Elevated Risk Of Injury Research Articles

Coronectomy of mandibular third molar teeth with caries or resorption ‘at‐risk' of inferior dentoalveolar nerve injury

AbstractAimCoronectomy is an elective surgical technique designed to reduce the risk of morbidity to the inferior dental nerve for those mandibular third molars (M3M) deemed to pose such risk. Successful coronectomy relies on the retention of a vital root with non‐inflamed pulpal tissue and healthy surrounding bone. For this reason coronectomy in teeth with disease affecting the pulp has been widely contraindicated based on theoretical presumption rather than evidence. The current case series challenges this common supposition and highlights evidence in other dental specialties to support the use of coronectomy in selected cases of teeth with pulpal involvement.MethodsOver a 5‐year period, 22 M3M teeth closely related to the IDN canal with either caries or internal resorption were treated with coronectomy. Preoperative assessment included both 2D and 3D imaging which helped determine risk assessment.ResultsAll patients had a minimum of 1 year post‐coronectomy review. No patients reported persistent symptoms or required root retrieval. Radiographically, there were no suggestions of apical radiolucency to indicate associated apical disease.ConclusionThis small case series provides an early insight and potential scope for considering coronectomy in selective carious or internally resorbing M3M deemed at having an elevated risk of IDN injury.

Detection of Persisting Concussion Effects on Measures of Neuromechanical Responsiveness

Abstract INTRODUCTION Numerous investigations have documented elevated risk for musculoskeletal injury following sport-related concussion, which suggests that an unrecognized vulnerability persists beyond the resolution of symptoms and return to sport participation. Improved clinical testing methods are needed to better assess the interrelated neurocognitive and neuromuscular capabilities of athletes who may have elevated susceptibility to MSK injury, and possible risk for long- term alterations in brain function, despite resolution of overt concussion symptoms. The term “neuromechanics” refers to the study of interactions between neural, biomechanical, and environmental dynamics We use the term “neuromechanical responsiveness” (NMR) to designate the ability to optimally integrate neurocognitive and neuromuscular processes during participation in sport-related activities. NMR testing may play an critical role in optimizing safe return to play circumstances. METHODS A cohort of 48 elite athletes (34 males: 23.8 ± 4.4 yr; 14 females: 25.4 ± 4.5 yr) performed visuomotor reaction time (VMRT) tests involving rapid manual contact with illuminated target buttons that included 2 dual-task conditions: 1) simultaneous oral recitation of scrolling text (VMRT + ST) and 2) simultaneous verbal responses to identify the right or left direction indicated by the center arrow of the Eriksen flanker test (VMRT + FT). A whole-body reactive agility (WBRA) test requiring side-shuffle movements in response to visual targets was used to assess reaction time, speed, acceleration, and deceleration. RESULTS Concussion occurrence at 2.0 ± 2.3 yr prior to testing was reported by 21 athletes. Strong univariable associations were found for VMRT + FT left minus right difference = 15 ms (OR = 7.14), VMRT + ST outer 2-ring to inner 3-ring ratio = 1.28 (OR = 4.58), and WBRA speed asymmetry = 7.7% (OR = 4.67). A large VMRT + FT X VMRT + ST interaction effect was identified (OR = 25.00). Recursive partitioning identified a 3-way VMRT + FT X VMRT + ST X WBRA interaction that had 100% positive predictive value for identification of athletes with concussion history, whereas negative status on all 3 factors provided 90% negative predictive value. CONCLUSION Performance on dual-task VMRT tests and the WBRA test identified NMR deficiencies among elite athletes who reported a history of concussion.

Focusing on Health and Not Simply Health Care.

As Americans consider the future of health coverage, there is one continually undervalued area worthy of attention, namely prevention. The article reviews the significant gains from the Affordable Care Act as well as the remaining needs to promote health and well-being and not solely focus on the treatment of illness and injury. It identifies changes in policies that would broaden future goals beyond the receipt of clinical care to the creation of a health system committed to also recognizing and addressing the social determinants of health and meaningfully incorporating consumers, particularly those with elevated risk of preventable illness, injury, and death, in policymaking.

