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BACKGROUND: This study evaluated psoas muscle area (PMA) as a predictor of frailty and functional outcome in trauma patients. METHODS: The cohort included 211 trauma patients admitted to an urban level I trauma center from March 2012 to May 2014 who consented to participate in a longitudinal study and underwent abdominal-pelvic computed tomography scans during their initial evaluation. Physical component scores (PCS) of the Veterans RAND 12-Item Health Survey were administered to assess physical functionality at baseline and at 3, 6, and 12 months after injury. PMA in mm(2) and Hounsfield units was calculated using the Centricity PACS system. Statistical models were stratified by injury severity score (ISS)

Female participation in sport has increased sharply during the last few decades, and for the third straight Olympic Games, there were more women than men on the US roster for the 2020 Tokyo Games. Given this, an understanding of the differences between men and women with respect to exercise-induced cardiac remodeling is critical for those caring for female athletes. Recent studies have provided insight into female-specific cardiac remodeling and have enhanced our understanding on the upper limits of cardiac remodeling in female athletes and how these adaptations compare with sedentary females, male athletes, and cardiomyopathies. Female athletes display fewer signs of adaptive remodeling on ECG compared with male athletes. Structurally, male athletes have larger absolute cardiac dimensions, but female athletes have similar or larger chamber size when adjusted for body size. Female athletes have a lower incidence of sudden cardiac arrest or death compared with male athletes in the early competitive years (high school, college, and professional) and in the masters athlete years. In addition, female athletes are less likely to have coronary disease and atrial fibrillation compared with male athletes. Data on longevity indicate that female athletes live longer than their sedentary counterparts. Unlike men, there has been no convincing association of extreme exercise and cardiovascular disease in longer-term endurance female athletes. The underlying mechanisms of these sex-based differences are not very well understood, and future studies are warranted to better understand the mechanisms of cardiac adaptation in female athletes.

The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and "best judgment" assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.

Background The coronavirus (COVID‐19) pandemic led to disruptions in operative and hospital capabilities as the country triaged resources and canceled elective procedures. This study details the operative experience of a safety‐net hospital for cancer‐related operations during a 3‐month period at the height of the pandemic. Methods Patients operated on for or diagnosed with malignancies of the abdomen, breast, skin, or soft‐tissue (September 3, 2020–September 6, 2020) were identified from operative/clinic schedules. Sociodemographics, tumor and treatment characteristics, and COVID‐19 information was identified through retrospective chart review of a prospectively maintained database. Descriptive statistics were calculated. Results Fifty patients evaluated within this window underwent oncologic surgery. Median age was 61 (interquartile range: 53–68), 56% were female, 86% were White, and 66% were Hispanic. The majority (28%) were for colon cancer. Only two patients tested positive for COVID‐19 preoperatively or within 30 days of their operation. There were no mortalities during the 1‐year study period. Conclusion During the COVID‐19 pandemic, many hospitals and operative centers limited interventions to preserve resources, but oncologic procedures continued at many large‐volume academic cancer centers. This study underscores the importance of continuing to offer surgery during the pandemic for surgical oncology cases at safety‐net hospitals to minimize delays in time‐sensitive oncologic treatment.

This paper deals with the bounded robust controller design for event wise multiple models of the nonlinear hybrid dynamical systems (NHDS) with matched and unmatched uncertainties. The Hamilton-Jacobi-Bellman (HJB) equation based bounded robust control problem is proposed using a suitable non-quadratic term in the objective function of event wise local linearized model. The families of local bounded control laws are designed, to enforce stability using Lyapunov theorem for the individual events with the knowledge of the maximum bound of uncertainty. Using direct method of Lyapunov stability, the local bounded control law is shown to be optimal with respect to the objective function of the system under uncertainty. The new generalized Lyapunov function is proposed with crisp logic variables to establish the stability around the equilibrium points using bounded robust control law. Simulation and experimental results are presented, which validates the proposed bounded robust control approach.

Supplemental Digital Content is available in the text., Background: Cardiac involvement among hospitalized patients with severe coronavirus disease 2019 (COVID-19) is common and associated with adverse outcomes. This study aimed to determine the prevalence and clinical implications of COVID-19 cardiac involvement in young competitive athletes. Methods: In this prospective, multicenter, observational cohort study with data from 42 colleges and universities, we assessed the prevalence, clinical characteristics, and outcomes of COVID-19 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020, to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible COVID-19 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Imaging Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19 378 athletes tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3018 (mean age, 20 years [SD, 1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least 1 element of cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) followed by cardiac magnetic resonance imaging (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21 of 2999 [0.7%]), cardiac troponin (24 of 2719 [0.9%]), and transthoracic echocardiography (24 of 2556 [0.9%]). Definite, probable, or possible SARS-CoV-2 cardiac involvement was identified in 21 of 3018 (0.7%) athletes, including 15 of 2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6 of 198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-CoV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15 of 119 [12.6%]) versus a primary screening CMR (6 of 198 [3.0%]). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (odds ratio, 3.1 [95% CI, 1.2, 7.7]) or at least 1 abnormal triad test result (odds ratio, 37.4 [95% CI, 13.3, 105.3]). Five (0.2%) athletes required hospitalization for noncardiac complications of COVID-19. During clinical surveillance (median follow-up, 113 days [interquartile range=90 146]), there was 1 (0.03%) adverse cardiac event, likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short-term follow-up.

