Shoulder and Elbow Range of Motion Can Be Maintained in Major League Baseball Pitchers Over the Course of the Season, Regardless of Pitching Workload.

BACKGROUND: Studies examining the evolution of shoulder and elbow range of motion (ROM) in baseball pitchers over a single season have yielded inconsistent results. PURPOSE: To evaluate shoulder and elbow ROM in Major League Baseball (MLB) pitchers over a single season and to assess for correlations between these changes and measures of a pitcher's workload. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Bilateral shoulder ROM (internal rotation [IR], external rotation [ER], and total range of motion [TROM]) was assessed in 92 MLB pitchers pre- and postseason. Shoulder forward flexion (FF) was measured in 64 pitchers, horizontal adduction (HA) was measured in 87 pitchers, and elbow ROM was measured in 86 pitchers. Data collected included demographics (age, height, weight, and body mass index) and measures of workload for pitchers (pitches thrown, innings pitched, and mean fastball velocity). Pitchers were not specifically excluded if they had an injury during the season but had recovered and were actively pitching at the time of postseason measurements. The change in motion from pre- to postseason was measured and the associations with player demographics and workload were calculated by use of the Pearson correlation coefficient. RESULTS: On average, pitchers demonstrated an increase in dominant shoulder ER from 118.8° to 125.4° (P < .001) and TROM from 173.1° to 181.7° (P < .001). HA was increased by an average of 15.7° (P < .001). The average shoulder IR (P = .189), FF (P = .432), and elbow ROM (flexion, P = .549; extension, P = .185) remained similar over the span of the season. Average glenohumeral IR deficit did not increase. Pitcher demographics and measures of throwing workload (total pitches thrown, innings pitched, mean fastball velocity) were not significantly correlated with changes in shoulder or elbow ROM. CONCLUSION: Significant increases in dominant shoulder ER, TROM, and HA were identified in MLB pitchers over the course of a single baseball season. These ROM changes were not correlated with measures of pitching workload.

Decreased Hip Internal Rotation Increases the Risk of Back and Abdominal Muscle Injuries in Professional Baseball Players: Analysis of 258 Player-seasons.

INTRODUCTION: The relationship of hip range of motion (ROM) to shoulder, elbow, abdominal, and back injuries remains undefined. METHODS: We assessed hip ROM on players reporting to Major League Spring Training for an organization over six seasons (2010 to 2015). Hip ROM was correlated with player abdominal, back, shoulder, and elbow injury status for those seasons using multivariate binomial logistic regression analysis. RESULTS: A total of 258 player-seasons (129 pitchers and 129 position players) resulted in 20 back and 35 abdominal injuries across all players and 28 elbow and 25 shoulder injuries in pitchers. Hip ROM did not correlate with shoulder or elbow injuries. Hip internal rotation deficit of 5° correlated with core injury (odds ratio [OR], 1.40; P = 0.024 for pitchers; OR, 1.35; P = 0.026 for position players) and back injury (OR, 1.160; P = 0.022 for pitchers). DISCUSSION: Hip internal rotation deficits were predictive of back and abdominal injuries but not shoulder or elbow injury.

The Impact of Workload on the Evolution of Hip Internal and External Rotation in Professional Baseball Players Over the Course of the Season.

BACKGROUND: Although restricted hip range of motion (ROM) is associated with an increased risk for injuries in baseball players, the evolution of hip ROM over the season remains undefined. HYPOTHESIS: Hip ROM profiles would be symmetric between hips and positions (pitchers vs position players) but would decrease from preseason to postseason. Additionally, it was hypothesized that this decrease in motion would correlate with workload. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Bilateral hip ROM was assessed in 96 professional baseball players (54 pitchers, 42 position players) preseason and postseason. ROM comparisons were made between lead and trailing hips, pitchers and position players, and preseason and postseason measures. The change from preseason to postseason was correlated with player demographics and measures of workload for pitchers and position players. RESULTS: Preseason hip ROM was symmetric between hips; however, pitchers demonstrated increased preseason lead hip internal rotation (IR) (P = .018) and bilateral hip total ROM (TROM) (P < .020) compared with position players. From preseason to postseason, position players lost 7° of external rotation (ER) (P ≤ .005 ). In pitchers, the loss of IR correlated with increased pitches (P = .016) and innings (P = .037), while the loss of ER (P = .005 ) and TROM (P = .014) correlated with increasing mean fastball velocity. Workload for position players did not correlate with motion loss. CONCLUSION: Symmetric hip ROM profiles should be anticipated in baseball players; however, pitchers may have increased preseason IR and TROM and postseason ER and TROM relative to position players. Although loss of motion correlated with workload in pitchers, this was not the case for position players. Hip motion should be monitored over the course of the season. This is particularly true for pitchers who lose IR as workload increases, which may place them at a greater risk for injuries.

Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre.

IMPORTANCE: Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs) which involve multiple health disciplines working together to provide team-based care. OBJECTIVE: THE PURPOSE OF THIS PROJECT WAS: (1) to explore the use of an online resource, the Interprofessional Resource Centre (IRC), when planning for interprofessional change and; (2) to explore the experience of planning interprofessional change. DESIGN AND SETTING: Six FHTs organized under the structure of one Local Health Integrated Network (LHIN) in Ontario, Canada. INTERVENTION: Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity. RESULTS: Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support. CONCLUSION AND RELEVANCE: Based on the results of the study, it appears that online resource centers do have some value in knowledge translation when combined with in-person meetings. In exploring the planning of interprofessional change in primary health care teams, it was found that buy-in with physicians is a key challenge.

An alternative to pay-for-performance: one health plan's approach to quality improvement.

To address concerns about the quality of care, health plans have used varying approaches to support quality improvement (QI). Pay-for-performance (P4P) is the most commonly used and discussed approach. P4P programs have many challenges in design and execution, particularly for Medicaid providers. In order to find an alternative to P4P, CareOregon--a nonprofit health plan serving Medicaid and Medicare enrollees--developed the Care Support and System Innovation (CSSI) Program. An evaluation was conducted to assess the overall affect of the CSSI Program in promoting comprehensive improvements in quality of care and the extent to which it has the potential to offer a viable alternative to P4P. The evaluation found that the CSSI Program successfully addressed many challenges inherent in P4P. The CSSI Program engaged providers, fostered a culture of QI within CareOregon's network, and provided practices with the opportunity to develop sustainable and innovative solutions to address quality concerns. Success of the program was attributed to CareOregon's focus on building relationships while providing technical assistance and responsive funding. While health outcome data were not available to assess impact on CareOregon's members, evaluation findings highlight the importance of collaboration in QI efforts, and suggest that the model has the potential to overcome many of the challenges faced by P4P.

Hospitality workers' attitudes and exposure to secondhand smoke, hazardous chemicals, and working conditions.

OBJECTIVE: Compelling reasons exist for labor and public health to collaborate. For example, compared to white-collar workers, blue-collar and service workers are much more likely to be targeted by the tobacco industry and become smokers. The purpose of this descriptive study was to assess if there were ways public health and labor could collaborate to document the health attitudes and needs of hospitality industry workers. METHODS: Eligible union members were identified through an electronic enrollment file consisting of 3,659 names maintained by the union. The mail survey instrument covered exposure to secondhand smoke, exposure to hazardous chemicals and materials, time pressure and job demands, and work-related pain/disability. Additional questions related to age, gender, race/ethnicity, level of education, employment history, English proficiency, and self-reported health status. RESULTS: Study results demonstrated that important health information could be successfully collected on unionized workers. Survey data showed that union members were a very diverse group who were exposed to secondhand smoke and supported working in clean-air settings. Workers, especially housekeeping staff, characterized their work as being chaotic and demanding, while almost half of workers reported work-related pain. CONCLUSIONS: Key to the successful collaboration was establishing trust between the parties and emphasizing data collection that served the information needs of both organizations. Opportunities exist to improve the health and working conditions of this population. Health interventions need to be designed to take into consideration the very diverse, mostly female, and limited English proficiency of this group of workers.

Youth tobacco sales in a metropolitan county: factors associated with compliance.