Epidemiology of Injuries in Ice Hockey

Hockey is a skillful contact sport with an elevated injury risk at higher levels of play. An understanding of injury incidence, type, mechanism, and severity at various levels of competition aids the clinician treating these athletes. The purpose of this clinical review is to discuss the epidemiology of hockey injuries at various levels of participation, including youth, high school, junior, college, and professional. A literature search was performed by a review of PubMed, Embase, and Cochrane databases and included articles published from 1988 to 2017. Studies were included in this review if determined to be of high quality and containing injury data relevant to the levels of competition. Pertinent data regarding ice hockey injury epidemiology and prevention at various levels of competition were analyzed. Clinical review. Level 4. Youth, high school, junior, college, and professional hockey players have unique injury patterns. Injuries occur much more often in a game compared with a practice, and injury risk increases with each level of competition. Preventative measures, such as mandatory facial protection and delayed body checking in games until age 13 years, are proven strategies to reduce the risk of facial injury and concussion. An understanding of common injury types and mechanisms according to age and level of play aids the clinician in diagnosis and management. This information can also guide preventative strategies in the areas of education, coaching, rule enforcement, rule modifications, equipment improvement, and sportsmanship.

Visual-Spatial Memory Deficits Are Related to Increased Knee Valgus Angle During a Sport-Specific Sidestep Cut

Background: Identifying athletes at an increased risk of injury is a promising approach to improve the effect of injury prevention interventions; however, it requires first identifying the potential athlete-specific risk factors. Cognitive ability was recently shown to correlate with noncontact anterior cruciate ligament injury rates and lower extremity mechanics, marking an underexplored area. A better understanding of how individuals’ cognitive ability is associated with neuromuscular control during sport-specific tasks may improve injury prevention. Hypothesis: Athletes with lower cognitive performance on a standardized cognitive assessment would demonstrate greater increases in knee valgus angle and moment when performing a sidestep cut with soccer ball dribbling versus without. Visual-spatial memory was expected to demonstrate stronger relationships than reaction time or processing speed. Study Design: Descriptive laboratory study. Methods: Fifteen male collegiate club soccer players participated (mean ± SD: 20.7 ± 2.0 years, 1.78 ± 0.07 m, 76.5 ± 8.9 kg). Participants performed anticipated 45° run-to-cut trials with and without a dual task of dribbling a soccer ball. Peak early-stance knee valgus angle and moment for the plant limb were calculated. Participants also completed a cognitive assessment to evaluate visual memory, verbal memory, reaction time, and processing speed. These composite scores were entered as candidate predictors for a stepwise regression analysis on the dual-task change scores in lower extremity biomechanical parameters (ie, ball handling – non–ball handling). Results: Visual memory composite score (a measure of visual-spatial memory) was the only cognitive outcome significantly associated with the change in biomechanical parameters. Each unit decrease in the visual memory composite score was associated with an increase of 0.21°± 0.05° in peak knee valgus angle during the ball-handling task as compared with the non–ball handling task (R2 = 52%, P = .003). Conclusion: Visual-spatial memory was associated with neuromuscular control during a sidestep cutting task during soccer ball dribbling, with deficits in this cognitive domain being associated with increased peak knee valgus angle. Clinical Relevance: Assessing visual-spatial memory ability may provide useful information to better understand conditions associated with impaired neuromuscular control and to potentially identify athletes at an elevated risk for musculoskeletal injury.

Influence of caffeine upon tolerance to a simulated hemorrhagic challenge in habituated users

