UF Health Shands Rehab Hospital

BACKGROUND: Fear of reinjury and lack of confidence influence return-to-sport outcomes after anterior cruciate ligament (ACL) reconstruction. The physical, psychosocial, and functional recovery of patients reporting fear of reinjury or lack of confidence as their primary barrier to resuming sports participation is unknown. PURPOSE: To compare physical impairment, functional, and psychosocial measures between subgroups based on return-to-sport status and fear of reinjury/lack of confidence in the return-to-sport stage and to determine the association of physical impairment and psychosocial measures with function for each subgroup at 6 months and 1 year after surgery. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Physical impairment (quadriceps index [QI], quadriceps strength/body weight [QSBW], hamstring:quadriceps strength ratio [HQ ratio], pain intensity), self-report of function (International Knee Documentation Committee [IKDC]), and psychosocial (Tampa Scale for Kinesiophobia-shortened form [TSK-11]) measures were collected at 6 months and 1 year after surgery in 73 patients with ACL reconstruction. At 1 year, subjects were divided into "return-to-sport" (YRTS) or "not return-to-sport" (NRTS) subgroups based on their self-reported return to preinjury sport status. Patients in the NRTS subgroup were subcategorized as NRTS-Fear/Confidence if fear of reinjury/lack of confidence was the primary reason for not returning to sports, and all others were categorized as NRTS-Other. RESULTS: A total of 46 subjects were assigned to YRTS, 13 to NRTS-Other, and 14 to NRTS-Fear/Confidence. Compared with the YRTS subgroup, the NRTS-Fear/Confidence subgroup was older and had lower QSBW, lower IKDC score, and higher TSK-11 score at 6 months and 1 year; however, they had similar pain levels. In the NRTS-Fear/Confidence subgroup, the IKDC score was associated with QSBW and pain at 6 months and QSBW, QI, pain, and TSK-11 scores at 1 year. CONCLUSION: Elevated pain-related fear of movement/reinjury, quadriceps weakness, and reduced IKDC score distinguish patients who are unable to return to preinjury sports participation because of fear of reinjury/lack of confidence. Despite low average pain ratings, fear of pain may influence function in this subgroup. Assessment of fear of reinjury, quadriceps strength, and self-reported function at 6 months may help identify patients at risk for not returning to sports at 1 year and should be considered for inclusion in return-to-sport guidelines.

STUDY DESIGN: Cross-sectional cohort. OBJECTIVES: (1) To examine differences in clinical variables (demographics, knee impairments, and self-report measures) between those who return to preinjury level of sports participation and those who do not at 1 year following anterior cruciate ligament reconstruction, (2) to determine the factors most strongly associated with return-to-sport status in a multivariate model, and (3) to explore the discriminatory value of clinical variables associated with return to sport at 1 year postsurgery. BACKGROUND: Demographic, physical impairment, and psychosocial factors individually prohibit return to preinjury levels of sports participation. However, it is unknown which combination of factors contributes to sports participation status. METHODS: Ninety-four patients (60 men; mean age, 22.4 years) 1 year post-anterior cruciate ligament reconstruction were included. Clinical variables were collected and included demographics, knee impairment measures, and self-report questionnaire responses. Patients were divided into "yes return to sports" or "no return to sports" groups based on their answer to the question, "Have you returned to the same level of sports as before your injury?" Group differences in demographics, knee impairments, and self-report questionnaire responses were analyzed. Discriminant function analysis determined the strongest predictors of group classification. Receiver-operating-characteristic curves determined the discriminatory accuracy of the identified clinical variables. RESULTS: Fifty-two of 94 patients (55%) reported yes return to sports. Patients reporting return to preinjury levels of sports participation were more likely to have had less knee joint effusion, fewer episodes of knee instability, lower knee pain intensity, higher quadriceps peak torque-body weight ratio, higher score on the International Knee Documentation Committee Subjective Knee Evaluation Form, and lower levels of kinesiophobia. Knee joint effusion, episodes of knee instability, and score on the International Knee Documentation Committee Subjective Knee Evaluation Form were identified as the factors most strongly associated with self-reported return-to-sport status. The highest positive likelihood ratio for the yes-return-to-sports group classification (14.54) was achieved when patients met all of the following criteria: no knee effusion, no episodes of instability, and International Knee Documentation Committee Subjective Knee Evaluation Form score greater than 93. CONCLUSION: In multivariate analysis, the factors most strongly associated with return-to-sport status included only self-reported knee function, episodes of knee instability, and knee joint effusion.

