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Background Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory arthritis that impacts biomechanical features of gait. This systematic review describes the effects of JIA on gait motion parameters and walking performance. Methods Six databases were searched (PubMed/Medline, Cochrane, the EBSCOHost database SPORTDiscus, Web of Science, and Embase). Studies were restricted to children with any subtype of JIA who were assessed for gait motion features (kinematic, kinetic, temporalspatial) or walking performance (velocity or distance covered); could include intervention or treatment exposure with measures of gait and gait speed; could involve comparison of gait in JIA to healthy controls. Quality of evidence was assessed using the GRADE system. This systematic review was registered at PROSPERO (CRD42018109582) Results The search yielded 625 papers, 23 of which described biomechanical features of gait and/or assessed walking performance. Twenty studies measured walking velocity and walking ability using simple field tests or laboratory methods. Eleven studies measured temporalspatial parameters such as cadence, step length, stride length, step width, single and double support time. Nine studies evaluated kinetic measurements including joint power, flexion and extension and joint moments. Nine studies evaluated kinematic parameters including range of motion, pelvic tilt, center of motion and trunk sway. Conclusions Key features of gait in children with JIA include slower gait velocity, shortened step length, decreased range of motion at the hip, knee and ankle with trend towards flexion, decreased joint power, anteriorly tilted pelvis and trunk with shifted center of motion. There is a potential to ameliorate JIA-related gait changes with exercise and/or pharmaceutical interventions.

Background Non-therapeutic interventions such as practicing good hand hygiene continue to be the mainstay of protection from SARS-CoV-2 and other emerging respiratory viruses. Methods We have evaluated a range of commercially available personal care products including soaps, handwash liquids and alcohol-based hand sanitizers for antiviral efficacy against a clinical isolate of SARS-CoV-2 using internationally accepted standardized protocols at user-relevant contact time-points and product dilutions. Results All the tested products resulted in 3 to 4 log reduction of SARS-CoV-2 titer. Conclusion Our data re-affirms recommendations by global public health authorities that proper hand hygiene can reduce SARS-CoV-2 viral load significantly which should likely limit spread of the contagion.

Learning to thrive in the context of refugee resettlement can be a difficult task to consider and sustain when so much focus is given to promoting survival, recovery from trauma and self-sufficiency. It is argued that this resettlement paradigm is rooted in notions of refugee passivity, primarily motivated by a minimalistic approach to social assimilation. We argue this resettlement paradigm suffocates thriving by imposing the government’s aim of achieving independence instead of privileging the newly arrived person, their lived experiences, dreams and aspirations. This article shares how an ethic of thriving in resettlement, with its focus on relationality, could transform the way we think about ‘integration’ and what ‘successful resettlement’ means within the Australian context. To anchor what the ethic of thriving offers the resettlement sector we share lessons learned from applying a thriving paradigm to YoungMILE—a mentorship project dedicated to launching young refugee arrived leaders in the community. This unique programme embraced relational, experimental and exploratory approaches characterised by flexibility, mutual learning, curiosity, listening to bigger goals and acknowledging the skill sets of people’s past experiences. Importantly, the project also prioritised connecting people of refugee background and the host community to promote meaningful integration.

The aim of the study was to compare the effectiveness of concentrically focused resistance training to eccentrically focused resistance training on physical function and functional pain in knee osteoarthritis.This is a randomized, single-blinded controlled 4-mo trial. Older adults with knee osteoarthritis (N = 88; 68.3 ± 6.4 yrs, 30.4 ± 6.9 kg/m, and 67.4% women) were randomized to eccentrically focused resistance training, concentrically focused resistance training, or no-exercise control. Main outcomes included chair rise time, stair climb time, 6-min walk test distance, temporal-spatial parameters of gait, community ambulation, and functional pain.Leg muscle strength improved in both training groups compared with no-exercise control. There were no significant group × time interactions for any functional performance score (chair rise time, stair climb time, 6-min walk test distance, gait parameters, community ambulation). Compared with no-exercise control, functional pain scores were reduced for chair rise (-38.6% concentrically focused resistance training, -50.3% eccentrically focused resistance training vs. +10.0%) and stair climb (-51.6% concentrically focused resistance training, -41.3% eccentrically focused resistance training vs. +80.7%; all P0.05). Pain scores were reduced during the 6-min walk and in early recovery with concentrically focused resistance training compared with the remaining two groups (P0.05).Either resistance exercise type improves activity-related knee osteoarthritis pain, but concentrically focused resistance training more effectively reduced severity of ambulatory pain and pain upon walking cessation.

Published on 06 Feb 2022 The COVID-19 pandemic, and the resulting closure of daycare centers worldwide, led to unprecedented changes in children’s learning environments. This period of increased time at home with caregivers, with limited access to external sources (e.g., daycares) provides a unique opportunity to examine the associations between the caregiver-child activities and children’s language development. The vocabularies of 1742 children aged 8-36 months across 13 countries and 12 languages were evaluated at the beginning and end of the first lockdown period in their respective countries (from March to September 2020). Children who had less passive screen exposure and whose caregivers read more to them showed larger gains in vocabulary development during lockdown, after controlling for SES and other caregiver-child activities. Children also gained more words than expected (based on normative data) during lockdown; either caregivers were more aware of their child’s development, or vocabulary development benefited from intense caregiver-child interaction during lockdown, or both. We discuss these results in the context of the extraordinary circumstances of the COVID-19 pandemic and highlight limitations of the study. Funding for Polish sample: grant from National Science Center NCN (Poland), no 2018/31/B/HS6/03916. NK was partly supported by the Research Council of Norway through its Centres of Excellence funding scheme [project number 223265].