Caffeine is an adenosine receptor antagonist and its consumption in caffeine naïve individuals is associated with increased blood pressure. However, the influence of caffeine consumption upon blood pressure in individuals habituated to caffeine is less clear. Approximately 300mg of caffeine is consumed daily by 80% of the United States active duty military yet the influence of caffeine upon tolerance to a simulated hemorrhagic challenge in habituated users is unknown. Our aim was to examine the influence of caffeine consumption upon tolerance to a simulated hemorrhagic challenge (Lower Body Negative Pressure; LBNP) in habitual caffeine consumers. Eight healthy participants (age: 27 ± 6 yrs, Ht: 179 ± 10 cm, Wt: 76.0 ± 14.4 kg) completed three double blinded, counterbalanced trials (Caffeine, Decaffeinated and Water). Following baseline measures of cardiovascular control (including mean arterial pressure, MAP; mmHg and total peripheral resistance, TPR; mmHg/l/min) participants drank (6.25ml/kg body mass) either water (Water; volume control), decaffeinated coffee (Decaffeinated; placebo control) or caffeinated coffee (Caffeine; 4 mg caffeine/kg body mass). Participants were measured again following the ingestion of the drink (pre LBNP) and then underwent a graded LBNP protocol (−20mmHg, −30mmHg, etc.) until pre‐syncope. LBNP tolerance was quantified as cumulative stress index (CSI; mmHg*min). Data are presented at baseline (pre drink), prior to LBNP (pre LBNP and post drink), a common time point during LBNP tolerated by all individuals in all trials (−30mmHg) and at pre syncope. MAP increased from baseline to pre LBNP in all trials (Caffeine: from 84 ± 7 to 98 ± 7 mmHg; Decaffeinated: from 90 ± 10 to 94 ± 7 mmHg and Water: from 89 ± 9 to 97 ± 6 mmHg; P < 0.05 in all trials). MAP was reduced at pre syncope in all trials (Caffeine: 59 ± 4 mmHg; Decaffeinated: 57 ± 4 and Water: 60 ± 7 mmHg; all P < 0.05 relative to pre LBNP). MAP was not different between trials at any time point (P > 0.05). TPR was not different from baseline during LBNP in the Water and Decaffeinated trials (from: 13 ± 2 and 14 ± 2 to −30mmHg: 16 ± 3 and 16 ± 2 mmHg/l/min, respectively both P > 0.05 vs. baseline) but increased during LBNP in the Caffeine trial (from: 13 ± 2 to −30mmHg: 18 ± 3 mmHg/l/min; P = 0.004 vs. baseline). LBNP Tolerance was greater in the Caffeine trial (941 ± 376 mmHg*min, 19.2 ± 4.8 min) relative to the Decaffeinated trial (686 ± 382 mmHg*min, 15.7 ± 5.1 min; CSI: P = 0.021), but was not different relative to the Water trial (Water: 816 ± 383 mmHg*min, 17.5 ± 5.0 min; CSI: P = 0.093). Caffeine consumption alters cardiovascular control during a simulated hemorrhagic challenge and may influence LBNP tolerance in habitual caffeine users, although this affect appears to be small. This may have implications for the treatment of a hemorrhagic insult in individuals who are habitual caffeine users and whom have an elevated risk of hemorrhagic injury (e.g. soldiers).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Effects of Endurance Sports on Children and Youth.

In the United States, youth participation in sports continues to increase yearly. This increase in participation, in conjunction with the trend toward early sports specialization and year round training, has led to a similar increase in athletically developed injuries. These injuries vary in nature and acuity, with the type of injury often related to the athlete's age, sport, and level of training. Endurance athletes are at an elevated risk of injury as they frequently push their body to the limit during their arduous training. Pediatric endurance athletes can be particularly vulnerable, especially to overuse injuries, given their unique and ever-changing physiological state. It is important to understand the specific challenges facing not only the physical, but also the emotional well-being of these pediatric endurance athletes to maximize performance while minimizing injury and potential long-term sequelae.

Energy Availability in Athletics: Health, Performance, and Physique.

The reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events. In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters. Health concerns with functional hypothalamic amenorrhea include impaired bone health, elevated risk for bone stress injury, and cardiovascular disease. Furthermore, LEA negatively affects recovery, muscle mass, neuromuscular function, and increases the risk of injuries and illness that may affect performance negatively. LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior. Long-term LEA causes metabolic and physiological adaptations to prevent further weight loss, and athletes may therefore be weight stable yet have impaired physiological function secondary to LEA. Achieving or maintaining a lower body mass or fat levels through long-term LEA may therefore result in impaired health and performance as proposed in the Relative Energy Deficiency in Sport model. Preventive educational programs and screening to identify athletes with LEA are important for early intervention to prevent long-term secondary health consequences. Treatment for athletes is primarily to increase energy availability and often requires a team approach including a sport physician, sports dietitian, physiologist, and psychologist.

Relationship Between 2-Dimensional Frontal Plane Measures and the Knee Abduction Angle During the Drop Vertical Jump.

