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In an effort to change unsafe tractor operating behaviors among Appalachian youth resulting from practices and habits learned through a socialization process (termed an "apprenticeship of observation"), this study implemented a four-part intervention in high school agricultural education classes that included implementation of a cost-effective rollover protective structure (CROPS) curriculum. The curriculum included farm safety information, specific NIOSH plans for CROPS construction, and procedures for CROPS installation on unprotected tractors. In this exploratory study, pre- and post-assessments were conducted using theory of planned behavior (TPB) constructs to measure changes in four factors that influence changes in learner behavior: learner attitude, perceived social norms, behavioral control, and perceived behavioral intention. Students' perceived knowledge and skills gained through the intervention were also measured because they are integral components in assessing the effectiveness of a curriculum intervention. Participants (N = 83) were high school students from seven schools in three states in the Appalachian region. Findings revealed statistically significant differences in student attitudes toward the use of life-saving CROPS and in perceived knowledge and skills gained through the curriculum implementation. The CROPS curriculum can be an effective intervention effort for addressing the social and behavioral effects of farm youths' apprenticeships of observation by creating more positive attitudes and learning outcomes among youth at risk for tractor rollover fatalities. Recommendations are provided for expanding the applications of the curriculum intervention and the TPB constructs.

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.

Traumatic abdominal wall hernia (TAWH) after blunt injury is uncommon. Diagnosis requires careful examination and high index of suspicion. We report a case of a 12-year-old boy who complained of painful abdominal swelling over the left iliac fossa after a bicycle-handlebar hit his abdomen. TAWH was diagnosed clinically and confirmed with ultrasound and computed tomography (CT) scan. He developed incarceration after 12 hours of admission and subsequently underwent primary repair without mesh. As TAWH is usually associated with other concomitant injuries, it is important that we are meticulous to rule out other serious concomitant injuries.

Power calculations. (DOCX 15 kb)

Baseline study questionnaire. (PDF 710 kb)

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.

UK emissions of sulphur dioxide decreased by 94% between 1970 and 2010 and are projected to decrease by another 50% by 2020 as coal fired power stations are decommissioned. We used the Community Multiscale Air Quality model to create maps of sulphur (S) deposition to assess the impact of these forecast decreases in S emissions on net S deposition to crops in England and Wales. Currently, average S deposition, net of S leaching, varies little between the UK regions, being greatest in Yorkshire and Humberside (Y&H), at ca. 5–6 kg/ha S, and least in Wales, at ca. 3–4 kg/ha S. However, even in Y&H S deposition is no more than 25% of S uptake by cereals and only ca. 10% of S uptake by oilseed rape (OSR). By 2020, net S deposition is predicted to decrease by between 30 and 60% and will be no more than 15% of S uptake by cereal crops and 375-mm overwinter rainfall. The need for S fertilizer appears to be greatest for grass swards cut more than once.

This study with three Appalachian county agricultural education programs examined the feasibility, effectiveness, and impact of integrating a cost-effective rollover protective structure (CROPS) project into high school agricultural mechanics classes. The project aimed to (1) reduce the exposure to tractor overturn hazards in three rural counties through the installation of CROPS on seven tractors within the Cumberland Plateau in the east region; (2) increase awareness in the targeted rural communities of cost-effective ROPS designs developed by the National Institution for Occupational Safety and Health (NIOSH) to encourage ROPS installations that decrease the costs of a retrofit; (3) test the feasibility of integration of CROPS construction and installations procedures into the required agricultural mechanics classes in these agricultural education programs; and (4) explore barriers to the implementation of this project in high school agricultural education programs. Eighty-two rural students and three agricultural educators participated in assembly and installation instruction. Data included hazard exposure demographic data, knowledge and awareness of CROPS plans, and pre-post knowledge of construction and assessment of final CROPS installation. Findings demonstrated the feasibility and utility of a CROPS education program in a professionally supervised secondary educational setting. The project promoted farm safety and awareness of availability and interest in the NIOSH Cost-effective ROPS plans. Seven CROPS were constructed and installed. New curriculum and knowledge measures also resulted from the work. Lessons learned and recommendations for a phase 2 implementation and further research are included.

