Return to Sports Following Shoulder Injury: Clinical Evaluation, Isokinetic, and Functional Testing.

ABSTRACT: The shoulder is commonly injured in overhead sports. This is associated with a high degree of mobility at the expense of stability, sports specific demands, high volume or intensity of practice and competition, biomechanical deficits, and poor technique. Following injury, the return to competition process includes nonsurgical or surgical treatment, comprehensive rehabilitation, and a structured return to sports program. The return to sports continuum is divided into phases which include return to practice of the sport, return to competition at a lower level or with reduced performance, and return to expected performance. Components of the return to sports decision include clinical evaluation of physical and psychological readiness, measurement of muscle strength using isokinetic tests, evaluation of overhead functional tasks, and progression in a supervised interval throwing program. The evidence for the effectiveness of return to sports programs following shoulder injury is limited but evolving and is an area that will merit continued investigation.

Effect of the COVID-19 Pandemic on Musculoskeletal Care in the Emergency Room.

OBJECTIVE: Study the effect of the coronavirus disease (COVID-19) pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints. METHODS: Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM codes were used to assign the primary diagnosis. Joinpoint regression was applied to a time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year. RESULTS: Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2% for all-cause and 35.8% for MSK encounters. Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain. CONCLUSION: The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restrictions and a change in patients behaviors. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.

Quantitative Assessment and Spatial Analysis of Metals and Metalloids in Soil Using the Geo-Accumulation Index in the Capital Town of Romblon Province, Philippines.

The municipality of Romblon in the Philippines is an island known for its marble industry. The subsurface of the Philippines is known for its limestone. The production of marble into slab, tiles, and novelty items requires heavy equipment to cut rocks and boulders. The finishing of marble requires polishing to smoothen the surface. During the manufacturing process, massive amounts of particulates and slurry are produced, and with a lack of technology and human expertise, the environment can be adversely affected. Hence, this study assessed and monitored the environmental conditions in the municipality of Romblon, particularly the soils and sediments, which were affected due to uncontrolled discharges and particulates deposition. A total of fifty-six soil and twenty-three sediment samples were collected and used to estimate the metal and metalloid (MM) concentrations in the whole area using a neural network-particle swarm optimization inverse distance weighting model (NN-PSO). There were nine MMs; e.g., As, Cr, Ni, Pb, Cu, Ba, Mn, Zn and Fe, with significant concentrations detected in the area in both soils and sediments. The geo-accumulation index was computed to assess the level of contamination in the area, and only the soil exhibited contamination with zinc, while others were still on a safe level. Nemerow's pollution index (NPI) was calculated for the samples collected, and soil was evaluated and seen to have a light pollution level, while sediment was considered as "clean". Furthermore, the single ecological risk (Er) index for both soil and sediment samples was considered to be a low pollution risk because all values of Er were less than 40.

In Situ Measurements of Domestic Water Quality and Health Risks by Elevated Concentration of Heavy Metals and Metalloids Using Monte Carlo and MLGI Methods.

The domestic water (DW) quality of an island province in the Philippines that experienced two major mining disasters in the 1990s was assessed and evaluated in 2021 utilizing the heavy metals pollution index (MPI), Nemerow's pollution index (NPI), and the total carcinogenic risk (TCR) index. The island province sources its DW supply from groundwater (GW), surface water (SW), tap water (TP), and water refilling stations (WRS). This DW supply is used for drinking and cooking by the population. In situ analyses were carried out using an Olympus Vanta X-ray fluorescence spectrometer (XRF) and Accusensing Metals Analysis System (MAS) G1 and the target heavy metals and metalloids (HMM) were arsenic (As), barium (Ba), copper (Cu), iron (Fe), lead (Pb), manganese (Mn), nickel (Ni), and zinc (Zn). The carcinogenic risk was evaluated using the Monte Carlo (MC) method while a machine learning geostatistical interpolation (MLGI) technique was employed to create spatial maps of the metal concentrations and health risk indices. The MPI values calculated at all sampling locations for all water samples indicated a high pollution. Additionally, the NPI values computed at all sampling locations for all DW samples were categorized as "highly polluted". The results showed that the health quotient indices (HQI) for As and Pb were significantly greater than 1 in all water sources, indicating a probable significant health risk (HR) to the population of the island province. Additionally, As exhibited the highest carcinogenic risk (CR), which was observed in TW samples. This accounted for 89.7% of the total CR observed in TW. Furthermore, all sampling locations exceeded the recommended maximum threshold level of 1.0 × 10-4 by the USEPA. Spatial distribution maps of the contaminant concentrations and health risks provide valuable information to households and guide local government units as well as regional and national agencies in developing strategic interventions to improve DW quality in the island province.

Musculoskeletal Conditions in Older Men and Women: An Emergency Room Study.

OBJECTIVE: To study the utilization of emergency room (ER) services for health complaints of the musculoskeletal (MSK) system in older men and women. METHODS: Data from all medical encounters at the ER of a teaching hospital for calendar years 2016-2020 were extracted from an electronic database. MSK encounters were defined as those with ICD 10-CM M and S codes in the primary diagnosis field of the database. Frequency distributions were calculated by year, sex, and age group for MSK and all encounters. The most frequent codes used by sex and age groups were assessed. RESULTS: The number of unique patients with medical encounters at the ER during the five-year period was 94,346. There was a total of 220,153 encounters (median:1 encounter per patient; interquartile range:1-3). A 33.2% reduction in the number of encounters occurred in 2020 compared to 2019. The total number of unique patients in the 60 yr. and older group was 24,412 (25.9% of all unique patients). The total number of encounters in the group 60 yr. and older was 56,294 (25.6% of all encounters). Women accounted for 31,488 (56%) encounters in this age group. A total of 12,744 encounters (22.6%) in older adults involved the MSK system and this proportion decreased with increasing age. The most common MSK conditions included low back pain, pain in joints, and femoral fractures. CONCLUSION: Older adults with MSK health conditions represent a substantial portion of ER patients. Many MSK health conditions could be evaluated and treated in other health care settings.

