text:
Preseason shoulder range of motion screening and in-season risk of shoulder and elbow injuries in overhead athletes: systematic review and meta-analysis
Federico Pozzi1,2,
Hillary A Plummer3,
Ellen Shanley4,
Charles A Thigpen4,
Chase Bauer5,
Melissa L Wilson6,
Lori A Michener2
1 Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
2 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
3 Andrews Research & Education Foundation, Gulf Breeze, Florida, USA
4 ATI Physical Therapy, Greenville, South Carolina, USA
5 Western University of Health Sciences, Pomona, California, USA
6 Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
Correspondence to Dr Federico Pozzi, Department of Physical Therapy, University of Florida, Gainesville, FL 32611, USA; fpozzi{at}phhp.ufl.edu
Objective To characterise whether preseason screening of shoulder range of motion (ROM) is associated with the risk of shoulder and elbow injuries in overhead athletes.
Design Systematic review and meta-analysis.
Data sources Six electronic databases up to 22 September 2018.
Eligibility criteria Inclusion criteria were (1) overhead athletes from Olympic or college sports, (2) preseason measures of shoulder ROM, (3) tracked in-season injuries at the shoulder and elbow, and (4) prospective cohort design. Exclusion criteria were (1) included contact injuries, (2) lower extremity, spine and hand injuries, and (3) full report not published in English.
Results Fifteen studies were identified, and they included 3314 overhead athletes (baseball (74.6%), softball (3.1%), handball (16.1%), tennis (2.0%), volleyball (2.0%) and swimming (2.2%)). Female athletes are unrepresented (12% of the overall sample). Study quality ranged from 11 to 18 points on a modified Downs and Black checklist (maximum score 21, better quality). In one study, swimmers with low (<93°) or high (>100°) shoulder external rotation were at higher risk of injuries. Using data pooled from three studies of professional baseball pitchers, we showed in the meta-analysis that shoulder external rotation insufficiency (throwing arm <5° greater than the non-throwing arm) was associated with injury (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01).
Conclusion Preseason screening of shoulder external rotation ROM may identify professional baseball pitchers and swimmers at risk of injury. Shoulder ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of injuries. The results of this systematic review and meta-analysis should be interpreted with caution due to the limited number of studies and their high degree of heterogeneity.
PROSPERO registration number CRD42017072895.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Overuse shoulder and elbow injuries are common across different overhead athletes regardless of age, sex and level of playing.1–5 Evaluating potential environmental-specific (extrinsic) and individual-specific (intrinsic) risk factors for shoulder and elbow injuries in overhead athletes is a research priority. Extrinsic risk factors include sport specialisation, training intensity, number of games per week, and number of pitches or throws per game and over a year.6–10 Extrinsic factors may contribute to overuse injuries due to repetitive load on the shoulder and elbow without adequate time to recover. Intrinsic non-modifiable risk factors include age, height, sex and previous injury.6 7 Impairments of joint range of motion (ROM) except when attributable to humeral torsion,11–17 strength18 19 and neuromuscular control20 are intrinsic modifiable risk factors because their effect may be modifiable through targeted injury prevention programmes.21
Changes or side-to-side differences of shoulder ROM result from the repetitive demands of overhead sport,22–24 but they may also be a risk factor for injury. In Keller's systematic review, injured overhead athletes (baseball, handball and tennis) had deficits of shoulder internal rotation, external rotation and total rotation ROM.16 Limitations included studies with cross-sectional and retrospective designs, so it is impossible to determine whether the deficits in ROM were present before the injury or were an adaptation to the injury.16 Using prospective cohort studies, Bullock et al's17 meta-analysis showed that high school baseball players who sustained an in-season shoulder and elbow injuries have less preseason shoulder internal rotation (absolute value: 44°, side-to-side difference: 5°) and total rotation (absolute value 160°, side-to-side difference: 8°) ROM compared with players who did not sustain an injury during the season. However, the authors did not report the magnitude of risk of in-season injuries with an odds or risk ratio for the players with the defined preseason ROM values.17 Understanding the strength of the association between risk factors (preseason ROM) and outcomes (injury) is critical to evaluate the ability of preseason ROM to predict risk of injury in overhead athletes, and to design screening and prevention programmes.21
The purpose of this systematic review and meta-analysis was to summarise the available evidence, to evaluate the quality of research methods and to characterise the association of preseason shoulder ROM with future risk of shoulder and elbow injuries in prospective cohorts of overhead athletes. We hypothesised that preseason ROM measures of shoulder internal rotation, external rotation, horizontal adduction, shoulder flexion and total rotation have the potential to identify overhead athletes at risk of shoulder and elbow injuries.
This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.25 The review protocol was registered on PROSPERO.
Data source and search
The following databases were queried for existing evidence (from their inception to September 2018): MEDLINE, Scopus, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and SPORTdiscus (via Ebsco). A full-time librarian from the Norris Medical Library of the University of Southern California developed and conducted the search strategy for each database. The search strategies used to query MEDLINE and Cochrane Library are reported in online supplementary appendix A and were adapted for the other databases. Three senior authors with expertise in upper extremity injury in overhead athletes (ES, CAT and LAM) reviewed the list of the included studies to identify studies that were not found through the systematic search of the databases. Further, the reference list of the included studies was hand searched for additional missing studies.
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Identified articles were imported in Endnote (Clarivate Analytics, Philadelphia, USA) to screen for duplicates. Afterward, they were exported into Covidence (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia; available at www.covidence.org) for screening and full-text selection. The following inclusion criteria were used to determine eligibility: (1) inclusion of overhead athletes from Olympic or National Collegiate Athletic Association sanctioned collegiate sports (wide participation), (2) use of preseason measures of ROM; (3) tracked injuries at the shoulder and/or elbow throughout the season, and (4) use of a prospective cohort design. Exclusion criteria included the following: (1) sport does not require overhead repetitive activities; (2) inclusion of contact injuries; (3) lower extremity, spine and hand injuries; and (4) full report not published in English. Studies that assessed humeral retrotorsion were excluded from this review because this physical impairment is not modifiable.26 27 Studies that assessed the effectiveness of specific interventions to reduce the risk of shoulder and elbow injuries were excluded from this review.
Two authors (FP and HAP) independently screened the title and abstract to identify relevant studies for the full-text review. A subsample of 100 studies were randomly selected to calculate the agreement between the two reviewers (Cohen's kappa=0.88, indicating high level of agreement). During both the title and abstract screening and the full-text review, disagreements between the two authors were first discussed. If consensus was not achieved, a third author (LAM) was consulted to make the final decision regarding inclusion or exclusion.
Assessment of methodological quality
Two authors (PF and HAP) independently scored the methodological quality of each included study using a modified version of the Downs and Black Checklist.28 The Cochrane Handbook recommends the use of this checklist to appraise non-randomised studies.29 The original Down and Black Checklist contains 27 yes/no questions distributed over five sections: reporting, external validity, internal validity (bias and selection bias) and power. Previous systematic reviews that investigated injury risk factors in athletes recommended modifying the Downs and Black Checklist because 6 out of the original 27 questions do not apply to prospective cohort studies.20 30 Further, the score of question number 27 (Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%?) was converted into a dichotomous output (yes=1, the study met the a priori sample target; no=0, the study did not report or did not meet the a priori sample target). The modified checklist used in this study had a maximum score of 21 points, which indicated higher methodological quality. For each article, the raw score and the percentage score [(raw score/21 possible points)×100] was reported. During the assessment of methodological quality, disagreements between the two authors were first discussed. If consensus was not achieved, a third author (LAM) was consulted to make the final decision regarding specific scores.
One author (FP) extracted the data, which was checked for consistency by a second author (HAP). The following information was obtained: (1) author, (2) year of publication, (3) sport, (4) study population, (4) sample size, (5) sex, (6) age, (7) participants reporting discomfort or injury at baseline evaluation, (8) participants lost to follow-up, (9) number of participants included in the analysis, (10) number of seasons, (11) injury definition, (12) injury tracking, (13) number of injuries and (14) number of injured participants.
An injury was defined as any shoulder-related or elbow-related complaint incurred due to competition or training.31 Injuries to the shoulder and elbow had to be tracked during the season by healthcare personnel, in-season player interview or self-reported questionnaires.
ROM testing procedures, the direction of ROM testing and the side tested were recorded. ROM measurements included two types of variables: (1) absolute ROM of the throwing arm and (2) ROM of the throwing arm expressed as a function of the ROM of the non-throwing arm. The latter often includes a specific ROM cut-off to define the absence or presence of a specific ROM deficit. The type of ROM measure and the cut-off used to identify ROM deficit were extracted for the analysis.
Only ROM variables that were included as predictors in at least three studies were considered for the meta-analysis. For the studies included in the meta-analysis, odds or risk ratios, confidence intervals and p values were extracted. A random-effect meta-analysis was conducted using the method of Mantel-Haenszel stratified by the direction of ROM and the type of measurement (absolute and deficit). The primary outcome was shoulder and elbow injuries. For all ROM measurements, except for shoulder internal rotation difference, the summarised effect estimate was the odds ratios. For shoulder internal rotation difference, Shanley et al 12 reported the risk ratio as effect estimate, while Wilk et al 32 33 reported the odds ratio. In order to synthesise the data between these studies12 32 33 and to provide an overall estimate, crude odds ratios were converted to crude risk ratios using the formula
where RR is the risk ratio; OR is the odds ratio; and R0 is equal to the risk of a positive outcome in the unexposed group. Summary effect estimates and 95% confidence intervals were reported.
I2 statistic assessed the heterogeneity of each ROM meta-analysis. Funnel plot and Egger's test evaluated publication bias and the possibility of a small study effect.
The database search was completed on 22 September 2018. The search identified 10 539 studies (figure 1): 2855 duplicates were removed; 7684 studies were screened; and 93 studies were reviewed in full text. Fifteen studies11–15 32–41 met the inclusion and exclusion criteria and were included.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.25 Superscript numbers indicate the corresponding reference. ROM, range of motion.
Study characteristics
Table 1 summarises the characteristics of the included studies. A total of 3314 (female=385) athletes of overhead sports were included in this review, specifically, baseball (n=2471, female=27), softball (n=103, all female), handball (n=535, female=161), tennis (n=65, female=25), volleyball (n=66, female=32) and swimming (n=74, female=37). Six studies included samples of both female and male athletes,12–14 34 39 40 but only one considered sex as a covariate in the analysis.39 One study12 included a cohort of baseball and softball players but reported independent analyses for each sport. One study35 included a cohort of youth and adolescent baseball pitchers but reported independent analyses for each age group. A group of authors reported data from the same cohort in two different manuscripts, one that analysed risk factors for shoulder32 and one for elbow injuries.33 Most of the studies followed up athletes for one competitive season. Nine studies tracked injuries across multiple seasons (range of two to eight seasons).11 32 33 35 37 38 40 41 Athletes were re-evaluated at the beginning of each season in seven studies,11 32 33 35 37 38 41 while one considered injuries occurring over a 2-year span.40 After accounting for athletes evaluated for multiple seasons and lost to follow-up, the total included sample was 3750, specifically baseball (n=3026), softball (n=103), handball (n=428), tennis (n=55), volleyball (n=64) and swimming (n=74).
Injury definition varied across studies (table 1). The cumulative shoulder and elbow injury rate in the overall sample of overhead athletes was 17% (666/3750). Divided by sport, the cumulative shoulder and elbow injury rate was 14% (431/3026) for baseball,11 12 32–38 41 9% (9/103) for softball,12 43% (182/428) for handball,15 39 44% (24/55) for tennis,40 4% (3/64) for volleyball14 and 23% (17/74) for swimming.13
The average score on the modified Downs and Black Checklist was 14.9%±2.1% (range 11–18, online supplementary appendix B). Six studies achieved a score of at least 16, which is greater than 75%.11 13 15 34 36 39
ROM measurements
Shoulder ROM directions included flexion, internal and external rotation, and horizontal adduction. Shoulder flexion ROM was measured using a standard goniometer with participants supine, and this methodology was consistent across studies.11 32 33 40 Shoulder internal and external rotation ROMs were measured either with a goniometer11 12 14 32 33 38 or a digital inclinometer13 15 35–37 39 41 with participants supine with shoulder abducted at 90° and elbow flexed at 90°. Horizontal adduction ROM was measured with either a goniometer11 12 34 or a digital inclinometer35 37 41 with participants supine, according to the procedure described by Laudner et al.42 Further, nine studies11 12 15 32–34 36–39 41 calculated the total rotation of motion by summing internal and external ROMs.
Preseason screening and in-season shoulder and elbow injuries
Methodological differences prevented including the results of eight studies in the meta-analysis.13 14 34 37 38 40 41 43 Three studies32 33 38 from the same group of investigators had overlapping data collection time frames: three competitive seasons, from 2005 to 2008,38 and eight competitive seasons, from 2005 to 2012.32 33 Only the data from the eight competitive seasons were included in the meta-analysis.32 33 Softball players were excluded from the internal rotation deficit meta-analysis because none of the nine softball players with at least 20° of shoulder internal rotation deficit sustained an injury.12 Table 2 summarises the results excluded from the meta-analysis. Shanley et al 35 used a receiver operating characteristics curve to calculate the preseason cut-off of shoulder ROM deficit with the highest sensitivity for risk of shoulder and elbow injuries. In adolescent baseball pitchers, a shoulder internal rotation deficit of at least 13° and a shoulder horizontal adduction deficit of at least 15° were associated with a 5.8 and 4.1 greater risks of shoulder and elbow injuries.35 The same analysis did not produce any significant results in youth baseball pitchers.35 Shanley et al 12 reported that high school baseball players with deficit of shoulder internal rotation ROM greater than 25° are at higher risk (risk ratio=4.8) of injury. In contrast, Tyler et al 37 reported that high school pitchers with no internal rotation deficit (side-to-side difference of less than 0°) are at higher risk of shoulder and elbow injuries (risk ratio=4.9) compared with pitchers with a loss of internal rotation of at least 20°. Walker et al 13 reported that swimmers with low (<93°) and high (>100°) absolute shoulder external rotations are at risk of a shoulder injury (odds ratios=24.9 and 23.0, respectively) compared with swimmers with shoulder external rotation within 93° and 100°. The odds ratios increased to 32.5 (external rotation <93°) and 35.4 (external rotation >100°) when the statistical model included swimming training distance. Prospective studies in softball,12 tennis40 and volleyball14 players showed that preseason shoulder ROM is not associated with in-season shoulder and elbow injuries.
Summary of the results from the study that were not included in the meta-analysis
Meta-analyses included data from prospective cohorts of baseball and handball players.11 12 15 32 33 36 39 Two studies reported effect estimates that were adjusted based on baseline characteristics (detailed information reported in figure 2).15 39 Independent meta-analysis evaluated absolute shoulder ROM of external rotation,15 36 39 internal rotation15 36 39 and total rotation.15 36 39 Other studies measured the absolute value of internal and external rotations,13 14 40 41 as well as total rotation,34 41 but the methodological differences13 41 in the predictive analysis or incomplete results reporting14 40 prevented from including these studies in the respective meta-analysis. Only one study measured the absolute value of shoulder flexion and shoulder horizontal adduction.11 The results of the meta-analyses indicated that absolute shoulder ROM is not associated with shoulder and elbow injuries (figure 2). A large degree of heterogeneity between studies was found for the absolute value of absolute shoulder internal rotation (I2=71.9%, p=0.03) and total rotation (I2=62.1%, p=0.07) ROMs.