ObjectivesThe use of headgear is a controversial issue in girls’ lacrosse. We compared concussion rates among high school lacrosse players wearing versus not wearing lacrosse headgear.MethodsStudy participants included a sample of convenience of high schools with girls’ lacrosse from across the United States. Certified athletic trainers reported athlete exposure and injury data via the National Athletic Treatment, Injury and Outcomes Network during the 2019 through 2021 seasons. The Headgear cohort was inclusive of high schools from the state of Florida, which mandate the use of ASTM standard F3137 headgear, while the Non-Headgear cohort was inclusive of the remaining states, none of which have headgear mandates. Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI) were calculated. IRRs with corresponding CIs that excluded 1.00 were deemed statistically significant.Results141 concussions (Headgear: 25; Non-Headgear: 116) and 357,225 Athlete Exposures (AE) were reported (Headgear: 91,074AE; Non-Headgear: 266,151AE) across all games and practices. Overall, the concussion injury rate per 1000AE was significantly higher in the Non-Headgear cohort (0.44) than the Headgear Cohort (0.27) (IRR=1.59, 95% CI:1.03 - 2.45). The IRR was significantly higher for the Non-Headgear cohort during games (1.74, 95% CI: 1.00, 3.02) but not for practices (1.42, 95% CI: 0.71, 2.83).ConclusionsThese findings indicate that concussion rates among high school girls’ lacrosse players not wearing headgear were 59% higher than those wearing headgear. These data support the use of protective headgear to reduce the risk of concussion among high school female lacrosse athletes.SummaryWhat are the new findingsThe use of lacrosse headgear meeting the ASTM F3137 standard was associated with a lower risk of experiencing a concussion injury among high school girls’ lacrosse players.How might these findings impact clinical practice in the future?Lacrosse headgear may be warranted for use for concussion risk mitigation among high school girls’ lacrosse players.Lacrosse headgear may be considered for concussion risk mitigation at other levels of play such as the youth or collegiate levels; further study is warranted.

BACKGROUND Some recreational runners with obesity successfully train or compete without musculoskeletal injury. Insight into the key kinetic strategies of injury-free heavier runners is necessary to appropriately guide development of safe training programs for this population. OBJECTIVE To determine key biomechanical strategies of running in individuals with body mass index (BMI) values above and equal to and higher than 30 kg/m2 . DESIGN This was a case-control study. PARTICIPANTS Runners with obesity (n =18; 42.7 years, 38.9% women) who were matched by sex, age, footstrike type, footwear characteristics, and running speed with healthy runners (n = 36; 41.7 years, 32.5% women). SETTING Research laboratory affiliated with an academic medical center. METHODS A seven-camera optical motion analysis system was used to capture running kinematics and an instrumented treadmill captured kinetic data. MAIN OUTCOMES Main outcomes were temporal spatial parameters, joint excursions, peak ground reaction forces (GRFs), joint moments, vertical average loading rate (VALR), impulses, and vertical stiffness (Kvert ). RESULTS Runners with obesity demonstrated 15% less vertical excursion of the center of mass, 18% wider strides, and 3% longer stance times than nonobese runners (P

We are writing in response to the editorial “ROPS Are Not Homemade” by W. E. Field, R. Tormoehlen, S. Ehlers, C. Cheng, A. Talbert, G. Deboy, D. Haberlin, and C. V. Schwab, which was published in the July 2019 issue of the Journal of Agricultural Safety and Health (Field et al., 2019). The editorial warns secondary school teachers and FFA advisors about the potential liability of fabricating and installing low-cost rollover protective structures (ROPS) as service learning projects for agricultural education students. The apparent intent of the editorial is to discourage teachers and advisors from carrying out such projects. We wish to present arguments as to why these are actually highly beneficial projects to undertake, and perhaps one of our best hopes for significantly reducing the number of tractor overturn injuries and fatalities by directly involving our nation’s youth. Keywords: Homemade ROPS, ROPS, Tractor overturns.

Background The study purpose was to determine whether 2-stage revision procedures result in superior outcomes and whether reverse shoulder arthroplasty produced superior outcomes to hemiarthroplasty or anatomic total shoulder arthroplasty at the time of reimplantation. Methods Our prospectively collected database was retrospectively reviewed for all surgically treated infected shoulder arthroplasties between 2006 and 2014. We included 47 patients in this study: 27 underwent a 2-stage revision, and 20 were treated with an antibiotic spacer as definitive treatment. Preoperative laboratory results, intraoperative cultures and pathology findings, recurrence of infection, complications, and outcome measures were compared between treatment groups. Results A recurrent infection developed in 3 patients in the antibiotic spacer group and 2 patients in the 2-stage revision group ( P = .25). A total of 20 procedure-related complications and 11 medical complications occurred between the 2 groups; however, there was no statistically significant difference between groups. The 2-stage group had statistically significantly better Constant scores (58.1 vs. 33.3, P = .04) and elevation (94.4° vs. 48.6°, P = .02) than the antibiotic spacer group. Subanalysis of the 2-stage revision group showed that reverse total shoulder arthroplasties had statistically superior Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons, University of California at Los Angeles, and Constant scores; elevation; and abduction compared with hemiarthroplasties or anatomic total shoulder arthroplasties. Conclusion Two-stage revision procedures and use of an antibiotic spacer for definitive management of periprosthetic shoulder infections appear to be similar and effective in eradicating infections. Two-stage revisions using a reverse total shoulder arthroplasty at the time of reimplantation generate superior range of motion and functional outcome scores.

