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A narrative review of little league shoulder: Proximal humeral physis widening is only one piece of the puzzle, it is time to consider posterior glenoid dysplasia
No full textBaseball athletes across all levels of play are at an increased risk for upper extremity injury due to the supraphysiologic demands on the shoulder and elbow during overhead throwing. Little league baseball players present with a unique subset of injuries that can affect the growth plate, commonly at the shoulder or the elbow. Ascertaining a diagnosis and plan of care for little league shoulder (LLS) historically focuses on the proximal humeral physis in skeletally immature throwing athletes presenting with shoulder pain. However, while not a current standard of care, posterior glenoid dysplasia is often present in youth baseball athletes presenting with LLS, warranting a shift in the way clinicians evaluate for and treat the youth baseball athlete’s pathologic shoulder. Therefore, purpose of this narrative review is 2-fold: first, to describe the current standard of care as it relates to a diagnosis of LLS, and second, to critically describe a comprehensive evaluation process for youth throwing athletes with shoulder pain that includes screening for evidence of posterior glenoid dysplasia. This paper summarizes the current state of the available evidence for anatomic considerations of LLS in the baseball athletes throwing shoulder. Additionally, we provide a framework for clinical evaluation using a multidisciplinary approach to evaluate the entire kinetic chain of the youth baseball athlete presenting with LLS and posterior glenoid dysplasia. A case study is presented to describe common presentations, clinical and objective examinations, and a plan of care from time of evaluation to return to throwing
Perspectives on adaptation in a stroke self-management program: A multiple case study
No full textBackground: Occupational Adaptation occurs when a person develops a response to meet an occupational challenge. This process is disrupted when a person experiences a life altering event, such as stroke. Stroke self-management programs equip persons with stroke with education and skills to manage the daily tasks associated with their condition. Few studies have explored the adaptive process survivors experience as they seek to effectively use the tools provided through stroke self-management programs. The objective was to explore the adaptive process of three individuals following participation in a stroke self-management program.
Method: A multiple case study design was used. Three participants completed an interview focused on their adaptive experiences as they learned to self-manage personal stroke risk factors. Each case study interview was analyzed to identify themes across cases.
Results: Four themes were identified: (a) knowledge acquisition to generate an adaptive response, (b) behavioral change and adjustment in routines, (c) increased proactivity and personal responsibility and, (d) vvaluating the adaptive response-Physiological and emotional changes in health.
Conclusion: The participants’ increased awareness and understanding of personal stroke risk factors facilitated the adaptive process, which resulted in increased efficiency, effectiveness, satisfaction, and engagement in health promoting behavior to self-manage their stroke condition
Election reform and campaign finance: Did Alaska’s top 4 nonpartisan primaries and ranked‐choice general elections affect political spending?
No full textObjective: Ranked-choice voting (RCV) is increasingly seen as a way to reduce political polarization and increase voter choice in elections, but little is known about its effect on candidate fundraising. In 2022, Alaska held its first election using a nonpartisan Top 4 primary followed by a ranked-choice general election. We analyze the effect of this new system on campaign financing practices in state legislative elections. There are many reasons to expect RCV to increase campaign spending, broaden the donor pool, and prompt donors to support candidates to whom they would not otherwise contribute.
Method: We measure changes in fundraising over the past decade in Alaska legislative elections. We conduct a network analysis of campaign contributors in Alaska for the 2018, 2020, and 2022 state legislative elections.
Results: RCV had minimal consequences for campaign fundraising. Our ability to draw broader conclusions about the relationship between RCV and campaign finance is complicated by unusual features of Alaska politics.