Forest plot indicating the meta-analysis results for all preseason ROM screening and subsequent risk of shoulder and elbow injuries. The summarised effect estimate was the odds ratios for absolute external, internal and total rotation and external and flexion deficit. The summarised effect estimate for internal rotation deficit was the risk ratio. a, adjusted for history of shoulder surgery. b, adjusted for sex and history of shoulder pain during the last season. c, adjusted for sex and shoulder pain at baseline. d, adjusted for player position (back player) and history of shoulder surgery. e, authors reported poor inter-rater and intrarater reliabilities of ROM measurements. CI, confidence interval; OR, odds ratio; ROM, range of motion; RR, risk ratio.
Independent meta-analyses evaluated shoulder flexion,11 32 33 external rotation11 32 33 and internal rotation ROM differences.12 32 33 Other studies measured external rotation differences34 36 37 41 and internal rotation differences,34–37 41 but methodological disparities in the predictive analysis,37 41 exclusion from multivariate predictive analysis34 and different angle cutoffs used to define ROM deficits35 36 prevented from including these studies in the respective meta-analyses. Shoulder total rotation and horizontal adduction ROM differences were measured in seven12 32 33 36–38 41 and four11 12 34 35 studies, respectively. However, the methodological differences in the predictive analysis,37 41 the different cut-offs used to define shoulder total rotation or horizontal adduction deficit,11 12 32 33 35 36 38 and exclusion from multivariate predictive analysis,34 prevented combining the data in meta-analyses. Three side-to-side ROM cut-offs were consistently used across studies to define specific ROM deficits: (1) shoulder flexion: non-throwing arm–throwing arm >5°11 32 33; (2) shoulder external rotation: throwing arm–non-throwing arm >5°11 32 33 and (3) shoulder internal rotation: non-throwing arm–throwing arm >20°.12 32 33 The results of the meta-analyses indicated that the presence of a 5° insufficiency of shoulder external rotation between the throwing and the non-throwing arms (ie, external rotation in the throwing arm was <5° greater than the non-throwing arm) is significantly associated with in-season shoulder and elbow injuries (odds ratio=1.90, 95% confidence interval 1.24 to 2.92, p<0.01; figure 2). The effect estimates of the meta-analysis for external rotation insufficiency did not have substantial heterogeneity (I2=0%, p=0.50). In contrast, a large degree of heterogeneity between studies was found for shoulder flexion difference (I2=71.4%, p=0.03).
Overall, the funnel plot was fairly symmetrical and contained within the borders of the funnel, indicating limited publication bias (figure 3). However, there is some evidence of publication bias for external rotation ROM deficit. The funnel plot positive asymmetry suggests that negative or null studies are missing from the published literature. Last, there was no evidence of small study bias (p=0.35).
Overall, the plot indicates that all reported studies lie within the 95% confidence limits, suggesting limited reporting bias. The proximity of most studies to the solid black line indicates the null results observed in the bulk of included studies. Some asymmetry is noted, especially for external rotation deficit, indicating likely reporting bias for this exposure.
This systematic review summarised the available evidence, evaluated methodological quality and analysed whether preseason screening of shoulder ROM is associated with the risk of shoulder and elbow injuries in overhead athletes. Overall, we identified 15 prospective cohort studies,11–15 32–41 with the majority focusing on baseball. Limited evidence was available for other overhead sports, such as handball, softball, volleyball, swimming and tennis. Female athletes are under-represented, accounting for 12% of the overall sample (34% after removing studies on baseball, which is a male-predominant sports). Only one prospective cohort study of a female-predominant sport of softball12 was identified for this review. Our overall hypothesis that preseason shoulder ROM across all overhead athletes identifies those at risk for upper extremity injuries was not confirmed. Summarising the evidence for the meta-analysis was challenging due to the methodological differences between studies. The meta-analysis included three shoulder absolute ROM variables (external, internal and total rotations) and three shoulder ROM deficit (flexion, internal rotation and external rotation). The results of the meta-analysis indicated that professional baseball pitchers were at higher risk of shoulder and elbow injuries when the throwing arm external rotation was not at least 5° greater than the non-throwing arm. Therefore, screening shoulder external rotation ROM may be valuable in professional baseball pitchers.
Four studies failed to outline the inclusion and exclusion criteria used to select their sample.32 33 37 41 The number of the athletes who were lost to follow-up was clearly described in three studies,13 34 39 and five studies reported both the number of athletes that were approached and the number of athletes who agreed to participate.15 34 36 39 40 Therefore, some of the included studies may suffer from selection bias. The investigator responsible for preseason measurements was blinded for hand dominance in three studies,12 35 36 exposing the remaining studies to potential investigator bias. Only five studies adjusted the analysis for potential confounders.11 13 15 32 39 Three studies calculated the required sample size a priori12 34 36: two studies met their target sample size34 36; one study recruited 82% of the estimated sample due to limited time to perform preseason screening.12 Therefore, the majority of the studies may lack sufficient sample size. Three studies did not report the investigator reliability in collecting shoulder ROM.11 34 37 Andersson et al 39 reported poor inter-rater and intrarater reliabilities for their ROM measurements, which are a critical threat to internal validity that can bias their results.
The risk of shoulder or elbow injuries increased almost twofold if the throwing shoulder of professional baseball pitchers did not have at least 5° greater external rotation compared with the non-throwing shoulder. It is well accepted that the throwing arm of overhead athletes displays greater external rotation ROM compared with the non-throwing arm.44 45 Greater shoulder external rotation increases the amount of motion available to develop ball velocity.46–48 Professional baseball pitchers with less throwing arm external rotation may employ other strategies, such as dropping their arm slot or allowing their arm to lag behind, to maintain throwing performance, which may place them at higher risk of injury.49 50 The fact that less throwing arm shoulder external rotation was associated with shoulder or elbow injury in two independent cohorts of professional baseball pitchers further corroborates the value of screening external rotation ROM in this population.11 21 32 The ultimate goal of athlete screening is to reduce their risk of injury by intervening on modifiable risk factors.21 Therefore, randomised clinical trials that compare the efficacy of the screening and intervention programme compared with usual training and prevention programmes only are necessary to fully understand the value of screening for shoulder external rotation deficit in professional baseball pitchers.
In contrast, younger baseball pitchers and position players (age 7–18 years) do not consistently display differences in shoulder external rotation in the throwing arm compared with the non-throwing arm.51 Although not included in the meta-analysis, four studies34 36 37 41 failed to find a positive association between shoulder external rotation difference and subsequent risk of shoulder or elbow injuries in cohorts of junior and high-school baseball players. Bullock et al 17 found no absolute differences of preseason shoulder external rotation ROM between a group of high school baseball players who suffered an in-season shoulder or elbow injury and a group who did not. Adaptation of shoulder external rotation ROM may occur over several years of playing and with increased level of performance, which may explain the findings in younger cohorts.
The current meta-analysis indicates that a shoulder internal rotation difference of at least 20° between the throwing and the non-throwing arms is not associated with future shoulder and elbow injuries. The heterogeneity of the studies included in the meta-analysis, which combined professional baseball pitchers32 33 and high school baseball players (position players included),12 must be considered when interpreting these results. Shoulder internal rotation may not be an important risk factor for professional baseball pitchers.11 32 33 In contrast, a recent meta-analysis showed that a preseason side-to-side difference of at least 5° of shoulder internal rotation characterised high school baseball players that sustained an in-season injury.17 Screening for 5° side-to-side difference in shoulder internal rotation may generate a high number of false positives, considering that previous studies found that only greater internal rotation difference (favouring the non-throwing arm) carried a higher risk of shoulder and elbow injuries (at least of 13°, adolescent pitchers, and at least 25°, high school baseball players; table 2).12 35 Additionally, one study found that high school baseball pitchers with no shoulder internal rotation deficit in their throwing arm have a higher incidence and a higher risk of shoulder and elbow injuries compared with those with at least 20° of shoulder internal rotation differences between the throwing and non-throwing arms.37 Thus, unwarranted stretching, which arbitrarily increases the internal rotation on the throwing arm, may also be deleterious for high school baseball players.
A shoulder flexion deficit of at least 5° in the throwing arm is not associated with shoulder and elbow injuries in a homogenous sample of professional baseball pitchers. It is important to note that the anatomical location of the injury was different between the studies included in this meta-analysis. Two studies considered only elbow injuries,11 33 while one considered only shoulder injuries.32 Based on the reported OR (figure 2), it is unclear why shoulder flexion ROM deficit in the throwing arm would be associated with risk of injury at the elbow, but not at the shoulder. Reduced shoulder flexion may be related to altered latissimus dorsi muscle flexibility. A shoulder flexion deficit of 5° in the throwing arm may result in a lower arm slot during throwing, which has been shown to increase elbow joint stress.52 53 Future studies should investigate this potential association.
Bullock et al 17 showed that, when measured at preseason, high school baseball players that sustained in-season shoulder and elbow injuries had at least 8° lower horizontal adduction ROM compared with players who did not get injured.17 When included in risk analysis, Shanley et al 35 found that high school baseball pitchers with a difference of horizontal adduction of at least 15° between the throwing and non-throwing arms were at four times greater risks of shoulder and elbow injuries. Similar findings were not reported in one cohort of professional baseball pitchers,11 or in studies including cohorts that combined high school baseball pitchers and position players.12 34 Taken together, these findings may indicate that players' age and position should be considered when screening horizontal adduction ROM.
Other overhead sports
The evidence available for other overhead sports was limited to two prospective cohorts from the same group of researchers for handball, and one prospective cohort each for softball, volleyball, tennis and swimming.
The two studies15 39 that screened absolute shoulder ROM of the throwing arm in handball players found opposite results. Clarsen et al 15 reported a small positive association between shoulder total rotation ROM and injury and no association for internal rotation ROM. In contrast, Andersson et al 39 reported a small positive association between shoulder internal rotation ROM and injury and no association for total rotation ROM. Caution is warranted when interpreting the results from Andersson et al 39 due to the poor inter-rater and intrarater reliability of the ROM measurements. These studies also have some methodological differences that may, in part, explain these contradictory results. Clarsen et al 15 included only male handball players, while Andersson et al 39 included both male and female. Each study used different confounders to adjust their analysis. Although both studies used the same definition of overuse injury consistent with a non-contact injury mechanism, Clarsen et al 15 acknowledged the inclusion of injuries that were acute flare-ups of chronic problems, long-term problems initially caused an acute trauma or purely caused by an acute trauma. The inclusion of acute injuries may also explain the higher injury rate (52%) reported by Clarsen et al 15 compared with the study of Andersson et al 39 (22%).
While swimmers have different biomechanical demands compared with throwing sports, shoulder pain and injuries are common due to the high repetitions of overhead motion and training volume.2 Based on the results of one study,13 swimmers with external rotation ROM in the low and high tertiles are at higher risk of shoulder and elbow injuries compared with swimmers whose shoulder external rotation ROM is within 93° and 100° (middle tertile). These results are independent of swimming training distance (table 2).13 This ideal external rotation ROM may be protective against shoulder injury, but confirmation of this finding in a second independent cohort of swimmers is needed before making strong recommendations for the use of shoulder ROM screening in this population.21
Absolute shoulder ROM or shoulder ROM deficits were not associated with shoulder or elbow injury in high school softball players,12 shoulder pain in professional volleyball players14 or upper extremity injury in tennis players.40
We acknowledge several limitations. Few prospective studies were identified for sports such as handball, softball, tennis, volleyball and swimming. The small number of studies included in each ROM meta-analysis (3 out of 15, 20%) is a significant limitation. With few studies, coverage of the overall effect size is of concern, and one cannot be certain that one large study is not determining the overall effect. Statistical power is limited when the number of studies is low. Lastly, the small number of studies prevented subgrouping within in each meta-analysis.
There was a high degree of heterogeneity among studies for age (youth to adults), position in baseball (pitchers only to combined cohort of pitchers and field players), competition level (competitive to professional athletes) and injury definition (overuse questionnaires, league managed disable lists, combination of symptoms and sonographic findings, symptom duration, and missing time from sport performance, from one game/practice, up to 3 weeks). Combining studies with substantial heterogeneity can mask true differences between studies. It can also lead to combining valid studies with biassed research, producing a biassed overall estimate.
In-season injuries often occur several weeks or months after screening (preseason), and it is possible that the association between screening findings and injuries weakens over time. This is an inherent limitation of all the studies included in this systematic review, as none of the studies reported the time elapsed between screening and injury. Future studies should investigate whether more frequent in-season screenings of factors theorised to relate to injury risk provide better identification of overhead athletes at risk of injury. Most of the included studies did not account for previous injury or exposure (ie, frequency of sport-related activities) in the analysis. This is an important limitation as these factors have been linked to injury and can be potential confounders. The aetiology of injury is multifactorial, and shoulder ROM represents only one risk factor for shoulder and elbow injuries. Thus, the results of this systematic review and meta-analysis should be interpreted with caution.
Absolute shoulder ROM or shoulder ROM differences do not appear to be consistent risk factors for shoulder and elbow injuries across different overhead athletes. Age, competition level and position should be considered when screening the shoulder ROM of baseball player. Professional baseball pitchers whose external rotation ROM in the throwing arm was not at least 5° greater than their non-throwing arm were twice as likely to sustain in-season shoulder or elbow injuries. Similar findings were not observed in adolescent or high school baseball pitchers. Limited evidence suggested that swimmers with abnormally low or high external rotation are at higher risk of shoulder injuries. Limited evidence suggested that ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of shoulder and elbow injuries.
What is already known
The repetitive demands of overhead sport lead to side-to-side changes in shoulder range of motion (ROM), such as increased external rotation and decreased external rotation. However, injured overhead athletes have impairment of shoulder ROM compared with non-injured overhead athletes.
What are the new findings
Professional baseball pitchers whose external rotation ROM in the throwing arm is not at least 5° greater than the non-throwing arm were twice as likely to sustain in-season shoulder or elbow injuries
Limited evidence: swimmers with external rotation of less than 93° or greater than 100° may be at higher risk of shoulder injuries than swimmers whose ROM is between those limits.
Limited evidence: ROM screening may not be effective to identify handball, softball, volleyball and tennis players at risk of shoulder and elbow injuries.
We acknowledge Robert Edward Johnson, University of Southern California, for developing and conducting the systematic search of the databases.
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This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Data supplement 1
Twitter @FedPT1, @chuck-thigpen, @LoriM_PT
Collaborators Robert Edward Johnson.
Contributors FP, HAP and LAM: conception and design of the work, acquisition, analysis and interpretation of data; drafting of the manuscript and revision; and final approval. ES and CAT: design of the work and interpretation of data, manuscript revision and final approval. CB: acquisition and interpretation of data, manuscript revision and final approval. MLW: analysis and interpretation of data, manuscript revision and final approval.
Funding FP received salary to complete this work from the Career Development Award sponsored by tge Academy of Orthopaedic Physical Therapy; and the Rehabilitation Research Career Development Program sponsored by the National Institute of Health (K12 HD055929). This publication was supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science of the U.S. National Institutes of Health. The content is solely the responsibility of the authors anddoes not necessarily represent the official views of the National Institutes of Health.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.


