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In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate's foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)

In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate's foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)


In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj smiles during an interview with the Associated Press in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate's foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)


In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate's foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)


3 ACL tears won’t keep Creighton’s Martin Krampelj off court

By ERIC OLSON

AP Sports Writer

Wednesday, October 24

OMAHA, Neb. (AP) — No one would have blamed Creighton’s Martin Krampelj if he had decided basketball wasn’t for him anymore after he tore the anterior cruciate ligament in his left knee.

Coming back from one ACL tear is quite common.

Coming back from three is not.

Krampelj was establishing himself as one of the most improved players in the Big East when he stepped awkwardly on teammate Kaleb Joseph’s right foot during a game against Seton Hall on Jan. 17. He got the bad news the next day, and if there was any self-pitying thought of “Oh, no, not again,” it was fleeting.

“When I got my MRI results, I was like, ‘I’m coming back,’ ” Krampelj said. “It’s so worth it.”

The 6-foot-9, 235-pound junior forward from Slovenia (his name is pronounced Mar-TEEN CROM-pul) knew all too well what was ahead following surgery. The rehabilitation process is not only hard work, it can be painful. There are mental obstacles, none more prevalent than fear of re-injury. He also would have to rebuild his conditioning.

“There would be a lot of people giving it up after the first or second one,” Krampelj said. “I’m not a quitter. I’m not going to give up, and that’s it.”

Krampelj first tore his left ACL during a tournament in France in 2013 in a non-contact situation. He tore his right ACL during a practice early in the 2015-16 season when he got tangled with former teammate Zach Hanson. And then there was the fluke landing on Joseph’s foot that resulted in yet another tear in the left knee.

“Everything happens for a reason. I believe in that,” Krampelj said. “You never know what it’s good for. God gives the toughest battles to the toughest soldiers.”

Former Purdue star Robbie Hummel, who came back from two ACL tears in 2010, said he isn’t sure he would have the wherewithal to do what Krampelj is attempting.

“It’s hard to continually put everything you have into something and to be consistently disappointed by it, especially with something that should be joyful,” Hummel said. “It’s fun to play college basketball, it’s fun to play a sport at a high level like that. When you keep getting let down in a way, it can be really, really frustrating and really hard. Respect to Martin for coming back again and again because it is a tough process.”

Dr. Andrew Cosgarea, professor of orthopedic surgery and chief of the Division of Sports Medicine at the Johns Hopkins School of Medicine, said while it’s not unusual for people to tear ACLs multiple times, it’s rare for elite athletes to play at the same level following multiple tears.

“There is such a finite opportunity for success at the Division I and professional level, and I think you run out of time, you become selected out, you lose those opportunities when you’re gone that much,” Cosgarea said.

Creighton head athletic trainer Ben McNair said Krampelj’s upbeat attitude has helped him battle through the arduous rehab. When dealing with one or more ACL tears, McNair said, the medical staff explains to the athlete the higher risk of re-injury and lays out the rehab plan, and then it’s up to the athlete whether he or she wants to do the work necessary to play again.

“Martin is a full-speed-ahead kind of guy. Usually, you have to pull the reins back on him rather than kick him in the butt,” McNair said.

Krampelj played on national teams in Slovenia before leaving in 2014 to attend Impact Academy in Sarasota, Florida. He drew recruiting interest from West Virginia, Rhode Island, Virginia Tech and Georgia Tech but was sold on Creighton when 14,000 fans showed up to watch an exhibition game during his official campus visit.

He took a redshirt year after the ACL tear seven games into the 2015-16 season, and he backed up first-round draft pick Justin Patton during an injury-free 2016-17. Before getting hurt last January, Krampelj was averaging 11.9 points and 8.1 rebounds and was second in the Big East in field goal percentage.

Until now, Creighton coach Greg McDermott has never had a player attempt a comeback after three ACL tears in his 25 years as a head coach. Though Krampelj injured an ankle in preseason practice, he’s being counted on right away to give the Bluejays a strong inside presence. His leadership also is needed on a team that lost four of its top six scorers, including Marcus Foster and NBA draft pick Khyri Thomas.

