The Financial and Professional Impact of Anterior Cruciate Ligament Injuries in National Football League Athletes.

BACKGROUND: Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population. PURPOSE: To quantify the impact of ACL injuries on salary and career length in NFL athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of the NFL. The main outcomes were the percentage of players remaining in the NFL and mean salary at 1, 2, 3, and 4 years after injury. Cohorts were subdivided based on initial salary: group A,$2,000,000. Mean cumulative earnings were calculated by multiplying the percentage of players remaining in the league by their mean salaries and compounding this each season. RESULTS: NFL athletes suffered 219 ACL injuries from 2010 to 2013. The 7504 other player seasons in the NFL during this time were used as controls. Significantly fewer ACL-injured players than controls remained in the NFL at each time point (P \u3c .05). In group A, significantly less ACL-injured players remained in the NFL at 1 to 3 seasons after injury (P \u3c .05), and in group B, significantly less ACL-injured players remained in the NFL at 1 and 2 seasons after injury (P \u3c .05). There was no significant decrease in group C. Players in groups A and B remaining in the NFL also had a lower mean salary than controls (P \u3c .05 in season 1). The mean cumulative earnings over 4 years for ACL-injured players was$2,070,521 less per player than uninjured controls. CONCLUSION: On average, ACL-injured players earned $2,070,521 less than salary-matched controls over the 4 years after injury. Players initially earning less than$2 million per year have lower mean salaries and are less likely to remain in the league than uninjured controls. The careers of players initially earning over $2 million per year, meanwhile, are not negatively affected. This demonstrates the degree of negative impact these injuries have on the careers of NFL players. It also indicates that a player\u27s standing within the league before injury strongly influences how much an ACL injury will affect his career

Comparison of research framing preferences and information use of state legislators and advocates involved in cancer control, United States, 2012–2013

INTRODUCTION: Evidence-based policy plays an important role in prevention of cancer and other chronic diseases. The needs of actors involved in policy decision-making should inform knowledge translation strategies. This study examines the differences between state legislators and advocates in how they seek and use information and what their preferences are for how research information is framed. METHODS: We conducted a cross-sectional comparison of survey responses by US advocates (n = 77) and state legislators (n = 265) working on issues related to cancer control. RESULTS: Advocates differed significantly from legislators on all demographic characteristics. Advocates reported seeking and using information more frequently than legislators, though legislators used legislative research bureaus more often (0.45 point difference, P = .004). Both legislators and advocates prioritized the presentation and timeliness of research information similarly but reported different preferences for source (information bias, information relevance, delivery of information by trusted person) of research information. Several differences between advocates and legislators were modified by participant age. CONCLUSION: Our study provides insights for development of knowledge translation strategies to enhance evidence-based policy making for cancer control that are tailored to state-level legislators and advocates. Additional research efforts should evaluate the effectiveness of such knowledge translation strategies, particularly among advocates

Sequential Sectioning of the Ulnar Collateral Ligament of the Elbow in Cadaveric Arms with Ulnohumeral Laxity Assessed by Dynamic Ultrasonography

