Pickleball Primer: An Overview of Common Injuries, Treatment, and Optimization Strategies in Pickleball Athlete.

Pickleball is one of the fastest growing sports in the United States with millions of players nationwide. It is a relatively appealing sport because of its ease of access, low impact, and highly social atmosphere, allowing players of all ages to participate. As the number of players continues its dramatic increase, player injuries are certain to increase in turn. There is little to no orthopaedic research on pickleball-related injuries and a paucity of data regarding treatment and prevention strategies. This summary was designed to familiarize orthopaedic surgeons with the basics of the sport and highlight potential pickleball-related injuries they may encounter in practice.

Crabs ride the tide: incoming tides promote foraging of Giant Mud Crab (Scylla serrata).

BACKGROUND: Effective fisheries management of mobile species relies on robust knowledge of animal behaviour and habitat-use. Indices of behaviour can be useful for interpreting catch-per-unit-effort data which acts as a proxy for relative abundance. Information about habitat-use can inform stocking release strategies or the design of marine protected areas. The Giant Mud Crab (Scylla serrata; Family: Portunidae) is a swimming estuarine crab that supports significant fisheries harvest throughout the Indo-West Pacific, but little is known about the fine-scale movement and behaviour of this species. METHODS: We tagged 18 adult Giant Mud Crab with accelerometer-equipped acoustic tags to track their fine-scale movement using a hyperbolic positioning system, alongside high temporal resolution environmental data (e.g., water temperature), in a temperate south-east Australian estuary. A hidden Markov model was used to classify movement (i.e., step length, turning angle) and acceleration data into discrete behaviours, while also considering the possibility of individual variation in behavioural dynamics. We then investigated the influence of environmental covariates on these behaviours based on previously published observations. RESULTS: We fitted a model with two well-distinguished behavioural states describing periods of inactivity and foraging, and found no evidence of individual variation in behavioural dynamics. Inactive periods were most common (79% of time), and foraging was most likely during low, incoming tides; while inactivity was more likely as the high tide receded. Model selection removed time (hour) of day and water temperature (°C) as covariates, suggesting that they do not influence Giant Mud Crab behavioural dynamics at the temporal scale investigated. CONCLUSIONS: Our study is the first to quantitatively link fine-scale movement and behaviour of Giant Mud Crab to environmental variation. Our results suggest Giant Mud Crab are a predominantly sessile species, and support their status as an opportunistic scavenger. We demonstrate a relationship between the tidal cycle and foraging that is likely to minimize predation risk while maximizing energetic efficiency. These results may explain why tidal covariates influence catch rates in swimming crabs, and provide a foundation for standardisation and interpretation of catch-per-unit-effort data-a commonly used metric in fisheries science.

Habitat transitions by a large coastal sciaenid across life history stages, resolved using otolith chemistry.

Many coastal species move between estuarine and coastal environments throughout their life. Migration patterns develop as a result of ecology and evolution and must be understood to effectively manage harvested stocks. This study examined movements across estuarine and coastal marine habitats in adult Mulloway (Argyrosomus japonicus); a commercially, indigenous and recreationally harvested sciaenid of south-eastern Australia. Chemical profiles across the otolith (ear bone) were used to examine transitions between estuary and marine habitats over life history. Patterns in otolith Ba:Ca concentrations indicated that the majority of fish migrated between estuary and marine habitats, but a small proportion of fish appeared to remain in either the estuary or the marine habitat. Such movements may potentially be driven by a range of biological and environmental factors. This approach allows questions about the life history and habitat use of Mulloway to be addressed, which will aid management and provide a platform for future research on Mulloway, other sciaenid's and coastal migratory species.

Understanding discarding in trawl fisheries: A model based demersal case study with implications for mitigating and assessing impacts.

Despite research and public scrutiny over recent decades, discarding continues to be an issue for trawl fisheries. Previous research demonstrates that environmental, biological, operational, legislative and socioeconomic drivers affect a fisher's decision to discard an organism. Therefore, the reduction of fishery discards requires a better understanding of fishery-specific drivers. Despite considerable research and mitigation, further work is required to reduce discarding to acceptable levels (currently ~ 50% in Australia). To better understand the drivers of discarding, this study used a modelling approach to determine environmental and operational factors that drive discarding in the New South Wales (NSW) ocean prawn trawl fishery (OPT). Further, the study investigated the relationship between the discarded number of individuals from all functional species groups (i.e. elasmobranchs, crustaceans and fish combined) and the retained catch weight. This model was also run on just fish partly due to their disproportionally high contribution to the discard assemblage (e.g. 76% of all species or higher taxon) and importance (e.g. to the ecosystem and fisheries). The results quantified relationships of environmental and operational drivers of discarding and the relationship of fish discarding and retained catch weight was found to be linear. However, the identified relationships appear complicated and, whilst an important first step, more work is required to identify all drivers influencing discarding practices. We, in combination with previous research, suggest implementation of effort quotas may be a suitable management initiative to reduce discarding and its impact; at least whilst more research is conducted to better understand this complex process. Furthering our understanding of discarding is urgent given its global impact and the rate of discarding in the OPT.

Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration.

ABSTRACT: Prescription opioids remain an important driver of the opioid crisis in the United States. The purpose of this study was to examine recent changes in opioid prescribing patterns in the Military Health System (MHS) which is a nationwide health system service active duty military personnel and civilian beneficiaries. All patients prescribed opioid analgesics by MHS providers and filled at MHS pharmacies between 2014 and 2018 were identified. Prescriptions were converted to oral morphine equivalents (OMEs) and categorized based on prescribing specialty and formulation. Total opioid prescription counts and opioid prescription counts weighted by the annual number of outpatient encounters for each specialty were calculated, as were total OMEs and daily OMEs per prescription. A total of 3,427,308 prescriptions were included. Primary care providers and surgeons wrote 47% and 29% of opioid prescriptions, respectively. Over the study period, there was a 56% decline in annual opioid prescriptions, 25% decline in median total OMEs, and a 57% decline in opioid prescriptions per patient encounter. The proportion of prescriptions written for >90 OMEs per day declined 21%. Declines in opioid prescriptions and quantities were observed in nearly all specialties over the study period. The results of this study suggest a broad-based shift towards less opioid prescribing.

Trial of a novel experimental design to test depuration of PFASs from the edible tissues of Giant Mud Crab following exposure under natural conditions in the wild.

Poly and perfluorinated alkyl substances (PFASs) are persistent organic pollutants (POPs) that are highly resistant to environmental degradation, and have been detected in a broad range of terrestrial and aquatic species. Portunid crabs have been shown to accumulate comparatively high concentrations of PFASs, but previous work examining depuration in crabs was inconclusive. Here, we trialled a novel experimental design to study depuration of PFASs from edible tissues of portunid crabs, using paired claw samples, and trial this design with Giant Mud Crab Scylla serrata exposed to the contaminant under natural conditions. We found evidence for depuration of perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS) and perfluorooctanoic acid (PFOA), but with depuration half-lives as high as 40 days (for PFOS). We also observed substantial variability in the data, including differences in PFAS concentrations between claws from the same individuals, potentially resulting from claw loss and re-growth prior to capture. These results have broad implications for assessing and minimising exposure risk in seafood species.

Shifts in Prescribers' Initial Postoperative Opioid Prescriptions Following Primary Total Hip Arthroplasty Between 2014 and 2018.

BACKGROUND: The opioid epidemic is a public health crisis impacting the practice of surgeons performing primary total hip arthroplasty (THA). Seeking to evaluate changes in prescribers' practices, we asked the following questions: (1) Have the initial discharge opioids following THA changed and (2) Have initial total oral morphine milligram equivalents (OME) prescribed following THA decreased since 2014? METHODS: We retrospectively reviewed discharge prescriptions for 4233 primary THAs performed between fiscal years (FYs) 2014 and 2018 throughout our healthcare system. Drug, dosing, and total OMEs were recorded. We categorized prescriptions into 3 groups: short-acting narcotics only, short-acting plus long-acting narcotics, and short-acting narcotics plus tramadol. Mean age was 59 and 63% were males. RESULTS: The proportion of patients receiving tramadol increased from 2% (FY14) to 25% (FY18) while long-acting opioid prescriptions decreased from 44% (FY14) to 14% (FY18). Oxycodone (82%) was the most common short-acting narcotic. In total, we observed a 27% decrease in initial OME prescribed to a mean of 683 mg (FY18) (P < .0001). Short-acting only protocols had a 19% OME decrease to 589 mg (FY18). Short plus long-acting protocols haed a 23% OME decrease to 939 mg (FY18). Short-acting plus tramadol had an OME of 849 mg (FY18). CONCLUSION: Despite a 27% observed decrease in initial OME prescription following THA, the 683 mg mean OME in FY18 was high. Substituting tramadol for a long-acting narcotic failed to have a dramatic clinical impact on decreasing OME. These data suggest that decreasing the number of short-acting narcotic pills is a critical factor in decreasing OME.

