Outcome of Turf Toe Injuries in NFL Players Madi, Naji S.; Parekh, Tejas J.; Parekh, Selene G.
The Journal of foot and ankle surgery,
January-February 2023, 2023 Jan-Feb, 2023-01-00, 20230101, Volume:
62, Issue:
1
Journal Article
Peer reviewed
The increase in artificial turf in the 1970s was thought to have contributed to increased incidence of turf toe injury in National Football League (NFL) players. To our knowledge, there are no ...publications that have analyzed the impact of this injury on performance. This is a retrospective case series. Online resources were used to identify NFL players who sustained a turf toe injury between the 2011 and 2014 seasons. The performance of each offensive skill player was analyzed separately by calculating their power rating (PR) over 6 seasons. Injured offensive skill players were then compared to a control group consisting of all RBs and WRs without a turf toe injury who competed in the 2012 season. Seventy-one turf toe injuries were identified. Twenty-nine occurred on grass, 29 on turf and the playing surface of 13 injuries could not be identified. The average PR prior to injury was 105.7/season (7.3/game), 87.3 (6.9/game) for the season of injury and 115.5 (8.1/ game) for postinjury seasons. The PR was not significantly different after a turf toe injury compared to before injury or to uninjured control player. There was no significant difference in NFL players’ performances after turf toe injury based on power ratings.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Optimal risk stratification with machine learning (ML) from myocardial perfusion imaging (MPI) includes both clinical and imaging data. While most imaging variables can be derived automatically, ...clinical variables require manual collection, which is time-consuming and prone to error. We determined the fewest manually input and imaging variables required to maintain the prognostic accuracy for major adverse cardiac events (MACE) in patients undergoing a single-photon emission computed tomography (SPECT) MPI.
This study included 20 414 patients from the multicentre REFINE SPECT registry and 2984 from the University of Calgary for training and external testing of the ML models, respectively. ML models were trained using all variables (ML-All) and all image-derived variables (including age and sex, ML-Image). Next, ML models were sequentially trained by incrementally adding manually input and imaging variables to baseline ML models based on their importance ranking. The fewest variables were determined as the ML models (ML-Reduced, ML-Minimum, and ML-Image-Reduced) that achieved comparable prognostic performance to ML-All and ML-Image. Prognostic accuracy of the ML models was compared with visual diagnosis, stress total perfusion deficit (TPD), and traditional multivariable models using area under the receiver-operating characteristic curve (AUC). ML-Minimum (AUC 0.798) obtained comparable prognostic accuracy to ML-All (AUC 0.799, P = 0.19) by including 12 of 40 manually input variables and 11 of 58 imaging variables. ML-Reduced achieved comparable accuracy (AUC 0.796) with a reduced set of manually input variables and all imaging variables. In external validation, the ML models also obtained comparable or higher prognostic accuracy than traditional multivariable models.
Reduced ML models, including a minimum set of manually collected or imaging variables, achieved slightly lower accuracy compared to a full ML model but outperformed standard interpretation methods and risk models. ML models with fewer collected variables may be more practical for clinical implementation.
Purpose
We sought to evaluate the diagnostic performance for coronary artery disease (CAD) of myocardial blood flow (MBF) quantification with
18
F-flurpiridaz PET using motion correction (MC) and ...residual activity correction (RAC).
Methods
In total, 231 patients undergoing same-day pharmacologic rest and stress
18
F-flurpiridaz PET from Phase III Flurpiridaz trial (NCT01347710) were studied. Frame-by-frame MC was performed and RAC was accomplished by subtracting the rest residual counts from the dynamic stress polar maps. MBF and myocardial flow reserve (MFR) were derived with a two-compartment early kinetic model for the entire left ventricle (global), each coronary territory, and 17-segment. Global and minimal values of three territorial (minimal vessel) and segmental estimation (minimal segment) of stress MBF and MFR were evaluated in the prediction of CAD. MBF and MFR were evaluated with and without MC and RAC (1: no MC/no RAC, 2: no MC/RAC, 3: MC/RAC).
Results
The area-under the receiver operating characteristics curve (AUC 95% confidence interval) of stress MBF with MC/RAC was higher for minimal segment (0.89 0.85–0.94) than for minimal vessel (0.86 0.81–0.92,
p
= 0.03) or global estimation (0.81 0.75–0.87,
p
< 0.0001). The AUC of MFR with MC/RAC was higher for minimal segment (0.87 0.81–0.93) than for minimal vessel (0.83 0.76–0.90,
p
= 0.014) or global estimation (0.77 0.69–0.84,
p
< 0.0001). The AUCs of minimal segment stress MBF and MFR with MC/RAC were higher compared to those with no MC/RAC (
p
< 0.001 for both) or no MC/no RAC (
p
< 0.0001 for both).