Objectives: Injury of the ulnar collateral ligament (UCL), whether acute or chronic, is potentially career-threatening for elite overhead throwing athletes. Dynamic ultrasound (DUS) allows for rapid, cost-effective, non-invasive, and non-radiating evaluation of the UCL and elbow joint both at rest and with applied stress. The purpose of this study was to determine the amount of cadaveric elbow valgus laxity with sequential UCL sectioning using DUS. Our objective was to quantify which portions of the UCL must be injured to cause the varying levels of laxity seen clinically on DUS testing. No prior study has used DUS to quantify valgus joint laxity with sequential cadaveric UCL sectioning. It was hypothesized that the change in laxity due to release of the anterior band of the UCL would be greater than that seen when the posterior and transverse bands were cut. Methods: Twelve cadaveric elbows were dissected free of skin and subcutaneous tissue by an experienced orthopaedic surgeon. Baseline DUS at rest and with applied valgus stress was then performed by an experienced ultrasonographer. Sequential sectioning of the medial elbow soft-tissue stabilizing structures was then carried out with valgus stress applied to the joint at each sectioning interval utilizing a standardized device (Telos, Marburg, Germany). First the transverse band of the UCL was released, followed by the posterior band, then the anterior bundle of the anterior band, the remaining posterior bundle of the anterior band, and finally the complete flexor pronator mass. Results: Mean ulnohumeral laxity in millimeters with 95% CIs was calculated for each step of the sequence. The deltas between each step of the dissection were also calculated with means and 95% CIs. Mean baseline laxity of the unstressed ulnohumeral joint at rest was 3.2 mm (CI, 2.2-4.2); with the addition of valgus stress, mean laxity was 4.7 mm (CI, 3.5-6.0). When the transverse band was cut, ulnohumeral laxity increased to a mean of 5.5 mm (CI, 4.0-7.0). With release of the posterior band, mean laxity was 6.4 mm (CI, 4.3-8.5). When the anterior bundle of the anterior band of the UCL was cut, mean ulnohumeral laxity was 8.4 mm (CI, 5.7-11.0) and when the entire anterior band was released, mean laxity was 10.9 mm (CI, 7.8-14.0). Complete release of the flexor pronator muscle mass resulted in mean ulnohumeral laxity of 15.5 mm (CI, 12.9-18.1). The largest deltas were observed with release of the anterior bundle of the anterior band (2.0 mm; CI, 1.0-3.0), the entire anterior band (2.6 mm; CI, 1.3-3.8), and flexor pronator mass (4.6 mm; CI, 1.3-3.8). Release of the transverse and posterior bands of the UCL resulted in deltas of 0.74 mm (CI, 0.1-1.3) and 0.9 mm (CI, 0.3-1.5) respectively. Conclusion: DUS allows for rapid, cost-effective, non-invasive, non-radiating evaluation of the elbow joint and UCL both at rest and with applied valgus stress. Previous studies have indicated that DUS can identify abnormalities of the UCL associated with chronic degeneration and ligamentous injury including thickening of the anterior band of the UCL as well as hypoechoic foci/calcifications. The results of the current cadaveric study suggest that different changes in clinical laxity are seen on DUS with injury of particular bands of the UCL. Early identification and localization of injury to a particular band of the UCL may allow more appropriate selection of patients who will benefit from operative treatment. © The Author(s) 2013

Covariability in the Monthly Mean Convective and Radiative Diurnal Cycles in the Amazon

The diurnal cycle of convective clouds greatly influences the radiative energy balance in convectively active regions of Earth, through both direct presence, and the production of anvil and stratiform clouds. Previous studies show that the frequency and properties of convective clouds can vary on monthly timescales as a result of variability in the monthly mean atmospheric state. Furthermore, the radiative budget in convectively active regions also varies by up to 7 Wm-2 in convectively active regions. These facts suggest that convective clouds connect atmospheric state variability and radiation variability beyond clear sky effects alone. Previous research has identified monthly covariability between the diurnal cycle of CERES-observed top-of-atmosphere radiative fluxes and multiple atmospheric state variables from reanalysis over the Amazon region. ASVs that enhance (reduce) deep convection, such as CAPE (LTS), tend to shift the daily OLR and cloud albedo maxima earlier (later) in the day by 2-3 hr. We first test the analysis method using multiple reanalysis products for both the dry and wet seasons to further investigate the robustness of the preliminary results. We then use CloudSat data as an independent cloud observing system to further evaluate the relationships of cloud properties to variability in radiation and atmospheric states. While CERES can decompose OLR variability into clear sky and cloud effects, it cannot determine what variability in cloud properties lead to variability in the radiative cloud effects. Cloud frequency, cloud top height, and cloud microphysics all contribute to the cloud radiative effect, all of which are observable by CloudSat. In addition, CloudSat can also observe the presence and variability of deep convective cores responsible for the production of anvil clouds. We use these capabilities to determine the covariability of convective cloud properties and the radiative diurnal cycle

Management of Elbow Dislocations in the National Football League.