Bioaccumulation of perfluoroalkyl substances in exploited fish and crustaceans: Spatial trends across two estuarine systems.

Spatial patterns in perfluoroalkyl substances were quantified for exploited fish and crustaceans across two contrasting Australian estuaries (Port Stephens and Hunter River). Perfluorooctane sulfonate (PFOS) was detected in 77% of composites from Port Stephens and 100% of composites from Hunter River. Most species from Port Stephens showed a clear trend with distance to source. In contrast, only a subset of species showed this trend in the Hunter River, potentially due to species movement patterns and differing hydrology. Spatial modelling showed that PFOS concentrations were expected to exceed the relevant trigger value up to ~13,500 m from the main point source for Port Stephens and ~9000 m for the Hunter River. These results represent the first major investigation of bioaccumulation of PFASs in exploited species in Australian estuaries, and highlight various factors that can contribute to spatial patterns in bioaccumulation.

Low-back electromyography (EMG) data-driven load classification for dynamic lifting tasks.

OBJECTIVE: Numerous devices have been designed to support the back during lifting tasks. To improve the utility of such devices, this research explores the use of preparatory muscle activity to classify muscle loading and initiate appropriate device activation. The goal of this study was to determine the earliest time window that enabled accurate load classification during a dynamic lifting task. METHODS: Nine subjects performed thirty symmetrical lifts, split evenly across three weight conditions (no-weight, 10-lbs and 24-lbs), while low-back muscle activity data was collected. Seven descriptive statistics features were extracted from 100 ms windows of data. A multinomial logistic regression (MLR) classifier was trained and tested, employing leave-one subject out cross-validation, to classify lifted load values. Dimensionality reduction was achieved through feature cross-correlation analysis and greedy feedforward selection. The time of full load support by the subject was defined as load-onset. RESULTS: Regions of highest average classification accuracy started at 200 ms before until 200 ms after load-onset with average accuracies ranging from 80% (±10%) to 81% (±7%). The average recall for each class ranged from 69-92%. CONCLUSION: These inter-subject classification results indicate that preparatory muscle activity can be leveraged to identify the intent to lift a weight up to 100 ms prior to load-onset. The high accuracies shown indicate the potential to utilize intent classification for assistive device applications. SIGNIFICANCE: Active assistive devices, e.g. exoskeletons, could prevent back injury by off-loading low-back muscles. Early intent classification allows more time for actuators to respond and integrate seamlessly with the user.

Depuration of perfluoroalkyl substances from the edible tissues of wild-caught invertebrate species.

Detection and quantification of poly- and perfluoroalkyl substances (PFASs) in aquatic organisms is increasing, particularly for saltwater species. Depuration can remove PFASs from the tissues of some species once they are removed from the contaminant source, but it is not known if this process occurs for saltwater crustaceans. Such information is important for managing human health risks for exploited migratory species following exposure. We present the results of a depuration trial for School Prawn (Metapenaeus macleayi) and Mud Crab (Scylla serrata), two commercially important crustaceans in Australia. Perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorooctanoic acid (PFOA) were present in samples of both species collected following exposure under natural conditions in contaminated estuaries. Depuration was tested in uncontaminated water for 33days. PFOA was present at levels close to LOR in both species, and was not detected after 4.5h and 72h in School Prawn and Mud Crab respectively. PFHxS was rapidly depurated by School Prawn, and had a depuration half-life of 5.7h. PFOS was also depurated by School Prawn, with a depuration half-life of 158.5h. PFHxS and PFOS concentrations were highly variable in Mud Crab both at the start, and during the depuration experiment, and a depuration model could not be fitted to the data. For School Prawn, depuration of total PFASs to the relevant screening value for protection of human health (9.1µgkg-1) occurred within 7.1h. Rapid depuration of PFASs in School Prawn indicates that human health risks associated with consumption may decrease as this species migrates away from the contamination source. Further research is required to better understand the relationships between contaminant load and life-history characteristics (such as growth, reproduction, and moult cycle) in Mud Crab, and future work should target broader time frames for depuration in this species.

Preliminary investigation of perfluoroalkyl substances in exploited fishes of two contaminated estuaries.