Context: Knee abduction angle (KAA), as measured by 3-dimensional marker-based motion capture systems during jump-landing tasks, has been correlated with an elevated risk of anterior cruciate ligament injury in females. Due to the high cost and inefficiency of KAA measurement with marker-based motion capture, surrogate 2-dimensional frontal plane measures have gained attention for injury risk screening. The knee-to-ankle separation ratio (KASR) and medial knee position (MKP) have been suggested as potential frontal plane surrogate measures to the KAA, but investigations into their relationship to the KAA during a bilateral drop vertical jump task are limited. Objective: To investigate the relationship between KASR and MKP to the KAA during initial contact of the bilateral drop vertical jump. Design: Descriptive. Setting: Biomechanics laboratory. Participants: A total of 18 healthy female participants (mean age: 24.1 [3.88]y, mass: 65.18 [10.34]kg, and height: 1.63 [0.06]m). Intervention: Participants completed 5 successful drop vertical jump trials measured by a Vicon marker-based motion capture system and 2 AMTI force plates. Main Outcome Measure: For each jump, KAA of the tibia relative to the femur was measured at initial contact along with the KASR and MKP calculated from planar joint center data. The coefficient of determination (r2) was used to examine the relationship between the KASR and MKP to KAA. Results: A strong linear relationship was observed between MKP and KAA (r2 = .71), as well as between KASR and KAA (r2 = .72). Conclusions: Two-dimensional frontal plane measures show strong relationships to the KAA during the bilateral drop vertical jump.

Sex and stride length impact leg stiffness and ground reaction forces when running with body borne load

This study quantified leg stiffness and vGRF measures for males and females using different stride lengths to run with four body borne loads (20, 25, 30, and 35 kg). Thirty-six participants (20 males and 16 females) ran at 4.0 m/s using either: their preferred stride length (PSL), or strides 15% longer (LSL) and shorter (SSL) than PSL. Leg stiffness and vGRF measures, including peak vGRF, impact peak and loading rate, were submitted to a RM ANOVA to test the main effect and interactions of load, stride length, and sex. Leg stiffness was greater with the 30 kg (p = 0.016) and 35 kg (p < 0.001) compared to the 20 kg load, but decreased as stride lengthened from SSL to PSL (p < 0.001) and PSL to LSL (p < 0.001). Males exhibited greater leg stiffness than females with SSL (p = 0.029). Yet, males decreased leg stiffness with each increase in stride length (p < 0.001; p < 0.001), while females only decreased leg stiffness between PSL and LSL (p = 0.014). Peak vGRF was greater with the addition of body borne load (p < 0.001) and increase in stride length (p < 0.001). Both impact peak and loading rate were greater with the 30 kg (p = 0.034; p = 0.043) and 35 kg (p = 0.004; p = 0.015) compared to the 20 kg load, and increased as stride lengthened from SSL to PSL (p = 0.001; p = 0.004) and PSL to LSL (p < 0.001; p < 0.001). Running with body borne load may elevate injury risk by increasing leg stiffness and vGRFs. Injury risk may further increase when using longer strides to run with body borne load.

К оценке риска профессионального заболевания органов слуха отдельных категорий работников энергетических предприят

The electric power industry refers to kinds of economic activity characterized by elevated risk of injuries and occupational diseases because power industry workers have to deal with high voltage, to work at height, and may be exposed to the effect of harmful and dangerous industrial factors. Therefore, determination of risks and occupational diseases for keeping them to a minimum is among the most important tasks. It should be taken into account that the conditions for the occurrence of occupational deceases are usually formed under the effect of a complex combination of several factors. In the overall structure of occupational morbidity, hearing loss due to noise and vibration sickness are the prevailing kinds of deceases, although their indicators in the electric power industry are significantly lower than their nation-wide levels in Russia. The most problematic professions in regard of this pathology are locksmiths for repair of boiler house equipment, boiler house operators, locksmiths for repair of steam and gas turbine equipment, drivers, and tractor drivers. It has been established that hearing disorders are associated with age, sex (they are observed more frequently in men), smoking, and noise characteristics. Exposure to increased noise levels leads to the formation of not only cardiovascular, but also endocrine pathologies, and may also be a risk factor for the development of gestational hypertension and congenital malformations of the fetus. The article presents a quantitative assessment of the risk of occupational hearing organ disorders due to the negative effect of noise in increasing its level due to equipment ageing or violation of technological regimes, and from using of personal protective equipment. A set of preventive measures is recommended for workers of noisy production facilities and professions in the power industry.

Quality improvement in neurology: Epilepsy Quality Measurement Set 2017 update.

