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  • 1
    Online Resource
    Online Resource
    Early Experiences Designing a Scalable COVID-19 Reusable Elastomeric Respirator
    ASME International ; 2022
    In:  Journal of Medical Devices Vol. 16, No. 1 ( 2022-03-01)
    Details
    In: Journal of Medical Devices, ASME International, Vol. 16, No. 1 ( 2022-03-01)
    Abstract: The COVID-19 pandemic created an unprecedented shortage of personal protective equipment (PPE) for healthcare workers—especially respirators. In response to a lack of commercial respirator equipment, a multidisciplinary prototyping hackathon was held and the key components required to develop an inexpensive, scalable “COVID-19 reusable elastomeric respirator” (RER-19) were identified. Available hospital supplies were assessed based on their published technical specifications to meet each of the key component requirements. The fully assembled prototype was then validated through user testing, and volunteers underwent standard fit testing with cardiopulmonary monitoring while wearing the RER-19 in a small pilot study. Multiple social media platforms were then used to disseminate educational information on respirator assembly, use, and maintenance. Here, we present our institution's initial experience with prototyping to meet a specific healthcare challenge, in combination with prompt dissemination of information to educate and empower healthcare workers in the face of a critical PPE shortage during an unprecedented and evolving pandemic.
    Type of Medium: Online Resource
    ISSN: 1932-6181 , 1932-619X
    URL: Article
    DOI: 10.1115/1.4054055
    Language: English
    Publisher: ASME International
    Publication Date: 2022
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  • 2
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    Ulnar Collateral Ligament Tear in Elite Baseball Pitchers: Are High School Showcase Exposures Associated With Injury?
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 11 ( 2022-09), p. 3073-3082
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 11 ( 2022-09), p. 3073-3082
    Abstract: Ulnar collateral ligament reconstruction (UCLR) surgeries have increased significantly in amateur and professional baseball pitchers. Although showcase participation has been considered an injury risk factor, limited data are available to corroborate this association. Hypothesis: Elite pitchers achieving fastball velocities ≥90, ≥92, and ≥95 mph at younger ages would be more likely to undergo UCLR earlier in their careers compared with pitchers not achieving these velocity thresholds at younger ages. Elite pitchers participating in high showcase volumes would be more likely to undergo UCLR compared with elite pitchers participating in fewer showcases. Study Design: Cohort study; Level of evidence, 3. Methods: Descriptive, showcase performance, and injury data from pitchers selected in the first 5 rounds of the Major League Baseball draft (2011-2020) were gathered from publicly available databases. Continuous and categorical variables for pitchers undergoing UCLR and those not undergoing UCLR were compared, and multivariable analysis was performed using logistic regression. We used standard deviations (SDs) of ±1 SD of mean age at first UCLR to define early-career versus late-career UCLR subgroups after normal distribution was confirmed (Shapiro-Wilk test; P = .183). The “early” UCLR group was defined as ≤−1 SD (19.09 years), whereas the “late” UCLR group was defined as ≥+1 SD (24.79 years). Trends in time were evaluated using linear regression. Results: Of the 845 pitchers selected, 659 pitchers (78.0%) had retrievable showcase performance data. Of the 845 pitchers, 229 (27.1%) underwent UCLR. Peak fastball velocity recorded at showcases was the strongest predictor of UCLR (adjusted odds ratio, 1.19; 95% CI, 1.02 to 1.39; P = .03). Peak fastball velocity in high school (HS) was significantly higher among pitchers who underwent UCLR compared with pitchers in the no-UCLR group (91.57 vs 90.71 mph, respectively; 95% CI, −1.43 to −0.29; P 〈 .01). Age at which pitchers participated in their first HS showcase was significantly younger for the early versus the late UCLR group (15.53 vs 16.51 years, respectively; 95% CI, −1.53 to −0.41; P 〈 .01). Elite pitchers with early UCLR participated in nearly twice as many showcases compared with the late UCLR group (5.38 vs 2.89, respectively; 95% CI, 0.43 to 4.54; P = .02). The mean number of HS showcases that elite pitchers attended more than doubled during the 2011-2020 study period (from 2.88 to 6.00 total showcases; P 〈 .001). Mean age at which pitchers attended their first HS showcase steadily declined as well over the 10-year period (from 16.52 to 15.63 years; P 〈 .001). Conclusion: Peak fastball velocity was the strongest predictor of UCLR in elite pitchers before initiating professional careers. Elite amateur pitchers attended more showcases at younger ages in a decade-long trend. Overall, the variables included in this multivariable analysis were weak predictors, explaining only 3.8% of the variance in UCLR rates.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221113859
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
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    Effect of High School Showcase Exposures and Timing of Ulnar Collateral Ligament Tear on Professional Baseball Careers in Elite Pitchers
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 4 ( 2023-03), p. 926-934
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 4 ( 2023-03), p. 926-934
    Abstract: Showcase participation has been considered a risk factor for elbow injuries. It remains unclear whether high school (HS) showcase volume negatively affects pitchers’ career paths. Because pitchers are achieving 90 mph thresholds at younger ages, it is unknown whether shorter time intervals between achieving 90 mph thresholds and dates of ulnar collateral ligament reconstruction (UCL-R), known as time to tear (TTT), may affect career trajectory. Hypothesis: Elite pitchers with higher HS showcase volumes would be less likely to reach Major League Baseball (MLB) level compared with elite pitchers with fewer HS showcase appearances. Elite pitchers with longer TTT intervals would be more likely to achieve MLB level. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, HS showcase and professional performance, and injury data from pitchers selected in the first 5 rounds of the MLB draft (2011-2017) were gathered from publicly available databases. Continuous and categorical variables were compared for the following subgroups: UCL-R group and pitcher group not undergoing UCL-R; “early” and “late” UCL-R groups; and pitchers achieving and pitchers not achieving MLB level. Multivariable analysis was performed using logistic regression. Standard deviations of ±1 SD were used to define early career versus late career UCL-R subgroups after normal distribution was confirmed (Shapiro-Wilk test; P = .227). The early UCL-R group was defined as those pitchers undergoing UCL-R ≤−1 SD from the mean age at first injury (group mean age, 19.43 years), whereas the late UCL-R group was defined as ≥+1 SD from that age (group mean age, 25.19 years). Results: Of 611 pitchers, 455 (74.5%) had HS showcase performance data, and 608 (99.5%) had professional performance data. In total, 184 (30.1%) pitchers underwent UCL-R. Fewer pitchers who underwent early UCL-R achieved the MLB level compared with pitchers who underwent late UCL-R (48.1% vs 86.2%; P = .006). Elite pitchers who pitched in ≥10 showcases in HS had half the odds of achieving the MLB level compared with pitchers who participated in 〈 10 HS showcases (adjusted odds ratio, 0.50; 95% CI, 0.29-0.86; P = .012). For every year longer that an elite pitcher did not tear his UCL after achieving the 90 mph threshold at an HS showcase (TTT after 90 mph [per year]), the likelihood of achieving the MLB level increased by 24% (adjusted odds ratio, 1.24; 95% CI, 1.02-1.52; P = .032). Conclusion: Higher HS showcase volume in elite pitchers was associated with a lower likelihood of achieving MLB level. A longer TTT after 90 mph (per year) was significantly associated with achieving MLB level in elite pitchers.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221150509
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2063945-4
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  • 4