Perfluoroalkyl substances (PFASs) are being increasingly detected in a range of aquatic and terrestrial ecosystems, often resulting from the use of legacy fire-fighting foams. This study conducted an initial investigation of the concentrations of PFASs in the commercially and recreationally exploited species Dusky Flathead, Mud Crab, School Prawn, Sea Mullet, Yellowfin Bream, Eastern King Prawn and Sand Whiting, across two contaminated estuaries. All samples contained perfluoro-n-octane sulfonate (PFOS) except four Yellowfin Bream samples (two from each estuary). Perfluoro-n-octanoic acid (PFOA) was detected only in School Prawn samples from Fullerton Cove, while perfluoro-n-hexane sulfonate (PFHxS) was detected in prawn muscle and in fish liver samples from both estuaries. This study presents one of the first surveys of PFAS in a range of edible saltwater fish and crustaceans in Australia, and these baseline levels of contamination will prove useful for informing future surveys of these emerging contaminants.

Using simulation for teaching femoral arterial access: A multicentric collaboration.

OBJECTIVE: To assess the impact of simulation training on complications associated with femoral arterial access obtained by first year cardiology fellows. BACKGROUND: Prior studies demonstrate a higher incidence of arterial access related complications among patients undergoing invasive cardiac procedures. METHODS: First year cardiology fellows at four teaching hospitals in Michigan tracked their femoral access experience and any associated complications between July 2011 and June 2013. Fellows starting their academic training in July 2012 were first trained on a specially developed simulator before starting their rotation in the catheterization laboratory. The primary outcome was access proficiency, defined as five successful femoral access attempts without any complication or need to seek help from a more experienced team member. RESULTS: A total of 1,278 femoral access attempts were made by 21 fellows in 2011-2012 compared with 869 femoral access attempts made by 21 fellows in 2012-2013. There was a lower rate of access related complications in patients undergoing access attempts by first year fellows in year 2 compared with year 1 (2.1% versus 4.5%, P = 0.003). The number of procedures to achieve procedural proficiency was significantly higher in year 1 compared with year 2 (median 20 versus 10, P = 0.007). CONCLUSIONS: Incorporation of simulation in the training of first year fellows was associated with an improvement in proficiency and a clinically meaningful reduction in vascular complications.

A pulsatile blood vessel system for a femoral arterial access clinical simulation model.

The model-based, rapid-prototyping-enabled design and manufacture of a pulsatile blood vessel (PBV) for high-fidelity mannequin-based clinical simulations is presented. The PBV presented here is a pressurized, flexible tube with alternating fluid pressure created by a pump to mimic the behavior of a human vessel in response to pulsatile pressure. The use of PBVs is important for the fidelity of a clinical simulator that requires residents to palpate and/or access the vessel. In this study, a PBV is presented which features the integration of 3D modeling using patient-specific computed tomography (CT) data, mold fabrication using rapid-prototyping, and finite element method for estimating the required pumping pressure to generate the same level of force (about 1.5 N) experienced by the user through palpation. The relationship between this palpation force and the vessel pressure is studied using two strategies: finite element analysis (FEA) and experiments in a femoral arterial access simulator with a pump, artificial vessel, and surrounding phantom tissue. The experimental results show a discrepancy of 8.7% from the FEA-predicted value. Qualitative validation is done by exposing and surveying 19 interventional cardiology residents at four major educational institutions to the simulator for accuracy of its feel. The overall survey results are positive.

Effect of lead use on back and shoulder postural muscle activity in healthy young adults.

OBJECTIVE: The primary goal of this study was to test the hypothesis that wearing the 3.7 kg vest portion of a radiological shielding garment (a "lead") significantly increases lower back and shoulder muscle activity in quasistatic erect and forward-flexed postures. Secondarily, the authors examined the effects of gender and forward-flexed posture as well as their interactions with lead use. BACKGROUND: The use of a lead is mandatory for interventionalists during surgical procedures. Because the vest portion of a lead weighs considerably more than normal clothing, there is concern that its use increases the risk of developing back and shoulder pain. METHOD: In a repeated-measures study design, 19 young healthy male and female adults assumed standardized erect or forward-flexed postures, both with and without wearing the vest portion of a lead. Shoulder and lower back muscle activity was measured via surface electromyography, normalized by maximum voluntary contraction values. Data were analyzed using general linear models and repeated-measures ANOVA (significant for p < .05). RESULTS: Use of the lead did not result in a significant increase in muscle activity in the lower back or shoulders, despite perceived increases in effort and discomfort. Posture proved to be the most significant secondary factor affecting activity in the lower back, and participant gender proved insignificant. CONCLUSION: Short-term use of the lead does not appear to contribute to the incidence of back pain or injury in interventionalists. Avoiding flexed postures could more directly reduce the likelihood of pain or injury. APPLICATION: Potential applications include assessing and improving operating room ergonomics for physicians.