OBJECTIVE: To describe and identify factors associated with tobacco sales in a metropolitan county. SETTING: King County, Washington is the largest county in Washington State with an estimated population of 1.8 million or about 30% of the state's population. DATA SOURCE: The data analysis is based on compliance checks in King County between January 2001 and March 2005. The 8879 checks were conducted by 91 youth operatives aged 14-17. Analysis of data was completed in 2006. STATISTICAL ANALYSIS: The outcome variable for this analysis was whether "a sale was made" to a youth operative during a compliance check. Associations between independent variables and the outcome variable were examined using 2 x 2 tables, univariate (unadjusted) logistic regression, and multivariate (adjusted) logistic regression analysis. RESULTS: Overall tobacco sales during the 4-year and 3-month period was 7.7%. Convenience stores selling gas were significantly more likely to sell tobacco products to minors, whereas restaurants, bars, and tobacco discount stores were less likely to sell to minors. Other factors that were significantly associated with sales are described. CONCLUSIONS: In a county that has adopted many of the required youth access laws, opportunities still exist to reduce sales of tobacco products to minors. Asking for age and photo identification still appears to be an effective strategy in reducing sales of tobacco products to minors.

Assessment of public health workforce bioterrorism and emergency preparedness readiness among tribes in Washington State: a collaborative approach among the Northwest Center for Public Health Practice, the Northwest Portland Area Indian Health Board, and the Washington State Department of Health.

This article examines the collaboration, methodology, results, and lessons learned stemming from the experience of a unique university, state, and tribal collaborative model for public health emergency preparedness assessment activities. This collaborative model may be applicable to other public health preparedness efforts, as well as the broader range of general public health or workforce development partnerships between state, local, and tribal health departments and academic institutions.

A novel method to correct for pitch and yaw patient setup errors in helical tomotherapy.

An accurate means of determining and correcting for daily patient setup errors is important to the cancer outcome in radiotherapy. While many tools have been developed to detect setup errors, difficulty may arise in accurately adjusting the patient to account for the rotational error components. A novel, automated method to correct for rotational patient setup errors in helical tomotherapy is proposed for a treatment couch that is restricted to motion along translational axes. In tomotherapy, only a narrow superior/inferior section of the target receives a dose at any instant, thus rotations in the sagittal and coronal planes may be approximately corrected for by very slow continuous couch motion in a direction perpendicular to the scanning direction. Results from proof-of-principle tests indicate that the method improves the accuracy of treatment delivery, especially for long and narrow targets. Rotational corrections about an axis perpendicular to the transverse plane continue to be implemented easily in tomotherapy by adjustment of the initial gantry angle.

Radiation characteristics of helical tomotherapy.

Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-board imaging capability (MVCT) and therefore differs from conventional treatment units. Different design goals resulted in some distinctive radiation field characteristics. The most significant differences in the design are the lack of flattening filter, increased shielding of the collimators, treatment and imaging operation modes and narrow fan beam delivery. Radiation characteristics of the helical tomotherapy system, sensitivity studies of various incident electron beam parameters and radiation safety analyses are presented here. It was determined that the photon beam energy spectrum of helical tomotherapy is similar to that of more conventional radiation treatment units. The two operational modes of the system result in different nominal energies of the incident electron beam with approximately 6 MeV and 3.5 MeV in the treatment and imaging modes, respectively. The off-axis mean energy dependence is much lower than in conventional radiotherapy units with less than 5% variation across the field, which is the consequence of the absent flattening filter. For the same reason the transverse profile exhibits the characteristic conical shape resulting in a 2-fold increase of the beam intensity in the center. The radiation leakage outside the field was found to be negligible at less than 0.05% because of the increased shielding of the collimators. At this level the in-field scattering is a dominant source of the radiation outside the field and thus a narrow field treatment does not result in the increased leakage. The sensitivity studies showed increased sensitivity on the incident electron position because of the narrow fan beam delivery and high sensitivity on the incident electron energy, as common to other treatment systems. All in all, it was determined that helical tomotherapy is a system with some unique radiation characteristics, which have been to a large extent optimized for intensity modulated delivery.