text:
Alan Sadovnik, PhD
Board of Governors Distinguished Service Professor
Associate Director, Center for Collaboration and the Urban Child (CCUC)
sadovnik@newark.rutgers.edu
CV/Résumé
Public Policy Analysis / Public Policy
Urban Policy
Dr. Alan Sadovnik is a Board of Governors Distinguished Service Professor in the School of Public Affairs and Administration at at Rutgers University–Newark where he is also the Associate Director of the Center for Collaboration and the Urban Child. He is a recent recipient of Rutgers, The State University of New Jersey's Faculty Scholar Teacher Award for 2017-2018 in recognition of his outstanding contributions in research and teaching. He is currently on the editorial board of Teachers College Record and has served on the boards of The American Education Research Journal, History of Educational Quarterly and The Urban Review, Sociology of Education and Educational Foundations. Dr. Sadovnik has authored and edited numerous books as well as dozens of journal articles and book chapters and ten major urban educational policy reports on Newark, New Jersey and the nation.
PhD: New York University, Sociology
MA: New York University, Sociology
BA: Queens College, Sociology and Education
Board of Governors Distinguished Service Professor Alan Sadovnik Honored with Faculty Scholar-Teacher Award
New SPAA Course Provides Historical Context to Plight of Newark Public Schools
Board of Governors Distinguished Service Professor Alan Sadovnik Weighs In on Betsy DeVos Nomination
SPAA Roundtable Addresses Implications of the Trump Presidency