OBJECTIVE: Recent work suggests that psychological influence on pain intensity and knee function should be considered for patients after anterior cruciate ligament reconstruction (ACLR). The Tampa Scale for Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS) have been used to determine psychological influence in these patients. However, TSK and PCS factor structures have not been described for patients with ACLR. This study investigated 2 groups of patients post-ACLR to determine if the use of shortened questionnaires is warranted. METHODS: Cross-sectional study in which patients completed measures during early (n=105, median days from surgery=56.0) and late (n=184, median days from surgery=195.0) postoperative phases of ACLR rehabilitation. RESULTS: Shortened questionnaires for fear of pain, fear of injury, and somatic focus were generated for the TSK-11. A shortened questionnaire for magnification/helplessness and rumination was generated for the PCS in the late group only. There were minimal differences in the shortened questionnaires for clinical subgroups based on sex, ACLR graft type, method of injury, or nature of injury. Correlation and regression analyses suggested a shortened version of the TSK-11 for fear of injury was appropriate for use in the early postoperative phase, whereas the original TSK-11 scale may be appropriate for use in the late postoperative phase. There were no shortened versions of the PCS for consideration in the early postoperative phase, but a shortened version for magnification/helplessness was appropriate for use in the late postoperative phase. DISCUSSION: Shortened versions of the TSK-11 and PCS may be appropriate for ACLR populations, depending on the postoperative phase. These data may guide future research of psychological factors in ACLR populations so that levels predictive of risk for developing chronic pain and/or inability to return to pre-injury activity levels can be determined.

Psychological factors consistent with fear-avoidance models are associated with the development of chronic low back pain (LBP). As a result, graded activity (GA) and graded exposure (GX) have been suggested as behavioral treatment options. This clinical trial compared the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with GA or GX for patients with acute and sub-acute LBP. Our primary hypothesis was that GX would be most effective for those with elevated pain-related fear. In total, 108 patients enrolled in this clinical trial and were randomly assigned to receive TBC, GA, or GX. Outcomes were assessed by a blinded evaluator at 4 weeks and by mail at 6 months. The primary outcomes for this trial were disability and pain intensity, and the secondary outcomes were fear-avoidance beliefs, pain catastrophizing, and physical impairment. There were no differences in 4-week and 6-month outcomes for reduction of disability, pain intensity, pain catastrophizing, and physical impairment. GX and TBC were associated with larger reductions in fear-avoidance beliefs at 6 months only. Six-month reduction in disability was associated with reduction in pain intensity, while 6-month reduction in pain intensity was associated with reductions in fear-avoidance beliefs and pain catastrophizing. This trial suggests that supplementing TBC with GA or GX was not effective for improving important outcomes related to the development of chronic LBP.

Muscle atrophy is clearly related to a loss of muscle torque, but the reduction in muscle size cannot entirely account for the decrease in muscle torque. Reduced neural input to muscle has been proposed to account for much of the remaining torque deficits after disuse or immobilization. The purpose of this investigation was to assess the relative contributions of voluntary muscle activation failure and muscle atrophy to loss of plantarflexor muscle torque after immobilization. Nine subjects (ages 19-23) years with unilateral ankle malleolar fractures were treated by open reduction-internal fixation and 7 weeks of cast immobilization. Subjects participated in 10 weeks of rehabilitation that focused on both strength and endurance of the plantarflexors. Magnetic resonance imaging, isometric plantarflexor muscle torque and activation (interpolated twitch technique) measurements were performed at 0, 5, and 10 weeks of rehabilitation. Following immobilization, voluntary muscle activation (56.8 +/- 16.3%), maximal cross-sectional area (CSA) (35.3 +/- 7.6 cm(2)), and peak torque (26.2 +/- 12.7 N-m) were all significantly decreased ( p < 0.0056) compared to the uninvolved limb (98.0 +/- 2.3%, 48.0 +/- 6.8 cm(2), and 105.2 +/- 27.0 N-m, respectively). During 10 weeks of rehabilitation, muscle activation alone accounted for 56.1% of the variance in torque ( p < 0.01) and muscle CSA alone accounted for 35.5% of the variance in torque ( p < 0.01). Together, CSA and muscle activation accounted for 61.5% of the variance in torque ( p < 0.01). The greatest gains in muscle activation were made during the first 5 weeks of rehabilitation. Both increases in voluntary muscle activation and muscle hypertrophy contributed to the recovery in muscle strength following immobilization, with large gains in activation during the first 5 weeks of rehabilitation. In contrast, muscle CSA showed fairly comparable gains throughout both the early and later phase of rehabilitation.