McDermott likes Krampelj’s chances for a successful return.

“To come back and be as athletic as he is, there is not one ounce of athleticism he’s lost during the process,” McDermott said. “In fact, it seems he’s come back stronger and with more authority in that he’s doing athletically. It’s a real credit to him and his work ethic that he’s back to the point he is.”

More AP college basketball: https://collegebasketball.ap.org and https://twitter.com/AP_Top25

Opinion: Machine Learning to Improve Care

By Robert Graboyes

InsideSources.com

To what extent can your doctor’s functions be automated — replaced or enhanced by intelligent machines? How might such automation improve care and reduce costs? These questions are central to understanding Clover Health — a California-based company providing Medicare Advantage insurance plans in seven states: New Jersey, Pennsylvania, Tennessee, Georgia, Arizona, South Carolina and Texas.

A while back, I hosted a dinner in New York for a dozen-plus health care innovators — entrepreneurs, medical school professors, futurists, etc. Someone in the room asked, “How much of today’s physician services can be reduced to algorithms?”

An algorithm is a set of instructions (like a computer program) leading to unambiguous results. Feed in a patient’s biological metrics, desires and other characteristics and receive a diagnosis of the patient’s illness, causal factors, and a prescribed treatment regimen.

At the New York dinner, attendees speculated that between 80 percent and 97.5 percent of what doctors do today could ultimately be distilled down to algorithms — theoretically allowing computers to substitute for physician expertise (and leaving doctors free to perform higher-level cognitive tasks).

Clover Health straddles medicine and technology. Its chief technology officer, Andrew Toy, came not from health care but rather from Google, Android, MTV and Morgan Stanley. His LinkedIn biography describes Clover as “a technology oriented Medicare Advantage company focused on changing healthcare by developing rule-and-ML based models and interventions that improve member outcomes.”

With ML (machine learning), algorithms rewrite themselves as the machine “learns” more and more about patient care. I’ve written about a recent case where IBM’s Watson computer “read” a Japanese leukemia patient’s medical records, genetic data, and 20 million journal articles on leukemia (all in around 10 minutes) and concluded that teams of doctors had misdiagnosed her illness and treated her with the wrong medications. Watson effectively, continually reprogrammed itself to analyze the patient’s illness in ways no human had done.

Watson’s counter-intuitive leukemia diagnosis is an extreme example of machine learning, though it may suggest what medicine will look like in, say, 25 years. Clover Health is attempting to use similar logical tools to manage routine care. Let me explain, based on recent conversations with Toy and Jason Alderman, Clover’s chief communications officer.

Clover aims to be ahead of the curve on applying machine learning to day-to-day patient management. They collect data from enrollees’ hospital and provider visits, examine the data for insights, and allow their algorithms to test hypotheses, learn, and find trends that in all likelihood no human would discover.

Goals include getting patients to seek care outside of high-cost emergency rooms, taking their medications, and managing chronic diseases (such as diabetes). Machine learning enables Clover to predict with 85 percent accuracy whether a patient is likely to face hospitalization within 28 days.

Clover, acting on the advice of its algorithms, has its call center contact enrollees when problems seem likely. If systems indicate more serious need of intervention, nurse practitioners and medical assistants visit enrollees’ homes. Every one of these actions is recorded and fed back into Clover’s data warehouse, which allows machine learning to constantly improve future interventions.

Medicare’s rules pose challenges to Clover’s model. Stringent network access rules make it difficult to expand the insurer’s territory. Mandated minimum wait-time and access requirements may be mechanical and differ substantially from realities of time and access.

A particular challenge is Medicare’s Star Ratings system. Medicare rates each plan on a scale of 1 (poor) to 5 (excellent). A 1-star plan can only enroll new members during select portions of the year; a 5-star plan can recruit anytime. High ratings also earn plans bonuses for patient compliance.

Hence, Clover argues, plans often play to the test rather than to their enrollee’s health and personal interests. As an example, African-American enrollees are less likely than white enrollees to get annual flu shots. Hence, the rating system provides an incentive to avoid African-American enrollees.

