SHOULDER JOINT VELOCITY DURING FASTBALL PITCHING IN BASEBALL

The purpose of this study was to assess the rotation and translation velocity of the shoulder complex during fastball pitching in baseball. 8 pitchers from the Dutch AAA team performed each 3 fastball pitches. Their motion was recorded by an opto-electronic device. Kinematic computation was performed using the quaternion algebra. The results showed that the endo-rotation, depression and backward rotation velocity of the humerus at ball release are initiated by a translation of the scapular girdle in the forward and upward direction before ball release

THE ROLE OF PELVIS AND THORAX ROTATION VELOCITY IN BASEBALL PITCHING

The objective of the present study was to examine the relative timing of pelvis and thorax rotations in achieving high throwing velocities in baseball pitching. During the preseason, a kinematic analysis was performed on eight pitchers. Peak angular velocities of the pelvis and thorax were determined and separation, defined as the time between the moments of maximal rotation velocity of the pelvis and thorax, was calculated. By themselves, maximal pelvis and thorax rotation velocity were not associated with throwing velocity. Separation was positively and significantly associated with throwing velocity. Results indicate that the relative timing of pelvis and thorax peak rotation velocity in pitching fastballs in baseball is a determinant of throwing velocity in skilled pitchers

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

LONGITUDINAL CHANGES IN SHOULDER ROM AND STRENGTH IN ASSOCIATION WITH BALL-THROWING SPEED IN ELITE YOUTH BASEBALL PITCHERS

The purpose of this prospective study was to examine the longitudinal changes in shoulder ER ROM and relative IR strength in elite youth baseball pitchers over one year and to determine their associations with changes in ball speed for throwing fastballs. One hundred and five Dutch elite youth baseball pitchers were measured three times over a period of one year. Statistical analyses of the data revealed that changes in ER ROM and relative IR strength were not significantly associated with changes in ball-throwing speed

Individualised ball speed prediction in baseball pitching based on imu data

Ball velocity is considered an important performance measure in baseball pitching. Proper pitching mechanics play an important role in both maximising ball velocity and injury-free participation of baseball pitchers. However, an individual pitcher’s characteristics display individuality and may contribute to velocity imparted to the ball. The aim of this study is to predict ball velocity in baseball pitching, such that prediction is tailored to the individual pitcher, and to investigate the added value of the individuality to predictive performance. Twenty-five youth baseball pitchers, members of a national youth baseball team and six baseball academies in The Netherlands, performed ten baseball pitches with maximal effort. The angular velocity of pelvis and trunk were measured with IMU sensors placed on pelvis and sternum, while the ball velocity was measured with a radar gun. We develop three Bayesian regression models with different predictors which were subsequently evaluated based on predictive performance. We found that pitcher’s height adds value to ball velocity prediction based on body segment rotation. The developed method provides a feasible and affordable method for ball velocity prediction in baseball pitching

Influence of biomechanical models on joint kinematics and kinetics in baseball pitching

In baseball pitching, biomechanical parameters have been linked to ball velocity and potential injury risk. However, although the features of a biomechanical model have a significant influence on the kinematics and kinetics of a motion, this influence have not been assessed for pitching. The aim of this study was to evaluate the choice of the trunk and shoulder features, by comparing two models using the same input. The models differed in thoraco-humeral joint definition (moving or fixed with the thorax), joint centre estimation, values of the inertial parameters and computational framework. One professional pitcher participated in the study. We found that the different features of the biomechanical models have a substantial influence on the kinematics and kinetics of the pitchers. With a fixed thoraco-humeral joint the peak average thorax angular velocity was delayed and underestimated by 17% and the shoulder internal rotation velocity was overestimated by 7%. The use of a thoraco-humeral joint fixed to the thorax will lead to an overestimation of the rotational power at the shoulder and will neglect the power produced by the forward and upward translation of the shoulder girdle. These findings have direct implications for the interpretation of shoulder muscle contributions to the pitch

Focus of attention instructions during baseball pitching training

It has often been shown that performance and learning in movement tasks may be improved by focusing on the effect of the movement in the environment (external focus of attention) instead of the movement itself (internal focus of attention). Nevertheless, most coaching instructions and feedback information given in sports seem to favor an internal focus of attention over an external one. In the present study, we investigated coaches’ instructions and feedback in an instrumental sports action, viz. baseball pitching, in which external targets are readily identifiable, such as the strike area or the catcher’s glove. To this end, we recorded and analyzed the pitching instructions and feedback statements of six baseball coaches given to 70 elite youth baseball pitchers (mean age 15.3 (SD 1.67) years) during regular pitching training sessions over a training period of four weeks. All instructions and feedback statements were classified according to the type of focus of attention invoked (i.e. internal or external), and a rest category of all other statements. Of the statements promoting a specific focus of attention (717/1699), only 31% (224/717) were classified as external focus of attention statements. Correspondingly, the responses on a questionnaire filled out by the pitchers indicated that they used an internal focus of attention during practice and preferred to receive internally oriented over externally oriented instructions and feedback. The present results show that, even in sports involving clear external targets such as baseball pitching, the internal focus of attention instructions prevails, the experimental evidence in favor of external focus of attention instructions notwithstanding

Asymmetry and evolution over a one-year period of the upward rotation of the scapula in youth baseball pitchers

The pitching motion is an asymmetric action by which coordination of scapular rotation in the dominant arm might be affected in time and in comparison with the non-dominant arm. The study aimed to compare asymmetry and the evolution of scapular upward rotation over a one-year period. Data were collected twice, before and after a one-year period, from 92 participants (age = 15.1 SD 1.4 years, body height = 177.3 SD 10.9 cm, body weight 69.2 SD 14.5 kg). Scapular motion was tracked at different glenohumeral angles of elevation in the scapular plane: anatomical position (0°), 45°, 90° and 135°. Scapular upward rotation was calculated as the angle between the spinae scapula and the spine. Scapular upward rotation of the dominant arm was 5.1° (95% CI: 2.1°−8.1°) more compared to the non-dominant arm. Age group or glenohumeral angles of elevation did not affect this difference. Scapular upward rotation of the dominant arm decreased 1.9° (95% CI: −0.5° to 4.3°) after a one-year period, however, neither this observation, nor the interaction with age group or elevation angle was significant. These findings may indicate that pitchers could be at risk to develop shoulder injuries especially those that have been associated with scapular asymmetry