Neuro-Particle Swarm Optimization Based In-Situ Prediction Model for Heavy Metals Concentration in Groundwater and Surface Water.

Limited monitoring activities to assess data on heavy metal (HM) concentration contribute to worldwide concern for the environmental quality and the degree of toxicants in areas where there are elevated metals concentrations. Hence, this study used in-situ physicochemical parameters to the limited data on HM concentration in SW and GW. The site of the study was Marinduque Island Province in the Philippines, which experienced two mining disasters. Prediction model results showed that the SW models during the dry and wet seasons recorded a mean squared error (MSE) ranging from 6 × 10-7 to 0.070276. The GW models recorded a range from 5 × 10-8 to 0.045373, all of which were approaching the ideal MSE value of 0. Kling-Gupta efficiency values of developed models were all greater than 0.95. The developed neural network-particle swarm optimization (NN-PSO) models for SW and GW were compared to linear and support vector machine (SVM) models and previously published deterministic and artificial intelligence (AI) models. The findings indicated that the developed NN-PSO models are superior to the developed linear and SVM models, up to 1.60 and 1.40 times greater than the best model observed created by linear and SVM models for SW and GW, respectively. The developed models were also on par with previously published deterministic and AI-based models considering their prediction capability. Sensitivity analysis using Olden's connection weights approach showed that pH influenced the concentration of HM significantly. Established on the research findings, it can be stated that the NN-PSO is an effective and practical approach in the prediction of HM concentration in water resources that contributes a solution to the limited HM concentration monitored data.

A Hybrid Neural Network-Particle Swarm Optimization Informed Spatial Interpolation Technique for Groundwater Quality Mapping in a Small Island Province of the Philippines.

Water quality monitoring demands the use of spatial interpolation techniques due to on-ground challenges. The implementation of various spatial interpolation methods results in significant variations from the true spatial distribution of water quality in a specific location. The aim of this research is to improve mapping prediction capabilities of spatial interpolation algorithms by using a neural network with the particle swarm optimization (NN-PSO) technique. Hybrid interpolation approaches were evaluated and compared by cross-validation using mean absolute error (MAE) and Pearson's correlation coefficient (R). The governing interpolation techniques for the physicochemical parameters of groundwater (GW) and heavy metal concentrations were the geostatistical approaches combined with NN-PSO. The best methods for physicochemical characteristics and heavy metal concentrations were observed to have the least MAE and R values, ranging from 1.7 to 4.3 times and 1.2 to 5.6 times higher than the interpolation technique without the NN-PSO for the dry and wet season, respectively. The hybrid interpolation methods exhibit an improved performance as compared to the non-hybrid methods. The application of NN-PSO technique to spatial interpolation methods was found to be a promising approach for improving the accuracy of spatial maps for GW quality.

Musculoskeletal Conditions in the Emergency Room: A Teaching Opportunity for Medical Students and Residents.

OBJECTIVE: Assess the potential value of an emergency room (ER) for the teaching of musculoskeletal (MSK) medicine to medical students and residents in training. METHODS: Data from all encounters to the ER of a teaching hospital for calendar years 2016-2019 were extracted from an electronic database. Encounters with ICD-10-CM M codes (MSK system) and S codes (injury) were selected (MSK encounters). Frequency distributions were calculated by year, sex, and age group for all encounters and MSK encounters. Annual distributions of encounters involving the shoulder, hip, knee, and ankle joints were assessed. RESULTS: The number of unique patients seen during the four-year period was 84,094, and the number of encounters was 187,829 (Median: 1 encounter; interquartile range: 1-2). The mean number of encounters per year was 46,957 (range: 45,311- 48,382). There was no seasonal variation. Most patients were women (45,868; 54.6%) and young (20 29 yr.) adults (15,012; 17.8%), and these groups generated the largest numbers of encounters (women: 108,799; 57.9%; young adults: 35,969; 19.1%). A total of 41,353 encounters (22.0% of all encounters) involved the MSK system. The shoulder, hip, knee, and ankle were involved in 2,768 (1.5%), 1,592 (0.8%), 3,082 (1.6%), and 1,718 (0.9%) encounters, respectively. The most common conditions for each joint were shoulder pain, femoral fracture, knee contusion, and ankle sprain. CONCLUSION: Our findings suggest that ER physicians should have broad knowledge of MSK conditions and injuries. An ER is an excellent location for the teaching of MSK medicine to medical students and residents of other training programs.

The high price of anticancer drugs: origins, implications, barriers, solutions.

Globally, annual spending on anticancer drugs is around US$100 billion, and is predicted to rise to $150 billion by 2020. In the USA, a novel anticancer drug routinely costs more than $100,000 per year of treatment. When adjusted for per capita spending power, however, drugs are most unaffordable in economically developing nations, such as India and China. Not only are launch prices high and rising, but individual drug prices are often escalated during exclusivity periods. High drug prices harm patients - often directly through increased out-of-pocket expenses, which reduce levels of patient compliance and lead to unfavourable outcomes - and harms society - by imposing cumulative price burdens that are unsustainable. Moreover, high drug prices are not readily explained by rational factors, including the extent of benefit patients are likely to derive, the novelty of the agents, or spending on research and development. Herein, we summarize the available empirical evidence on the costs of anticancer drugs, probe the origins and implications of these high costs, and discuss proposed solutions.