redpajama_set_name: RedPajamaCommonCrawl


A new Buddhist Retreat Centre in Italy. We need your support to realise it!
Since the year 2000 we are looking for the new Italian retreat centre. Find out about us and our efforts.
Big project like this are brought forward through the enthusiasm and energy of idealistic friends. If you would like to help us, don't hesitate: contact us right away!
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text:
Anne of Green Gables Adapter Don Harron Dies at Age 90
The Canadian performer had a half-dozen Broadway credits to his name.
Hayley Levitt
Canadian performer and Broadway veteran Don Harron has died at age 90.
Canadian comedian, actor, and writer Don Harron, who garnered a number of Broadway credits throughout his career, died in his Toronto home on Saturday, January 17, after reportedly forgoing cancer treatment. He was 90 years old.
Harron is best known for his comic character Charlie Farquharson, which he created in 1952 on an episode of the variety series The Big Revue. He went on to enjoy an 18-season stint performing as Farquharson on the hit U.S. variety show Hee Haw.
Harron made his Broadway debut in 1954 in Home Is the Hero and went on to perform in Broadway productions of The Dark Is Light Enough (1955), Separate Tables (1956), The Tenth Man (1959), and Everybody Loves Opal (1961). He also adapted Heinrich von Kleist's The Broken Jug for a 1958 Broadway production and cowrote the script for the 1956 television musical Anne of Green Gables.
He is survived by his partner, Claudette Gareau, and his three daughters, Martha, Kelley, and Mary, who is a Canadian filmmaker best known for her films I Shot Andy Warhol, American Psycho, and The Notorious Bettie Page.
Tagged in this Story
Don Harron