The hemiparetic walking pattern is a common feature of an upper motor neuron impairment caused by stroke. Previous studies have recorded deviations in hemiparetic walking patterns. We aimed to quantify gait alterations poststroke relative to healthy gait across a range of walking speeds by a systematic review and meta-analysis. We searched databases including MEDLINE via PubMed, Web of Science, SPORTDiscus, Cumulative Literature Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials from 1927 to the end of July 2015 for all instrumented measured gait variables in (a) observational studies with stroke patients only and (b) interventional studies in healthy, age-matched (elderly) participants, and those with stroke published in English. We analyzed data using a patient-weighted random-effects method. The heterogeneity of methods and measures employed across studies limited the intended analyses. The search pooled 2,223 articles, of which we included 49 observational and 124 interventional studies involving 960 healthy elders and 4,691 participants with stroke. As expected, those with stroke have gait-speed-related statistical differences from those without stroke. Specifically, this meta-analysis determined that (a) only 2 spatial parameters consistently changed according to gait speed – step length and stride length – and (b) irrespective of speed, 9 spatiotemporal measures, 5 sagittal kinematic, and 3 kinetic measures from the analysis were statistically different from the healthy counterparts ( P < .05). These findings suggest the importance of using instrumented measurement techniques for evaluating stroke gait rehabilitation.

Purpose: Approximately 185 000 individuals undergo limb amputations every year. Of this population, 40% experience lower extremity amputations. A common musculoskeletal condition that develops afte...

INTRODUCTION This study aimed to compare the efficacy of eccentrically focused resistance exercise (ECC RT) to concentrically focused resistance exercise (CNC RT) on knee osteoarthritis (OA) symptoms and strength. METHODS Ninety participants consented. Participants were randomized to CNC RT, ECC RT, or a wait-list, no-exercise control group. Four months of supervised exercise training was completed using traditional weight machines (CNC RT) or modified-matched machines that overloaded the eccentric action (ECC RT). Main outcomes included one-repetition maximal strength (knee extension, leg flexion, and leg press), weekly rate of strength gain, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) total score and subscores. RESULTS Fifty-four participants (60-85 yr, 61% women) completed the study. Both CNC RT and ECC RT groups showed 16%-28% improvement relative to the wait-list, no-exercise control group (P = 0.003-0.005) for all leg strength measures. The rate of weekly strength gain was greater for CNC RT than for ECC RT for leg press and knee flexion (by 2.9%-4.8%; both, P < 0.05) but not knee extension (0.7%; P = 0.38). There were no significant differences in WOMAC total and subscores across groups over time. Leg press strength change was the greatest contributor to change in WOMAC total scores (R = 0.223). The change in knee flexion strength from baseline to month 4 was a significant predictor of the change in WOMAC pain subscore (F ratio = 4.84, df = 45, P = 0.032). Both modes of strength training were well tolerated. CONCLUSIONS Both resistance training types effectively increased leg strength. Knee flexion and knee extension muscle strength can modify function and pain symptoms irrespective of muscle contraction type. Which mode to pick could be determined by preference, goals, tolerance to the contraction type, and equipment availability.

Physiatry is a medical specialty focused on improving functional outcomes in patients with a variety of medical conditions that affect the brain, spinal cord, peripheral nerves, muscles, bones, joints, ligaments, and tendons. Social determinants of health (SDH) play a key role in determining therapeutic process and patient functional outcomes. Big data and precision medicine have been used in other fields and to some extent in physiatry to predict patient outcomes, however many challenges remain. The interplay between SDH and physiatry outcomes is highly variable depending on different phases of care, and more favorable patient profiles in acute care may be less favorable in the outpatient setting. Furthermore, SDH influence which treatments or interventional procedures are accessible to the patient and thus determine outcomes. This opinion paper describes utility of existing datasets in combination with novel data such as movement, gait patterning and patient perceived outcomes could be analyzed with artificial intelligence methods to determine the best treatment plan for individual patients in order to achieve maximal functional capacity.

Children with obesity experience musculoskeletal pain and reduced physical function and wellbeing, which collectively impact their fitness, strength, motor skills and even their ability to undertake simple tasks like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children’s physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity. Refereed/Peer-reviewed

This study determined the prevalence of joint pain among lacrosse officials and described the impact of pain thereof on current officiating duties on the field. Members of the US Lacrosse Officials Development Programme were provided with an electronic survey (a 15.7% response rate resulted in N = 1,441 of completed surveys). Pain sites and severity, previous injuries and current impact of musculoskeletal pain on officiating duties were captured. Pain was present in 18.1-40.1% of respondents at the foot, shoulder, back and knee. A total of 437 officials reported diagnoses of osteoarthritis ([OA]; knee 48.7%, hip 10.5%, spine 10.1%, shoulder 8.0%) and 247 reported OA in more than one joint (p .05). Officials with OA or previous lacrosse-related injuries reported frequent difficulty with running the entire field distance (p 0.0001), starting and stopping on the field (p 0.0001), keeping pace (p 0.0001), focusing on multiple actions of players at once (p 0.0001), and enjoyment (all p 0.0001). Musculoskeletal pain is a common, unrecognized issue in this population that interferes with sport officiating functions. Additional study is needed to objectively determine the impact of OA pain and musculoskeletal injuries on measurable performance outcomes on the field and subjective measures of focus, attention and enjoyment.

