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Purpose: To assess objective strain and subjective muscle soreness in "Bigs" (offensive and defensive line), "Combos" (tight ends, quarterbacks, line backers, and running backs), and "Skills" (wide receivers and defensive backs) in American college football players during off-season, fall camp, and in-season phases. Methods: Twenty-three male players were assessed once weekly (3-wk off-season, 4-wk fall camp, and 3-wk in-season) for hydroperoxides (free oxygen radical test [FORT]), antioxidant capacity (free oxygen radical defense test [FORD]), oxidative stress index (OSI), countermovement-jump flight time, Reactive Strength Index (RSI) modified, and subjective soreness. Linear mixed models analyzed the effect of a 2-within-subject-SD change between predictor and dependent variables. Results: Compared to fall camp and in-season phases, off-season FORT (P ≤.001 and <.001), FORD (P ≤.001 and <.001), OSI (P ≤.001 and <.001), flight time (P ≤.001 and <.001), RSI modified (P ≤.001 and <.001), and soreness (P ≤.001 and <.001) were higher for "Bigs," whereas FORT (P ≤.001 and <.001) and OSI (P =.02 and <.001) were lower for "Combos." FORT was higher for "Bigs" compared to "Combos" in all phases (P ≤.001,.02, and.01). FORD was higher for "Skills" compared with "Bigs" in off-season (P =.02) and "Combos" in-season (P =.01). OSI was higher for "Bigs" compared with "Combos" (P ≤.001) and "Skills" (P =.01) during off-season and to "Combos" in-season (P ≤.001). Flight time was higher for "Skills" in fall camp compared with "Bigs" (P =.04) and to "Combos" in-season (P =.01). RSI modified was higher for "Skills" during off-season compared with "Bigs" (P =.02) and "Combos" during fall camp (P =.03), and in-season (P =.03). Conclusion: Off-season American college football training resulted in higher objective strain and subjective muscle soreness in "Bigs" compared with fall camp and during in-season compared with "Combos" and "Skills" players. [ABSTRACT FROM AUTHOR]

Purpose: American football is widely played by college student-athletes throughout the United States; however, the associated injury risk is greater than in other team sports. Numerous factors likely contribute to this risk, yet research identifying these risk factors is limited. The present study sought to explore the relationship between playing experience and position on injury risk in NCAA Division I college football players. Methods: Seventy-six male college student-athletes in the football program of an American NCAA Division I university participated. Injuries were recorded over 2 consecutive seasons. Players were characterized based on college year (freshman, sophomore, junior, or senior) and playing position. The effect of playing experience and position on injury incidence rates was analyzed using a generalized linear mixed-effects model, with a Poisson distribution, log-linear link function, and offset for hours of training exposure or number of in-game plays (for training and game injuries, respectively). Results: The overall rates of non-time-loss and time-loss game-related injuries were 2.1 (90% CI: 1.8-2.5) and 0.6 (90% CI: 0.4-0.8) per 1000 plays, respectively. The overall rates of non-time-loss and time-loss training-related injuries were 26.0 (90% CI: 22.6-29.9) and 7.1 (90% CI: 5.9-8.5) per 1000 h, respectively. During training, seniors and running backs displayed the greatest risk. During games, sophomores, juniors, and wide receivers were at greatest risk. Conclusions: Being aware of the elevated injury risk experienced by certain player groups may help coaches make considered decisions related to training design and player selection. [ABSTRACT FROM AUTHOR]

The article offers information on the U.S. Uniform Interstate Family Support Act aimed to establish and modify child support orders and addresses the enforcement of child support obligations within the country.

The article focuses on the U.S. Supreme Court case Kulko v. California Superior Court, which dealt with personal jurisdiction in an interstate child custody case. Topics include the U.S. Uniform Reciprocal Enforcement of Support Act (URESA), the U.S. Uniform Interstate Family Support Act of 1992, and child support litigation.

The article discusses various uniform acts and model acts relating to the family law recommended by the U.S. Uniform Law Commission. The Uniform Child Abduction Prevention Act provides a valuable tool for deterring both domestic and international child abductions by parents and persons acting on behalf of the parents. The Uniform Child Custody Jurisdiction and Enforcement Act regulates interstate kidnapping of a child by the noncustodial parent. The Uniform Child Witness Testimony by Alternative Methods Act provides procedures in taking the testimony of children in criminal or civil proceedings. The Uniform Disposition of Community Property Rights at Death Act aims to preserve the rights of each spouse in property that was community property prior to a change of domicile.