The purpose of this study was to determine if lower-limb dominance is a potential etiologic factor in noncontact anterior cruciate ligament (ACL) tears. A multicenter retrospective case analysis was performed. In each of the participating centers, patients were questioned to confirm a noncontact ACL injury and to determine lower-limb dominance. Three hundred and two subjects (149 males and 153 females) who presented with unilateral noncontact ACL tears participated in the study. The relationships between limb dominance, side of injury, and gender were analyzed. There was no significant correlation between the side of injury and the dominant limb for kicking (p = 0.30). There was no significant gender effect of the relationship between side of injury and dominant limb (p = 0.36). When assessing gender types and side of ACL tears, females showed a strong trend toward tearing the left ACL more frequently than the right (p = 0.06). No such trend existed for males. The results of this study indicate that there is no significant relationship between lower-limb dominance and the likelihood of sustaining a noncontact ACL tear. However, the strong trend toward females tearing their left ACLs more often than their right ACLs warrants further investigation to determine what neuromuscular asymmetries may exist between the right and left lower limbs.

BACKGROUND: Plyometric exercise is used during rehabilitation after anterior cruciate ligament (ACL) reconstruction to facilitate the return to sports participation. However, clinical outcomes have not been examined, and high loads on the lower extremity could be detrimental to knee articular cartilage. PURPOSE: To compare the immediate effect of low- and high-intensity plyometric exercise during rehabilitation after ACL reconstruction on knee function, articular cartilage metabolism, and other clinically relevant measures. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: Twenty-four patients who underwent unilateral ACL reconstruction (mean, 14.3 weeks after surgery; range, 12.1-17.7 weeks) were assigned to 8 weeks (16 visits) of low- or high-intensity plyometric exercise consisting of running, jumping, and agility activities. Groups were distinguished by the expected magnitude of vertical ground-reaction forces. Testing was conducted before and after the intervention. Primary outcomes were self-reported knee function (International Knee Documentation Committee [IKDC] subjective knee form) and a biomarker of articular cartilage degradation (urine concentrations of crosslinked C-telopeptide fragments of type II collagen [uCTX-II]). Secondary outcomes included additional biomarkers of articular cartilage metabolism (urinary concentrations of the neoepitope of type II collagen cleavage at the C-terminal three-quarter-length fragment [uC2C], serum concentrations of the C-terminal propeptide of newly formed type II collagen [sCPII]) and inflammation (tumor necrosis factor-α), functional performance (maximal vertical jump and single-legged hop), knee impairments (anterior knee laxity, average knee pain intensity, normalized quadriceps strength, quadriceps symmetry index), and psychosocial status (kinesiophobia, knee activity self-efficacy, pain catastrophizing). The change in each measure was compared between groups. Values before and after the intervention were compared with the groups combined. RESULTS: The groups did not significantly differ in the change of any primary or secondary outcome measure. Of interest, sCPII concentrations tended to change in opposite directions (mean ± SD: low-intensity group, 28.7 ± 185.5 ng/mL; high-intensity group, -200.6 ± 255.0 ng/mL; P = .097; Cohen d = 1.03). Across groups, significant changes after the intervention were increased the IKDC score, vertical jump height, normalized quadriceps strength, quadriceps symmetry index, and knee activity self-efficacy and decreased average knee pain intensity. CONCLUSION: No significant differences were detected between the low- and high-intensity plyometric exercise groups. Across both groups, plyometric exercise induced positive changes in knee function, knee impairments, and psychosocial status that would support the return to sports participation after ACL reconstruction. The effect of plyometric exercise intensity on articular cartilage requires further evaluation. REGISTRATION NUMBER: Clinicaltrials.gov NCT01851655.