A progressive, treadmill-based VO2max is the gold standard of cardiorespiratory fitness determination but is rarely used in pediatric clinics due to time requirements and cost. Simpler and shorter fitness tests such as the Squat Test or Step Test may be feasible and clinically useful alternatives. However, performance comparisons of these tests to treadmill VO2max tests are lacking. The primary aim of this cross-sectional study was to assess the correlation between Squat and Step Test scores and VO2max in a pediatric population. As secondary outcomes, we calculated correlations between Rated Perceived Exertion Scale (RPE) scores, NIH PROMIS Physical Activity scores, and BMI z-score with VO2max, and we also evaluated the ability of each fitness test to discriminate low and high-risk patients based on the FITNESSGram. Forty children aged 10-17 completed these simple cardiorespiratory fitness tests. Statistically significant correlations were observed between VO2max and the Step Test (r = -0.549) and Squat Test (r = -0.429) scores, as well as participant BMI z-score (r = -0.458). RPE and PROMIS scores were not observed to be correlated with VO2max. Area Under the Receiver Operator Curve was relatively high for BMI z-scores and the Step Test (AUC = 0.813, 0.713 respectively), and lower for the Squat Test (AUC = 0.610) in discriminating risk according to FITNESSGram Scores. In this sample, the Step Test performed best overall. These tests were safe, feasible, and may add great value in assessing cardiorespiratory fitness in a clinical setting.

Background Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens. Methods/design This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18–60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRSpain). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count. Discussion The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population. Trial registration ClinicalTrials.gov, ID: NCT03300375. Registered on 2 October 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2362-0) contains supplementary material, which is available to authorized users.

To determine if hepatic venous pressure gradient (HVPG) correlates with advanced hepatic fibrosis, as a complement to transjugular (transvenous) core needle liver biopsy. After institutional review board approval, a retrospective review was conducted on 340 patients who underwent transjugular (transvenous) core needle liver biopsy with concurrent pressure measurements between 6/1/2007 and 6/1/2013. Spearman correlation and linear regression were performed. A receiver operating characteristic (ROC) curve was created and sensitivity, specificity, predictive values and likelihood ratios were calculated. Indications included hepatitis C, abnormal liver function tests, non-alcoholic steatohepatitis, autoimmune hepatitis, and cirrhosis, among others. Biopsies showed stage 1 or 2 fibrosis in 15.6% each, stage 3 fibrosis in 21.6%, stage 4 fibrosis in 40.7%, and no fibrosis in 6.5%. Mean HVPG was 6.5 mm Hg (SD 5.0) with a range of 0–26 mm Hg. Spearman correlation coefficient for association between HVPG and fibrosis stage was 0.561 (p

Successful biliary drainage in case of intraductal papillary mucinous neoplasm (IPMN) with thick mucus by ERCP and internal drainage alone is usually inadequate. The mucolytic properties of acetylcysteine can offer a therapeutic benefit in this setting. We report a 50-year-old man with chronic pancreatitis and IPMN who had recurrent episodes of biliary obstruction due to mucous occlusion, despite multiple stent exchanges. A nasobiliary catheter was placed and infusion of acetylcysteine was performed which resulted in significant improvement of jaundice. He later underwent surgery after nutritional rehabilitation. This case report highlights the role of intrabiliary acetylcysteine infusions for mucous occlusions in IPMN.

BACKGROUND: Orthopaedic trauma patients frequently experience mobility impairment, fear-related issues, self-care difficulties, and work-related disability [12, 13]. Recovery from trauma-related injuries is dependent upon injury severity as well as psychosocial factors [2, 5]. However, traditional treatments do not integrate psychosocial and early mobilization to promote improved function, and they fail to provide a satisfying patient experience. QUESTIONS/PURPOSES: We sought to determine (1) whether an early psychosocial intervention (integrative care with movement) among patients with orthopaedic trauma improved objective physical function outcomes during recovery compared with usual care, and (2) whether an integrative care approach with orthopaedic trauma patients improved patient-reported physical function outcomes during recovery compared with usual care. METHODS: Between November 2015 and February 2017, 1133 patients were admitted to one hospital as orthopaedic trauma alerts to the care of the three orthopaedic trauma surgeons involved in the study. Patients with severe or multiple orthopaedic trauma requiring one or more surgical procedures were identified by our orthopaedic trauma surgeons and approached by study staff for enrollment in the study. Patients were between 18 years and 85 years of age. We excluded individuals outside of the age range; those with diagnosis of a traumatic brain injury [28]; those who were unable to communicate effectively (for example, at a level where self-report measures could not be answered completely); patients currently using psychotropic medications; or those who had psychotic, suicidal, or homicidal ideations at time of study enrollment. A total of 112 orthopaedic trauma patients were randomized to treatment groups (integrative and usual care), with 13 withdrawn (n = 99; 58% men; mean age 44 years ± 17 years). Data was collected at the following time points: baseline (acute hospitalization), 6 weeks, 3 months, 6 months, and at 1 year. By 1-year follow-up, we had a 75% loss to follow-up. Because our data showed no difference in the trajectories of these outcomes during the first few months of recovery, it is highly unlikely that any differences would appear months after 6 months. Therefore, analyses are presented for the 6-month follow-up time window. Integrative care consisted of usual trauma care plus additional resources, connections to services, as well as psychosocial and movement strategies to help patients recover. Physical function was measured objectively (handgrip strength, active joint ROM, and Lower Extremity Gain Scale) and subjectively (Patient-Reported Outcomes Measurement Information System-Physical Function [PROMIS®-PF] and Tampa Scale of Kinesiophobia). Higher values for hand grip, Lower Extremity Gain Scale (score range 0-27), and PROMIS®-PF (population norm = 50) are indicative of higher functional ability. Lower Tampa Scale of Kinesiophobia (score range 11-44) scores indicate less fear of movement. Trajectories of these measures were determined across time points. RESULTS: We found no differences at 6 months follow-up between usual care and integrative care in terms of handgrip strength (right handgrip strength β = -0.0792 [95% confidence interval -0.292 to 0.133]; p = 0.46; left handgrip strength β = -0.133 [95% CI -0.384 to 0.119]; p = 0.30), or Lower Extremity Gain Scale score (β = -0.0303 [95% CI -0.191 to 0.131]; p = 0.71). The only differences between usual care and integrative care in active ROM achieved by final follow-up within the involved extremity was noted in elbow flexion, with usual care group 20° ± 10° less than integrative care (t [27] = -2.06; p = 0.05). Patients treated with usual care and integrative care showed the same Tampa Scale of Kinesiophobia score trajectories (β = 0.0155 [95% CI -0.123 to 0.154]; p = 0.83). CONCLUSION: Our early psychosocial intervention did not change the trajectory of physical function recovery compared with usual care. Although this specific intervention did not alter recovery trajectories, these interventions should not be abandoned because the greatest gains in function occur early in recovery after trauma, which is the key time in transition to home. More work is needed to identify ways to capitalize on improvements earlier within the recovery process to facilitate functional gains and combat psychosocial barriers to recovery. LEVEL OF EVIDENCE: Level II, therapeutic study.