Conclusions
Minimal segment MBF or MFR estimation with MC and RAC improves the diagnostic performance for obstructive CAD compared to global assessment.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Category:
Midfoot/Forefoot, Sports, Trauma
Introduction/Purpose:
“Turf toe” is an injury to the great toe’s metatarsophalangeal joint capsule. The increase in artificial turf in the 1970’s was ...thought to have contributed to increased incidence of this injury in players of the National Football League (NFL). To our knowledge, there are no publications that have critically analyzed the impact of this injury on player performance. The goal of this study was to quantify the impact a turf toe injury has on NFL players, specifically in time to return to competition and their performance post-injury compared to pre-injury.
Methods:
This is a retrospective review of NFL players who sustained a turf toe injury between the 2011-2014 seasons. Online resources including NFL injury reports, player registries, game summary sites, NFL news articles, fantasy football sites and NFL blogs were used to identify players with this injury. Additionally, an injury database from theFantasyDoctors.com was used to further identify injured players. Recorded variables included player age, position, games missed, and type of playing surface on which the injury occurred. The performance of each offensive skill player was analyzed separately by calculating their power rating (total yards divided by 10 plus touchdowns multiplied by 6) for the 3 seasons prior to injury, the injury season (index season) and the 2 seasons immediately following. Injured offensive skill players were then compared to a control group consisting of all running backs and wide receivers without a turf toe injury who competed in the 2012 season.
Results:
71 turf toe injuries in 67 players were identified. Players’ average age was 26.4 years old. Injury by playing surface: 29 grass, 29 turf and 13 unidentified. The average time missed was 3.2 games. 9 players were placed on injured reserve and 8 required surgery. 16 offensive skill players were at or above 200 total points during the 6 observed seasons. The average power rating prior to injury was 105.7 per season (7.3 per game), 87.3 (6.9 per game) during the injury season and 115.5 (8.1 per game) for post-injury seasons. The power rating per season (p=0.53) and per game (p=0.4) was not significantly different after a turf toe injury compared to before. Power ratings were not significantly different from uninjured control players (p=0.24, p=0.27).
Conclusion:
”Turf toe” is a term used for an injury that has a wide spectrum of consequence depending on injury severity. A mild sprain of the great toe should respond well to conservative treatment with rest, taping and possibly an orthotic while a complete tear of the metatarsophalangeal joint capsule typically is season-ending and requires surgical repair. We were unable to show a statistically significant difference in NFL players’ performances after turf toe injury based on power ratings.
Aluminium 6061 has a widespread applications in the automotive and aerospace sectors. However, because of its poor tribological properties, its life is limited. In this investigation, a surface ...composite of Ti3AlC2 and Al 6061 alloy was prepared using friction stir processing and its effects have been studied. The examination of microstructure of the fabricated samples were studied using optical microscopy and scanning electron microscopy. The microstructural analysis revealed reduction in grain size within both the base metal FSPed and aluminium- Ti3AlC2 composites. The area mapping showed uniform dispersion of Ti3AlC2 particles within the friction stir processed zone. The microstructure refinement lead to increase in the microhardness. The average microhardness of the base metal was 65 HV0.2 and that of base metal FSPed and Al- Ti3AlC2 were 85 HV0.2 and 135 HV0.2. The grain refinement and uniform distribution of particles were found responsible for the improvement in wear properties. It was observed that the wear resistance improvement of more than 100% in comparison to the parent metal. The predominant wear mechanism, as demonstrated by scanning electron microscopy micrographs, was abrasive wear with varying degrees and features.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The reported study involves the synthesis of high purity layered ternary carbide Ti3AlC2 MAX phase material by mixing the TiH2, Al and TiC powders in a planetary ball mill followed by two step ...pressureless sintering in flowing Argon (Ar) atmosphere. XRD and Raman analysis confirms the presence of Ti3AlC2 phase without impurities of Al2O3 and TiC. The morphology studies using SEM confirms the lamellar structure of Ti3AlC2 and EDS measurements shows atomic percentage of Ti, Al and C are in compliance with the XRD phase analysis. X-ray Photoelectron spectroscopy investigations confirm the Ti–C bond. Core level XPS data of Al2p peak show a negative shift indicating electrostatic bonding of Al in Ti3AlC2. Ti2p and C1s core level spectra show the bonding of Mn+1Xn i.e TiC bond. TG-DSC results revealed approximately 7% increase in weight. Ti3AlC2 phase follows an endothermic pattern and does not undergo decomposition upto 1400 °C in vacuum environment. From XRD analysis at different temperatures, it was seen that Al2O3 and TiCx peaks started to form along with Ti3AlC2 at 1000 °C because of selective oxidation of Al into Al2O3. Thus, this study provides a beneficial approach to synthesis of high-purity Ti3AlC2 materials and understanding the thermal behaviour of Ti3AlC2 for high temperature applications.