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    Reliability of an Observational Biomechanical Analysis Tool in Adolescent Baseball Pitchers
    International Journal of Sports Physical Therapy ; 2021
    In:  International Journal of Sports Physical Therapy Vol. 16, No. 6 ( 2021-12-1)
    Details
    In: International Journal of Sports Physical Therapy, International Journal of Sports Physical Therapy, Vol. 16, No. 6 ( 2021-12-1)
    Abstract: 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. Purpose 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. Study Design Cross-sectional. Methods 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. Results Twenty asymptomatic pitchers ages 12-18 years were included. Total ACES scores ranged from 1 to 13, normally distributed. ACES total score demonstrated excellent intra-rater reliability within each rater (ICC for rater 1 = 0.99 (95% CI; 0.98, 0.99); ICC for rater 2 = 0.94; 95% CI: 0.84, 0.97); ICC for rater 3 = 0.98 (95% CI: 0.96, 0.99)). There was excellent interrater reliability across the trials and raters (ICC = 0.91; 95% CI: 0.82, 0.96). The ACES tool demonstrated acceptable kappas for individual items and strong ICC 0.91 (95% CI: 0.82, 0.96) for total scores across the trials. Regarding identification of biomechanical errors, “front side position” was rated erroneous in 84/120 ratings (70%), stride length in 52/120 ratings (43.3%) and lead hip position in 53/120 ratings (44.2%). Conclusions The 20-item ACES scoring tool with 2D video analysis demonstrated excellent intra- and interrater reliability when utilized by raters of different musculoskeletal disciplines. Future studies validating 2D vs. 3D methodology are warranted before ACES is widely disseminated and utilized for adolescent 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. Level of Evidence 3b
    Type of Medium: Online Resource
    ISSN: 2159-2896
    URL: Article
    DOI: 10.26603/001c.29869
    Language: English
    Publisher: International Journal of Sports Physical Therapy
    Publication Date: 2021
    detail.hit.zdb_id: 2628664-6
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  • 5
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    Importance of Preserved Tricuspid Valve Function for Effective Soft Robotic Augmentation of the Right Ventricle in Cases of Elevated Pulmonary Artery Pressure
    Springer Science and Business Media LLC ; 2022
    In:  Cardiovascular Engineering and Technology Vol. 13, No. 1 ( 2022-02), p. 120-128
    Details
    In: Cardiovascular Engineering and Technology, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2022-02), p. 120-128
    Abstract: In clinical practice, many patients with right heart failure (RHF) have elevated pulmonary artery pressures and increased afterload on the right ventricle (RV). In this study, we evaluated the feasibility of RV augmentation using a soft robotic right ventricular assist device (SRVAD), in cases of increased RV afterload. Methods In nine Yorkshire swine of 65–80 kg, a pulmonary artery band was placed to cause RHF and maintained in place to simulate an ongoing elevated afterload on the RV. The SRVAD was actuated in synchrony with the ventricle to augment native RV output for up to one hour. Hemodynamic parameters during SRVAD actuation were compared to baseline and RHF levels. Results Median RV cardiac index (CI) was 1.43 (IQR, 1.37–1.80) L/min/m 2 and 1.26 (IQR 1.05–1.57) L/min/m 2 at first and second baseline. Upon PA banding RV CI fell to a median of 0.79 (IQR 0.63–1.04) L/min/m 2 . Device actuation improved RV CI to a median of 0.87 (IQR 0.78–1.01), 0.85 (IQR 0.64–1.59) and 1.11 (IQR 0.67–1.48) L/min/m 2 at 5 min ( p  = 0.114), 30 min ( p  = 0.013) and 60 ( p  = 0.033) minutes respectively. Statistical GEE analysis showed that lower grade of tricuspid regurgitation at time of RHF ( p  = 0.046), a lower diastolic pressure at RHF ( p  = 0.019) and lower mean arterial pressure at RHF ( p  = 0.024) were significantly associated with higher SRVAD effectiveness. Conclusions Short-term augmentation of RV function using SRVAD is feasible even in cases of elevated RV afterload. Moderate or severe tricuspid regurgitation were associated with reduced device effectiveness.