Objectives This study evaluates the associations between post injury depressive symptomology and opioid use from the initial time of injury in orthopedic trauma patients without pre-existing psychiatric conditions. Design and setting This is a prospective study following the development of symptoms after orthopedic trauma injury conducted at a Level-1 trauma center. Patients Orthopedic trauma patients (N=96; 43.4±16.5 yrs, 40.6% women) Main outcome measures and analysis methods Beck Depression Inventory (BDI-II) was administered during index hospitalization and at 2-weeks, 6-weeks, and 3- months, and 6-months. In-hospital and out-patient opioid use were tracked. Regression analyses determined the relationship of opioid use and depressive symptoms during follow-up. Results Twenty percent of patients had moderate depressive symptom levels (BDI 20-28 points) and 11% had severe depressive symptom levels (BDI ≥29) at the time of their index hospitalization. Inpatient BDI-II depressive symptom severity levels were significantly related to depressive symptomology at 2 -weeks, 6 -weeks, and 3 -months. In-hospital or discharge opioid dose was not associated with initial or persistent depressive symptomology. Patients with persistent opioid use at 6 weeks had higher depressive symptoms six months following post-discharge than those who ceased opioid use by 6 -weeks post-discharge. Conclusions This study suggests that depressive symptomology immediately following musculoskeletal trauma is predictive for persistent depressive symptomology in a subset of our patient population. Inpatient BDI-II depressive symptom severity levels in the hospital were significantly related to BDI-II at 2-weeks, 6-weeks, and 3-months, and persistent opioid use, past 6-weeks, was independently associated with prolonged depressive symptomology as well. Further study into effective treatment and monitoring of mental health disturbances following trauma is needed, particularly in patients with continued need for and use of opioids after discharge.

Runners with injuries can benefit from a comprehensive evaluation that consists of a complete review of medical and training history, physical function assessments, pain symptoms, shoewear, and biomechanics while running to find characteristics that are related to injury. Sudden changes to training load (distance, speed, or frequency of runs), training surface, running gear, shoe type or orthotics, foot strike, or running form may trigger pain and injury onset. Functional assessments should include load-bearing tests (single-leg squats, balance) and non–load-bearing tests (flexibility of ankle, hip, and toes) to determine potential links in the kinetic chain that may not be able to transfer or sustain forces during the stance phase of the gait cycle. Physician involvement is recommended if the runner is symptomatic, and physical therapy consults are important for correcting biomechanical issues found in biomechanical analyses.

To determine the prevalence and risk factors associated with musculoskeletal injuries sustained in female adolescent volleyball players.Volleyball players (n = 276; 13-18 years), with any level of volleyball experience, were recruited. Participants completed a study-specific survey about their overall sport(s) involvement, training modalities, volleyball experience (beginner, intermediate, advanced), annual volume of volleyball play, injuries accrued during volleyball, and care received for injury.Annual volume of volleyball play was higher in advanced than beginner/intermediate players (490.0 hr/yr versus 302.3 hr/yr; p 0.0001). Nearly 67% (188/276) of participants incurred one or more volleyball-related injuries over the last year. The ankle (40.6%), fingers (36.6%), knee (21.2%), and shoulder (15.5%) were the most frequently reported injury. Injury prevalence was higher in advanced than beginner/intermediate players (73.5% versus 62.0%;More competitive and experienced adolescent female players may incur injuries due to progressively higher volumes of play as experience and competition level increase. Players who have committed to only playing volleyball participated in greater volumes of volleyball play, which increases the odds of sustaining an injury.Understanding injury risk factors may improve clinical management and injury prevention.

BackgroundThe aim of this systematic review was to identify principles of exercise interventions associated with improved physical function, weight management or musculoskeletal pain relief among young and middle-aged adults with obesity and propose an evidence-based exercise prescription that could assist in secondary prevention of osteoarthritis.MethodsA structured electronic review was conducted using MEDLINE, PubMed, and SPORTDiscus. The search string included 1) “obes*” AND “exercise” AND “interven*” AND “musculoskeletal pain OR knee pain OR hip pain”. Studies 1) were randomized controlled trials of humans, with a non-exercise control, 2) included participants aged 18–50 years, and 3) had outcomes that included physical function, musculoskeletal pain, and/or body composition. Studies were excluded if participants had peri-menopausal status, cancer, or obesity-related co-morbidities. A recommended exercise prescription was developed based on common principles used in the included exercise interventions with greatest change in function or pain.ResultsSeven studies were included. Similarities in exercise intensity (40–80% VO2max), frequency (three times per week), duration (30–60 min), and exercise mode (treadmill, cross-trainer, stationary bike, aquatic exercise) were observed in exercise interventions that resulted in improved physical function and/or pain, compared to non-exercise control groups.ConclusionCommon principles in exercise prescription for improvements in weight management, physical function and pain relief among otherwise healthy people with obesity. Exercise prescription including moderate intensity exercise for 30–60 min, three times per week can be considered an effective treatment for weight management and obesity-related musculoskeletal symptoms. Exercise should be recommended to at-risk individuals as part of secondary prevention of osteoarthritis.