text:
GOAL Four: SERVE Courageously—In Difficult Times
"whoever would be great among you must be your servant, and whoever wants to be first must be your slave—just as the Son of Man did not come to be served but to serve …" (Matthew 20:26-28)
Jesus's last exemplary lesson to the 12 disciples was performed in the few days before his crucifixion. He disrobed, bowed on his knees and washed their feet. He did the work of a lowly servant to model an example of true love. His service was an expression of his love. Though he gave them the commandment, this lifestyle was a decision each disciple had to make; a decision no longer to live for themselves, but for the glory of their master by serving their neighbor.
To serve courageously is the call to discipleship. It is an intentional decision to humble ourselves, step outside of our comfort zones and do something for others that may receive little to no recognition. We can serve out of fear, for the praise of others or to make ourselves feel good. But serving courageously is a conscientious decision to cast down our fears of failure, surrender our defensiveness and foci of control and step into a creative dimension of innovative service. Service that may have no personal benefit.
What was it that caused fishermen, tax collectors and everyday people who had just deserted their master and returned to their homes to do what they were comfortable in doing to change and become courageous leaders that impacted the world? They surrendered to the call of service that was motivated by love for God and their neighbor. They may have feared initially, but scriptures give us an insight into this transformation: "perfect love cast out all fear." (I John 4:18)
We can serve for the praise of others, but service that honors the Name of Christ Jesus is that which is compelled by love. This love empowers and guides us to be strong and courageous. When our service goes beyond our needs and is directed towards the felt needs of others, our stagnation is absolved and our creativity is unbound. We dream boldly because our faith expands beyond our limitations, trusting the power of Christ to live through us. He empowers us with his promises. He gives strength and courage to stretch our natural inclinations mirror his service.
The most recent COVID-19 pandemic and racial tensions have revealed so much of our natural inclinations to serve the self. As a Christ-centered community, I trust we will model what we teach: the value of serving our students, our community and neighbors in the cities and towns that surround our five campuses. We will serve with humility, with a clear understanding that our service is only a reflection of our relationship with Jesus Christ.
Joseph Jones, Ph.D.
December 01, 2021 Connections
Quiet Service Without Earthly Recognition
November 03, 2021 Connections
Learning Contentment: A Thanksgiving Reflection


Face it. It's frigid. You don't have to live in a Snuggie until the sun comes out again in spring. But then again this one is pretty cute. If you're looking for ways to keep that heating bill down without losing a toe, we've got a few tips.
1. Slippers. You know those chunky slippers with the non-slip bottom and the fluffy stuff inside? Get some. It doesn't matter how layered up the rest of you is if heat is escaping through this little piggy.
2. A good blanket. If you can afford it, go for down. If you're allergic, go for faux down. And check out Overstock's Blanket Buying Guide for more info.
3. Dress in layers. "Bundle up," said The Old Farmer's Almanac. "To avoid getting overheated inside, wear layers." Choose a "wicking polyester (or silk) undershirt next to your skin versus cotton."
4. Flip your fan. In the summer, the fan circulates the air, which can make you feel cooler. Flipping the switch "helps push warm air that's risen to the ceiling back down to the floor where you can feel it. The less that's wasted, the less demand there is on heating systems and the more you save," said Distractify.
5. Stay hydrated. Drinking water can actually help you stay warmer. Who knew? "Water is actually 'amazing' for retaining body heat," said The Week. "Simply put, the more you have in your system, the easier it is to keep warm. Stay hydrated - especially before you dash out into the frozen slush every morning,"
6. Light a fire. You can lower your heater by a few degrees by gathering in front of a warm fireplace. Plus, it'll give you a chance to snuggle.
7. Go for the combo of extra layers and hot drinks. "When you feel a chill, reach for a sweater instead of thermostat," said Distractify. "With the extra layers, your body will heat up much faster than the furnace can heat your house. Then, "drink lots of tea, coffee, hot chocolate and other warm liquids (including soup!) This will raise your body temperature in a jiffy."
8. Harness the sun. "During the day, open the blinds and curtains on the south-facing windows - and let the Sun warm you. At night, close the blinds and curtains to better insulate your home," said The Old Farmer's Almanac.
9. Seal it up. "Make sure your home is air sealed," said The Simple Dollar. "Air leaks and drafts allow warm air to quickly escape your house, resulting in tremendous heating and cooling bills. The solution to this problem is to check your home for air leaks and properly air seal any leaks you discover. You can get more info from this useful guide from the Department of Energy."
10. Shut 'em up. If you have guest rooms and other spaces you don't use, close the vents. This will force more air into the rooms you are using and make the heating system more efficient.


When we say "take your top off," you know what we mean: your beer cap of course! This custom bottle opener wall decor is a fun addition to any man cave or home bar. Made from sturdy American birch wood with a colorful beer bottle design, these personalized home signs will certainly add a pop. Made to order with the name of your choice, a steel bottle opener is affixed for fun functionality. Mount on any wall using the predrilled holes and your own finishing nails. This custom bottle opener wall decor is available in two sizes: Medium: 15.5" x 11.5" x 1/2" thick Large: 21" x 16" x 1/2" thick.


text:
Visiting AmaniI Floyd's Shares (account name: amaniifloyd)
What's The Video Game Optimizing Services Application?
The century has launched a fresh meaning such as hobbies. Thus, now you may invest your leisure time beneath the shadow of this digital world with an incredible computer game. Actually, today tens of thousands of gaming apps are present in the varying program outlets. Thus, the consumer can decide all the platform that they extremely eager to engage in . That is the reason why the programmers are introducing these programs in lots of types. In case you prefer gardening, now it's possible to create an magnificent garden merely by clicking your digital display. But, if anybody likes trilling and adventure feeling, they have the best possibilities. However, there is some position that games are bothering the performances of one's own mobile.
That's the reason we want to have a gaming overlay. Even though this really is often with a method, most of the consumers have no idea the precise means to attain its maximum positive aspects and where to down load a perfect instrument.
What is game refining companies indicates?
To start with, let's find out what is meant by this and which would be the gains available for users. Simply, this really can be a system that you can utilize for keeping the performances of your own mobile when playing matches. All of us know, the games really have been carrying tremendous storage out of the RAM if it's running. Thus, you may notice a substantial change in rate when compared to factory variation as soon as you get into a gaming application.
But, whenever you have game booster speed to maximize games, it could balance the RAM performances to play the game in addition to to continue to preserve the perfect features. This really is the basic job with this particular service.
Exactly what are the feasible ways to utilize Android game maximizing service?
This system is just as readily available for any of those os's for example iOS along with Android. It is not just a key that most of the special tools used in Android are taking the type of a app. As same as for this, the game optimizing service for matches also readily available to download as an app.
However, how you can select a ideal tool from a number of options? We know that you all are inside this doubt. That is precisely why we planned to fulfill you with this specific writing. Absolutely, the thing we're going to note down will probably amaze you. So, keep your eyes on the next few traces to observe the way to down load the ideal instrument for this.
Let us download game optimizing service Android app
Basically, don't squander your time and effort by hunting around the Google perform keep for a perfect device. Right here, we have attached the link to get into the Android app to optimizing the games you adore. So, we invite you to just tap on it. Once, you launch it on your monitor, it will get the job done immediately to wash your device for performances that are amazing.
The outlook Are you a game enthusiast who concerned about the sluggish functioning of one's cellphone only due to your favorite game? But, now you might have the perfect solution to play it while still appreciating with the original performances.
https://www.keepandshare.com/doc11/29370/what-s-the-video-game-optimizing-services-application
https://kvisit.com/Pg/uuUB
and Calendar
Creation date: Dec 6, 2020 4:28am Last modified date: Dec 6, 2020 4:28am Last visit date: Jan 15, 2021 12:22am


Awarded annually by the Dean of Graduate and Postdoctoral Affairs, in memory of Robert McKeown's career as a journalist of national stature, when merited, to a student in the doctoral program in Communication who has a background as a working journalist or whose research focuses on the news media or journalism practice. Recipients are selected by the Supervisor of Graduate Studies in Communication on the recommendation of the Graduate Committee in Communication. Eligible students must be Canadian Citizens or permanent residents of Canada (landed immigrant or a protected person), meet OSAP's Ontario Residency Requirements. The criteria for the award are academic merit and financial need. Endowed in 2005 by Lloyd Francis.