    Type of Medium: Online Resource
    ISSN: 1869-408X , 1869-4098
    URL: Article
    DOI: 10.1007/s13239-021-00562-7
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 6
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    The Modified Clinical Progression Scale for Pediatric Patients: Evaluation as a Severity Metric and Outcome Measure in Severe Acute Viral Respiratory Illness
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Pediatric Critical Care Medicine
    Details
    In: Pediatric Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health)
    Abstract: To develop, evaluate, and explore the use of a pediatric ordinal score as a potential clinical trial outcome metric in children hospitalized with acute hypoxic respiratory failure caused by viral respiratory infections. Design: We modified the World Health Organization Clinical Progression Scale for pediatric patients (CPS-Ped) and assigned CPS-Ped at admission, days 2–4, 7, and 14. We identified predictors of clinical improvement (day 14 CPS-Ped ≤ 2 or a three-point decrease) using competing risks regression and compared clinical improvement to hospital length of stay (LOS) and ventilator-free days. We estimated sample sizes (80% power) to detect a 15% clinical improvement. Setting: North American pediatric hospitals. Patients: Three cohorts of pediatric patients with acute hypoxic respiratory failure receiving intensive care: two influenza (pediatric intensive care influenza [PICFLU], n = 263, 31 sites; PICFLU vaccine effectiveness [PICFLU-VE], n = 143, 17 sites) and one COVID-19 ( n = 237, 47 sites). Interventions: None. Measurements and Main Results: Invasive mechanical ventilation rates were 71.4%, 32.9%, and 37.1% for PICFLU, PICFLU-VE, and COVID-19 with less than 5% mortality for all three cohorts. Maximum CPS-Ped (0 = home at respiratory baseline to 8 = death) was positively associated with hospital LOS ( p 〈 0.001, all cohorts). Across the three cohorts, many patients’ CPS-Ped worsened after admission (39%, 18%, and 49%), with some patients progressing to invasive mechanical ventilation or death (19%, 11%, and 17%). Despite this, greater than 76% of patients across cohorts clinically improved by day 14. Estimated sample sizes per group using CPS-Ped to detect a percentage increase in clinical improvement were feasible (influenza 15%, n = 142; 10%, n = 225; COVID-19, 15% n = 208) compared with mortality ( n 〉 21,000, all), and ventilator-free days (influenza 15%, n = 167). Conclusions: The CPS-Ped can be used to describe the time course of illness and threshold for clinical improvement in hospitalized children and adolescents with acute respiratory failure from viral infections. This outcome measure could feasibly be used in clinical trials to evaluate in-hospital recovery.
    Type of Medium: Online Resource
    ISSN: 1529-7535
    URL: Article
    DOI: 10.1097/PCC.0000000000003331
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 7
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    Home Run Derby Participation in Major League Baseball Players: Is There Associated Injury Risk and Impact on Second-Half Performance?