Abstract Results of preliminary psychometric evaluations of the Acute Aphasia Screening Protocol are presented. This protocol demonstrates good concurrent validity with the Western Aphasia Battery and good content and construct validity when compared to existing aphasia batteries. Test-retest reliability is high, indicating temporal stability of the procedure. Preliminary interjudge reliability is high within and across patients. These results indicate that the AASP may be a useful clinical tool for aphasia assessment when used for its specified purposes. The need for additional psychometric evaluation is described.

BACKGROUND: Self-report measures for assessing specific fear of activities have not been reported in the peer-reviewed literature, but are necessary to adequately test treatment hypotheses related to fear-avoidance models. OBJECTIVE: This study described psychomotor properties of a novel self-report measure, the Fear of Daily Activities Questionnaire (FDAQ). DESIGN: A prospective cohort design was used. METHODS: Reliability and validity cohorts were recruited from outpatient physical therapy clinics. Analyses for the reliability cohort included internal consistency and 48-hour test-retest coefficients, as well as standard error of measurement and minimal detectable change estimates. Analyses for the validity cohort included factor analysis for construct validity and correlation and multiple regression analyses for concurrent and predictive validity. Four-week responsiveness was assessed by paired t test, effect size calculation, and percentage of patients meeting or achieving MDC criterion. RESULTS: The FDAQ demonstrated adequate internal consistency (Cronbach alpha=.91, 95% confidence interval=.87-.95) and 48-hour test-retest properties (intraclass correlation coefficient=.90, 95% confidence interval=.82-.94). The standard error of measurement for the FDAQ was 6.6, resulting in a minimal detectable change of 12.9. Factor analysis suggested a 2- or 3-factor solution consisting of loaded spine, postural, and spinal movement factors. The FDAQ demonstrated concurrent validity by contributing variance to disability (baseline and 4 weeks) and physical impairment (baseline) scores. In predictive validity analyses, baseline FDAQ scores did not contribute variance to 4-week disability and physical impairment scores, but changes in FDAQ scores were associated with changes in disability. The FDAQ scores significantly decreased over a 4-week treatment period, with an effect size of .86 and 55% of participants meeting the minimal detectable change criterion. LIMITATIONS: The validity cohort was a secondary analysis of a clinical trial, and additional research is needed to confirm these findings in other samples. CONCLUSIONS: The FDAQ is a potentially viable measure for fear of specific activities in physical therapy settings. These analyses suggest the FDAQ may be appropriate for determining graded exposure treatment plans and monitoring changes in fear levels, but is not appropriate as a screening tool.

BACKGROUND: Information on baseball injury prevention and pitch count recommendations is growing, however, the incidence of throwing injuries continues to rise. This study is the first to assess knowledge of safe throwing guidelines and risk factors from the perspective of youth athletes. PURPOSE: The purpose of this study is two-fold: (1) to evaluate knowledge of safe throwing guidelines and (2) to assess the reporting of risk factors for throwing injuries in a sample of youth baseball players. STUDY DESIGN: Survey study of 98 overhead athletes between the ages of 4 and 18. METHODS: A 35-question survey was developed with questions related to knowledge of injury prevention, presence of risk factors associated with throwing injuries, and understanding and compliance with USA Baseball Medical & Safety Advisory Committee (USA BMSAC) overhead throwing guidelines. RESULTS: Respondents demonstrated variability in their knowledge of the USA BMSAC guidelines related to throwing frequencies. The 13-16 year old age group displayed the least knowledge of USA BMSAC guidelines. The 9-10 and 11-12 year old age groups demonstrated the greatest knowledge of recommended BMSAC guidelines. Eighty-five (82/98) percent of the respondents reported that they had never heard of the USA BMSAC guidelines. Sixty-two percent (59/98) disagreed with the statement, "The more you throw, the more likely you are to get an injury". Fifty-seven percent of respondents (39/98) indicated that they would not seek medical help if they experienced a tired or sore arm during a game. CONCLUSION: The results of this study suggest that young baseball players demonstrate the need for education on the following topics: the USA Baseball Medical and Safety Advisory Committee throwing guidelines, risk factors for developing throwing-related injuries, the long-term implications of playing with an injured or fatigued arm, and the benefit of seeking medical help when fatigue or soreness is experienced in the throwing arm. LEVEL OF EVIDENCE: Level 3.

