Notes

Any Conjecture involving NPVR ≥ 80% involving Ultrasound-Guided High-Intensity Centered Ultrasound Ablation for Uterine Fibroids.
sideration of potential genetic therapy approaches.'Data science' represents a set of mathematical and software development related techniques that are applied across a wide range of problems and industries. Practitioners of data science in human health-related domains typically see a world that differs substantially from practitioners in other domains such as advertising, finance, e-commerce, manufacturing, or social networking. This commentary discusses what those differences are (Project vs Product Focus, Independent vs Integrated Efforts, Causality vs Prediction Driven, Statistical vs Machine Learning Centricity) why they exist, and the future convergence that we believe is on the horizon. The concepts discussed can provide a starting point in which health and human performance-focused stakeholders can begin to align well-established data science applications from other domains to further enable innovative health and performance solutions.The shift to telehealth due to COVID-19 revealed that a new care model for the young athlete, which combines in-person and virtual visits, could be an enhancement to in-person care alone. This clinical suggestion is novel as it discusses the utility of a hybrid care model for the young athlete, which has not yet been described. Interacting with the patient and family virtually in the home environment offers benefits that are difficult to achieve in the clinic. Opportunities such as the ability to custom tailor the home program with consideration of the patient's learning abilities, provide movement quality feedback outside of the clinical environment, observe parent/caregiver feedback, involve family members who may not be available to attend in-person visits, and the possibility of converting an in-person cancelation to a telehealth visit in order to maintain continuity of care, are examples of how this model may optimize treatment. Consideration of investigating the impact on clinical outcomes and cost effectiveness is recommended.
5.
5.Individuals after anterior cruciate ligament reconstruction (ACLR) have a high rate of reinjury upon return to competitive sports. Deficits in motor control may influence reinjury risk and can be addressed during rehabilitation with motor learning strategies. When instructing patients in performing motor tasks after ACLR, an external focus of attention directed to the intended movement effect has been shown to be more effective in reducing reinjury risk than an internal focus of attention on body movements. While this concept is mostly agreed upon, recent literature has made it clear that the interpretation and implementation of an external focus of attention within ACLR rehabilitation needs to be better described. The purpose of this commentary is to provide a clinical framework for the application of attentional focus strategies and guide clinicians towards effectively utilizing an external focus of attention in rehabilitation after ACLR.
5.
5.
Youth sports participation is encouraged for proposed physical and psychological benefits. However early sport specialization and the potentially negative consequences may be a cause for concern.

To describe sport specialization in Canadian youth and investigate associations with previous injury and physical performance.

Cross-sectional study.

Junior high school students (grades 7-9, ages 11-16) were invited to participate. All participants completed a questionnaire capturing specialization level (low, moderate, high; based on year-round training, exclusion of other sports, and single-sport training) and injury history in the previous 12-months. Additionally, all participants completed physical performance measures including vertical jump (cm), predicted VO2max (mL/kg/min), single-leg balance (secs) and Y-Balance composite score (%). Logistic regression examined the association between school grade, school size, sex and sport specialization (Objective 1) and the association between sport specializatiossociated with sex, grade, or school size. Level of specialization was not associated with history of injury nor a range of physical performance measures.

Level 3.
Level 3.
While Athletic Trainers' (ATs) education emphasizes sport event coverage, Physical Therapists' (PTs) education may prepare them for event coverage responsibilities. The objectives of this study were to compare the perceived preparedness and decision-making related to acute injury/medical condition management among ATs and PTs and evaluate the relationship between perceived preparedness and decision-making.

ATs would report greater perceived preparedness and appropriate decision-making related to acute injury/medical conditions compared to PTs.

Cross-sectional, Online survey.

An electronic survey was disseminated to licensed ATs (n=2,790) and PTs (n=10,207). Survey questions focused on perceived preparedness for management of acute injuries/medical conditions. Respondents also completed questions that assessed clinical decision-making related to acute injury case scenarios. Kruskal-Wallis H-Tests and Spearman's Rho Correlations were used for the analysis. Significance was set to p<0.003 after adjustment for family-wise error.

Six-hundred and fifty-five respondents (292 ATs, 317 PTs, 46 dual credentialed PT/ATs) completed the entire survey. ATs had the highest level of perceived preparedness of all the groups (p<0.0003). Greater than 75% of PTs responded either "appropriately" or "overly cautious" to 10 of the 17 case scenarios, as opposed to 11 of the 17 case scenarios by ATs. Greater than 75% of the PTs who were board specialty certified in sports responded either "appropriately" or "overly cautious" to 13 case scenarios.

More ATs than PTs perceived themselves to be prepared to manage acute injuries/ medical conditions. Further, results indicate that PTs may be an effective and safe provider of event coverage. Conditions/injuries with low perceived preparedness or poor performance may offer both ATs and PTs an opportunity to identify areas for future training and education to optimize care for athletes with acute injuries or medical conditions.