Conclusions: There is little evidence that the adoption of a Top 4/RCV system in Alaska had immediate effects on campaign finance in state legislative elections. However, patterns may change as legislators and donors adapt to the new system
Structural characteristics, electronic properties, and coupling behavior of 12-4-12, 12-3-12, 12-2-12 cationic surfactants: A first-principles computational investigation and experimental raman spectroscopy
No full textIn this study, we present a comprehensive first-principles computational investigation focused on the structural characteristics, electronic properties, and coupling integrations of three cationic Gemini surfactants: 12-4-12, 12-3-12, and 12-2-12 ((CH3(CH2)11)(CH3)2-N+-(CH2)n-N+(CH3(CH2)11)(CH3)2, where n = 2, 3, or 4). By employing Density Functional Theory (DFT) computations, we aimed to gain insights into the fundamental aspects of these surfactant molecules, and the intermolecular interactions among these surfactant molecules. We examined different conformers of each surfactant, including parallel, wing, and bent conformers, and compared their relative stability and properties. We elucidated that the complex structural characteristics, electronic properties, and molecular arrangements of the surfactants vary according to the number of carbon atoms in the central spacer. We also conducted experimental Raman spectroscopy on the three surfactants to compare the results with our computational findings. Furthermore, we computed the coupling behaviors of different conformers of 12-4-12 surfactants in order to gain insights into their coupling mechanism
A financial toxicity screening and care coordination quality improvement program in a gynecology oncology urban practice
No full textBackground: Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer.
Objective: The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project.
Methods: The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer.
Results: Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores’ observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score.
Conclusion: Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination
Does blood flow restriction cause neuromuscular adaptability in lower limb musculature while pushing low-load resistance?
No full textIntroduction: Blood flow restriction (BFR) combined with resistance training can promote hypertrophy, enhance muscle activation, and improve function. Muscle electromyography (EMG) is commonly used to elucidate neuromuscular recruitment and highlight adaptive changes in recruitment due to BFR.
Purpose: This study used electromyography (EMG) to determine the influence of BFR on lower-extremity (LE) neuromuscular activation timing during resistive sled training.
Methods: Sixty-two participants were recruited (eight males and 54 females; mean age, 23 years). EMG) electrodes were placed on the belly of selected muscles of the dominant LE to record muscle activation. Participants pushed an XPO sled trainer at slow (60 bpm) and fast (140 bpm) walking speed protocols (three trials each) with and without the application of BFR to the LE for a total of 12 trials. The EMG variables assessed were time to peak, decay, and duration of muscle activation.
Results: The outcomes revealed several adaptations in EMG variables for functionally activated muscles above and below the cuff when pushing a sled while using BFR.
Conclusions & Clinical Relevance: Several tendencies have been identified in the gastrocnemius, tibialis anterior, and hip extensors depending on walking speed, which may be foundational to future research and should be explored further. Our results suggest that low-load BFR can benefit patients with leg musculature weakness, extensor musculature fatigue, and proximal thigh musculature rehabilitation
Prolonged water-only fasting followed by a whole-plant-food diet is a potential long-term management strategy for hypertension and obesity
No full textObjective: This single-arm, pre–post interventional trial (clinicaltrials.gov, NCT04515095) investigates the safety, feasibility, and potential effectiveness of prolonged water-only fasting followed by a whole-plant-food diet in the long-term management of hypertension and other cardiometabolic disorders. Methods: Safety was assessed based on adverse events (AEs) that were recorded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Feasibility was assessed based on retention rate, ability to complete minimal fast length, and intervention acceptability. Twenty-nine participants with stage 1 and 2 hypertension and without type 2 diabetes were enrolled from a residential fasting center. Results: Study retention was 100% at the end of the refeed and 93% at the six-week follow-up visit. Median (range) fasting and refeeding duration were 11 (7–40) and 5 (3–17) days, respectively, and 90% of participants were able to complete at least 7 days of fasting. The majority of AEs were mild (grade 1) and transient and there were no higher-grade or serious AEs. At the end of the intervention, median systolic/diastolic blood pressure had normalized to below 130/80 mmHg, body weight reduced by >5%, and anti-hypertensive medication was completely discontinued. These results were sustained for at least six weeks and potentially up to one year. Conclusions: Our data suggest that the intervention may be a feasible, well-tolerated, low-risk option for lowering and managing high blood pressure, excess body weight, and other cardiometabolic disorders in people with stage 1 and 2 hypertension
Consistent scholarship standards among DNP-prepared faculty needed: Actionable Insights
No full textDNP-prepared faculty report challenges and barriers to achieving success in academic roles when criteria for promotion includes scholarship. The purpose of this evidence-based initiative was to explore thoughtful scholarship standards for DNP-prepared faculty which can be adapted and transferred across academic institutions with the goal of elevating faculty scholarship. Given a paucity of available research evidence, a review and synthesis of non-research evidence was conducted. DNP scholarship standards from high-ranking intuitions were critically appraised, and this evidence, along with the diverse and collective expertise of the authors, was translated into recommendations for an inclusive model of rigor for DNP-prepared faculty scholarship. A template for appraising the scholarship of DNP-prepared faculty based on strategic evaluation of impact is included. Academic institutions may use this work to expand the fundamental level of evolving scholarship, determine parameters, and provide clarity and support to DNP-prepared faculty as they seek to progress in rank
Impact of menstrual cycle on submaximal exercise VO2 and critical power in active eumenorrheic females
No full textPURPOSE: The effects of the menstrual cycle (MC) on exercise metabolism and performance are equivocal. The purpose of this study was to investigate whether the MC impacted submaximal exercise oxygen consumption (VO2) and Critical Power (CP) in recreationally active, eumenorrheic females.