Abstract This systematic review and meta-analysis aimed to determine whether Olympic weightlifting (OW) exercises would improve sprint performance when compared to a control intervention, (no training, standard sport-specific training, traditional resistance training, or plyometric training). Medline, Web of Science, SportDiscus, CINAHL, and Biological Science from inception to September 2022 was searched. Two authors independently selected the included studies, extracted data, and appraised the risk of bias. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The primary meta-analysis combined the results of the sprint performance over the full length of each sprint test. The secondary meta-analyses combined the results of the sprint performance at 5, 10, and 20 m distance to capture information about the acceleration phase of the sprint tests. Eight studies with 206 athletes (female n=10, age range: 18.9–24.2 years) were identified. Sprint performance did not differ significantly comparing OW to the control intervention, nor at the full length (standardized mean difference=–0.07, 95% CI=–0.47 to 0.34, p=0.75, I2=46%) or during the acceleration phase (p≥0.26) of the sprint test. OW training does not improve sprint performance to a greater extent than comparator interventions.

Abstract We describe a patient with inordinate impairment in oral picture naming (as opposed to oral naming to definitions and viewed gestures). His naming errors were primarily semantically related or perseverative responses. He also had greater difficulty gesturing in response to viewed pictures than gesturing to verbal commands, and produced many semantic and perseverative gesture errors. He performed relatively well in some visual tasks (e.g. matching, object decision, and drawing), but was impaired on others (e.g. copying pictures). He had intact abilities for basic semantic processing of pictures (category sorting, cross-modal matching), but he demonstrated impairment in picture comprehension tasks requiring more detailed semantic information (matching associated pictures). We propose that this patient's impairment may be classified as optic aphasia and optic apraxia, and not visual associative agnosia in which we expect greater recognition Impairment. Current cognitive models that attempt to explain optic aphasia would have difficulty accounting entirely for this patient's impairments. We suggest that the information gained from right hemisphere visual processing is unable fully to activate and specify phonological and gestural output representations in the left hemisphere, either directly or by way of right hemisphere semantic processing.

Intravagal parathyroid adenomas remain an exceedingly rare diagnosis; however, their true incidence may be higher than currently known. It is important to keep intravagal sites within the list of potential ectopic locations of parathyroid adenomas.

Background: THAP1 mutation dystonia is a known genetic cause of generalized dystonia. THAP1 mutation frequently presents with clinical features of bulbar dysfunction, including oromandibular and lingual dystonia. Patients complain of significant speech, chewing, and swallowing difficulties leading to major occupational and social disabilities. While bilateral globus pallidus internus deep brain stimulation (DBS) is powerful therapy for generalized dystonia and improves dystonia symptoms in the cervical and limb region, it may not improve speech despite multiple adjustments to the stimulation parameters. Treating lingual dystonia symptoms with oral medications is commonly unsatisfactory. Botulinum toxin injection, a potent therapy for focal forms of dystonia is currently underutilized in clinical practice for treating lingual dystonia. Cases: We present two patients with THAP1 mutation reporting lingual dystonia symptoms. The first patient did not meet the eligibility criteria for DBS therapy due to significant psychiatric symptoms. The second patient received DBS with improvements in cervical, limb, and trunk symptoms but complained of severe speech difficulties that did not improve despite multiple programming sessions. These patients were treated with botulinum toxin injections every 12 weeks for more than 3 years, with speech improvements lasting most of the cycle. For the most part they tolerated botulinum toxin without bothersome side effects. Along with the clinical histories, we present objective perceptual analysis of speech samples collected before and after botulinum toxin injections in one of the treatment cycles. Conclusion: Botulinum toxin injections that are clinically beneficial for mitigating lingual dystonia symptoms should be utilized to address symptoms of THAP1 mutation dystonia that may not be amenable to other therapies, such as the DBS.