State-owned companies and some government bodies are to blame for many illegal sea reclamation projects, a senior official from the State Oceanic Administration has said.
"Sixty-one of the 62 illegal cases last year were conducted by governments and port holdings," said Liu Xincheng, vice-director of North China Sea Branch of the administration.
"Economic interests" were the direct cause for the reclamation, including the establishment of offshore drilling projects, he said.
Sea reclamation is a process in which natural and manmade materials, such as rocks , sand and tarps, are added to coastal areas and waterfronts in an attempt to make them more solid - essentially creating new land surfaces.
Generally, the cost per square meter for sea reclamation projects ranges from 220 yuan ($32) to 520 yuan. The cost to build on land is thousands of yuan per square meter, so projects on reclaimed land are much less expensive.
"Increasing demand for coastal areas and strict land control have caused some governments to approve illegal projects in coastal reclamation and enclosure," Liu said on Thursday. Environmentalists say that sea reclamation projects hurt marine ecosystems and may affect drainage and water flows.
According to the law, any person involved in illegal sea reclamation projects will be fined five to 15 times of what he pays for the project. The administration handed out fines totaling 27 million yuan for illegal sea reclamation last year. From 2006 to 2007, the illegally reclaimed sea area reached 189 sq km with a fine of less than 5 billion yuan, Liu said.
He said that in addition to illegal coastal reclamation, oil spills also had a serious effect on the marine environment.
Last year, 12 accidents, each involving spillage of less than 10 tons of oil off China's coast, polluted the waterways.
To tackle the problem, the administration established an oil "fingerprinting" database in May to help authorities identify vessels through the unique characteristics of the oil that was dumped.
On Sep 3 last year, 29 vessels from China and South Korea participated in a clean-up campaign for ocean oil spills.
So far, 17 offshore oil exploration firms, 36 exploratory drillings, 155 marine oil platforms and 1,187 oil wells operate in BohaiSea, administration figures showed.


text:
"Dune" Breathes New Life Into Frank Herbert's Source Material
The film is mesmerizing, transporting the viewer to a world so different from ours, yet so similar, writes film critic Audrey Ruppert. more
By Audrey Ruppert | 11/4/21 02:17 PM
"No Time To Die" Is A Stellar Farewell
Daniel Craig reprises his role of James Bond for the last time. more
By Audrey Ruppert | 10/6/21 10:21 AM
Sorry To Burst Your Bubble, But "Candyman" Falls Short Of Being A Horror Classic
The cast is full of up-and-comers, and the film itself is the "spiritual" sequel to the legendary 1992 slasher of the same name. more
By Audrey Ruppert | 9/8/21 04:30 PM
Despite An Engaging Premise, "Old" Fails To Live Up To Its Potential
"Old" had the potential to be an intriguing film or even a thought-provoking miniseries in the vein of "Black Mirror," but it proved to be neither. more
By Audrey Ruppert | 8/12/21 09:55 PM


If you haven't tried An Algebraic Challenge -- Part 3, you may try it.
INSTRUCTION: The below given question is just for self analysis of how much time you take to solve it. If you can solve the question WITHIN 28 SECONDS after reading the QUESTION, then, you are exceptional (according to me).
QUESTION: A says to B,"I am three times old as you were when I was as old as you are." The sum of their present ages is 64 years. What is the difference of their present ages (in years)?


This cracked me up when I first heard it. Perhaps because in humour, for all its subversions and inversions, there is almost always a baseline of truth.
In this case it succinctly illustrates the notion that you might well feel you can act with impunity when safe in the knowledge that someone, or something, will excuse or absolve you of any wrongdoing. Or better yet, if someone will take the fall for you.
Certainly Christianity predicates itself on the idea that one person was humanity's scapegoat, onto which we loaded our sins, before destroying him, simultaneously absolving us collectively of our culpability while trapping us individually into a sort of Stockholm syndrome of worship for the person who "saved" us.
This idea is also the mainstay of colonialism – often underpinned by religion.
Colonisers, for example, have notably always had political and legal dominion over an alien society, over the relations of economics and political dependence, over the education system and the arts, and have always exploited the racial and cultural inequalities of the colony because – as we all know – you need to divide before you can fully conquer.
Occupying the dual roles of great messiah and chief coloniser is Joseph Muscat – and you're either with him and his empire, or against them. Forget the mantra by an unknown Ramona Attard before the election – then compensated by a role at the communications desk of the Office of the Prime Minister – that "you can not agree with the Labour Party, but you can work with it".
Like colonisers before them, the present administration is robbing the Maltese blind, selling off the land to foreigners, sharing the spoils among themselves. Like colonisers before them they've bought the people with false promises and lies and, thus mollified, the Maltese quietly acquiesce.
To adapt Napoleon's phrase to the purpose: The religion of Muscat is excellent stuff for keeping common people quiet. Muscatism is what keeps the poor from murdering the rich.
So it is that Muscat's minions, now sufficiently duped, tie themselves into knots to 'keep the faith', readily forming opinions on things like the Egrant inquiry without actually reading it. They accuse government critics of being apostates and bay for their blood while the cult leader himself (and his wife) steadfastly avoids interviews except for those with paid-off journalists, while organising an inquisition of his own to hunt down 'heretics'.
They won't be troubled by minor details like facts, and when you confront them with any you can almost hear their minds strain under their own cognitive dissonance as they struggle to reconcile the indisputable with the undesirable, resorting instead to bullying, discrediting and dehumanising their critics, as they did to Daphne Caruana Galizia until she was assassinated.
Perhaps most symbolic of this cultural poverty is the tacit acceptance of all this by the artistic community. Artist Anish Kapoor, on a walk of compassion for refugees in London in 2015, said "it is important that artists are not outside the equation, we don't stand on the sidelines. Artists are part of the story of a response, we cannot stand aside and let others make the response".
What response have we had from Malta's singers, dancers, actors, comedians, playwrights, film-makers to anything really? If artists are typically the conscience and soul of a community, then what does this say about Malta's soul? A petition was signed by Maltese artists to support an international call for the dismissal of V18 chairman Jason Micallef – a number of those who signed it, did so anonymously.
Where are the protest songs? The Brechtian-style theatre pieces? The documentaries? Where are the Ira Loscos, the Red Electricks, the Emma Muscats, the Joseph Callejas of this island with their creative voices on the matter?
Where the comedians? Why is the enfant terrible of theatre Adrian Buckle not commissioning or producing relevant plays about it? Is censorship only a concern when it affects their own production? Is a restriction on press freedom not censorship?
As Victor Hugo famously put it: 'There is in every village a "torch" (the teacher) and an "extinguisher" (the priest).' The "torch" in this case being any critic or dissident, and the "extinguisher" being the great Church of Joseph – the Maltese government.
Aside from a few pithy (and entirely accurate) remarks from commentators on social media like Mario Vella, a show from Comedy Knights, and the sharp work of people like Sebastian Tanti Burlo and Steve Bonello, there has been worryingly little protest art.
Until the Maltese have developed independent thought, assumed individual and political responsibility, and developed a cultural scene of artists with backbone that give the Maltese identity an authentic voice instead of pandering sycophancy, the abysmal truth is that Malta will always be a colony – of its own making.


text:
Home > Overseas
Scottish Associations Worldwide
The Scottish Diaspora ~ The Global Scots
In the English Parliament of 1606, when a union between England and the inhabitants of Scotland was proposed it was met with indignant opposition.
"If we admit them into our liberties, we shall be overrun with them, as cattle (naturally) pent up by a slight hedg will (spill) over
it into a better soyl, and a tree taken from a barren place will thrive to excessive and exuberant branches in a better (place). "
That one, simple, 400 year old paragraph admirably sums up the amazing phenomenon of the Global Scots. That great family that has spread out into every corner of the world as mercenaries, traders, missionaries, engineers, doctors, teachers, naturalists, adventurers and every trade and profession known to Man.
We make no attempt to explain it but rejoice that from this often cold and tiny island on the northern fringe of mainland Europe, have come so many high achievers who have altered the course of history in so many nations and contributed so much to the well-being of the world that we know today.
Just how many Global Scots are there? Figures of 40 to 60 million are often bandied about - 8 to 12 times the population of modern Scotland!
In this corner of the web site we've laid out the welcome mat for those of Scottish descent now enjoying the citizenship of the USA, Canada, Australia or New Zealand . . . . and there's plenty room for more - Sweden, the Netherlands, Brazil . . . wherever there are significant numbers of Scots descendants who want to pull their chair up to the home fire now and again . . . there's a welcome and the promise of a good bit of 'crac'
We're actively seeking a representative from each country featured (or to be featured) who would take it upon themselves to keep us abreast of what's happening in the Scottish world where they live. Perhaps provide us with a list of Scottish/Celtic events and organisations, stories of early Scottish pioneers and settlers. . . . The sky's the limit? If that appeals to you - drop us a line!
The diaspora is not just limited to the Commonwealth. In RussiaGeneral Patrick Gordon expanded the empire of Peter the Great, andField Marshall Barclay de Toly saw off the military threat of Napoleon.In Japan, Thomas Blake Glover from Fraserburgh helped turn the countryinto an industrial giant by bringing young samurai to Scottishcolleges, by starting the imperial navy, and by founding the companywhich later was to become Mitsubishi. In China, France, Hungary, India,Italy, Poland and other countries there are monuments and statues inhonour of Scots who contributed to their new homeland.
Not all the emigrants became the stuff of legend, of course. The menand women who struggled through the wastelands from Hudson's Bay tofound Winnipeg are not known today individually. The 30,000 Scots whosettled in Poland in the late Middle Ages have largely merged with thelocal population, though their placenames remain. The descendants ofmissionaries planted in "Little Scotland" in the Caucasus by the FreeChurch may have ended up as keepers of the Botanic Gardens in StPetersburg, but the family Bible from home is still there.
Dressed to Kilt photos Lloyd Bishop
Click on a flag


text:
Bertil Ericsson (* 6. November 1908 in Falun; † 18. August 2002 in Sundsvall) war ein schwedischer Fußballspieler. Der Stürmer, der bei den Olympischen Spielen 1936 zum Kader der schwedischen Nationalmannschaft gehörte, lief für AIK und Sandvikens IF in der Allsvenskan auf.