•High Purity single phase Ti3AlC2 was synthesised by Pressureless Sintering using commercial powders i.e. TiH2, Al and TiC powders.•XPS investigations revealed a negative shift than the metallic Al signal, indicating electrostatic bonding.•The DSC analysis showed the selective oxidation of Al resulting in the formation of alumina along with Ti3AlC2.•High Temperature X-ray diffraction analysis reveals the formation of Al2O3 at 1000 °C.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Present study discusses about a technique for producing high-purity Cr 2 AlC MAX phase materials and gaining insight into their thermal behavior for high-temperature applications. The ...research conducted involved synthesizing a pure layered ternary carbide Cr 2 AlC MAX phase material by mixing powders of Chromium, Aluminum, and Carbon and then subjecting them to two-step pressureless sintering process in argon atmosphere. First step involves the annealing of ball-milled mixture at 750 °C for 2 h followed by the second step in which the annealed mixture is subjected to heat-treatment at 1350 °C for 2 h. Analysis using XRD and Raman techniques revealed that the synthesized product consists of Cr 2 AlC phase, without any impurities. SEM studies confirmed that the Cr 2 AlC had a layered topography, while EPMA analysis indicated that the atomic percentage of Cr, Al, and C was consistent with the XRD phase analysis. XPS investigations confirmed the presence of Cr-C bonds representing M n+1 X n of the MAX phase material. TG-DSC results showed an approximately 2% increase in weight. The Cr 2 AlC phase exhibited an endothermic pattern below 725 °C, an exothermic pattern above it, and did not decompose up to 1400 °C in vacuum environment. High-temperature XRD analysis at various temperatures also confirmed no formation of Al 2 O 3 or CrO impurity compounds.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The investigation of the oxidation resistance and tensile behavior of aluminide coated and uncoated Ti6Al4V at room temperature and at 600 °C was carried out. Ti-Al coating was developed on Ti6Al4V ...by Hot-dip Aluminizing technique followed by solution treatment (900 °C/1 h), quenching in water and ageing treatment (500 °C/6 h). For a comparative analysis, the diffusion heat treatment was performed with and without oxygen plasma environment. The diffusion treatment without oxygen plasma is referred as thermal treatment while the diffusion treatment with oxygen plasma is referred as plasma treatment. The cyclic oxidation test was carried out for uncoated samples, thermally treated (THT samples) and plasma treated samples (PAHT samples) at 600 °C for 120 h. Significant improvement in the oxidation resistance was observed for coated samples. Weight gain during oxidation studies in PAHT samples is almost 100 times less than uncoated samples and 8 times less than THT samples. The tensile test conducted at room temperature and at 600 °C showed marginal reduction of Ultimate tensile strength (UTS) and Yield strength (YS) of substrate for PAHT samples and THT samples. Plasma processing yields nanocrystalline coatings which have been found to improve oxidation resistance and would help address oxidation issues in gas turbine applications.
•Plasma processing yields nanocrystalline TiAl2 + TiAl3 phases.•Plasma samples reveal better oxidation resistance.•Coatings do not significantly alter the tensile properties of load bearing bulk.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Explainable artificial intelligence (AI) can be integrated within standard clinical software to facilitate the acceptance of the diagnostic findings during clinical interpretation.
This study sought ...to develop and evaluate a novel, general purpose, explainable deep learning model (coronary artery disease–deep learning CAD-DL) for the detection of obstructive CAD following single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).
A total of 3,578 patients with suspected CAD undergoing SPECT MPI and invasive coronary angiography within a 6-month interval from 9 centers were studied. CAD-DL computes the probability of obstructive CAD from stress myocardial perfusion, wall motion, and wall thickening maps, as well as left ventricular volumes, age, and sex. Myocardial regions contributing to the CAD-DL prediction are highlighted to explain the findings to the physician. A clinical prototype was integrated using a standard clinical workstation. Diagnostic performance by CAD-DL was compared to automated quantitative total perfusion deficit (TPD) and reader diagnosis.
In total, 2,247 patients (63%) had obstructive CAD. In 10-fold repeated testing, the area under the receiver-operating characteristic curve (AUC) (95% CI) was higher according to CAD-DL (AUC: 0.83 95% CI: 0.82-0.85) than stress TPD (AUC: 0.78 95% CI: 0.77-0.80) or reader diagnosis (AUC: 0.71 95% CI: 0.69-0.72; P < 0.0001 for both). In external testing, the AUC in 555 patients was higher according to CAD-DL (AUC: 0.80 95% CI: 0.76-0.84) than stress TPD (AUC: 0.73 95% CI: 0.69-0.77) or reader diagnosis (AUC: 0.65 95% CI: 0.61-0.69; P < 0.001 for all). The present model can be integrated within standard clinical software and generates results rapidly (<12 seconds on a standard clinical workstation) and therefore could readily be incorporated into a typical clinical workflow.
The deep-learning model significantly surpasses the diagnostic accuracy of standard quantitative analysis and clinical visual reading for MPI. Explainable artificial intelligence can be integrated within standard clinical software to facilitate acceptance of artificial intelligence diagnosis of CAD following MPI.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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