Epilepsy is a common condition in the United States. It is estimated that 1.2% of the population or 3.4 million people have epilepsy. This figure may be underestimated because of potential repercussions and stigma in disclosing epilepsy.1 Studies have shown that people with epilepsy are more likely to be unemployed or unable to work, have lower annual household incomes, be obese and physically inactive, and be less likely to marry.2,3 People with epilepsy can have poor overall health status, impaired intellectual and physical functioning, elevated risk of accidents and injuries, and negative side effects from antiseizure medications.2,3 It is estimated the annual direct medical cost of epilepsy in the United States is $9.6 billion; combined with indirect costs, the total rises to $15.5 billion yearly.2

Short time between shifts and risk of injury among Danish hospital workers: a register-based cohort study.

Objectives Short time between consecutive work shifts (quick returns, ie, ≤11 hours between shifts) is associated with sleepiness and fatigue, both of which have been linked to risk of injury. This paper aims to study quick returns between work shifts and risk of injury among Danish hospital workers. Method The study population included 69 200 employees, primarily working at hospitals, corresponding to 167 726 person years at risk between 2008-2015. Information on working hours was obtained from payroll data in the Danish Working Hour Database and linked, at an individual level, with data on 11 834 injury records identified in the National Patient Register and the Danish Register of Causes of Death. Multivariate Poisson regression models were used to calculate incidence rate ratios (IRR) with 95% confidence intervals (CI). Results Results showed the shorter the time between shifts, the higher the risk of injury. Thus, an elevated risk of injury was observed after quick returns compared with the standard 15-17 hours between shifts (IRR 1.39, 95% CI 1.23-1.58). Furthermore, when assessing the number of days since a quick return, the risk of injury was especially high within the first two days (day 1: IRR 1.39, 95% CI 1.23-1.58; day 2: IRR 1.39, 95% CI 1.21-1.58) following a quick return. Conclusions Our results suggest that quick returns increased the risk of injury, in particular within the first two days following a quick return. These findings point towards avoiding or reducing the number of quick returns in order to lower employees' risk of injury.

Barrow Innovation Center Case Series: Early Clinical Experience with Novel Surgical Instrument Used To Prevent Intraoperative Spinal Cord Injuries

The Barrow Innovation Center comprises an educational program in medical innovation that enables residents to identify problems in patient care and rapidly develop and implement solutions to these problems. Residents involved in this program noted an elevated risk of iatrogenic spinal cord injury during posterior cervical and thoracic procedures. The objective of this study was to describe this complication, and a novel solution was developed through a new innovation training program. A case report demonstrates the risk of iatrogenic spinal cord injury during posterior cervical decompression and fusion. Solutions to this problem were developed at the innovation center via an iterative process of prototype creation, cadaveric testing, and redesign. Patent law students who partnered with the center wrote and filed a provisional patent protecting the novel prototype designs. The concept of a protective shield for the spinal cord was developed, and within only 6 weeks the devices were provisionally patented and used in the operating room. This device was named the Myeloshield. Initial clinical experience indicates that the Myeloshield can be used without impeding the flow of surgery and has the potential to prevent iatrogenic spinal cord injury; this experience is presented through 2 case reports demonstrating the use of Myeloshields in the operating room. This report demonstrates how programs like the Barrow Innovation Center can provide neurosurgery residents with a unique educational experience in medical device innovation and intellectual property development and can serve as an avenue of surgical quality improvement and problem solving.

Who is More Injury‐Prone? Prediction and Assessment of Injury Risk

ABSTRACTInjuries are the primary determinant of an individual's mobility, which affect not just their workplace productivity in intensive environments such as manufacturing, but also their decision‐making ability and quality of life. Managers typically assign workers to projects or tasks without having knowledge about their functional capabilities or current state of injury risk as injuries remain highly underreported at workplaces for fear of reprisal and other reasons. Therefore, high‐quality research on injury prevention is nearly nonexistent. Procedures that we use in this study for developing a prediction model for identification of college football players at an elevated injury risk could also be used to quantify injury risk in various occupational settings. Using a number of measurements and models, we arrive at an estimate of an individual's injury likelihood. Our measures include ratings of movement efficiency through physical performance tests, acceleration using Internet of Things (IoT) devices, functional role classifications, and recorded exposures to high‐risk conditions. Findings prescribe several approaches and decision rules for prediction of injury risk and suggest that training programs need to consider an individual's injury risk rather than offer a ‘one‐size‐fits‐all’ approach. The analytics models derived from a combination of injury risk screening and surveillance data can be used for making decisions about targeting employee‐centric risk‐reduction interventions, improved matching of tasks to individuals, or deciding job rotation for improved performance, all while enhancing the quality of life of individuals and reducing the escalating costs of work‐related injuries borne by employers. These models can also be developed for smartphones.

