of perceptual priors has been hypothesised to underpin a range of differences in inferential and sensory processing in autism spectrum disorders. However, empirical evidence to support this has not been well established. The present study uses an electroencephalography paradigm involving changes of facial identity and person category (actors etc.) to explore how levels of autistic traits (AT) affect predictive coding at multiple stages in the visual processing hierarchy. The study uses a rapid serial presentation of faces, with hierarchically structured sequences involving both periodic and aperiodic repetitions of different stimulus attributes (i.e., person identity and person category) in order to induce contextual expectations relating to these attributes. It investigates two main predictions: (1) significantly larger and late neural responses to change of expected visual sequences in high-relative to low-AT, and (2) significantly reduced neural responses to violations of contextually induced expectation in high- relative to low-AT. Preliminary frequency analysis data comparing high and low-AT show greater and later event-related-potentials (ERPs) in occipitotemporal areas and prefrontal areas in high-AT than in low-AT for periodic changes of facial identity and person category but smaller ERPs over the same areas in response to aperiodic changes of identity and category. The research advances our understanding of how abnormalities in predictive coding might underpin aberrant perceptual experience in autism spectrum. This is the first stage of a research project that will inform clinical practitioners in developing better diagnostic tests and interventions for people with autism.

Keywords: hierarchical visual processing, face processing, perceptual hierarchy, prediction error, predictive coding

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4 The Role of Parental Stress and Emotion Regulation in Responding to Children’s Expression of Negative Emotion

Authors: Lizel Bertie, Kim Johnston

Abstract:

Parental emotion regulation plays a central role in the socialisation of emotion, especially when teaching young children to cope with negative emotions. Despite evidence which shows non-supportive parental responses to children’s expression of negative emotions has implications for the social and emotional development of the child, few studies have investigated risk factors which impact parental emotion socialisation processes. The current study aimed to explore the extent to which parental stress contributes to both difficulties in parental emotion regulation and non-supportive parental responses to children’s expression of negative emotions. In addition, the study examined whether parental use of expressive suppression as an emotion regulation strategy facilitates the influence of parental stress on non-supportive responses by testing the relations in a mediation model. A sample of 140 Australian adults, who identified as parents with children aged 5 to 10 years, completed an online questionnaire. The measures explored recent symptoms of depression, anxiety, and stress, the use of expressive suppression as an emotion regulation strategy, and hypothetical parental responses to scenarios related to children’s expression of negative emotions. A mediated regression indicated that parents who reported higher levels of stress also reported higher levels of expressive suppression as an emotion regulation strategy and increased use of non-supportive responses in relation to young children’s expression of negative emotions. These findings suggest that parents who experience heightened symptoms of stress are more likely to both suppress their emotions in parent-child interaction and engage in non-supportive responses. Furthermore, higher use of expressive suppression strongly predicted the use of non-supportive responses, despite the presence of parental stress. Contrary to expectation, no indirect effect of stress on non-supportive responses was observed via expressive suppression. The findings from the study suggest that parental stress may become a more salient manifestation of psychological distress in a sub-clinical population of parents while contributing to impaired parental responses. As such, the study offers support for targeting overarching factors such as difficulties in parental emotion regulation and stress management, not only as an intervention for parental psychological distress, but also the detection and prevention of maladaptive parenting practices.

Keywords: emotion regulation, emotion socialisation, expressive suppression, non-supportive responses, parental stress

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3 Improving Access and Quality of Patient Information Resources for Orthognathic Treatment: A Quality Improvement Project

Authors: Evelyn Marie Richmond, Andrew McBride, Chris Johnston, John Marley

Abstract:

Background: Good quality patient information resources for orthognathic treatment help to reinforce information delivered during the initial consultation and help patients make informed decisions about their care. The Consultant Orthodontists and a Dental Core Trainee noted limited patient engagement with the British Orthodontic Society (BOS) 'Your Jaw Surgery' online resources and that the existing BOS patient information leaflet (PIL) could be customised and developed to meet local requirements. Aim: The quality improvement project (QIP) aimed to improve patients' understanding of orthognathic treatment by ensuring at least 90% of patients had read the new in-house patient information leaflet (PIL) and a minimum of 50% of patients had accessed the British Orthodontic Society (BOS) 'Your Jaw Surgery' online resources before attending the joint orthognathic multidisciplinary clinic by June 2023. Methods: The QIP was undertaken in the orthodontic department of the School of Dentistry, Belfast. Data was collected prospectively during a 6-month period from January 2023 to June 2023 over 3 Plan, Do, Study, Act (PDSA) cycles. Suitable patients were identified at consultant orthodontic new patient clinics. Following initial consultation for orthognathic treatment, patients were contacted to complete a patient questionnaire. Design: The change ideas were a poster with a QR code directing patients to the BOS 'Your Jaw Surgery' website in consultation areas and a new in-house PIL with a QR code directing patients to the BOS 'Your Jaw Surgery' website. Results: In PDSA cycle 1, 86.7% of patients were verbally directed to the BOS 'Your Jaw Surgery' website, and 53.3% accessed the online resources after their initial consultation. Although 100% of patients reported reading the existing PIL, only 64.3% felt it discussed the risks of orthognathic treatment in sufficient detail. By PDSA cycle 3, 100% of patients reported being directed to the BOS 'Your Jaw Surgery' website, however, only 58.3% engaged with the website. 100% of patients who read the new PIL felt that it discussed the risks of orthognathic treatment in sufficient detail. Conclusion: The slight improvement in access to the BOS 'Your Jaw Surgery' website shows that patients do not necessarily choose to access information online despite its availability. The uptake of the new PIL was greater than reported patient engagement with the BOS 'Your Jaw Surgery' website, which indicates patients still value written information despite the availability of online resources.