Background Orthopedic trauma injury impacts nearly 2.8 million people each year. Despite surgical improvements and excellent survivorship rates, many patients experience poor quality of life (QOL) outcomes years later. Psychological distress commonly occurs after injury. Distressed patients more frequently experience rehospitalizations, pain medication dependence, and low QOL. This study was developed to test whether an integrative care approach (IntCare; ten-step program of emotional support, education, customized resources, and medical care) was superior to usual care (UsCare). The primary aim was to assess patient functional QOL (objective and patient-reported outcomes) with secondary objectives encompassing emotional wellbeing and hospital outcomes. The primary outcome was the Lower Extremity Gain Scale score. Methods/design A single-blinded, single-center, repeated measures, randomized controlled study is being conducted with 112 orthopedic trauma patients aged 18–85 years. Patients randomized to the IntCare group have completed or are receiving a guided ten-step support program during acute care and at follow-up outpatient visits. The UsCare group is being provided the standard of care. Patient-reported outcomes and objective functional measures are collected at the hospital and at weeks 2, 6, and 12 and months 6 and 12 post surgery. The main study outcomes are changes in Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires of Physical Function quality of life, Satisfaction with Social Roles, and Positive-Illness Impact, Post-Traumatic Stress Disorder Check List, and the Tampa Scale of Kinesiophobia-11 from baseline to month 12. Secondary outcomes are changes in objective functional measures of the Lower Extremity Gain Scale, handgrip strength, and range of motion of major joints from week 2 to month 12 post surgery. Clinical outcomes include hospital length of stay, medical complications, rehospitalizations, psychological measures, and use of pain medications. A mixed model repeated measures approach assesses the main effects of treatment and time on outcomes, as well as their interaction (treatment × time). Discussion The results from this study will help determine whether an integrative care approach during recovery from traumatic orthopedic injury can improve the patient perceptions of physical function and emotional wellbeing compared to usual trauma care. Additionally, this study will assess the ability to reduce the incidence or severity of psychological distress and mitigate medical complications, readmissions, and reduction of QOL after injury. Trial registration ClinicalTrials.gov, NCT02591472. Registered on 28 October 2015. Electronic supplementary material The online version of this article 10.1186/s13063-017-2430-5) contains supplementary material, which is available to authorized users.

Depressive symptoms have a known negative impact on outcomes following musculoskeletal injury. This study determined the pre-injury prevalence of psychiatric diagnoses of depression and anxiety, medication lapses and psychiatric consult services among patients admitted for orthopaedic trauma.This is a retrospective study of data from our Level-1 trauma center. Patients admitted to the orthopaedic trauma service during 2010-2015 were included (N = 4053). Demographics, Injury Severity Scores (ISS), mental health diagnoses, psychotropic medications, medication type and delay, psychiatric consultation use, intensive care unit (ICU) stay and total hospital length of stay (LOS) were abstracted from medical records and the institutional trauma registry.The 12-month prevalence of a major depressive episode is 6.6%-8.6% in adults in the United States. In our database, only 152/4053 (3.8%) of the patients had documented medical history of depression (80%) or anxiety (30%), and these patients had a 32% longer LOS (p 0.016). Nearly two-thirds of patients who used psychotropic medications prior to injury experienced a delay in receiving these medications in the hospital (median = 1.0 day, range 0-14 days). Sixteen percent of patients also received a new psychotropic medication while hospitalized: an antipsychotic (8/16 patients, to treat delirium), an anxiolytic (3/16 patients for acute anxiety), or an antidepressant (1/16). Among patients with depression or anxiety, 16.7% received a psychiatric consult. Patients with psychiatric consults had higher ISS, were more likely to have longer ICU LOS and had longer hospital LOS than those without consults (all p 0.05).The prevalence of depression and anxiety is grossly under-reported in our registry compared to national prevalence data. Patients with pre-existing disease had longer LOS and a higher rate of extended ICU care. Further studies are needed to characterize the true prevalence of disease in this patient population and its effect on patient outcomes after traumatic orthopaedic injury.

In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%–71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons.