METHODS: Eight eumenorrheic females (Age: 33 ± 8 y, VO2max: 36.9 ± 3.8 ml/kg/min) completed fasted exercise testing in 3 distinct phases of the MC (early follicular, late follicular, and mid luteal). MC phase was determined using calendar-based counting, ovulation test strips, and confirmed via serum hormones (estrogen and progesterone). For submaximal exercise, participants cycled for 20 min at 50% VO2max while VO2 and respiratory exchange ratio (RER) were measured with indirect calorimetry. Rating of perceived exertion (RPE) was measured with Borg 6-20 Scale. After submaximal exercise, participants rested for 10 min and performed a 3-min all-out test to assess CP. Power output (W) was continuously measured to determine CP, which was defined as mean W in final 30 sec of 3-min all-out test. Repeated measures ANOVA was used to assess differences in submaximal responses for VO2 and RER, and 3-min all-out CP. Friedman tests were used to assess differences in RPE.
RESULTS: For submaximal cycling, VO2 did not differ across MC (early follicular: 1.27 ± 0.22 L/min, late follicular: 1.27 ± 0.20 L/min, mid-luteal: 1.27 ± 0.22 L/min; p-value = 0.98; effect size = 0.01). However, RER was higher during late follicular (0.91 ± 0.03) than early follicular (0.89 ± 0.05) and mid-luteal (0.89 ± 0.03) phases (p = 0.12; effect size = 0.30). RPE was lower during late follicular (11 ± 2) compared to early follicular (13 ± 2) and mid luteal (13 ± 2)(p = 0.04). For the 3-min all-out test, CP did not differ by MC phase (early follicular: 138 ± 31 W, late follicular: 136 ± 33 W, mid luteal: 136 ± 31 W; p = 0.52; effect size = 0.07).
CONCLUSIONS: These preliminary results in 8 recreationally active, eumenorrheic females suggest that submaximal exercise VO2 and CP do not differ across the MC, despite minor differences in submaximal substrate utilization and perceived exertion.
Texas Woman's University ORSP Small Gran
Occupational stress, well-being, and pediatric occupational therapists: A mixed-methods study
No full textOccupational stress is a risk factor for the sustainability of occupational therapy. This mixed methods study aimed to investigate the self-reported stress levels of pediatric occupational therapists. A qualitative descriptive approach followed a quantitative descriptive correlational study. The results indicated that a third of pediatric occupational therapists surveyed for this study scored severe to dangerous levels of workplace stress, with another third falling into the moderate range of workplace stress. The mean stress score of this study compared to the mean score of the validating sample of the Workplace Stress Scale (WSS) indicated that there were significantly higher stress levels of the participants in this study compared to the validating sample with a large effect size. The WSS and the Work Environment Impact Scale-Self Report (WEIS-SR) demonstrated a significant positive relationship. WSS and the WEIS-SR significantly negatively correlated with the Scales of General Wellbeing-clinical tool. Being married is the only significant predictor of increased occupational stress and decreased well-being. The significant well-being predictors of occupational stress were calmness, connection, autonomy, awareness, optimism, and development. The interplay of positive and negative work experiences of occupational stress shaped the participant's work functioning and well-being. It provided detailed descriptions to understand further the dynamic interaction between occupational stress, general well-being, and work functioning. All three are needed for pediatric occupational therapists' health, employee retention, and professional sustainability