Increased Risk of Fragility Fractures among HIV Infected Compared to Uninfected Male Veterans

BACKGROUND: HIV infection has been associated with an increased risk of fragility fracture. We explored whether or not this increased risk persisted in HIV infected and uninfected men when controlling for traditional fragility fracture risk factors. METHODOLOGY/PRINCIPAL FINDINGS: Cox regression models were used to assess the association of HIV infection with the risk for incident hip, vertebral, or upper arm fracture in male Veterans enrolled in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC). We calculated adjusted hazard ratios comparing HIV status and controlling for demographics and other established risk factors. The sample consisted of 119,318 men, 33% of whom were HIV infected (34% aged 50 years or older at baseline, and 55% black or Hispanic). Median body mass index (BMI) was lower in HIV infected compared with uninfected men (25 vs. 28 kg/m²; p<0.0001). Unadjusted risk for fracture was higher among HIV infected compared with uninfected men [HR: 1.32 (95% CI: 1.20, 1.47)]. After adjusting for demographics, comorbid disease, smoking and alcohol abuse, HIV infection remained associated with an increased fracture risk [HR: 1.24 (95% CI: 1.11, 1.39)]. However, adjusting for BMI attenuated this association [HR: 1.10 (95% CI: 0.97, 1.25)]. The only HIV-specific factor associated with fragility fracture was current protease inhibitor use [HR: 1.41 (95% CI: 1.16, 1.70)]. CONCLUSIONS/SIGNIFICANCE: HIV infection is associated with fragility fracture risk. This risk is attenuated by BMI

Listeria monocytogenes in Milk Products

peer-reviewedMilk and milk products are frequently identified as vectors for transmission of Listeria monocytogenes. Milk can be contaminated at farm level either by indirect external contamination from the farm environment or less frequently by direct contamination of the milk from infection in the animal. Pasteurisation of milk will kill L. monocytogenes, but post-pasteurisation contamination, consumption of unpasteurised milk and manufacture of unpasteurised milk products can lead to milk being the cause of outbreaks of listeriosis. Therefore, there is a concern that L. monocytogenes in milk could lead to a public health risk. To protect against this risk, there is a need for awareness surrounding the issues, hygienic practices to reduce the risk and adequate sampling and analysis to verify that the risk is controlled. This review will highlight the issues surrounding L. monocytogenes in milk and milk products, including possible control measures. It will therefore create awareness about L. monocytogenes, contributing to protection of public health

Changes in a Starting Pitcher’s Performance Characteristics Across the Duration of a Major League Baseball Game

Purpose:With a view to informing in-game decision making as it relates to strategy and pitcher health, this study examined changes in pitching-performance characteristics across 9 innings of Major League Baseball (MLB) games.Methods:129 starting MLB pitchers met the inclusion criteria for this study. Pitch type, speed, ball movement, release location, and strike-zone data—collected using the MLB’s ball-tracking system, PITCHf/x—were obtained for 1,514,304 pitches thrown from 2008 to 2014.Results:Compared with the 1st inning, the proportion of hard pitches thrown decreased significantly until the 7th inning, while the proportions of breaking and off-speed pitches increased. Significant decreases in pitch speed, increases in vertical movement, and decreases in release height emerged no later than the 5th inning, and the largest differences in all variables were generally recorded between the 1st inning and the late innings (7–9). Pitchers were most effective during the 2nd inning and significantly worse in innings 4 and 6.Conclusion:These data revealed that several aspects of a starting pitcher’s pitching characteristics exhibited changes from baseline as early as the 2nd or 3rd inning of an MLB game, but this pattern did not reflect the changes in his effectiveness. Therefore, these alterations do not appear to provide reasonable justification for relieving a starting pitcher, although future work must address their relevance to injury. From an offensive standpoint, batters in the MLB should anticipate significantly more hard pitches during the early innings but more breaking and off-speed pitches, with decreasing speed, as the game progresses.</jats:sec

Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

Background: Ulnar collateral ligament (UCL) reconstruction surgeries in Major League Baseball (MLB) have increased significantly in recent decades. Although several risk factors have been proposed, a scientific consensus is yet to be reached, providing challenges to those tasked with preventing UCL injuries. Purpose: To identify significant predictors of UCL reconstruction in MLB pitchers. Study Design: Case control study; Level of evidence, 3. Methods: Demographic and pitching performance data were sourced from public databases for 104 MLB pitchers who underwent UCL reconstruction surgery and 104 age- and position-matched controls. These variables were compared between groups and inserted into a binary logistic regression to identify significant predictors of UCL reconstruction. Two machine learning models (naïve Bayes and support vector machine) were also employed to predict UCL reconstruction in this cohort. Results: The binary linear regression model was statistically significant (χ2(12) = 33.592; P = .001), explained 19.9% of the variance in UCL reconstruction surgery, and correctly classified 66.8% of cases. According to this model, (1) fewer days between consecutive games, (2) a smaller repertoire of pitches, (3) a less pronounced horizontal release location, (4) a smaller stature, (5) greater mean pitch speed, and (6) greater mean pitch counts per game were all significant predictors of UCL reconstruction. More specifically, an increase in mean days between consecutive games (odds ratio [OR], 0.685; 95% CI, 0.542-0.865) or number of unique pitch types thrown (OR, 0.672; 95% CI, 0.492-0.917) was associated with a significantly smaller likelihood of UCL reconstruction. In contrast, an increase in mean pitch speed (OR, 1.381; 95% CI, 1.103-1.729) or mean pitches per game (OR, 1.020; 95% CI, 1.007-1.033) was associated with significantly higher odds of UCL reconstruction surgery. The naïve Bayes classifier predicted UCL reconstruction with an accuracy of 72% and the support vector machine classifier with an accuracy of 75%. Conclusion: This study identified 6 key performance factors that may present significant risk factors for UCL reconstruction in MLB pitchers. These findings could help to enhance the prevention of UCL reconstruction surgery in MLB pitchers and shape the direction of future research in this domain. </jats:sec