Alderman says Clover will always focus on the wellbeing of patients over its Star Rating. He said their goal is to do the right thing and will work with the Centers for Medicare & Medicaid Services to enhance the Star Ratings system and to link metrics far more directly to patient health and quality outcomes.

ABOUT THE WRITER

Robert Graboyes is a senior research fellow with the Mercatus Center at George Mason University, where he focuses on technological innovation in health care. He is the author of “Fortress and Frontier in American Health Care” and has taught health economics at five universities. He wrote this for InsideSources.com.

Broncos backup QB Chad Kelly arrested in trespassing case

By KATHLEEN FOODY and ARNIE STAPLETON

Associated Press

Wednesday, October 24

DENVER (AP) — Denver Broncos backup quarterback Chad Kelly was arrested Tuesday on suspicion of criminal trespass after a couple reported he came into their suburban house uninvited and sat down on their couch “mumbling incoherently,” according to court records.

General manager John Elway said the team was “very, very disappointed in Chad and the situation he put himself into” and suggested the Broncos were pondering Kelly’s future with the club.

Kelly attended a Halloween costume party hosted by Von Miller on Monday night that has long been a tradition for Broncos players and their significant others.

The Broncos were trying to figure out what happened after Kelly left the party.

“We are in the process of getting all the facts and talking to Chad, and then we’ll figure out exactly which direction we’re going to go,” Elway said on his weekly radio show on Orange & Blue 760. “When the team has a get-together, (it) is always a good thing. You like . when they get together and the camaraderie that goes along with being a team. But when you have one person that kind of puts a dent in the whole process, it’s very disappointing.

“We’re going to look into this, and look into it very seriously, because the charges are very, very serious and we understand that,” Elway said. “We will look into this and then make decisions as we go.”

The 24-year-old Kelly posted $2,500 bond Tuesday and was released. He’s due back in court Wednesday.

According to court records, a couple told police that a stranger came into their Englewood home after 1 a.m. The intruder sat down on the couch next to the woman, who was holding the couple’s young child, and was “mumbling incoherently,” according to the records.

The man yelled at the intruder to get out and hit him in the back with an aluminum tube from a vacuum. The homeowners showed police surveillance video of a man wearing dark pants, a white long sleeve shirt with a brown vest and a red scarf around his neck entering the front door.

The homeowner told police he thought the door was locked but police found no signs that someone had forced their way inside.

Police said they found Kelly sitting inside a black SUV parked about a block from the couple’s home. Kelly matched the surveillance video footage and the man later identified him as the person who came into the house, according to court documents.

Police and court records do not address Kelly’s physical state at the time, and there is no mention of testing for alcohol or substance use.

Police said officers made the arrest “without incident.”

Kelly’s arrest could put the second-year pro in line for discipline from the Broncos or the league, which doesn’t need a court conviction to mete out punishment for a violation of the NFL’s code of conduct.

“We are reviewing the matter,” the NFL said in an email to The Associated Press.

The Broncos chose Kelly with the final pick of the 2017 NFL draft. Although Kelly brought an attitude that had often crossed the line in college, Elway said fellow Hall of Fame quarterback Jim Kelly personally vouched for his nephew, so Elway signed off on the selection.

Chad Kelly missed his rookie season while recovering from knee and wrist injuries, then beat out former first-round draft pick Paxton Lynch last summer to serve as the backup for starter Case Keenum.

Keenum signed a two-year, $36 million deal in March but is off to a middling start for the Broncos (3-4). He has eight touchdown passes and nine interceptions after throwing for 22 TDs with just seven interceptions last season in Minnesota, where he led the Vikings to the NFC championship.

Kelly has played just one snap, a kneel-down on the final play of the first half against the Rams two weeks ago while Keenum was being evaluated for a concussion.

On Monday, coach Vance Joseph said he’d be comfortable with Kelly at quarterback should anything happen to Keenum.

The only other quarterback on the Broncos roster is Kevin Hogan, a third-year pro from Stanford who was awarded to Denver off waivers from Washington last month.

Kelly’s spectacular college career at Ole Miss was marked by off-field slip-ups, although he hadn’t been in any trouble since the Broncos drafted him.