Exertional heat stroke is one of the top three causes of death in young athletes, particularly high school football players. Despite evidence that these deaths are completely avoidable with appropriate prevention and treatment, deaths still occur at an alarming rate. Wet bulb globe temperature (WBGT) is the preferred method of both the National Athletic Trainers' Association and American College of Sports Medicine to measure heat intensity. Based on the WBGT, activity modification guidelines (AMG) dictate work-to-rest ratios, activity levels and duration, protective equipment worn, and length and frequency of hydration breaks. Due to the cost of handheld WBGT monitors, smartphone apps that estimate WBGT have been considered an alternative. However, it is unclear how WBGT values estimated by these smartphone apps compare to those measured on-site using handheld WBGT monitors. We compared WBGT values estimated by a commercial smartphone app to those taken on-site at the same time and place. Thirteen athletic trainers measured WBGT in the field during high school football practices over a three-month season in North Central Florida. A paired sample t-test indicated the smartphone app significantly overestimated WBGT (29.0°C ± 4.1°C) compared to on-site measures (26.4°C ± 3.2°C) ( r =0.580; t(943)=-23.38, p

The ulnar collateral ligament (UCL) of the elbow has been a subject of extensive research and discussion in recent years not only in the medical community but also in the media and by coaches, players, and parents. This is in part due to the rising incidence of UCL injuries and subsequent surgical reconstruction, specifically in overhead throwing athletes. Due to this widespread increase in injury to this structure, it is paramount to understand when it is appropriate to pursue nonoperative versus operative management. As such, the purpose of this article will be to review the basic anatomy, risk factors for UCL injury in overhead throwing athletes, treatment approaches, and future directions for prevention and treatment of injury based on the evidence-based data in the peer-reviewed literature.

Lacrosse imposes multiple simultaneous physical demands during play including throwing and catching a ball while holding a crosse, running, cutting, and jumping. Often, these skills are completed while experiencing contact from another player leading to both on-and-off platform movements. Other motions include defensive blocking and pushing past defenders. Repetitive motions over sustained durations in practice or competition impart mechanical stresses to the shoulder or elbow joints, supportive muscles, and connective tissue. Preparation for lacrosse participation involves bilateral optimization of strength and durability of stabilizer muscles. Passing and shooting skills are encouraged to be equally effective on both sides; therefore, symmetric strength and flexibility are vital for prehabilitation and rehabilitation efforts. This article will: 1) provide insights on the upper-extremity musculoskeletal demands of lacrosse and related sports with similar throwing motion and 2) describe prehabilitation and rehabilitation methods that improve athlete durability and reduce likelihood of upper-extremity injury.

This study tested interactions between age and running speed on biomechanics, metabolic responses and cardiopulmonary responses. Three-hundred participants ran at preferred and standardized speeds. Age group (younger, masters [≥40 years]) by speed (self-selected 8.8 km/h, 11.2 km/h and 13.6 km/h) interactions were tested on main outcomes of sagittal kinematic, temporal spatial, metabolic and cardiopulmonary parameters. At all speeds, angular displacements of the ankle, pelvis and knee were less in masters than younger runners (Hedges g effect size range = 0.30-1.04; all p

Repetitive throwing and hitting motions in baseball place mechanical stresses to the lumbar spine which may cause low back pain (LBP). Pain may be due to vertebral stress reactions or insufficiency fractures, intervertebral disc degeneration or intervertebral disc herniation. Untreated chronic conditions have high potential to lead to a more significant injury such as spondylolysis. Chronic LBP increases the risk for missed playing time, early career termination and lower quality of life after retirement. Proper clinical assessment and prevention/rehabilitation of LBP in this population is thus important for performance, play time and overall long-term quality of life. This narrative review synopsizes the available evidence for assessment and rehabilitation of baseball players with LBP, including the structured rehabilitative techniques and programmes which should be administered to affected players. The state of the evidence suggests that there are deficits in identifying the optimal prevention and rehabilitation prescription components for the variety of LBP-inducing injuries in this athletic population.

Shoulder injuries in overhead throwing athletes are very common. Throwing volume and mechanical forces that are placed on the glenohumeral joint and associated soft tissue structures are contributors. Poor biomechanics and weak links in the kinetic chain place this athletic population at increased risk for shoulder injuries. Common biomechanical deficiencies in overhead throwing athletes typically involve poor sequential timing of muscle activity and insufficient coordination also presented in shoulder elevation and other functional tasks. Kinetic chain deficits will lead to injury due to poor transference of energy from the lower extremities to the dominant upper extremity. Correction of these deficits involves effective treatment and prevention strategies. These include core and hip strengthening, balance training, optimize timing of biomechanical phases and events for each throwing movement, and following recommended rest guidelines. This article will synopsize current evidence of sport-specific injury mechanisms, injury treatment, and prevention of the shoulder in overhead throwing athletes.