Werdegang
Ericsson begann mit dem Fußballspielen in seiner Heimatstadt bei Falu IK. Nach Abschluss seines Wehrdienstes beim Infanterieregiment I20 in Umeå strebte er eine Ausbildung bei Påhlmans Handelsinstitut und Schartaus Handelsinstitut in Stockholm an. Aus diesem Grund schloss er sich zu Beginn seiner Ausbildung 1932 dem seinerzeit noch in Stockholm beheimateten Klub AIK an, parallel verdiente er sich seinen Lebensunterhalt beim Versicherungsunternehmen Städernas allmänna brandstodsbolag. Aufgrund einer Verletzung und einer Krankheit kam er für den amtierenden Meister jedoch kaum zum Zug. Im September debütierte er für den Verein in der Allsvenskan, zum 6:1-Erfolg über IFK Göteborg steuerte er einen Treffer bei, anschließend bestritt er noch zwei weitere Ligaspiele.

Zu Weihnachten 1932 kehrte Ericsson in seine Heimatstadt zurück und fand beim Sandvikens Jernverk eine Anstellung. In der Folge wechselte er Anfang 1933 zu AIKs Ligakonkurrenten Sandvikens IF. Hier etablierte er sich als regelmäßiger Torschütze und empfahl sich für die Nationalmannschaft. Im Juni des Jahres debütierte er beim 6:2-Erfolg der Auswahlmannschaft im Rahmen der Qualifikation für die Weltmeisterschaftsendrunde 1934 gegen Estland im Nationaljersey, neben Knut Kroon, Lennart Bunke, Sven Andersson und Torsten Bunke glänzte er als Torschütze und traf zweimal. Obwohl auch im folgenden Spiel gegen Dänemark zweifacher Torschütze wurde er zunächst nicht mehr berücksichtigt und gehörte nicht zum schwedischen Kader bei der WM-Endrunde. Im Anschluss an das Turnier gehörte er wieder unregelmäßig zur Nationalelf, im Sommer 1936 wurde er für die Olympischen Spiele in Berlin nominiert. Bei der überraschenden 2:3-Niederlage gegen Japan stand er jedoch nicht auf dem Spielfeld. Im folgenden Jahr bestritt er sein letztes Länderspiel, insgesamt traf er in zehn Ländervergleichen zehnmal.

Bis 1944 trat Ericsson für Sandvikens IF in der Allsvenskan an, insgesamt bestritt er für den Klub 211 Allsvenskanspiele und erzielte dabei 132 Tore. Parallel engagierte er sich ab 1938 in der Vereinsarbeit und war in dieser Funktion auch zeitweise in die Arbeit des Technischen Komitees beim Svenska Fotbollförbundet eingebunden. 1944 zog er nach Sundsvall, wo er nach dem Abstieg von Sandvikens IF im Sommer des Jahres auch sportlich wechselte und sich dem Kubikenborgs IF anschloss. Nach seinem Karriereende 1946 zog er kurzzeitig nach Härnösand und war für Ramström tätig, kehrte aber zwei Jahre später wieder nach Sundsvall zurück. Dort blieb er Kubikenborgs IF als Trainer und Funktionär verbunden.

2001 wurde Ericsson im Vorfeld der Weltmeisterschaftsendrunde 2002 aufgrund des überraschenden Erfolges der japanischen Nationalelf 1936 von einem japanischen Fernsehteam interviewt, das Gespräch im Rahmen der Vorberichterstattung auf das Turnier 2002 gesendet. Zudem wurde er zu einem Turnierbesuch eingeladen, lehnte aber das Angebot ab. Kurz nach Ende des Turniers verstarb er im August des Jahres im Alter von 93 Jahren.

Im Sommer 1936 gelang Ericsson beim Auftaktspiel der Spielzeit 1936/37 gegen IFK Göteborg nach zirka fünf Sekunden eines der schnellsten Tore der Fußballgeschichte, als er direkt vom Anstoß weg den Ball ins gegnerische Tore schoss.

Weblinks
 Bertil Ericsson in der Datenbank von aik.se

Fußballnationalspieler (Schweden)
Fußballspieler (AIK Solna)
Geboren 1908
Gestorben 2002
Schwede
Mann

redpajama_set_name: RedPajamaWikipedia


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Here at Epic Juice, we love hearing stories like this. Want to share your story? Send us an email!


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The biggest TV reality show Bigg Boss is going to start in just a few days now. This time it will launch its 12th season. According to the reports. like every year this time also its going to give you an extra dosage of entertainment. The show is starting on September 16, 2018. Some of the contestants will take part in pairs in the show while some will enter alone.
In the celebrity contestants, the one name which is now doing the rounds is of Sreesanth. Yes, the controversial famous Indian cricketer, S. Sreesanth will also be the contestant on the show, reportedly. he was famous as Kerela Express when he used to play for team India. After his name busted in a spot-fixing case in IPL, he was not only banned but was also sent to the jail on September 13, 2013.
A lifetime ban was imposed on him after that! the other controversy on his name was when he got slapped by Indian Turbanator, Harbhajan Singh. He was making fun of their team when they lost their match.


high quality and brand new. including 2 bar stool and 1 table.
Aluminum Frame, lightweight, durable and sturdy. Excellent hand-weaving technique with fashion design.
Modern and stylish design. Design for outdoor but can be used indoor.
bar table with a glass top.
Easy to move. Assembly Required.
Details: Our 3 pieces rattan bar dining furniture set includes 1 table and 2 bar stool, offering a unique design that is made of sturdy wicker rattan and lightweight aluminum frame. The PE rattan wicker is water and UV resistant, enabling it to withstand moderate weather conditions, however extra protection may be needed for extreme weather conditions. It is designed for outdoors, this set is perfect for patios, back yards or anywhere you need it, but also Nice enough for inside your home.
distance from seat to floor: 28.3"
size of footrest to floor: 9.8"