He was kicked off the Clemson team in 2014 after arguing with coaches during the spring game. He also was arrested after a bar fight in 2014, eventually pleading guilty to a misdemeanor charge of disorderly conduct.

In October 2016, he was involved in a brawl at his brother’s high school football game in New York. He ran onto the field after his brother, Casey Kelly, apparently took a late hit and video shows several coaches restraining him on the field.

Although he didn’t play in the Senior Bowl after his final season at Ole Miss because of a right knee injury, he was in attendance all week in Mobile, Alabama, so he could talk with NFL teams about his off-field troubles.

At the time, he said being upfront about his missteps was important: “You’ve got to be honest, of course, but you’ve got to admit to what you did and you’ve got to try to convince them that you’ve learned from those mistakes and that you’re not going to make them again. The owner doesn’t want to hear about it. The GM doesn’t want to hear about what you did. They want to know if you’ve learned from it and won’t make the same mistake twice.”

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Red Sox beat Dodgers 8-4 at Fenway in World Series opener

By BEN WALKER

AP Baseball Writer

Wednesday, October 24

BOSTON (AP) — The Fenway Funhouse proved too tricky, too cold and just too much for the beach boys.

Andrew Benintendi, J.D. Martinez and the Boston Red Sox came out swinging in the World Series opener, seizing every advantage in their quirky ballpark to beat the Los Angeles Dodgers 8-4 on a chilly, windy Tuesday night.

Benintendi had four hits, Martinez drove in two early runs and pinch-hitter Eduardo Nunez golfed a three-run homer to seal it. The 108-win Red Sox got a solid effort from their bullpen after an expected duel between aces Chris Sale and Clayton Kershaw never developed.

From the get-go, old Fenway Park caused all sorts of problems for the Dodgers.

Mookie Betts led off for the Red Sox with a popup that twisted first baseman David Freese as he tried to navigate the tight foul space near the stands and gauge the gusts. Lost, he overran the ball and it dropped behind him.

“You never really know,” Benintendi said. “The flag will be blowing one way, and the wind is actually blowing the other. You have to be on your toes pretty much.”

Given a second chance, Betts lined a single that set up a two-run first inning.

“It was important for us to score first and kind of put some pressure on them,” he said.

In the seventh, newly inserted left fielder Joc Pederson looked hesitant as he chased Benintendi’s soft fly, rushing toward the seats that jut out down the line. The ball ticked off his glove for a ground-rule double, and soon Nunez connected off Alex Wood to break open a 5-4 game.

“We didn’t play the defense that we typically do. I thought we left some outs out there,” Dodgers manager Dave Roberts said. “And it didn’t make Clayton’s job any easier.”

The crowd and cold temperatures were no picnic for Los Angeles, either.

The oddly angled ballpark became an echo chamber even before the first pitch. Chants of “Beat LA!” began early, Kershaw got heckled with a sing-song serenade and Dodgers villain Manny Machado heard loud boos all evening.

Only one person wearing Dodger blue drew a cheer: Roberts, saluted in pregame introductions for the daring steal that turned the tide in Boston’s 2004 playoff comeback against the Yankees.

“I think we had the advantage tonight with the weather and stuff. We’ve been playing through it,” Red Sox pitcher Nathan Eovaldi said.

It was 53 degrees at first pitch and it dropped into the mid-40s by the end. That was the coldest game for Los Angeles this season and quite a contrast from last year’s World Series, when it was a record 103 degrees for the opener at Dodger Stadium against Houston.

“We won Game 1 last year and lost the Series, so maybe we’ll try it out this way. See if we can win one,” Kershaw said.

Game 2 is Wednesday night, when it’s supposed to be even colder. David Price, fresh from beating Houston in the ALCS clincher, starts against Hyun-Jin Ryu.

Both teams rely heavily on analytics, and it showed: With each manager searching for the most beneficial matchup, the clubs combined to use 12 pitchers and six pinch-hitters.

Benintendi scored three times for Boston, trying for its fourth championship in 15 seasons.