The Relative Risk of Achilles Tendon Injury in Patients Taking Quinolones.

To examine the association between quinolone use and Achilles tendon injury, comparing well-matched cohorts of users of quinolone and nonquinolone antibiotics, and well-matched cohorts of quinolone users and patients not using any nonquinolone antibiotics. This retrospective cohort study used Clinformatics data from 2008-2014. Using the propensity score, we matched quinolone users with other antibiotic users and quinolone users with nonusers. The primary outcome was Achilles tendon injury within 6months. Bivariate analyses determined risk factors for Achilles tendon injury, and conditional logistic regression assessed the impact of quinolone use on these injuries. A total of 716,522 fluoroquinolone users were matched with other antibiotic users, and 645,034 fluoroquinolone users were matched with nonusers. Rates of Achilles tendon injury were less than 0.5% in all groups. Quinolone use increased the risk of Achilles tendon injury compared with other antibiotic users (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.17-1.31) and nonusers (OR 1.54, 95% CI 1.44-1.64). Interaction with age did not significantly impact the relationship between quinolone use and Achilles injury; however, older quinolone users had a slightly higher relative risk of injury than nonusers versus younger patients. Furthermore, the youngest group of patients had similarly elevated relative risk for injury with quinolone use as did the elderly. Although quinolone use increases the risk of Achilles tendon injury, the absolute risk increase is minimal, especially when compared with similar morbidity patients taking other nonquinolone antibiotics. In relatively healthy populations, such as the one studied here, quinolone use may not make a clinically significant contribution to risk of Achilles tendon injury, at any age range, among those in need of such drugs.

Wednesday, September 26, 2018 9:00 AM – 10:00 AM Best Papers: 6. Diagnostic accuracy and clinical impact of motor evoked potential (MEP) monitoring during 4,425 posterior extradural lumbosacral procedures involving the L5 vertebra

BACKGROUND CONTEXT The value of intraoperative neuromonitoring (IONM) is predicated on accurate diagnostic information and the clinical impact is contingent on effective action. Spontaneous electromyography (sEMG) and somatosensory evoked potentials (SSEPs) have known limitations in diagnosing spinal nerve root motor dysfunction. In this study, we assessed the diagnostic accuracy and utility of MEPs during lumbosacral procedures in which there is elevated risk of L5 nerve root injury and consequent foot drop. STUDY DESIGN/SETTING Posterior lumbosacral procedures involving the L5 vertebral level and monitored with MEPs, in mixed combination with sEMG and SSEPs, from October 2015 to October 2017 were reviewed retrospectively from a multi-institutional IONM database. Procedures involving thoracic levels, a lateral or oblique approach, pediatrics, tumors, or tethered cords were excluded. The diagnostic results of MEPs, sEMG, and SSEPs were calculated with respect to motor neurologic outcome in the immediate postoperative period. Positive diagnostic results were defined as unresolved SSEP or MEP alerts or episodes of sEMG reported to the surgeon. Fully resolved SSEP or MEP alerts, or no IONM alerts, were negative results. Deficit rates, sensitivities and specificities were calculated together with 95% Wilson confidence intervals (CIs); odds of new motor deficit were calculated using small-sample correction and Wald 95% CIs. In addition, the actions prompted by alerts were reviewed and grossly categorized as either (A) active surgical and/or pharmacological/physiological intervention, (B) patient repositioning, or (C) surgical pause. RESULTS There were 16 new onset motor deficits in 4,425 procedures (0.36%, Wilson 95% CI: [0.22, 0.59]). The sensitivity of MEPs was 93.8% [71.7, 99.7]. The sensitivities of sEMG and SSEPs were much lower, 18.8% [6.6, 43.0] and 37.5% [13.7, 69.4] respectively. MEP specificity was 97.2% [96.6, 97.6]. For unresolved MEP alerts (n=139), the rate of new motor deficit was 10.8% [6.6, 17.0]; relative to procedures with no alerts or fully resolved alerts, the odds of a new motor deficit were significantly increased (OR=257.1, Wald 95% CI: [65.9, 1918.8], p CONCLUSIONS MEPs have excellent diagnostic accuracy during lumbosacral procedures involving the L5 vertebra. Unresolved TA MEP alerts are associated with a high incidence of foot drop injuries, but the resolution of MEP alerts has a demonstrable positive clinical impact. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Long-term visuospatial performance abnormalities among elite athletes reporting history of concussion