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 2 ( 2021-02-01), p. 232596712098335-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 2 ( 2021-02-01), p. 232596712098335-
    Abstract: The Major League Baseball (MLB) All-Star Game (ASG) Home Run Derby (HRD) remains a highly anticipated event, during which contestants can take hundreds of maximum-effort swings en route to hitting a multitude of home runs. Critics have openly questioned the risk-benefit of HRD participation as it pertains to injury, alterations in swing mechanics, and timing. Purpose: To determine whether participation in the MLB ASG HRD was associated with both increased injury risk and decline in second-half performance in MLB players. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players who participated in the HRD between 2006 and 2019 were identified through publicly available internet databases. A control group of ASG participants who had the highest home run totals in the first half of the corresponding MLB season were selected as a control group. Multivariable linear regression was used to determine independent associations between HRD participation and batting metrics in the second half of the season. Multivariable logistic regression also assessed the impact of HRD participation on injured list placement during the second half of the concurrent MLB season. Results: A total of 114 HRD participants and 114 ASG participant controls competed during the study period. No statistically significant differences were seen in batting metrics in the second half of the MLB season between HRD participants and ASG controls, although HRD participants had a significantly lower wins-above-replacement statistic for the season compared with controls (4.69 ± 2.06 vs 5.33 ± 2.08; P = .021). HRD participation was not significantly associated with injury during the second half. The number of HRD rounds in which a player participated did not result in a statistically significant increased odds of injury during the second half of the MLB season. Conclusion: HRD participants did not have increased odds of being placed on the injured list during the second half of the MLB season compared with controls, nor did they experience second-half performance declines in offensive production versus controls when multivariable linear regression analysis was performed.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967120983350
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
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  • 8
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    Epidemiology of childhood death in Australian and New Zealand intensive care units
    Springer Science and Business Media LLC ; 2019
    In:  Intensive Care Medicine Vol. 45, No. 9 ( 2019-9), p. 1262-1271
    Details
    In: Intensive Care Medicine, Springer Science and Business Media LLC, Vol. 45, No. 9 ( 2019-9), p. 1262-1271
    Type of Medium: Online Resource
    ISSN: 0342-4642 , 1432-1238
    URL: Article
    DOI: 10.1007/s00134-019-05675-1
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 1459201-0
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  • 9
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    Predicting Postoperative Physiologic Decline After Surgery
    American Academy of Pediatrics (AAP) ; 2019
    In:  Pediatrics Vol. 143, No. 4 ( 2019-04-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 143, No. 4 ( 2019-04-01)
    Abstract: Projecting postoperative recovery in pediatric surgical patients is challenging. We assessed how the patients’ number of complex chronic conditions (CCCs) and chronic medications interacted with active health issues to influence the likelihood of postoperative physiologic decline (PoPD). METHODS: A prospective study of 3295 patients undergoing elective surgery at a freestanding children’s hospital. During preoperative clinical evaluation, active health problems, CCCs, and medications were documented. PoPD (compromise of cardiovascular, respiratory, and/or neurologic systems) was measured prospectively every 4 hours by inpatient nurses. PoPD odds were estimated with multivariable logistic regression. Classification and regression tree analysis distinguished children with the highest and lowest likelihood of PoPD. RESULTS: Median age at surgery was 8 years (interquartile range: 2–15); 2336 (70.9%) patients had a CCC; and 241 (7.3%) used ≥11 home medications. During preoperative evaluation, 1556 (47.2%) patients had ≥1 active health problem. After surgery, 882 (26.8%) experienced PoPD. The adjusted odds of PoPD were 1.2 (95% confidence interval [CI]: 1.0–1.4) for presence versus absence of an active health problem; 1.4 (95% CI: 1.0–1.9) for ≥11 vs 0 home medications; and 2.2 (95% CI: 1.7–2.9) for ≥3 vs 0 CCCs. In classification and regression tree analysis, the lowest rate of PoPD (8.6%) occurred in children without an active health problem at the preoperative evaluation; the highest rate (57.2%) occurred in children with a CCC who used ≥11 home medications. CONCLUSIONS: Greater than 1 in 4 pediatric patients undergoing elective surgery experienced PoPD. Combinations of active health problems at preoperative evaluation, polypharmacy, and multimorbidity distinguished patients with a low versus high risk of PoPD.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-2042
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2019
    detail.hit.zdb_id: 1477004-0
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  • 10
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    The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation
    Frontiers Media SA ; 2021
    In:  Transplant International Vol. 34, No. 10 ( 2021-10), p. 1928-1937
    Details
    In: Transplant International, Frontiers Media SA, Vol. 34, No. 10 ( 2021-10), p. 1928-1937
    Type of Medium: Online Resource
    ISSN: 0934-0874 , 1432-2277
    URL: Issue
    URL: Article
    DOI: 10.1111/tri.v34.10
    DOI: 10.1111/tri.13956
    Language: English
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 1463183-0
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