Level 3b.
Level 3b.
The tibialis posterior (TP) muscle plays an important role in normal foot function. Safe, efficacious therapeutic approaches addressing this muscle are necessary; however, the location of the muscle in the deep posterior compartment can create challenges.

The purpose of this study was to assess the accuracy of needle placement in the TP muscle and determine the needle placement in relation to the neurovascular structures located within the deep compartment.

Cross Sectional Study.

Needle placement and ultrasound imaging were performed on 20 healthy individuals. A 50 mm or 60 mm needle was inserted between 30 - 50% of the tibial length measured from the medial tibiofemoral joint. The needle was inserted in a medial to lateral direction into the right extremity with the patient in right side lying. Selleck JKE-1674 Placement of the needle into the TP muscle was verified with ultrasound imaging, and the shortest distance from the needle to the posterior tibial artery and tibial nerve was measured. The depth from the skin to the superficial border of the TP muscle was also measured.

Ultrasonography confirmed the needle filament was inserted into the TP muscle in all 20 individuals and did not penetrate the neurovascular bundle in any individual. The mean distance from the needle to the tibial nerve and posterior tibial artery was 10.0 + 4.7 mm and 10.2 + 4.7 mm respectively. The superficial border of the TP muscle from the skin was at a mean depth of 25.8 + 4.9 mm.

This ultrasound imaging needle placement study supports placement of a solid filament needle into the TP muscle with avoidance of the neurovascular structures of the deep posterior compartment when placed from a medial to lateral direction at 30-50% of the tibial length.

2b.
2b.
Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time intensive testing procedures prevent high school coaches from accurately performing frequent movement screens on their players.

To establish the intra-rater and inter-rater reliability of a novel arm care screening tool based on the concepts of the Functional Movement Screen (FMS™) and Selective Functional Movement Assessment (SFMA™) in high school coaches.

Methodological intra- and inter-rater reliability study.

Thirty-one male high school baseball players (15.9 years ± 1.06) were independently scored on the Arm Care Screen (ACS) by three examiners (two coaches, one physical therapist) in real-time and again seven days later by reviewing video recordings of each players' initial screening performance. Results from each examiner were compared within and between raters using Cohen's kappa and percent absolute agreement.

Substantial to excellent intra-rater and inter-rater reliability were established among all raters for each component of the ACS. The mean Cohen's kappa coefficient for intra-rater reliability was 0.76 (95% confidence interval, 0.54-0.95) and percent absolute agreement ranged from 0.82-0.94 among all raters. Inter-rater reliability demonstrated a mean Cohen's kappa value of 0.89 (95% confidence interval, 0.77-0.99) while percent absolute agreement between raters ranged from 0.81-1.00. Intra- and inter-rater reliability did not differ between raters with various movement screening experience (p>0.05).

High school baseball coaches with limited experience screening movement can reliably score all three components of the ACS in less than three minutes with minimal training.

Level 3, Reliability study.
Level 3, Reliability study.
Improper pitching mechanics are a risk factor for arm injuries. While 3-dimensional (3D) motion analysis remains the gold standard for evaluation, most pitchers and clinicians do not have access to this costly technology. Recent advances in 2-dimensional (2D) video technology provide acceptable resolution for clinical analysis. However, no systematic assessment tools for pitching analysis exist.

To determine the reliability of the Assessment of biomeChanical Efficiency System (ACES) screening tool using 2D video analysis to identify common biomechanical errors in adolescent pitchers.

Cross-sectional.

Adolescent baseball pitchers underwent analysis using 2D video in indoor settings. Observational mechanics were collected using a 20-item scoring tool (ACES) based on 2D video analysis. Fleiss' kappa, interclass correlation coefficients (ICC), and frequencies were used to examine intra-/interrater reliability based on common pitching errors.

Twenty asymptomatic pitchers ages 12-18 years were included. Tlescent pitchers. ACES is a practical and reliable clinical assessment tool utilizing 2D video analysis for coaches, instructors, and sports medicine providers to screen adolescent pitchers for common biomechanical errors.

3b.
3b.
The OnBaseU screen was developed to evaluate a baseball pitcher's ability to perform movement patterns key to pitching. However, due to lack of validation, it is unclear what application is ideal for this screen.

To compare four OnBaseU tests to relevant pitching mechanics measured using 3D motion capture to evaluate if the OnBaseU screen can be used to assess pitching mechanics. The secondary purpose was to compare OnBaseU and 3D motion capture seated trunk rotation test results to determine the validity of the OnBaseU test.

OnBaseU screening and 3D motion capture pitching evaluations were completed for 103 adolescent pitchers (age = 15.2 ± 1.29 years; height = 1.80 ± 0.0866 m; weight = 76.2 ± 13.8 kg). A motion capture seated trunk rotation test was also conducted on 80 of the 103 youth players (age = 15.2 ± 1.32 years; height = 1.80 ± 0.0889 m; weight = 75.7 ± 13.9 kg).

Stride length and OnBaseU side step walkout test data were moderately correlated, and all other comparisons were not correlated or were minorly correlated.
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