In this brief report, we describe the safety of reopening US Olympic and Paralympic Training facilities (USOPTFs) during the coronavirus disease 2019 (COVID-19) pandemic from July 2020 through October 2020. We evaluated the prevalence of COVID-19 infection at the time of reentry and cardiopulmonary sequelae of COVID-19 in elite athletes. All athletes returning to a USOPTF were required to go through a reentry protocol consisting of an electronic health history, a 6-day quarantine including twice-daily symptom surveys, COVID-19 polymerase chain reaction and antibody testing, physical examination, 12-lead electrocardiogram, high-sensitivity cardiac troponin I, and pulmonary function testing. Athletes with current or prior COVID-19 infection also underwent an echocardiogram, cardiology consultation, and additional testing as indicated. All athletes followed rigorous infection prevention measures and minimized contact with the outside community following reentry. At the time of this report, 301 athletes completed the reentry protocol among which 14 (4.7%) tested positive for active (positive polymerase chain reaction test, n = 3) or prior (positive antibody test, n = 11) COVID-19 infection. During the study period, this cohort accrued 14,916 days living and training at USOPTFs. Only one (0.3%) athlete was subsequently diagnosed with a new COVID-19 infection. No cardiopulmonary pathology attributable to COVID-19 was detected. Our findings suggest that residential elite athlete training facilities can successfully resume activity during the COVID-19 pandemic when strict reentry and infection prevention measures are followed. Dissemination of our reentry quarantine and screening protocols with COVID-19 mitigation measures may assist the global sports and medical community develop best practices for reopening of similar training centers.

Heat Exchanger (HE) is a widely used device in industrial applications for both cooling and heating processes because it can sustain a wide range of temperature and pressure parameters without affecting the output performance of the system. In this paper, we propose a Higher-Order Sliding Mode (HOSM) controller for HE connected via a data communication network. The higher-order sliding mode controller is well known for chattering attenuation which occurs due to switching control action in a sliding mode control technique. The HOSM controller based on super-twisting algorithm is proposed to compensate for the random communication network delay and process delay in the presence of model uncertainties of HE. The sufficient condition for stability is ensured by the trivial Lyapunov function. The simulation results demonstrate the efficacy of the designed controller for the HE in terms of chattering, delay compensation, and faster convergence. Further, the performance of HE is compared in two ways. In first case, the proposed controller performance is compared for a HE system with network delay and without network delay. In the second case, the performance of the proposed controller is compared with the conventional constant plus proportional rate reaching law based controller.

Infrared (IR) thermographic assessment of ocular surface temperature (OST) is gaining interest as an adjuvant method to evaluate the ocular surface. It is a quick, non-invasive test that causes minimal, if any, discomfort to patients. The purpose of this article was to summarize research on how OST relates to tear film parameters and dry eye disease (DED). PubMed, Google Scholar, and Scopus searches for specific terms were carried out and eligible articles reviewed. OST of the central cornea is ~34-35°C when measured as a single time-point (typically right after a blink). Dynamically, OST values decrease over time at a rate of ~ −0.01 °C/s in healthy eyes. Single time-point OST values are impacted by temperature, with positive correlations noted with both ambient (1°C↓ results in ~0.16°C↓ in OST) and body (1°C↑ results in ~0.98°C↑ in OST) temperature. Single time-point OST values are also impacted by tear parameters, with negative correlations noted with tear break-up time (TBUT; r=−0.61) and positive correlations with lipid layer thickness (~r=0.50). Dynamically, the rate of OST cooling over the interblink period correlates with various tear parameters including Schirmer’s test scores (r=−0.39), tear meniscus height (r=−0.52) and the rate of tear film break-up (r=−0.74). These data imply that OST decreases more rapidly in individuals with greater tear production, larger tear volumes, and shorter tear break-up times (faster rates of tear film break-up). There are discrepancies in relationships between OST and DED across studies, which is not surprising given that DED encompasses a number of different phenotypic presentations. However, most studies found that OST decreases at a more rapid rate in DED vs. control groups. As such, cooling rate may have utility as a screening tool in DED in combination with established point-of-care tests.

Netarsudil is a relatively new medication for the treatment of primary open-angle glaucoma and ocular hypertension. It has been associated with red eyes and burning after instillation. Reticular epitheliopathy is a relatively rare complication of netarsudil that has been described in patients with preexisting corneal edema. We report the case of a healthy 76-year-old woman who developed reticular epitheliopathy after full-thickness penetrating keratoplasty that completely resolved following discontinuation of the medication. In cases where netarsudil is initiated for treatment of glaucoma or, off-label, endothelial dysfunction, reticular epithelial edema should be considered in patients complaining of a decline in vision and severe pain.