Context: Participation in lacrosse has dramatically increased since 2001. Changes in the game rules, sport equipment, and athlete characteristics have all contributed to the injury patterns in lacrosse over time. Objective: A summary of lacrosse-related musculoskeletal injuries. Data Sources: Medline, CINAHL, Scopus, and Web of Science were searched for articles relating to the epidemiology and mechanisms of lacrosse injuries in high school and collegiate lacrosse players. Study Selection: The search strategy used the following keywords: lacrosse, injury, musculoskeletal, high school, intercollegiate, knee, shoulder, fracture, ankle, foot, concussion, and surveillance. Studies were included if they reported injury risk, injury type, or injury mechanism in high school or collegiate lacrosse players. Study Design: Systematic review. Level of Evidence: Level 4. Data extraction: Injury type, frequency, and mechanism as well as population were extracted. Results: Thirteen cohort studies and an additional 15 case series and reports were included. For all lacrosse players, ankle, knee, and hand/wrist were key sites for acute injury. Among collegiate players, preseasonal play elicits more injuries than seasonal play. Female players incur more noncontact and overuse injuries than male players. Boys have 3 to 5 times the risk for sustaining a fracture compared with girls in competition and practice. Women experienced fewer concussions but more facial fractures than men. Injuries to the foot/ankle, head, face, and wrist/hand more often required surgery in girls than in boys. Conclusion: Male players incur more injuries than female players. However, because of the collisional nature of play, more shoulder, arm, and upper leg injuries occur in male players. Fractures to the head and hand occur relatively more frequently in female players. Injury risk can be modified with appropriate training regimens and by respecting the game rules.

Research regarding musculoskeletal injury risk has focused primarily on anatomical, neuromuscular, hormonal, and environmental risk factors; however, subsequent injury risk screening and intervention programs have been largely limited to neuromuscular factors and have faced challenges in both implementation and efficacy. Recent studies indicate that poor neurocognitive performance, either at baseline or in the aftermath of a concussion, is associated with elevated risk of musculoskeletal injury. Despite the relatively limited current understanding regarding the nature of the relationship between different aspects of neurocognitive performance and musculoskeletal injury risk, this is a promising area of research that may yield significant advances in musculoskeletal injury risk stratification, rehabilitation, and prevention.

Pre-existing psychiatric illness, illicit drug use, and alcohol abuse adversely impact patients with orthopaedic trauma injuries. Obesity is an independent factor associated with poorer clinical outcomes and discharge disposition, and higher hospital resource use. It is not known whether interactions exist between pre-existing illness, illicit drug use and obesity on acute trauma care outcomes.This cohort study is from orthopaedic trauma patients prospectively measured over 10 years (N = 6353). Psychiatric illness, illicit drug use and alcohol were classified by presence or absence. Body mass index (BMI) was analyzed as both a continuous and categorical measure (30 kg/mStatistically significant BMI by pre-existing condition (psychiatric illness, illicit drug use) interactions existed for LOS and number of acute care services provided (β values 0.012-0.098; all p 0.05). The interaction between BMI and psychiatric illness was statistically significant for discharge to locations other than home (β = 0.023; p = 0.001).Obese patients with orthopaedic trauma, particularly with preexisting mental health conditions, will require more hospital resources and longer care than patients without psychiatric illness. Early identification of these patients through screening for psychiatric illness and history of illicit drug use at admission is imperative to mobilize the resources and provide psychosocial support to facilitate the recovery trajectory of affected obese patients.