Matt Kemp homered and Justin Turner had three hits for the Dodgers, aiming for their first crown since 1988. Machado drove in three runs, and his RBI grounder in the fifth inning made it 3-all.

Boston retook the lead in the bottom half when Xander Bogaerts hustled to beat out a potential inning-ending double play — Dodgers reliever Ryan Madson seemed to celebrate a little too early.

Rafael Devers followed with an RBI single, making it 5-3 and giving himself an early birthday present. He turned 22 at midnight, three minutes before the game ended.

Martinez, who led the majors with 130 RBIs, gave the crowd a scare when his foot slipped rounding second base on a run-scoring double in the third. He fell hard, but soon got up.

Steve Pearce, ruled safe at first on a replay review, scored from there on Martinez’s double. The ball hit a metal garage-type grate on the far center-field wall and took a weird carom, giving Pearce extra time to score.

A garage-style grate, used for groundskeeping vehicles and such. What other park has that in play?

A day before this opener, Kershaw and most of the Dodgers pooh-poohed the prospect that Fenway would cause them trouble. Most of them had never played at the oldest ballpark in the majors, built in 1912, but said they were sure they’d be OK.

It didn’t quite turn out that way in their first trip to Fenway since 2010.

Besides, clubs coming to Beantown have other things to worry about.

“I think the biggest challenge for a team coming in here is you’re playing the Boston Red Sox,” Eovaldi said Monday.

The only other time the Dodgers and Red Sox met in the World Series was 1916, when Babe Ruth helped pitch Boston to the championship. Those games were at Braves Field, the bigger home park of the city’s National League franchise.

Kershaw and Sale each started out wearing short sleeves, but neither warmed to the possibility of the marquee matchup. In similar outings, both were pulled before getting an out in the fifth.

Kershaw took the loss in his first appearance at Fenway, tagged for five runs on seven hits and three walks. The three-time NL Cy Young Award winner fell to 9-9 in the postseason, his October results falling short of his brilliant regular-season resume.

“All the way around it wasn’t a good night,” Kershaw said.

Sale threw 91 pitches in his first outing since the ALCS opener. He was hospitalized last week for an unspecified stomach illness.

Matt Barnes, the first of six Boston relievers, got the win. Eovaldi pitched the eighth and Craig Kimbrel worked the ninth as the Red Sox bullpen held the Dodgers to one run on three hits in five innings.

Boston manager Alex Cora won in his first try guiding a club in the Series. This also marked the first World Series game between teams led by minority managers.

YAY FOR YAZ

Red Sox great Carl Yastrzemski bounced the ceremonial first pitch, and decided that just wouldn’t do. So he called for another ball, and the 79-year-old Hall of Famer threw a strike to injured Boston star Dustin Pedroia.

FIRST UP

The Red Sox have won Game 1 in six straight World Series, dating to 1975 vs. the Big Red Machine. … Boston is 8-0 this postseason when scoring first. … The team that wins the opener has won 62 percent of the championships.

UP NEXT

Price had been 0-9 in 11 postseason starts before pitching six scoreless innings to help close out the Astros in Game 5. Ryu was 1-1 with a 3.40 ERA in three playoff starts this year.

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In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate’s foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/10/web1_121633696-fc3ddda9d0944c29a2b166859a9d3fc6.jpgIn this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate’s foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)

In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj smiles during an interview with the Associated Press in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate’s foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/10/web1_121633696-59f45e8286d0474e8f9a9888aef3f785.jpgIn this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj smiles during an interview with the Associated Press in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate’s foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)

In this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate’s foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)
https://www.sunburynews.com/wp-content/uploads/sites/48/2018/10/web1_121633696-dc8df9b09819467fae9e687ac55f6e81.jpgIn this Oct. 11, 2018 photo, Creighton NCAA college basketball forward Martin Krampelj shoots baskets in Omaha, Neb. Krampelj is coming back this season after recovering from a third torn anterior cruciate ligament. He tore the ACL in his left knee for the second time when he stepped on a teammate’s foot in a game last January. He also has torn the ACL in his right knee. Krampelj said he never had a doubt he would return from his latest injury. (AP Photo/Nati Harnik)
Sports, Health

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