The timing and quantity of fertilizer and herbicide applications in agricultural systems are critical where maximizing vigour and yield is the ultimate goal. While fertilizers are applied to the soil to promote plant growth, herbicides are commonly used to control weeds in order to reduce the weeds’ competition for nutrients. Satellite imagery is frequently used to monitor agricultural activities and vegetation indices VIs are widely applied in temporal analysis of crop status. This study considers monitoring Landsat VIs for the period between 5 June and 27 October 2014 in agricultural systems under four different management treatments at the Kellogg Biological Station KBS, in Michigan, USA. The results show that 1 fine-tuning conventional treatments by intense early herbicide applications in combination with no-tilled soil results in significantly higher VIs during the early growth stage, a more rapid maturity rate, and the highest crop yield; 2 nitrogen uptake from nitrate-based rather than from ammonium-based fertilizers might be more beneficial in terms of crop vigour and yield return; 3 organic treatments, with organic corn and no agricultural chemicals, keep higher VIs longer in the season at the cost of lower yield; and 4 genetically modified GM breeds under conventional or reduced-chemical treatments have synchronized early senescence. A positive correlation between VIs during the early growth stage and yield is observed for conventional no-till treatment coefficient of determination, R2 = 0.70. The correlation becomes gradually weaker with each month from late June to October 29 June: R2 = 0.70; 16 August: R2 = 0.61; 17 September: R2 = 0.44; 27 October: R2 = 0.01. The analysis of variance ANOVA–Tukey–Kramer approach suggests significant differences in VIs between organic and GM corn treated conventionally or with reduced chemicals for the preharvest season 27 October 2014. The leave-out-one cross-validation analysis confirms the predictive accuracy of the model mean square error MSE = 0.0014. The rapid evolution of herbicide-resistant weeds requires constant refinement of chemical inputs to agricultural systems, thus making the monitoring of Landsat VIs important in the years to come.

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients. Level of Evidence V

Intracranial calcifications in the pediatric population are frequently encountered on imaging studies and may be seen in association with a variety of disease states. This review article provides an overview of the various pathological entities which may result in calcification on pediatric neuroimaging studies, including their key clinical, imaging, and histological features. For ease of discussion, disease categories are grouped into neoplastic, infectious, vascular, iatrogenic, and metabolic etiologies. The phakomatoses are discussed as well. It is hoped that the information contained in this review will assist the reader in formulating an appropriate differential diagnosis when intracranial calcifications are identified on imaging examinations.

Background: Girls’ lacrosse headgear that met the ASTM International performance standard (ASTM F3137) became available in 2017. However, the effects of headgear use on impact forces during game play are unknown. Purpose: To evaluate potential differences in rates, magnitudes, and game-play characteristics associated with verified impacts among players with and without headgear during competition. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 49 female high school participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered for this study, which took place during the 2016 (no headgear; 18 games) and 2017 (headgear; 15 games) seasons. Wearable sensors synchronized with video verification were used. Descriptive statistics, impact rates, and chi-square analyses described impacts and game-play characteristics among players with and without headgear. Differences in mean peak linear acceleration (PLA) and peak rotational velocity (PRV) between the no headgear and headgear conditions were evaluated using a linear generalized estimating equation regression model to control for repeated within-player measurements. Results: Overall, 649 sensor-instrumented player-games were recorded. A total of 204 impacts ≥20 g recorded by the wearable sensors were verified with video analysis (102 no headgear; 102 headgear). Most impacts were imparted to the player’s body (n = 152; 74.5%) rather than to the player’s head (n = 52; 25.5%). Impact rates per player-game did not vary between the no headgear and headgear conditions (0.30 vs 0.34, respectively; impact rate ratio, 0.88 [95% CI, 0.37-2.08]). There was no association between impact frequency by mechanism or penalties administered between the no headgear and headgear conditions for overall or direct head impacts. The generalized estimating equation model estimated a significant reduction in mean impact magnitudes overall (PLA: –7.9 g [95% CI, –13.3 to –2.5]; PRV: –212 deg/s [95% CI, –359 to –64]) with headgear relative to no headgear. No game-related concussions were reported during this study. Conclusion: Lacrosse headgear use was associated with a reduction in the magnitude of overall impacts but not a significant change in the rate of impacts, how they occur, or how penalties were administered for impacts sustained during competition. Further research is needed with a larger sample and different levels of play to evaluate the consequences of headgear use in girls’ lacrosse.

ObjectivesTo determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores.DesignCross-sectional electronic survey.SettingEmergency departments (EDs) (n=112) in the UK and Ireland.ParticipantsEmergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019.Main outcome measureNFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery.ResultsThe median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5–90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%–50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%–75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%–100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9).ConclusionHigher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.

Different landing surfaces may affect lower extremity biomechanical performance during athletic tasks. The magnitude of this effect on clinical screening measures such as jump-landings is unknown. This study determined the effect of court (CS), grass (GS), and tile (TS) surfaces on Landing Error Scoring System (LESS) grades. A repeated-measures design was used. Forty (21F, 19M; mean age = 23.8 ± 2.4 yr) recreational athletes performed a jump-landing task on three different landing surfaces. 2D videography recorded jump-landings in the frontal and sagittal planes. A 2 X 3 (sex by surface) mixed-model repeated-measures analysis of variance was used to examine main and interaction effects associated with surface and sex. No significant sex by landing surface interactions existed for LESS grades. No significant differences were observed on LESS grades for the main effect of surface (CS = 4.83 ± 1.31 points; GS = 5.01 ± 1.40 points; TS = 5.09 ± 1.86 points; all p>0.05). Correlations were found between LESS grades among different conditions (r range=0.587 to 0.611; all p