Background: Elbow ulnar collateral ligament (UCL) injuries are common, particularly in adolescent athletes playing overhead sports. While the incidence and outcomes of surgical UCL injuries are well documented, the nonsurgical UCL injury patterns and injury management in this population are not yet known. Purpose/Hypothesis: The purpose of this study was to retrospectively assess the injury severity and subsequent management of UCL injuries among competitive athletes aged 11 to 22 years. We hypothesized that nonsurgical UCL injuries would occur more frequently in younger athletes compared with older athletes. Study Design: Descriptive epidemiological study. Methods: Electronic medical records (using International Classification of Diseases, 9th Revision and 10th Revision and Current Procedural Terminology codes) and keyword searches were used to identify all patients with sports-related UCL injuries between January 2000 and April 2016. A total of 136 records were included. Patients were stratified into 3 age brackets (age 11-13 years, n = 17; age 14-16 years, n = 49; age 17-22 years, n = 70). There were no prior elbow surgical interventions. The main outcome measures included the frequency and severity of UCL injuries and injury management (surgical, nonsurgical). Independent variables included age, UCL injuries per year, and sport classification. Results: There were 53 surgical and 83 nonsurgical UCL injuries. The number of nonsurgical cases increased 9-fold from 2000-2008 to 2009-2016. The UCL injuries were distributed as follows: 60 sprains, 39 partial tears, 36 ruptures, and 1 rerupture. Moreover, 7% of sprains, 51% of partial tears, and 78% of ruptures underwent UCL reconstruction. Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries; and age 17-22 years, 44.3% of total injuries) ( P = .007). UCL injury volume was most commonly associated with javelin (odds ratio, 6.69; 95% CI, 0.72-61.62; P = .07) and baseball (odds ratio, 1.55; 95% CI, 0.69-3.51; P = .32). Conclusion: Younger athletes sustained less severe UCL injuries more often than older athletes. Participation in javelin and baseball was associated with a greater likelihood of UCL injuries based on our dataset. This is the first study to provide data on the volume of nonsurgical UCL injuries among athletes in various sports.

Cup position is crucial for optimal outcomes in total hip arthroplasty. Radiographic assessment of component position is routinely performed in the early postoperative period.The aims of this study were to determine in a controlled environment if routine radiographic methods accurately and reliably assess the acetabular cup position and to assess if there is a statistical difference related to the rater's level of training.A pelvic model was mounted in a spatial frame. An acetabular cup was fixed in different degrees of version and inclination. Standardized radiographs were obtained. Ten observers including five fellowship-trained orthopaedic surgeons and five orthopaedic residents performed a blind assessment of cup position. Inclination was assessed from anteroposterior radiographs of the pelvis and version from cross-table lateral radiographs of the hip.The radiographic methods used showed to be imprecise specially when the cup was positioned at the extremes of version and inclination. An excellent inter-observer reliability (Intra-class coefficient0,9) was evidenced. There were no differences related to the level of training of the raters.These widely used radiographic methods should be interpreted cautiously and computed tomography should be utilized in cases when further intervention is contemplated.

Tranexamic acid (TXA) can reduce blood loss and decrease transfusion rates after total knee arthroplasty (TKA). The purpose of our study was to evaluate the efficacy of TXA in a homogenous, consecutive cohort of patients undergoing simultaneous bilateral primary TKA. This was a retrospective study of 50 consecutive patients who underwent bilateral simultaneous primary TKA between 2011 and 2015. Of these, 20 patients received TXA and 30 patients did not receive TXA and served as the control group. Primary outcome measurements were intraoperative estimated blood loss, hemoglobin (Hb) and Hematocrit (Hct) levels on postoperative day (POD) 1 and POD2, and blood transfusion rates. Secondary outcomes included length of stay (LOS), knee flexion/extension range of motion (ROM), and postoperative complications. There was no difference between groups for preoperative Hb and Hct (all p > 0.05). The TXA group demonstrate higher Hb levels at POD1 (11.7 in TXA vs. 10.4 controls; p

In the field of human health care, health monitoring system has a great significant role. The health monitoring contributes a wide variety of applications such as hospital, home care unit, sports training and emergency monitoring system. In this work, a wireless biosignal system is designed for health monitoring which integrates both the extracting and monitoring of the biosignal such as ECG, EEG and EMG. The developed integrating system is used for wireless monitoring of patient's biopotential changes of the heart, neuronal activity of the brain and muscles of the body. Dry electrodes, biosignal amplifier and filters are used for the development of this wireless system. The system also allows the continuous monitoring and graphical representation of the health condition of patient on a computer screen, even if the physician is away from the patient. The successful implementation of this wireless system is help to overcome the limitations of wired health monitoring system. Obviously it is a solution to bridging the gap between the doctor and the patients and best to be used on rural areas. Ultimate goal of this paper is to implement a low cost, high efficient wireless system for health monitoring.