Background: Although much literature exists regarding the treatment and management of elbow dislocations in the general population, little information is available regarding management in the athletic population. Furthermore, no literature is available regarding the postinjury treatment and timing of return to play in the contact or professional athlete. Purpose: To review the clinical course of elbow dislocations in professional football players and determine the timing of return to full participation. Study Design: Case series; Level of evidence, 4. Methods: All National Football League (NFL) athletes with elbow dislocations from 2000 through 2011 who returned to play during the season were identified from the NFL Injury Surveillance System (NFL ISS). Roster position, player activity, use of external bracing, and clinical course were reviewed. Mean number of days lost until full return to play was determined for players with elbow dislocations who returned in the same season. Results: From 2000 to 2011, a total of 62 elbow dislocations out of 35,324 injuries were recorded (0.17%); 40 (64.5%) dislocations occurred in defensive players, 12 (19.4%) were in offensive players; and 10 (16.1%) were during special teams play. Over half of the injuries (33/62, 53.2%) were sustained while tackling, and 4 (6.5%) patients required surgery. A total of 47 (75.8%) players who sustained this injury were able to return in the same season. For this group, the mean number of days lost in players treated conservatively (45/47) was 25.1 days (median, 23.0 days; range, 0.0-118 days), while that for players treated operatively (2/47) was 46.5 days (median, 46.5 days; range, 29-64 days). Mean return to play based on player position was 25.8 days for defensive players (n = 28; median, 21.5 days; range, 3.0-118 days), 24.1 days for offensive players (n = 11; median, 19 days; range, 2.0-59 days), and 25.6 days for special teams players (n = 8; median, 25.5 days; range, 0-44 days). Conclusion: Elbow dislocations comprise less than a half of a percent of all injuries sustained in the NFL. Most injuries occur during the act of tackling, with the majority of injured athletes playing a defensive position. Players treated nonoperatively missed a mean of 25.1 days, whereas those managed operatively missed a mean of 46.5 days

Avalanche dynamics of radio pulsar glitches

We test statistically the hypothesis that radio pulsar glitches result from an avalanche process, in which angular momentum is transferred erratically from the flywheel-like superfluid in the star to the slowly decelerating, solid crust via spatially connected chains of local, impulsive, threshold-activated events, so that the system fluctuates around a self-organised critical state. Analysis of the glitch population (currently 285 events from 101 pulsars) demonstrates that the size distribution in individual pulsars is consistent with being scale invariant, as expected for an avalanche process. The waiting-time distribution is consistent with being exponential in seven out of nine pulsars where it can be measured reliably, after adjusting for observational limits on the minimum waiting time, as for a constant-rate Poisson process. PSR J0537$-$6910 and PSR J0835$-$4510 are the exceptions; their waiting-time distributions show evidence of quasiperiodicity. In each object, stationarity requires that the rate $\lambda$ equals $- \epsilon \dot{\nu} /$, where $\dot{\nu}$ is the angular acceleration of the crust, $$ is the mean glitch size, and $\epsilon\dot{\nu}$ is the relative angular acceleration of the crust and superfluid. There is no evidence that $\lambda$ changes monotonically with spin-down age. The rate distribution itself is fitted reasonably well by an exponential for $\lambda \geq 0.25 {\rm yr^{-1}}$. For $\lambda < 0.25 {\rm yr^{-1}}$, its exact form is unknown; the exponential overestimates the number of glitching pulsars observed at low $\lambda$, where the limited total observation time exercises a selection bias.Comment: Accepted for publication in the Astrophysical Journa

Bounds on the growth of high Sobolev norms of solutions to 2D Hartree Equations

In this paper, we consider Hartree-type equations on the two-dimensional torus and on the plane. We prove polynomial bounds on the growth of high Sobolev norms of solutions to these equations. The proofs of our results are based on the adaptation to two dimensions of the techniques we previously used to study analogous problems on $S^1$, and on $\mathbb{R}$.Comment: 38 page