Objectives: Traumatic brain injury is a leading cause of death and disability in the United States. While the impact of early multiple organ dysfunction syndrome has been studied in many critical care paradigms, the clinical impact of early multiple organ dysfunction syndrome in traumatic brain injury is poorly understood. We examined the incidence and impact of early multiple organ dysfunction syndrome on clinical, functional, and disability outcomes over the year following traumatic brain injury.Design: Retrospective cohort study.Setting: Patients enrolled in the Transforming Clinical Research and Knowledge in Traumatic Brain Injury study, an 18-center prospective cohort study of traumatic brain injury patients evaluated in participating level 1 trauma centers.Subjects: Adult (age > 17 yr) patients with moderate-severe traumatic brain injury (Glasgow Coma Scale < 13). We excluded patients with major extracranial injury (Abbreviated Injury Scale score ≥ 3).Interventions: Development of early multiple organ dysfunction syndrome, defined as a maximum modified Sequential Organ Failure Assessment score greater than 7 during the initial 72 hours following admission.Measurements and Main Results: The main outcomes were: hospital mortality, length of stay, 6-month functional and disability domains (Glasgow Outcome Scale-Extended and Disability Rating Scale), and 1-year mortality. Secondary outcomes included: ICU length of stay, 3-month Glasgow Outcome Scale-Extended, 3-month Disability Rating Scale, 1-year Glasgow Outcome Scale-Extended, and 1-year Disability Rating Scale. We examined 373 subjects with moderate-severe traumatic brain injury. The mean (SD) Glasgow Coma Scale in the emergency department was 5.8 (3.2), with 280 subjects (75%) classified as severe traumatic brain injury (Glasgow Coma Scale 3-8). Among subjects with moderate-severe traumatic brain injury, 252 (68%) developed early multiple organ dysfunction syndrome. Subjects that developed early multiple organ dysfunction syndrome had a 75% decreased odds of a favorable outcome (Glasgow Outcome Scale-Extended 5-8) at 6 months (adjusted odds ratio, 0.25; 95% CI, 0.12-0.51) and increased disability (higher Disability Rating Scale score) at 6 months (adjusted mean difference, 2.04; 95% CI, 0.92-3.17). Subjects that developed early multiple organ dysfunction syndrome experienced an increased hospital length of stay (adjusted mean difference, 11.4 d; 95% CI, 7.1-15.8), with a nonsignificantly decreased survival to hospital discharge (odds ratio, 0.47; 95% CI, 0.18-1.2).Conclusions: Early multiple organ dysfunction following moderate-severe traumatic brain injury is common and independently impacts multiple domains (mortality, function, and disability) over the year following injury. Further research is necessary to understand underlying mechanisms, improve early recognition, and optimize management strategies. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic pain treated with opioids are at an increased risk for opioid misuse or opioid use disorder (OUD). Recent years have seen a stark increase in abuse, misuse, and diversion of prescription opioid medications. The aim of this study was to investigate trends in changing rates of opioid use disorder among patients with chronic pain., Methods: The National Inpatient Sample (NIS) database identified chronic pain admissions with OUD from 2011 to 2015. Patients were identified from the NIS database using International Classification of Diseases (9th and 10th revisions) diagnosis codes for chronic pain and OUD. Annual estimates and trends were determined for OUD, patient characteristics, OUD among subgroups of chronic pain conditions, and discharge diagnosis., Results: We identified 10.3 million patients with chronic pain. Of these, 680,631 patients were diagnosed with OUD. The number of patients with OUD increased from 109,222 in 2011 to 172,680 in 2015 (P < 0.001). Similarly, there were upward trends of OUD among females (53.2% to 54.5%; P = 0.09), patients 65 to 84 years of age (11.8% to 17%; P < 0.001), Medicare-insured patients (39.5% to 46.0%; P < 0.01), patients with low annual household incomes (27.8% to 33.3%; P < 0.001), and patients with cannabinoid use disorder (7.2% to 8.3%; P = 0.01). The prevalence of OUD increased from 2011 to 2015 in patients with chronic regional pain syndrome (5.53% to 7.46%; P = 0.01) and spondylosis (1.32% to 1.81%; P < 0.001)., Conclusions: These findings suggest that the prevalence of OUD increased substantially from 2011 to 2015. Disparities of OUD with increasing opioid use among vulnerable populations including women, those with Medicare insurance, tobacco use disorder, and low annual income should be explored further., (© 2019 World Institute of Pain.)

Object: The purpose of this study was to report the prevalence of neurosurgeons with both medical degrees (MDs) and doctorates (PhDs) at top-ranked US academic institutions and to assess whether the additional doctorate education is associated with substantive career involvement in academia as well as greater success in procuring National Institutes of Health (NIH) research funding compared with an MD-only degree., Methods: The authors reviewed the training of neurosurgeons across the top 10 neurosurgery departments chosen according to academic impact (h index) to examine whether MD-PhD training correlated significantly with career outcomes in academia., Results: Six hundred thirteen neurosurgery graduates and residents between the years 1990 and 2012 were identified for inclusion in this analysis. Both MD and PhD degrees were held by 121 neurosurgeons (19.7%), and an MD alone was held by 492. Over the past 2 decades, MD-PhD trainees represented a gradually increasing percentage of neurosurgeons, from 10.2% to 25.7% (p < 0.01). Of the neurosurgeons with MD-PhD training, a greater proportion had appointments in academic medicine compared with their MD-only peers (73.7% vs 52.3%, p < 0.001). Academic neurosurgeons with both degrees were also more likely to have received NIH funding (51.9% vs 31.8%, p < 0.05) than their single-degree counterparts in academia. In a national analysis of all active NIH R01 grants awarded in neurosurgery, MD-PhD investigators held a disproportionate number, more than 4-fold greater than their representation in the field., Conclusions: Dual MD-PhD training is a significant factor that may predict active participation in and funding for research careers among neurological surgeons at top-ranked academic institutions. These findings and their implications are of increasing relevance as the population of neurosurgeons with dual-degree training continues to rise.

Military anesthesiologists must master the complexities of modern anesthesia at home, like their civilian counterparts, and also be prepared to provide effective, safe anesthesia in the chaotic and austere environment of the modern battlefield. This article describes the Army Regional Anesthesia Initiative and Operational Anesthesia Rotation programs designed to facilitate this difficult goal.