Elevated risk for musculoskeletal injury after concussion may relate to impaired responsiveness to changing environmental conditions, which might be identified by appropriately designed clinical screening tests. A retrospective cohort study involved 48 elite athletes at an Olympic training center (34 males: 23.8 ± 4.4 years; 14 females: 25.4 ± 4.5 years). A 60-second test of dual-task visuomotor reaction time (VMRT) involved rapid manual contact with illuminated target buttons while simultaneously providing verbal responses to identify the right or left direction indicated by the center arrow of 20 successive trials of the Eriksen flanker test. A whole-body reactive agility (WBRA) test measured side-shuffling movements in response to 20 virtual reality targets that randomly appeared in right or left positions on a large computer monitor. A meaningful association was defined as having a 90% confidence interval lower limit > 1.0. Concussion occurrence prior to testing (2.0 ± 2.3 years) was reported by 44% of the athletes (21/48). Strong univariable associations with concussion history were found for dual-task VMRT asymmetry (left minus right visual field difference ≥ 15 ms; OR = 7.14) and time required to complete the WBRA test (≥ 73 seconds; OR = 6.40). A VMRT asymmetry X WBRA time interaction effect demonstrated 81% sensitivity and 75% specificity (OR = 13.00). A substantial bivariate correlation was also evident between the two continuous variables ( r = .454; P = .001). The occurrence of a lower extremity sprain or strain within the previous 12 months was reported by 67% of the athletes (32/48), which demonstrated an association with concussion history (53% sensitivity, 75% specificity; OR = 3.40). A cause-effect relationship cannot be inferred from retrospective analysis, but the results of both clinical tests suggest that impaired visuospatial performance capabilities may explain the previously reported elevation of musculoskeletal injury risk following concussion.

Classification of Human Posture from Radar Returns Using Ultra-Wideband Radar.

There is a great need for new technology that helps ensure the well-being of senior citizens who have compromised health and are at an elevated risk of injury due to falls. Being able to detect posture and postural changes may be helpful in prediction and prevention of impending falls. Ultra-Wideband (UWB) radar is an attractive means for patient monitoring because it is inexpensive, capable of penetrating obstacles, privacy preserving and it consumes little power. In this paper, classification of postures, namely sitting, standing and lying is presented using stand-off sensing using UWB radar in an indoor environment. It is found that using location specific classifiers, overall accuracy can be improved. In this paper, a decision tree classifier capable of achieving 85% overall accuracy is proposed. This classifier uses 33 features from 10 second data sample segments.

Blood Flow Restriction Therapy for Stimulating Skeletal Muscle Growth: Practical Considerations for Maximizing Recovery in Clinical Rehabilitation Settings

Inactivity following injury and surgery due to pain, instability, or immobilization results in loss of muscle mass and function. As a result, both risk of reinjury and overall recovery time are a prime concern for clinicians and therapists trying to minimize these deleterious effects. While resistance exercise has been demonstrated to be highly effective in combating loss of muscle mass and function, it is often not advised for postoperative or injured patients because of elevated risk of injury or exacerbating existing injury sites. Low-intensity resistance exercise (&lt;30% 1 repetition-maximum) performed with mild to moderate blood flow restriction (BFR) has been observed to elicit beneficial anabolic and functional responses in skeletal muscle that are governed by mechanisms that regulate muscle protein metabolism and myogenesis similar to the responses following high-intensity resistance exercise. On the basis of these findings, practical applications of BFR in clinical and sport settings have been developed to mitigate skeletal muscle loss following injury and accelerate rehabilitation. However, many aspects of the physiological effects of BFR therapy in rehabilitation settings remain unclear. This review provides current information regarding skeletal muscle responses to BFR with a focus on skeletal muscle protein metabolism, anabolic signaling, applied outcomes, and applications in the clinical setting.