OBJECTIVES This study explored the relationships between negative affective states (depression and anxiety), physical/functional status, and emotional well-being during early treatment and later in recovery after orthopaedic trauma injury. DESIGN This was a secondary observational analysis from a randomized controlled study performed at a Level-1 trauma center. PATIENTS Patients with orthopaedic trauma (N = 101; 43.5 ± 16.4 years, 40.6% women) were followed from acute care to week 12 postdischarge. MAIN OUTCOME MEASURES Patient-reported outcomes measurement information system measures of Physical Function, Psychosocial Illness Impact-Positive and Satisfaction with Social Roles and Activities and the Beck Depression Inventory-II and the State-Trait Anxiety Inventory were administered during acute care and at weeks 2, 6, and 12. Secondary measures included hospital length of stay, adverse readmissions, injury severity, and surgery number. RESULTS At week 12, 20.9% and 35.3% of patients reported moderate-to-severe depression (Beck Depression Inventory-II score ≥20 points) and anxiety (State-Anxiety score ≥40 points), respectively. Depressed patients had greater length of stay, complex injuries, and more readmissions than those without. The study sample improved patient-reported outcomes measurement information system T-scores for Physical Function and Satisfaction with Social Roles and Activities by 40% and 22.8%, respectively (P < 0.0001), by week 12. Anxiety attenuated improvements in physical function. Both anxiety and depression were associated with lower Psychosocial Illness Impact-Positive scores by week 12. CONCLUSIONS Although significant improvements in patient-reported physical function and satisfaction scores occurred in all patients, patients with depression or anxiety likely require additional psychosocial support and resources during acute care to improve overall physical and emotional recovery after trauma. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND:Cardiorespiratory fitness (CRF) is the only major risk factor that is not routinely assessed in the clinical setting, for preventive medicine. A valid and practical CRF test is needed for use in the clinics. The objective of this study is to demonstrate the validity of a 3-minute squat test to assess CRF in primary care. METHODS:A cross-sectional study in which the participants performed both the Ruffier squat test and the Balke maximal treadmill test. The study was conducted in a clinical setting from September 2016 to March 2017. We recruited a convenient sample of 40 adults between 18 and 64 years from the general U.S. population. Participants completed 30 squats in 45 seconds, paced by a metronome. Heart rate was measured at rest (P1), immediately after the test (P2), one minute after the test (P3). [Formula: see text] was measured using the Balke maximal treadmill fitness test. RESULTS:Of the 40 participants, there were 18 men and 22 women. Mean age was 31.2 years (SD = 9.9). We found that the best [Formula: see text] predictors were HR features P1/height and (P2-P3)/age3. Our best-performing model using these two features predicted individuals' CRF levels with an adjusted R2 of 0.637, sensitivity of 0.79, and specificity of 0.56. CONCLUSIONS:The study provided strong evidence for the validity of the squat test in the clinical setting. Further, the equation of our model along with [Formula: see text] normative tables provides an efficient and easy way to assess CRF in a primary care setting.

Lacrosse is a fast-paced game that incorporates elements from multiple sports, such as soccer, basketball, baseball, tennis, and hockey. The sport involves rapid changes of direction, endurance, sprinting, physical contact, rotational movement, passing, and shooting. Passing and shooting are further complicated by having a weighted object (ball) at the end of a long moment arm (crosse) which places increased stress on the body segments. Thus, it is important to properly prepare for sport participation by improving strength, endurance, and dynamic stability of the postural and core stability muscles. Because high mechanical loads are experienced during play, (re)establishment of symmetric strength and flexibility is essential for rehabilitation and injury prevention. This article will focus on the musculoskeletal demands placed on the body in lacrosse, the importance of core strength and dynamic stability to prevent injury, and the elements of both prehabilitation and rehabilitation programs to properly prepare the athlete for participation.

This chapter analyzes the food passions of Meiji-era poet and inventor of the modern haiku Masaoka Shiki (1867–1902). Bedridden for his final five years, he continued to obsessively consume and write about choice morsels he demanded from his family and disciples although his body was no longer capable of digesting them. The chapter illustrates the deceptive simplicity in Masaoka’s poetry and prose on food, and how his use of descriptive minimalism, lists, and personification worked to impart the “essences” of food and the (homo)social relationships evoked by eating. It suggests that Masaoka employed minimalism because language was insufficient to wholly convey one individual's sensual experience to another.

Background: Throwing injuries are common in high school baseball. Known risk factors include excessive pitch counts, year-round pitching, and pitching with arm pain and fatigue. Despite the evidence, the prevalence of pitching injuries among high school players has not decreased. One possibility to explain this pattern is that players accumulate unaccounted pitch volume during warm-up and bullpen activity, but this has not yet been examined. Hypotheses: Our primary hypothesis was that approximately 30% to 40% of pitches thrown off a mound by high school pitchers during a game-day outing are unaccounted for in current data but will be revealed when bullpen sessions and warm-up pitches are included. Our secondary hypothesis was that there is wide variability among players in the number of bullpen pitches thrown per outing. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Researchers counted all pitches thrown off a mound during varsity high school baseball games played by 34 high schools in North Central Florida during the 2017 season. Results: We recorded 13,769 total pitches during 115 varsity high school baseball starting pitcher outings. The mean ± SD pitch numbers per game were calculated for bullpen activity (27.2 ± 9.4), warm-up (23.6 ±8.0), live games (68.9 ±19.7), and total pitches per game (119.7 ± 27.8). Thus, 42.4% of the pitches performed were not accounted for in the pitch count monitoring of these players. The number of bullpen pitches thrown varied widely among players, with 25% of participants in our data set throwing fewer than 22 pitches and 25% throwing more than 33 pitches per outing. Conclusion: In high school baseball players, pitch count monitoring does not account for the substantial volume of pitching that occurs during warm-up and bullpen activity during the playing season. These extra pitches should be closely monitored to help mitigate the risk of overuse injury.