Missed the Kickstarter, not a problem. You still have a chance to get a deal and get ALL 15 stretch goals included.
1,431 backers pledged $116,316 to help bring this project to life.
We are using Crowdox as our pledge manager. That means you'll be able to manage your pledge amount for all the add-ons that you want after the Kickstarter project closes. At that time, you'll need to manage your pledge and enter your shipping address and complete your order. Click on the image above to to manage your pledge.
Please click on the image above If you need to retrieve an email for your survey, You can request it using this link.
Fight the opening battles of World War III; from desperate delaying actions by US Armored Cavalry and West German Panzergrenadier forces, to determined counterattacks by local ad-hoc armored forces against the might of the Soviet hordes. Strike fast with Soviet Air Assault troops in heliborne ops, securing roadways to allow the massed armor columns of the PACT to sweep westward into Germany. The devastating armed forces of West Germany, the United States, East Germany, and the Soviet Union are at your disposal in your quest to reshape the world, and history.
The weight of the tactical decisions rest solely on your shoulders. Can NATO slow the Soviet advance with the armor and infantry they can bring to bear? Or skillfully use Close Air Support and Attack Helicopter units to swing the tide of battle in your favor? Can the PACT slice through into Germany and cross the Rhine river, gateway to the conquest of all of Europe?
The WORLD AT WAR 85 system features a unique combat system that involves die rolls by both attacking units and defending units, which keeps both players engaged throughout the game. Die rolls are compared and hits applied quickly, as all the information you need to fight your units is on the counters. No combat results table is necessary. Initiative, formation activation, random turn length, and close air support are all smoothly integrated.
Twenty unique scenarios are provided in STORMING THE GAP, positing battles that might have been, using 1985 era equipment at PLATOON and BATTERY level. In Iron Horse, Iron Spear, direct the first local counterattack by US Armored Cavalry troops. In Vertical Strike, Soviet Heliborne Air Assault platoons strike hard and fast to pave the way for advancing PACT armor columns. The West Germans launch a desperate counterattack in Bundeswehr Gegenangriff. East German and Soviet forces attempt to break through hastily collected NATO companies, determined to deny the approaches to the river crossings in The Rhine.
The WORLD AT WAR 85 series features expansive rules for variable turn lengths, random formation activation, point blank and long weapon ranges, line of sight, anti-tank guided missile and surface-to-air missile ammunition reloading, headquarters assets and bonuses, indirect fire, close air support, night combat, minefield breaching, improved positions, movement and fire, assault, opportunity fire, anti-aircraft fire, attack helicopters, concealment, and more. All in a moderate complexity, yet flexible game system that plays fast!
The Formation Activation mechanics are perfectly suited for solitaire play. All unit counters are color-coded, with a corresponding Formation card. When drawn, these cards determine which units are activated on the map, keeping the flow of battle challenging, unknown, and exciting!
To make this the ultimate WWIII platoon tactical level package, we're including a Battle Generator. Using unit point listings and the game's geomorphic maps, players can unleash their creativity to design, share, and fight battles that only you can imagine.
It is all here, and YOU are IN COMMAND.
How to access Community Resources and your fellow players.
How to access an extensive library of World At War 85 system Boot Camp videos, with detailed how-to-play lessons.
Included in our Core Rules is our WaW85 Starter Kit, which gives you a Map, Counters, Formation cards to cut out, Player Aids and a Scenario to get you playing right away.
"How to use this Manual" section, detailing what you can expect in the game and how easiest to learn it.
A Design and Development essay.
You can download a list of changes from the first edition to new second edition HERE.
A complete full Scenario from "Storming the Gap", including Historical setup, Orders of Battle and setup instructions for the U.S. and Soviet forces involved, and Victory Conditions.
Our geomorphic 19.25 x 13.25 Maps included realistic, high-quality detail, allowing you to distinguish the unique terrain features without sacrificing immersion and printed on heavy card stock.
Our .75" rounded-corner platoon, battery, flight, and section counters feature larger number groupings, color-coded formations and symbology, with a large font for ease of reading. The counters are over 2mm thick, making them easy to pick up and hold.
Using poker-sized Formation Cards, Formation Decks are created before each scenario. Units are randomly activated by drawing off of the top of this deck, similar to the familiar chit pull mechanism. All numbers associated with Formation's HQ are present on the card, and the large font size makes them easily legible and easy to use even at a distance. The color-coded bar on the cards directly links it to the formation unit counters it activates.
The 23 full-color Player Aid cards are very easy to read. Large font size allows you to quickly locate unit information or capabilities, saving you from having to consult the rules directly. Along with the usual Terrain Effects Chart, Line of Sight examples, Weather Table, Battlefield Event.Friction table, etc, Storming the Gap includes 4 sets of National Unit Tables. Each set is two double-sided 11x17 (sample below), with one set for each of the four armies represented in the game (West German, East German, Soviet Union and the United States). These reference tables detail the capabilities of each and every unit type in your counter mix, with specific cross-references to the rules for each and every capability. If you are new to the equipment and organizations in the armies of 1985 this will be an invaluable resource.
A Campaign Map showing where every scenario within the game takes place in relation to 1985 West Germany.
The introduction to the scenario rules includes where to find support for the game online. The scenario guide tells you the time required to play each scenario, so you can match the time you have to play with the right scenario. Scenarios range from 1-map, 2-map and 3-maps in size and scope. Module rules provide additional rules that may override but also expand the Core Rules, as well as instructions for each scenario's setup .
Twenty different scenarios you can play, each with an "Historical" introduction, a mini-version of the Campaign map to showing that particular scenario's locale, full orders of battle, setup instructions and victory conditions.
Four Appendices to enhance your Storming the Gap experience: Your Units; The Origins of World War III; Notes on the Soviet "Liberators"; and Who are the Leaders in Storming the Gap?
For those who wish to play live over the internet or play by email, a VASSAL module will be available from the Lock 'n Load Publishing Resources area for World At War 85. For more information on VASSAL, click HERE.
At the start of each scenario, the Formation Cards matching the units that are participating are placed into the Formation Deck alongside either two or three End Operations cards and shuffled.
During play, the top card is drawn. If it is a Formation card, that group of units may recover from Disruption, reload ATGM ammunition, conduct off-board artillery strikes, and/or re-deploy its Headquarters counter to any unit in the formation across the map. Once those logistical functions are completed, each unit in the Formation may choose to either move, conduct direct fire, move & then direct fire, assault, or fire on-board indirect fire.
Once all Formation units have conducted their Actions (or opted not to), its "Formation Impulse" is complete, and the next card is drawn. The next Formation drawn then completes its own "Formation Impulse", and play continues in this fashion unless an End Operations card is dawn.
If the second (not first!) End Operations card is drawn, the Operations phase for the turn is over. So, you never know precisely when a turn's Actions will end. Any formations that have not been activated before the Operations Phase ends is guaranteed to be activated during the next turn.
When all game turns indicated in a scenario are completed, or either side is completely destroyed or has retreated off-map, the scenario ends and a winner is determined.
To conduct most fire combat situations in the game, simply roll the number of dice equal to the firepower value on the counter of the unit attacking. For each number equal to, or higher than, the To-Hit value of the firepower listed on the attacking counter is a hit on your target. The number of dice rolled can be mitigated by other effects; such as whether or not units are at full strength; if units are attempting to move & direct fire, etc. Range to targets also modifies the To-Hit numbers, as targets at point blank range are much easier to hit than those at long range.
However, combat in WORLD AT WAR 85 uses opposed die rolls, and means that your intended target gets a say in the combat outcome as well. Just as attack rolls need to pass the attacker's To-Hit number, the defending unit rolls dice equal to their armor value. For each die that is equal to, or higher than, the defender's armor value, they ignore one hit. Unarmored targets derive a Defensive bonus from the terrain it occupies, so smart movement is key in combat!
Any hits that get through can either Disrupt, Reduce or even eliminate the enemy unit.
All videos are using prototype game components.
What would a Kickstarter be without Stretch Goals? Well, we've got a TON of great content already designed, developed and ready to go to the printers and with your help it can all be unlocked. Every Kickstarter backer will receive ALL unlocked Stretch Goals as part of their pledge, at no additional charge.
All stretch goal content unlocked in this project will be available for purchase separately after the game hits retail but by backing today, you get all of this extra content as part of your pledge!
UNLOCKED - Stretch Goal 10: $55,000 Storm and Steel Second Wave Expansion Module.
Our add-ons are not required to play our game but allow you to enhance your gameplay. You may select these add-ons and add them to your pledge. The instructions are below.
Increase your pledge in the "Pledge Amount" box by the total of the add-ons you want to add (postage is already included).
What's the difference between an Add On and a Stretch Goal? It's simple. A Stretch Goal is something that LnLP will unlock as the Kickstarter campaign progress. An Add-On, as the name implies, is something that you can add on to your pledge, right from the get go.
Are you tired of getting bad rolls? Are you looking for something that would be better at randomized dice rolling?The difference between the Gravity Dice and a regular hard plastic dice is with a hard-plastic dice has a greater chance of rolling in a 4,5,6 due to a heavier surface area on the opposite side. With the Gravity dice, all sides have an equal chance of being rolled, due to all side having the same amount of surface area and being weight equally on all sides. Hard-plastic dice don't show any weight on a scale, Gravity Dice, have a weight of 8 grams.
You will receive a set of six precision-machined dice, three blue and three red with engraved World At War 85 dice case. These dice are made of 6061 aircraft-grade aluminum. They are CNC-machined by skilled technicians here in the United States. They are then anodized to Type II standards in Magna, UT. The technicians drill each hole to a perfectly-calculated depth to ensure you have the most precise and perfectly balanced die in the industry.
These are 100% pre-shrunk cotton t-shirts are are poly/cotton blends. Gildan Ultra Cotton T-shirt is a sturdy heavyweight cotton with double-needle stitched for durability. Size for your T-shirt will be selected during your post-Kickstarter campaign survey. The T-shirts will only be available in black.
First and foremost, this game is ready for the printer….NOW, including our Stretch Goals. Our production team has decades of experience and success in the gaming industry. We are leveraging that long experience and have worked diligently to prepare this project, and minimize the risk involved by trying to give you all what we believe you want in a Kickstarter: a game that is ready to print. We have completed all design, development, play-testing, artwork, graphics, and printer prototypes IN ADVANCE. Our project will immediately be sent for printing upon successful funding of this project. That will limit the risk of an extensive period awaiting fulfillment to our contributors.
We are using Crowdox as our pledge manager. That means you'll be able to manage your pledge amount for all the add-ons that you want after the Kickstarter project closes. We will post an update to notify backers when the pledge manager email is being sent out. At that time, you'll need to manage your pledge and enter your shipping address and complete your order.
Printing high-quality games is always a challenge. The risks have been minimized as this game has already been designed, developed, play tested and is ready for the printer. Give us your support and we give you a great game.


Beaches & Cream focuses on making delicious handcrafted premium ice cream and sorbets in small batches. Our flavors change every time you see us because we follow what's in season!
Check us out at your local farmers markets and pop ups in St. Pete!