Background: Saudi Arabia has made significant progress in enhancing its health security through robust preparedness and response mechanisms to address epidemics and biological threats. Given its strategic location, dense population centers, and the annual influx of pilgrims for Hajj and Umrah, the country faces unique challenges in disease prevention and control. The COVID-19 pandemic underscored the importance of resilient healthcare systems, rapid response frameworks, and digital health technologies. This study evaluates Saudi Arabia's health security strategies, focusing on preparedness, public awareness, and resource availability. Methods: A mixed-methods research design was employed, combining quantitative surveys with qualitative expert interviews. The study involved 250 survey respondents and 50 interviews with public health officials, healthcare professionals, and academic researchers. Data were collected through structured questionnaires, epidemiological trend analysis, in-depth interviews, and policy document reviews. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were thematically coded using NVivo software. Results: The findings revealed that 85% of participants had moderate to high awareness of epidemic preparedness strategies, though 15% reported low awareness. Half of the respondents expressed confidence in the health system's response capabilities, while 25% were not confident. Resource availability was inconsistent, with 50% reporting occasional shortages. Key challenges included insufficient public awareness (35%), lack of medical resources (25%), and coordination gaps (20%). Suggested improvements included more public awareness campaigns (45%) and increased healthcare funding (25%). Conclusion: Saudi Arabia has established a strong foundation for health security, but gaps remain in public awareness, resource allocation, and inter-sectoral coordination. Strengthening public education, ensuring consistent medical supplies, and enhancing collaboration between stakeholders are critical for future preparedness. The study highlights the need for continuous improvement and alignment with global health security standards to mitigate the impact of epidemics and biological threats effectively.

Abstract Background In 2021, CLSI endorsed a novel approach for preliminary susceptibility testing - direct Disk Diffusion (dDD) which involves applying antibiotic disks directly to fluid from the positive blood culture bottles, using non-standardized inocula. By providing preliminary susceptibility results within 8–24 hours of the growth signal, dDD offers a significantly faster alternative to traditional AST. This study aims to evaluate the performance and reliability of dDD in detecting antimicrobial susceptibility in Enterobacterales and Pseudomonas aeruginosa. The primary outcome measure is positive predictive value (PPV), which assesses the test’s accuracy in identifying isolates as susceptible when they are truly susceptible. Secondary outcomes include negative predictive value (NPV), sensitivity, specificity, major errors, and very major errors.Beta Lactam Zone size correlation to MIC in EnterobacteralesIn each graph, a dotted line runs through the y axis at the MIC breakpoint (AST) and a dotted line runs through the x axis at the zone size cutoff (dDD). The upper left quadrant represents the true negative (resistant by dDD and AST) isolates and the bottom right quadrant represents the true positives (susceptible by dDD and AST). The top right quadrant represents the very major errors (susceptible by dDD and resistant by AST) while the bottom left quadrant represents the major errors (resistant by dDD and susceptible by AST).Beta lactam antibiotics Zone size correlation to MIC in Pseudomonas aeruginosaIn each graph, a dotted line runs through the y axis at the MIC breakpoint (AST) and a dotted line runs through the x axis at the zone size cutoff (dDD). The upper left quadrant represents the true negative (resistant by dDD and AST) isolates and the bottom right quadrant represents the true positives (susceptible by dDD and AST). The top right quadrant represents the very major errors (susceptible by dDD and resistant by AST) while the bottom left quadrant represents the major errors (resistant by dDD and susceptible by AST). Methods This single center retrospective cohort study included all patients with at least one positive blood culture showing gram negative bacilli on Gram’s stain. Patients were excluded if death or discharge occurred within 48 hours of blood culture draw, incomplete susceptibility results, polymicrobial bacteremia, or admission to oncology service.Non-Beta-Lactam Zone size correlation to MIC in EnterobacteralesIn each graph, a dotted line runs through the y axis at the MIC breakpoint (AST) and a dotted line runs through the x axis at the zone size cutoff (dDD). The upper left quadrant represents the true negative (resistant by dDD and AST) isolates and the bottom right quadrant represents the true positives (susceptible by dDD and AST). The top right quadrant represents the very major errors (susceptible by dDD and resistant by AST) while the bottom left quadrant represents the major errors (resistant by dDD and susceptible by AST).Non-Beta-Lactam Zone size correlation to MIC in Pseudomonas aeruginosaIn each graph, a dotted line runs through the y axis at the MIC breakpoint (AST) and a dotted line runs through the x axis at the zone size cutoff (dDD). The upper left quadrant represents the true negative (resistant by dDD and AST) isolates and the bottom right quadrant represents the true positives (susceptible by dDD and AST). The top right quadrant represents the very major errors (susceptible by dDD and resistant by AST) while the bottom left quadrant represents the major errors (resistant by dDD and susceptible by AST). Results 2826 patients were found with gram negative bacteremia, with 617 remaining for analyses after exclusions (Enterobacterales n=487, Pseudomonas aeruginosa n=70). There is a high PPV for beta-lactam antibiotics tested against Pseudomonas aeruginosa (94-98%) and Enterobacterales (93-100%) using dDD results. The NPV of the test was widely variable for Enterobacterales (2-99%) but was slightly more reliable in Pseudomonas aeruginosa (40-100%). The test was much more likely to overcall resistance than to undercall resistance. Few very major errors were identified in both Enterobacterales (n=33) and Pseudomonas aeruginosa (n=6). Conclusion The reliability of dDD to detect susceptibility in Enterobacterales and Pseudomonas aeruginosa is highly accurate as demonstrated by the PPV for each antibiotic tested. Our study provides supportive evidence for the utility of dDD to provide quicker actionable results to escalate therapy when an active intervention is coupled with the result. Further study is needed on whether these results actually improve time to appropriate therapy. Disclosures Kathryn DeSear, PharmD, BCIDP, Abbvie: Advisor/Consultant|Biomerieux: Advisor/Consultant|Cormedix: Speaking|GSK: Advisor/Consultant|Shionogi: Case based discussion