Keywords: orthognathic surgery, patient information resources, quality improvement project, risks

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2 The Impact of the Covid-19 Crisis on the Information Behavior in the B2B Buying Process

Authors: Stehr Melanie

Abstract:

The availability of apposite information is essential for the decision-making process of organizational buyers. Due to the constraints of the Covid-19 crisis, information channels that emphasize face-to-face contact (e.g. sales visits, trade shows) have been unavailable, and usage of digitally-driven information channels (e.g. videoconferencing, platforms) has skyrocketed. This paper explores the question in which areas the pandemic induced shift in the use of information channels could be sustainable and in which areas it is a temporary phenomenon. While information and buying behavior in B2C purchases has been regularly studied in the last decade, the last fundamental model of organizational buying behavior in B2B was introduced by Johnston and Lewin (1996) in times before the advent of the internet. Subsequently, research efforts in B2B marketing shifted from organizational buyers and their decision and information behavior to the business relationships between sellers and buyers. This study builds on the extensive literature on situational factors influencing organizational buying and information behavior and uses the economics of information theory as a theoretical framework. The research focuses on the German woodworking industry, which before the Covid-19 crisis was characterized by a rather low level of digitization of information channels. By focusing on an industry with traditional communication structures, a shift in information behavior induced by an exogenous shock is considered a ripe research setting. The study is exploratory in nature. The primary data source is 40 in-depth interviews based on the repertory-grid method. Thus, 120 typical buying situations in the woodworking industry and the information and channels relevant to them are identified. The results are combined into clusters, each of which shows similar information behavior in the procurement process. In the next step, the clusters are analyzed in terms of the post and pre-Covid-19 crisis’ behavior identifying stable and dynamic information behavior aspects. Initial results show that, for example, clusters representing search goods with low risk and complexity suggest a sustainable rise in the use of digitally-driven information channels. However, in clusters containing trust goods with high significance and novelty, an increased return to face-to-face information channels can be expected after the Covid-19 crisis. The results are interesting from both a scientific and a practical point of view. This study is one of the first to apply the economics of information theory to organizational buyers and their decision and information behavior in the digital information age. Especially the focus on the dynamic aspects of information behavior after an exogenous shock might contribute new impulses to theoretical debates related to the economics of information theory. For practitioners - especially suppliers’ marketing managers and intermediaries such as publishers or trade show organizers from the woodworking industry - the study shows wide-ranging starting points for a future-oriented segmentation of their marketing program by highlighting the dynamic and stable preferences of elaborated clusters in the choice of their information channels.

Keywords: B2B buying process, crisis, economics of information theory, information channel

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1 A Proposed Treatment Protocol for the Management of Pars Interarticularis Pathology in Children and Adolescents

Authors: Paul Licina, Emma M. Johnston, David Lisle, Mark Young, Chris Brady

Abstract:

Background: Lumbar pars pathology is a common cause of pain in the growing spine. It can be seen in young athletes participating in at-risk sports and can affect sporting performance and long-term health due to its resistance to traditional management. There is a current lack of consensus of classification and treatment for pars injuries. Previous systems used CT to stage pars defects but could not assess early stress reactions. A modified classification is proposed that considers findings on MRI, significantly improving early treatment guidance. The treatment protocol is designed for patients aged 5 to 19 years. Method: Clinical screening identifies patients with a low, medium, or high index of suspicion for lumbar pars injury using patient age, sport participation and pain characteristics. MRI of the at-risk cohort enables augmentation of existing CT-based classification while avoiding ionising radiation. Patients are classified into five categories based on MRI findings. A type 0 lesion (stress reaction) is present when CT is normal and MRI shows high signal change (HSC) in the pars/pedicle on T2 images. A type 1 lesion represents the ‘early defect’ CT classification. The group previously referred to as a 'progressive stage' defect on CT can be split into 2A and 2B categories. 2As have HSC on MRI, whereas 2Bs do not. This distinction is important with regard to healing potential. Type 3 lesions are terminal stage defects on CT, characterised by pseudarthrosis. MRI shows no HSC. Results: Stress reactions (type 0) and acute fractures (1 and 2a) can heal and are treated in a custom-made hard brace for 12 weeks. It is initially worn 23 hours per day. At three weeks, patients commence basic core rehabilitation. At six weeks, in the absence of pain, the brace is removed for sleeping. Exercises are progressed to positions of daily living. Patients with continued pain remain braced 23 hours per day without exercise progression until becoming symptom-free. At nine weeks, patients commence supervised exercises out of the brace for 30 minutes each day. This allows them to re-learn muscular control without rigid support of the brace. At 12 weeks, bracing ceases and MRI is repeated. For patients with near or complete resolution of bony oedema and healing of any cortical defect, rehabilitation is focused on strength and conditioning and sport-specific exercise for the full return to activity. The length of this final stage is approximately nine weeks but depends on factors such as development and level of sports participation. If significant HSC remains on MRI, CT scan is considered to definitively assess cortical defect healing. For these patients, return to high-risk sports is delayed for up to three months. Chronic defects (2b and 3) cannot heal and are not braced, and rehabilitation follows traditional protocols. Conclusion: Appropriate clinical screening and imaging with MRI can identify pars pathology early. In those with potential for healing, we propose hard bracing and appropriate rehabilitation as part of a multidisciplinary management protocol. The validity of this protocol will be tested in future studies.

Keywords: adolescents, MRI classification, pars interticularis, treatment protocol

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