BACKGROUND: The COVID-19 pandemic interrupted the organized training of softball players, similar to the abrupt cessation of sports participation that can happen after an injury. Thus, the COVID-19 pandemic offers a unique model to study how sudden detraining influences softball players. METHODS: We recruited a sample of convenience of National Collegiate Athletic Association Division 1 softball players. They participated in three data collections: pre-lockdown (Jan 2020, T1), post-lockdown (Sept 2020, T2), and before the 2021 season (Jan 2021, T3). Between T1 and T2, players received an at-home conditioning and throwing program, but compliance was not strictly monitored. Between T2-T3, players resumed formal fall training (team-organized workouts, on-field practice, and within-team scrimmage games). At each time point, we collected bilaterally: 1) shoulder internal rotation (IR) and external rotation (ER) range of motion (ROM); 2) shoulder IR and ER strength; 3) hip IR and ER ROM; and 4) hip abduction and extension strength. We used four independent (2 Sides × 3 Timepoints) MANOVA with repeated measures; we followed up significant MANOVA main effect of time with Sidak posthoc tests for pairwise comparisons between time points. RESULTS: Fifteen players participated in this study. We found a significant MANOVA main effect of time for shoulder and hip ROM (p < 0.01). Between T1-T2, dominant shoulder ER ROM decreased 6.5°, dominant shoulder IR ROM increased 4.3°, and lead hip IR ROM increased 4.4°. Between T2-T3, dominant shoulder ER ROM increased 6.3° and trail hip ER ROM increased 5.9°. We found a significant MANOVA main effect of time for shoulder strength (p = 0.03) but not for hip strength (p = 0.18). Between T2-T3, non-dominant shoulder IR and ER increased 1.8 kg and 1.5 kg, respectively. CONCLUSION: A sudden and prolonged cessation of organized training generated changes in shoulder and hip ROM but affected strength to a lesser extent. The loss of shoulder ER and increased lead hip IR ROM are maladaptive as they are associated with injury in overhead athletes. Resuming team-organized training and scrimmage reversed some (shoulder ER), but not all of these changes. Practitioners should monitor clinical variables regularly and be aware of potential changes due to unexpected and prolonged interruptions in training, such as when players suffer sports-related injuries.